Why Physician Trainees Don't Report Possible Medical Errors

Tinker Ready, October 20, 2016

There are several reasons for medical students' reluctance to speak up when they observe possible adverse events.

When medical students have questions about the safety of the care they see, most aren't comfortable challenging the providers who deliver it.

There are several reasons for that reticence, a survey published in the American Journal of Medical Quality finds.

A medical student is like a fly on the wall, said Lakshmana Swamy, MD, MBA, the lead author of the study and now chief medical resident at the Veterans Administration hospital in West Roxbury, MA. "We're not bearing the burden of care, but we spend many, many hours observing care," he said.

Unlike residents, medical students still have one foot outside the world of medicine, giving them a different perspective on the care they see. The study was designed to measure that perspective—it only asked whether the student's perceived problems, he said.


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Swamy and fellow physician trainees at Wright State University's Boonshoft School of Medicine, in Dayton, OH, surveyed their colleagues.

They found that 62% of the respondents perceived problems in safety and 44% saw what they considered lack of evidence-based care. Most striking to Swamy was that 90% of the respondents said they had observed adverse events, and 29% perceived avoidable adverse events on a monthly basis.

Although the survey gauged perception, not actual medical errors, only 51% of students said they were comfortable reporting incidents to their superiors and only 20% noted a change in response to their concerns.

But whether the quality issues were real or not, they should be addressed, said Swamy.

"The problem is that they are seeing things and they are not talking about them. They are not learning about them. Either they are missing the opportunity to learn about quality and safety, or they are missing the opportunity to learn about clinical medicine."

Tinker Ready

Tinker Ready is a contributing writer at HealthLeaders Media.

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