Distress from self-perceived medical errors common among resident physicians

About one-third of surveyed resident physicians report committing at least one major error during the study period, often associated with substantial personal distress, according to a study in the September 6 issue of JAMA, a theme issue on medical education.

Medical errors and patient safety are an important concern for patients and physicians. The proportion of hospitalized patients affected by medical errors has been estimated to be 5 percent to 10 percent, although it has approached 50 percent in some studies, according to background information in the article. The illness, death, and financial costs of these events may be great. Many reports on medical errors have focused on the rate at which errors affect patients. Less is known about the proportion of physicians who commit errors.

Colin P. West, M.D., Ph.D., of the Mayo Clinic College of Medicine, Rochester, Minn., and colleagues evaluated the frequency of perceived medical errors among internal medicine residents and measured the association of these medical errors with resident quality of life (QOL), burnout, symptoms of depression, and empathy. The study included data provided by 184 (84 percent) of 219 eligible internal medicine residents at Mayo Clinic Rochester. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and quality of life every 3 months and measures of burnout (depersonalization, emotional exhaustion, and personal accomplishment) and symptoms of depression every 6 months.

The researchers found that overall, 34 percent of study participants reported at least 1 major medical error during the study period, and 43 percent of residents completing at least 1 year of training reported errors. Of the participants, 20 percent reported 1 error, 6 percent reported 2 errors, and 8 percent reported 3 or more errors during the study period. Making a medical error in the previous 3 months was reported by an average of 14.7 percent of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life and worsened measures in all domains of burnout.

Participants who reported self-perceived errors were about 3 times more likely to screen positive for depression. In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months.

"Our results also suggest that residency programs should ensure that efforts are in place to prevent, identify, and treat burnout and to promote empathy and well-being for the welfare of residents and patients," the authors write.

"A majority of residents discuss their errors with colleagues, supervising faculty, or friends and family, but formal programs to provide additional support for physicians who make errors appear warranted. Further investigation to identify the most effective post-error support mechanisms is needed in parallel with ongoing system efforts to reduce error rates and resident distress," the researchers conclude.

(JAMA. 2006;296:1071-1078. Available pre-embargo to the media at www.jamamedia.org.)

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Editor's Note: This work was supported by a Medicine Innovation Development and Advancement System grant from the Mayo Clinic Department of Medicine. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


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