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