Derm residents’ errors often go unreported

Dermatology residents not only commit medical errors and witness others do the same, but they often fail to report the errors or take steps to prevent them, results of a new study suggest.

A research team led by Erik Stratman, M.D., program director for the dermatology residency program at Marshfield Clinic, Marshfield, Wis., sought to identify the source of medical errors among dermatology residents.

The researchers surveyed 142 dermatology residents from 44 programs in the United States and Canada. Some of the findings include:

• Of those who had accidentally stuck themselves with a patient’s needle, about 45 percent said they did not report it through the proper channels;

• About 83 percent said they had copied and pasted information from a patient’s previous visit into his or her medical record without checking its accuracy;

• Nearly 97 percent reported mislabeling right or left body parts during examinations or biopsies;

• About 60 percent said they work with at least one attending physician who intimidated them, thus reducing the likelihood of the residents reporting safety issues they witness;

• Nearly 80 percent said they had witnessed an attending disregard safety steps.

“The most significant finding in the study is that there are several patient safety gaps occurring in residency,” Dr. Stratman tells Dermatology Times. “Some of these safety issues fall onto the shoulders of residents through personal accountability, like declaring when a needle-stick injury has occurred, but the study also suggests system and environmental issues that programs and departments must identify and work to resolve.”

In particular, he says, when residents fail to identify safety issues due to fear of or intimidation by supervisors and teachers, that’s a problem that program leadership must discuss.

“This study is an early step to draw attention to the problem,” Dr. Stratman says. “Hopefully, programs can explore these safety issues - like needle-stick injury, specimen mislabeling, inaccurate biopsy-site identification, cutting and pasting unconfirmed old history information, and perceived workplace intimidation - as part of their upcoming journal clubs when reviewing this study.”

The study was published online April 9 in JAMA Dermatology.