Medical Malpractice & Hospital Residents
Medical residency in the United States strives to prepare medical school graduates for independent practice. The most prevalent training model, in which residents move quickly from observing to practicing on patients, is known as “see one, do one, teach one.” Dr. Bertrand Bell, head of the Bell Commission, adds to that, “sometimes kill one.” According to a 2005 study published in the Archives of Internal Medicine, teaching hospitals experience greater numbers of medical errors because of the inexperience of medical residents combined with long work hours and the large number of patients they see. In 2007, another study also published in Archives found that residents played a pivotal role in committing medical errors because of insufficient supervision.
Medical Errors Involving Residents: The July Effect
University of California researchers documented the so-called July effect, a long-held belief that patient harm increases during the month when medical school graduates start working as residents. The researchers analyzed 28 years of federal death-certificate data and found that the number of hospital patients killed by medication errors spiked 10% only in July, and only in counties with teaching hospitals. A federally funded study, led by Harvard University researchers, examined 20 years of malpractice claims from five insurance companies. It found that residents played a role in about a third of the cases involving medical error. Supervision breakdowns and insufficient experience emerged as contributing factors that lead to medical errors.
Preventing Medical Errors Involving Hospital Residents
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, a 2009 report from the IOM (Institute of Medicine), affirms that revisions to residents’ workloads are necessary to better protect patients against fatigue-related errors and to enhance the learning environment for residents. The report recommends that residency programs provide regular opportunities for sleep each day and each week during resident training. It also recommends that the Accreditation Council for Graduate Medical Education provide better monitoring of duty hour limits and that residency review committees set guidelines for the patient caseload of residents. In addition, patient handover procedures and supervision of residents needs to be improved. Unless these changes take place, residency programs are not providing what residents or their patients deserve.