Study provides insight into malpractice risk for physicians in training

BOSTON – A recently published study in Academic Medicine performed by Massachusetts General Hospital (MGH) investigators has identified areas in which physician trainees are at particularly high risk of being involved in malpractice claims. The study was conducted to inform clinical educators’ approach to training physicians. Using a national database operated by Harvard’s malpractice insurer called the Controlled Risk Insurance Company (CRICO), the authors reported that claims involving trainees were rare and that the most common final diagnosis of malpractice claims involving physician trainees was puncture or laceration during surgery. 

A commonly used definition of adverse event is patient harm resulting from medical care rather than patients’ underlying disease. Medical education requires a careful balance of providing trainees with graduated responsibility, while ensuring safe, high quality care.

“The fundamental goal behind this work was reducing adverse events,” says lead author Laura C. Myers MD, MPH, of the MGH Division of Pulmonary and Critical Care Medicine. “Now that we know to target procedures, the next step will be to evaluate the curricula and policies related to technical training of residents and fellows.” 

The authors examined claims from 32 teaching institutions across the country. Of more than 30,000 claims, only 581 came from teaching hospitals and had a physician trainee (either resident or fellow) involved in the adverse events. The majority (81%) involved residents.  The authors reported that claims involving physician trainees were more likely to involve a procedure (71%) versus control claims (58%). Additionally, inadequate supervision and poor technical performance were the most common contributing factors in trainee-involved claims.

“Ensuring adequate procedural supervision is crucial in preventing these adverse events and we hope that training directors in procedural specialties will use this information.  Many programs have already implemented simulation programs for physician trainees to hone procedural skills in a safe, learning environment,” says Myers, who was a fellow in the Lawrence Center for Quality and Safety at MGH during the study.  “We may also need to adjust our threshold for trainees attaining procedural independence. The Accreditation Council for Graduate Medical Education’s framework for progressive responsibility is a useful guide.”

“Our study represents the broad landscape of risk across states and really tries to address the physician trainee at the point of care.  Of the case claims, only 32% had a physician trainee actually named as a defendant despite being involved in the adverse event,” says Myers.  “State policies differ drastically with regard to physician trainees being named as defendants in claims. Florida grants immunity to physician trainees who are practicing within their scope.  Further work is needed to determine the consequences of state level policies, such as immunity, as well as the effectiveness of patient safety efforts undertaken to prevent adverse events involving physician trainees,” Myers adds. 

Co-authors of the Academic Medicine report are Rajshri Gartland MD MPH from the Department of Surgery at MGH; Jillian Skillings, Lisa Heard MSN, onathan Einbinder, MD, MPH, CRICO; Edward Bittner, MD, PhD, from the Department of Anesthesia at MGH and Joshua Metlay MD PhD and Elizabeth Mort MD MPH from the Department of Medicine at MGH.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $1 billion and comprises more than 8,500 researchers working across more than 30 institutes, centers and departments. In August 2019 the MGH was once again named #2 in the nation by U.S. News & World Report in its list of "America’s Best Hospitals."