Bookmark & Share

Favorites	Google
Digg	Del.icio.us
Twitter	Facebook

>> More...

A study published in the British Medical Journal suggests that the rate of medical errors among medical interns and residents at teaching hospitals is significantly greater at the beginning of the academic year regardless of trainees' level of clinical experience, Reuters reports. For the retrospective cohort study, researchers from the University of Geneva in Switzerland and colleagues examined administrative and patient data collected between October 1995 and December 2000 by the Department of Anaesthesia and Perioperative Medicine at Alfred Hospital, a university-affiliated hospital in Melbourne, Australia, for 19,560 patients having an anesthetic procedure. The procedures were performed by 93 first- through fifth-year anesthesia trainees in their initial year of training at the facility. Over the study period, 2,672 undesirable events occurred, more often in the first month of the academic year than any subsequent month, even after adjusting for confounders such as patients' comorbidities and surgical interventions. The most common types of undesirable events that occurred during anesthetic procedures at the start of the academic year included severe uncontrolled hypotension and hypertension and technical failures of arterial line insertion. However, the increase in excess risk for undesirable events decreased progressively after the first month and disappeared after the fourth month. Noting that their findings "confirm the presence of a learning curve" and that errors occurred despite more one-on-one supervision at the beginning of the academic year, the researchers suggest that training facilities place a greater focus on technical procedures to develop and enhance trainees' technical skills without risk of serious injuries to patients. The researchers also suggest improving trainees' "orientation and integration" at the beginning of their employment; staggering training start dates; implementing written standard working practices; and increasing the intensity of supervision, even for more advanced trainees. Meanwhile, writing in an accompanying editorial, researchers from the Utrecht Medical Centre in the Netherlands and the University of New South Wales in Sydney, Australia, acknowledge that there is no ideal approach to train new trainees but suggest that programs consider "human factors," such as fatigue, when training staff. Although one study researcher recommends that the issue be addressed across all disciplines, he notes that the findings at the Australian hospital may not apply elsewhere. For example, anesthesiology residents in the United States have one-on-one supervision during their first four weeks of training (Myers Lowe, Reuters, 10/16/09; Haller et al., British Medical Journal, 10/13/09; Barach/Johnson, British Medical Journal, 10/13/09).