Study Shows How Increased Supervision Of Residency Trainees Impacts Medical Errors

The results of a recent study relating to professional medical liability in a hospital with a large educational focus were published in JAMA Internal Medicine. The purpose was to see if increasing the level of supervision of physician residents would decrease the volume of medical errors they commit.

The heightened levels of supervision were conducted by 22 attending physicians. There were 188 residents in training used in the project, all of which were soon-to-be physicians in the realm of internal medicine. The randomized clinical evaluation, which lasted for a period of nine months, surprisingly showed that the additional supervision did not reduce the volume of medical mistakes.

Study Details

The interventional study, believed to be the first of its kind, is part of a larger overall effort to identify ways of increasing patient safety among those admitted to a clinical inpatient setting. The 22 physicians participated in supervising the residents as they made their rounds to visit with admitted patients. All of the supervising physicians had in excess of five years of experience and consisted of a mix of males and females. A total of 1,259 patients were involved in the project.

Key Findings

• The rate of medical errors did not appear to be impacted by heightened levels of direct supervision
• Residency programs should allow those in training to have a consistent balance of both supervision and autonomy
• The interns reduced their verbal interaction with patients when being supervised
• Residents reported that they were less efficient when supervised
• The attending doctors felt that their supervisory presence increased the quality of patient care

Physician Residency

After graduating from medical school, students further their education by entering residency programs where they receive more “hands-on” training. Data from the American Medical Association for 2016 indicated that approximately 131,000 individuals were in a residency program. The majority of residencies are conducted in a hospital or clinic where the student works hectic schedules that often involve overnight (third-shift) hours.

The periods of residency extend from between roughly three to seven years depending on the specialty and generally include a salary of over $40,000. After completion of the residency, the individual may have some additional training requirements prior to obtaining their license to practice medicine.

Resident Medical Malpractice Liability

Dr. Cornelius Thiels, of the Mayo Clinic in Rochester, Minnesota, analyzed 87 cases of medical malpractice that involved surgical residents. In roughly half of these cases, the plaintiff prevailed. Quite contrary to the JAMA study, in 48 of these cases the attending physician was found to have demonstrated a failure in direct supervision.

Dr. Thiels’ report acknowledged the importance of having residency training that offers the truly “hands-on” education needed. He stated that civil liability is critical for serving as a deterrent against performing poor quality medical care and that those harmed should be able to recover proper compensation. Thiels found that the supervising physician and/or the hospital organization were usually responsible for potential incidents of malpractice involving residents. Supervising physicians are subject to this imputed liability, which is largely considered a standard function of employment.