Lack of supervision adds to resident errors, study finds

A review of 240 medical liability cases tied 70% of such errors to not enough attending oversight.

By Myrle Croasdale, AMNews staff. Nov. 26, 2007.

Residents are vulnerable to making errors that stem from teamwork breakdowns, especially a lack of attending supervision, according to a study in the Oct. 22 Archives of Internal Medicine.

In response, some experts said residencies should focus on better supervision, along with improved team communications. One went so far as to call for a new model of resident training and patient care. Others disagreed, saying residencies had improved such issues since the study's data were compiled and did not need significant restructuring.

Hardeep Singh, MD, MPH, lead study author, is among those who believe improvements in resident supervision are in order.

"It's important that resident programs pay attention to supervision and teamwork issues even more than before," said Dr. Singh, an internist with the Dept. of Veterans Affairs in Houston and an assistant professor at Baylor College of Medicine.

Out of 889 medical liability claims reviewed, Dr. Singh and his colleagues found 240 claims where residents played a part in serious patient injuries or deaths.

Resident errors tied to teamwork-related factors, particularly attending physician supervision failures, took place in 70% of the cases that were reviewed.

In 72% of cases, judgment errors, such as failures of memory or vigilance, were a factor. In 58%, a lack of technical competence or knowledge, such as residents' diagnosis or patient monitoring, was involved.

All of the lawsuits were closed, and the errors occurred between 1979 and 2001. In 2003, resident work-hour limits were imposed, a change that dramatically restructured many medical residencies.