Elsevier

World Neurosurgery

Volume 109, January 2018, Pages e563-e570
World Neurosurgery

Original Article
Neurosurgical Resident Error: A Survey of U.S. Neurosurgery Residency Training Program Directors' Perceptions

https://doi.org/10.1016/j.wneu.2017.10.022Get rights and content

Background

Efforts to address resident errors and to enhance patient safety have included systemic reforms, such as the Accreditation Council for Graduate Medical Education's (ACGME's) mandated duty-hour restrictions, and specialty-specific initiatives such as the neurosurgery Milestone Project. However, there is currently little data describing the basis for these errors or outlining trends in neurosurgical resident error.

Methods

An online questionnaire was distributed to program directors of 108 U.S. neurosurgery residency training programs to assess the frequency, most common forms and causes of resident error, the resulting patient outcomes, and the steps taken by residency programs to address these errors.

Results

Thirty-one (28.7%) responses were received. Procedural/surgical error was the most commonly observed type of error. Transient injury and no injury to the patient were perceived to be the 2 most frequent outcomes. Inexperience or resident mistake despite adequate training were cited as the most common causes of error. Twenty-three (74.2%) respondents stated that a lower post graduate year level correlated with an increased incidence of errors. There was a trend toward an association between an increased number of residents within a program and the number of errors attributable to a lack of supervision (r = 0.36; P = 0.06). Most (93.5%) program directors do not believe that mandated duty-hour restrictions reduce error frequency.

Conclusions

Program directors believe that procedural error is the most commonly observed form of error, with post graduate year level believed to be an important predictor of error frequency. The perceived utility of systemic reforms that aim to reduce the incidence of resident error remains unclear.

Introduction

The cost of measurable medical errors resulting in patient harm was estimated to be $17.1 billion in 2008.1 Nearly 200,000 patients die annually in the United States from these potentially preventable medical errors.2 Resident errors, or medical errors made by physicians-in-training, are not uncommon and contribute to this problem. Prior studies3 have found that anywhere from a third to nearly half of residents have reported committing an error during their training. Efforts to address this issue have included the Accreditation Council for Graduate Medical Education (ACGME) mandates for specific supervision policies, work hour restrictions, and “milestones”-based assessment of residents.4 Errors surrounding surgical care are particularly important to consider. Nearly 50%–67% of adverse events within hospitals can be attributed to surgical care, with half having been potentially preventable in the first place.5 Results from a survey distributed to all neurological surgery residents in the United States and Puerto Rico in 2011 revealed that 6% of respondents admitted to making an error, resulting in patient harm, at the end of an extended shift.6

Within the field of neurosurgery, however, data on the incidence and nature of resident error remain generally sparse. In the present study, we queried neurosurgery residency program directors across the country regarding the frequency and types of resident errors at their institutions. We provide a quantitative and qualitative summary of their responses and describe the resulting patient outcomes in these cases. We also queried program directors as to their perceptions of the underlying causes of these errors and the initial steps taken by their programs to address these errors. Finally, we performed a review of the literature to assess the efficacy of national interventions, such as the ACGME's duty-hour restrictions, on reducing the rate at which medical errors occur and to better understand the epidemiology of neurosurgical resident error. We hope this study will provide guidance and insights to enable further reductions in the incidence of resident error.

Section snippets

Survey Development and Dissemination

The online software Survey Monkey (Palo Alto, California, USA) was used to generate a 19-question survey assessing the nature and frequency of resident error at academic neurosurgical institutions. The survey was distributed by e-mail, in January 2017, to the program directors for 108 neurosurgery residency training programs within the United States. The survey was kept open for 3 weeks. Reminder e-mails were sent twice (at the end of week 1 and at the end of week 2) during this period.

Response Rate and Residency Program Demographics

The questionnaire was distributed to the program directors for 108 neurological surgery residency programs across the United States. A total of 31 (28.7%) responses were received. Thirty program directors provided data regarding their current resident complement. The median number of residents per program was 14 (range, 3–28). Most (22; 73.3%) programs self-identified as being medium-sized (which had anywhere from 8–21 residents). The median reported annual frequency of resident errors was 3

Background

Medical errors are defined as preventable adverse events or complications arising from either a failure to execute or a failure to plan.7 Although training the next generation of physicians and surgeons is a fundamental educational mission at academic institutions across the country, it is imperative to ensure that resident participation in clinical activities does not adversely affect patient outcomes or result in an increased rate of errors.8 However, before interventions targeted at reducing

Conclusion

Medical errors have significant implications for resident education and patient care. They are often made in the perioperative setting. The frequency, nature, and management of neurosurgical resident errors have not been evaluated in the past. In the present study, we found that procedural and diagnostic errors were reportedly the 2 most common forms of neurosurgical resident error. Errors were primarily believed to be due to either resident inexperience or resident mistake despite adequate

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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