Graduate medical education poses unique challenges for the delivery of safe patient care because work carried out by medical trainees often involves special risks. Although those in the medical profession recognize these risk factors, there have been few studies to date about the types and causes of trainee errors. This study analyzes medical malpractice claims from five liability insurers from 2002 to 2004 to determine the clinical circumstances and contributing factors of injuries that occurred and how claims associated with trainee error differed from claims involving non-trainee error.
In 240 out of the 889 cases studied, the role of trainees in contributing to the injuries was considered moderately important. The adverse outcomes in these cases were generally severe: one-third resulted in significant physical injury, one-fifth in major physical injury and an additional one-third in death. The researchers found that errors of judgment (72%), teamwork breakdowns (70%) and lack of technical competence (58%) were the most prevalent reasons for the outcomes. In teamwork breakdowns, most errors occurred from lack of supervision and handoff problems. Both these types of transgressions happened more frequently among trainees than non-trainees. In 82 percent of the cases involving lack of supervision, attending physicians' failure to supervise residents was an issue. In almost half of the cases involving a lack of technical competence, diagnostic decision-making was the primary task at hand. The results of this study should help orient future training programs in graduate medical education.