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Resident physicians’ clinical training and error rate: the roles of autonomy, consultation, and familiarity with the literature

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Abstract

Resident physicians’ clinical training poses unique challenges for the delivery of safe patient care. Residents face special risks of involvement in medical errors since they have tremendous responsibility for patient care, yet they are novice practitioners in the process of learning and mastering their profession. The present study explores the relationships between residents’ error rates and three clinical training methods (1) progressive independence or level of autonomy, (2) consulting the physician on call, and (3) familiarity with up-to-date medical literature, and whether these relationships vary among the specialties of surgery and internal medicine and between novice and experienced residents. 142 Residents in 22 medical departments from two hospitals participated in the study. Results of hierarchical linear model analysis indicated that lower levels of autonomy, higher levels of consultation with the physician on call, and higher levels of familiarity with up-to-date medical literature were associated with lower levels of resident’s error rates. The associations varied between internal and surgery specializations and novice and experienced residents. In conclusion, the study results suggested that the implicit curriculum that residents should be afforded autonomy and progressive independence with nominal supervision in accordance with their relevant skills and experience must be applied cautiously depending on specialization and experience. In addition, it is necessary to create a supportive and judgment free climate within the department that may reduce a resident’s hesitation to consult the attending physician.

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Notes

  1. Medical treatment errors include errors caused by medical and nursing actions (in contrast to disease complications), events that result from equipment failure, failure to complete a planned action as intended (e.g., surgical events, events involving devices, patient protection, and care) or the choice of an inappropriate plan to achieve a goal (Kohn et al. 1999).

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Author information

Authors and Affiliations

  1. Faculty of Industrial Engineering and Management, Technion – Israel Institute of Technology, 32000, Haifa, Israel

    Eitan Naveh

  2. The Interdisciplinary Center (IDC), Herzliya, Arison School of Business, 46150, Herzliya, Israel

    Tal Katz-Navon

  3. Hadassah Hebrew University Medical Center, 91240, Jerusalem, Israel

    Zvi Stern

Authors
  1. Eitan Naveh
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  2. Tal Katz-Navon
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  3. Zvi Stern
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Corresponding author

Correspondence to Eitan Naveh.

Appendix

Appendix

Residents’ questionnaire

Level of autonomy

To what extent do the following statements characterize your work?

In my work:

  1. 1.

    I carry out the job myself.

  2. 2.

    I treat patients myself with minimum supervision.

  3. 3.

    I have autonomy in my clinical work.

Familiarity with up-to-date literature

To what extent do you…

  1. 4.

    Read relevant up-to-date medical literature?

  2. 5.

    Attend journal clubs and conferences?

  3. 6.

    You are (a) an internal (b) a surgery resident

  4. 7.

    Your year of residency (a) first (b) second (c) third (d) fourth (e) fifth

  5. 8.

    How many night shifts have you worked in the last 3 months? _____

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Naveh, E., Katz-Navon, T. & Stern, Z. Resident physicians’ clinical training and error rate: the roles of autonomy, consultation, and familiarity with the literature. Adv in Health Sci Educ 20, 59–71 (2015). https://doi.org/10.1007/s10459-014-9508-6

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  • DOI: https://doi.org/10.1007/s10459-014-9508-6

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