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An Examination of Medical Malpractice Claims Involving Physician Trainees.
Acad Med. 2020 08; 95(8):1215-1222.AM

Abstract

PURPOSE

To identify patient-, provider-, and claim-related factors of medical malpractice claims in which physician trainees were directly involved in the harm events.

METHOD

The authors performed a case-control study using medical malpractice claims closed between 2012-2016 and contributed to the Comparative Benchmarking System database by teaching hospitals. Using the service extender flag, they classified claims as cases if physician trainees were directly involved in the harm events. They classified claims as controls if they were from the same facilities, but trainees were not directly involved in the harm events. They performed multivariable regression with predictor variables being patient and provider characteristics. The outcome was physician trainee involvement in harm events.

RESULTS

From the original pool of 30,973 claims, there were 581 cases and 2,610 controls. The majority of cases involved residents (471, 81%). Cases had a statistically significant higher rate of having a trainee named as defendants than controls (184, 32% vs 233, 9%; P < .001). The most common final diagnosis for cases was puncture or laceration during surgery (62, 11%). Inadequate supervision was a contributing factor in 140 (24%) cases overall, with the majority (104, 74%) of these claims being procedure related. Multivariable regression analysis revealed that trainees were most likely to be involved in harm events in specialties such as oral surgery/dentistry and obstetrics-gynecology (OR = 7.99, 95% CI 2.93, 21.83 and OR = 1.85, 95% CI 1.24, 2.66, respectively), when performing procedures (OR = 1.58, 95% CI 1.27, 1.96), or when delivering care in the emergency room (OR = 1.65, 95% CI 1.43, 1.91).

CONCLUSIONS

Among claims involving physician trainees, procedures were common and often associated with inadequate supervision. Training directors of surgical specialties can use this information to improve resident supervision policies. The goal is to reduce the likelihood of future harm events.

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Authors+Show Affiliations

Myers LC
L.C. Myers is a research fellow, Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-2872-3388.
Gartland RM
R.M. Gartland is a surgical resident, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Skillings J
J. Skillings is data analyst, Controlled Risk Insurance Company, Boston, Massachusetts.
Heard L
L. Heard is senior program director, Patient Safety and Education, Controlled Risk Insurance Company, Boston, Massachusetts.
Bittner EA
E.A. Bittner is associate professor of anesthesia, Harvard Medical School, and program director, Critical Care Anesthesiology Fellowship, Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts.
Einbinder J
J. Einbinder is instructor of medicine, Harvard Medical School, member, Division of General Internal Medicine, Brigham and Women's Hospital, and assistant vice president, Advanced Data Analytics and Coding, Controlled Risk Insurance Company, Boston, Massachusetts.
Metlay JP
J.P. Metlay is professor, Department of Medicine, Harvard Medical School, professor of health policy and management, Harvard School of Public Health, and chief, General Internal Medicine Division, Massachusetts General Hospital, Boston, Massachusetts.
Mort E
E. Mort is assistant professor in health care policy, Harvard Medical School, member, Division of General Internal Medicine, and chief quality officer, Massachusetts General Hospital, Boston, Massachusetts.

MeSH

Case-Control StudiesDatabases, FactualDentistryEducation, Medical, GraduateEmergency Service, HospitalGynecologyHumansInsurance, LiabilityInternship and ResidencyLiability, LegalMalpracticeMedical ErrorsMultivariate AnalysisObstetricsSurgery, Oral

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31833853

Citation

Myers, Laura C., et al. "An Examination of Medical Malpractice Claims Involving Physician Trainees." Academic Medicine : Journal of the Association of American Medical Colleges, vol. 95, no. 8, 2020, pp. 1215-1222.
Myers LC, Gartland RM, Skillings J, et al. An Examination of Medical Malpractice Claims Involving Physician Trainees. Acad Med. 2020;95(8):1215-1222.
Myers, L. C., Gartland, R. M., Skillings, J., Heard, L., Bittner, E. A., Einbinder, J., Metlay, J. P., & Mort, E. (2020). An Examination of Medical Malpractice Claims Involving Physician Trainees. Academic Medicine : Journal of the Association of American Medical Colleges, 95(8), 1215-1222. https://doi.org/10.1097/ACM.0000000000003117
Myers LC, et al. An Examination of Medical Malpractice Claims Involving Physician Trainees. Acad Med. 2020;95(8):1215-1222. PubMed PMID: 31833853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Examination of Medical Malpractice Claims Involving Physician Trainees. AU - Myers,Laura C, AU - Gartland,Rajshri M, AU - Skillings,Jillian, AU - Heard,Lisa, AU - Bittner,Edward A, AU - Einbinder,Jonathan, AU - Metlay,Joshua P, AU - Mort,Elizabeth, PY - 2019/12/14/pubmed PY - 2020/9/29/medline PY - 2019/12/14/entrez SP - 1215 EP - 1222 JF - Academic medicine : journal of the Association of American Medical Colleges JO - Acad Med VL - 95 IS - 8 N2 - PURPOSE: To identify patient-, provider-, and claim-related factors of medical malpractice claims in which physician trainees were directly involved in the harm events. METHOD: The authors performed a case-control study using medical malpractice claims closed between 2012-2016 and contributed to the Comparative Benchmarking System database by teaching hospitals. Using the service extender flag, they classified claims as cases if physician trainees were directly involved in the harm events. They classified claims as controls if they were from the same facilities, but trainees were not directly involved in the harm events. They performed multivariable regression with predictor variables being patient and provider characteristics. The outcome was physician trainee involvement in harm events. RESULTS: From the original pool of 30,973 claims, there were 581 cases and 2,610 controls. The majority of cases involved residents (471, 81%). Cases had a statistically significant higher rate of having a trainee named as defendants than controls (184, 32% vs 233, 9%; P < .001). The most common final diagnosis for cases was puncture or laceration during surgery (62, 11%). Inadequate supervision was a contributing factor in 140 (24%) cases overall, with the majority (104, 74%) of these claims being procedure related. Multivariable regression analysis revealed that trainees were most likely to be involved in harm events in specialties such as oral surgery/dentistry and obstetrics-gynecology (OR = 7.99, 95% CI 2.93, 21.83 and OR = 1.85, 95% CI 1.24, 2.66, respectively), when performing procedures (OR = 1.58, 95% CI 1.27, 1.96), or when delivering care in the emergency room (OR = 1.65, 95% CI 1.43, 1.91). CONCLUSIONS: Among claims involving physician trainees, procedures were common and often associated with inadequate supervision. Training directors of surgical specialties can use this information to improve resident supervision policies. The goal is to reduce the likelihood of future harm events. SN - 1938-808X UR - https://www.unboundmedicine.com/medline/citation/31833853/An_Examination_of_Medical_Malpractice_Claims_Involving_Physician_Trainees_ L2 - https://doi.org/10.1097/ACM.0000000000003117 DB - PRIME DP - Unbound Medicine ER -