Research Matters

Drs. Singh, Thomas and colleagues cited in the recent Institute of Medicine Report, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety" (December 2008)

The report asserts that "revisions to medical residents' workloads and duty hours are necessary to better protect patients against fatigue-related errors and to enhance the learning environment for doctors in training. The report recommends that residency programs provide regular opportunities for sleep each day and each week during resident training. In addition, it recommends that the Accreditation Council for Graduate Medical Education provide better monitoring of duty hour limits and that residency review committees set guidelines for residents' patient caseload. Patient handover procedures and supervision of residents should also be strengthened. Until these changes take place, residency programs are not providing what the next generation of doctors or their patients deserve."

http://www.iom.edu/?ID=60449

See chapters 4, 6, and 8 with multiple references to: Singh, H., E. J. Thomas, L. A. Petersen, and D. M. Studdert. 2007. Medical errors involving trainees: A study of closed malpractice claims from 5 insurers. Archives of Internal Medicine 167(19):2030-2036. This study evaluated 240 trainee-related malpractice cases from the Malpractice Insurers Medical Error Prevention Study (MIMEPS) in the areas of obstetrics, surgery, medications, and outpatient diagnosis. In addition to problems with handoff communication, causal characteristics for trainee errors included problems with teamwork, multiple levels of supervision, and diagnostic decision-making.