Doctors affiliated with teaching hospitals should get ready to get more involved with trainees. Physician residents are “highly vulnerable to errors,” a federal watchdog agency has found, and poor supervision is a major reason.


Researchers pulled a random sample of 889 malpractice claims from the files of five insurance companies. Their study was funded by Agency for Healthcare Research and Quality (AHRQ).

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Interns, residents, or fellows played a significant role in 240 (27%) of these claims. Almost 90% of the trainees were residents. Adverse outcomes were serious, with 53% of mistakes causing significant or major injuries; 33% were fatal.


The researchers found many factors contributing to the errors. Often, a particular case involved more than one factor. Errors in judgment led the list, mentioned in almost three out of four claims (72%).


“Teamwork breakdowns” were cited in 70% of the cases. More than half these claims (54%) involved a lack of supervision. Fumbled handoffs were an issue in almost a fifth (19%). These subfactors were disproportionately common among errors that involved trainees, the researchers note.


Technical incompetence was less frequent, at only 58%, and was most likely to occur during the diagnos-tic process or while monitoring patients’ conditions.


“House staff are particularly vulnerable to medical errors, owing to teamwork failures, especially lack of supervision,” the researchers conclude in Archives of Internal Medicine (2007;167:2030-2036). “Graduate medical education reform should focus on strengthening these aspects of training.”


That will probably be the tack AHRQ pursues. “We are continuing to learn about the critical role that effective teamwork plays in preventing medical errors and promoting patient safety,” says AHRQ director Carolyn M. Clancy, MD. “This study reminds us that we have a lot to do to ensure that hospitals are providing appropriate supervision to trainees and implementing team-training programs.”