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Medical Errors Common Among Doctors-in-Training

Residents say these mistakes can lead to depression, increasing risk of future mistakes

TUESDAY, Sept. 5, 2006 (HealthDay News) -- About one-third of American doctors-in-training report making at least one major error during the recent past, a new survey finds.

Often, the errors were associated with a great deal of personal distress. That distress, in turn, increased the odds of future errors, setting off a vicious cycle.

"Historically, there has been an attitude that training to be a doctor is stressful and that's just part of the process and you just need to deal with it," said Dr. Tait Shanafelt, senior author of the study and assistant professor of medicine at the Mayo Clinic in Rochester, Minn. "What we are starting to explore is that there may be consequences to the distress, that it may actually influence the care they provide."

The study is published in the Sept. 6 issue of the Journal of the American Medical Association, a theme issue on medical education.

In 1999, the U.S. Institute of Medicine published a landmark report on medical errors that found that up to 100,000 U.S. patients die each year because of preventable mistakes. While that report and many others on medical errors focused on the patient part of the equation, fewer have looked at the physicians who actually commit the errors.

Several previous studies suggested that a significant proportion of graduate medical trainees do make mistakes. These physicians have been called the "second victims," experiencing distress, guilt, shame and depression in response to having made a mistake.

For the new study, the researchers looked at how often perceived medical errors occurred among medical residents at the Mayo Clinic in Rochester. The researchers then cross-referenced this information with additional data on quality of life, burnout, symptoms of depression and empathy for 184 resident physicians.

"Other studies have looked at fatigue or sleep deprivation," Shanafelt explained. "The unique thing about our study is that we're looking at how distress relates to medical errors."

The residents in this study were followed from the beginning of their residency training for up to three years.

Thirty-four percent of respondents reported making at least one major medical error during the period under study; 43 percent of residents completing at least one year of training reported errors.

Of the participants, 20 percent reported one error, 6 percent reported two errors, and 8 percent reported three or more errors during the study period. An average of 14.7 percent of participants at each quarter said they had made an error in the past three months.

These errors were associated with a subsequent decrease in quality of life and increases in measures of burnout for the residents. Doctors-in-training who reported errors were about three times more likely to test positive for depression.

"Physicians who perceive they have made an error have a profound increase in symptoms of depression in the following three months, and a profound increase in burnout," Shanafelt said.

These stressors were likely to have their own effect.

"The other very notable part of the study is that individuals who have higher degrees of burnout were markedly more likely to report an error in the following three months," Shanafelt. "It does appear that it may influence the care they provide."

Any solutions to this problem are likely to be complex.

"This is a challenging problem," Shanafelt said. "There appear to be both personal and professional factors that contribute to distress, so any possible solutions are going to need to both address all the potential sources of distress and then also help set up a support system to address stress as it develops."

"Our current study primarily has identified this association," he continued. "We are in the process of starting to study some solutions."

Another study in the same issue of JAMA found that more than 80 percent of medical interns surveyed in 2003-2004 said they were working more hours than currently mandated. In 2003, the Accreditation Council for Graduate Medical Education established work-hour limits for all physicians-in-training -- a maximum of 30 consecutive work hours; a maximum of 80 work hours each week, averaged over four weeks; and one day per week that is free of all duties.

Many interns are paying a price for those long hours. They're at greater risk of job-related injuries such as needlesticks and cuts, another study in the journal found.

More information

The National Patient Safety Foundation has more on patient safety.

SOURCES: Tait Shanafelt, M.D., assistant professor of medicine, Mayo Clinic, Rochester, Minn.; Sept. 6, 2006, Journal of the American Medical Association
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