Poor Resident Supervision Leads to Increased Medical Errors at Teaching Hospitals

If you’re in the hands of a medical resident, make sure that the resident has supervision. National medical research increasingly supports the concern that poorly supervised doctors-in-training at teaching hospitals are more likely to make mistakes that can lead to patient harm, or even death.

According to a 2005 study published in the Archives of Internal Medicine, teaching hospitals experience greater numbers of medical mistakes because of the inexperience of medical residents coupled with the long work shifts and large number of patients that residents see. Researchers for the study surveyed nearly 700 residents from about 40 different clinical areas at two Harvard teaching hospitals. Overall, the researchers found that about half of the residents reported treating patients with severe “adverse events” or “complications”. When those same residents were asked if they believed that they had caused the error, one-fourth said yes. Unfortunately, most patients’ complications were considered significant and inadequate supervision was cited as a major contributing factor.

Another study conducted in 2007 also found that residents played a pivotal role in committing medical errors because of lax supervision. That study, also published in the Archives, analyzed data from 900 malpractice claims and found 240 in which residents “played an important role in harmful errors”. Again, poor supervision—either by faculty physicians or upper-level residents—accounted for over half of the cases of resident errors.

Finally, two months ago, researchers at UC San Diego reported a 10% nationwide increase in medication errors that killed patients during the month of July, the traditional start date for new residents. In response to the mounting evidence linking poor supervision of medical residents to medical errors, Congress requested a study on the state of medical residencies nationwide in 2008. That reported, issued by the Institute of Medicine, urged residency programs to implement a set of “measurable standards” as to when and how medical residents are able to consult with faculty doctors so that the “programs provide adequate, direct, onsite supervision”.

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