title: Ordering errors by first-year residents: evidence of learning from mistakes.
abstract: OBJECTIVE
  To study patterns of ordering errors, we reviewed charts of patients cared for by first-year residents at our community-based teaching hospital.
  
  
  RESULTS
  In month one, 39 of 1248 orders (3.1%) were rated as errors. In contrast, 9 of 1072 orders (0.84%) in month six were rated as errors (p < 0.001). Of the 48 errors identified, 36 (75%) related to medications (choice, dose, route, frequency, or duration). Over half (53%) of these errors involved antimicrobials, pulmonary medications, or diabetes-related drugs. For all errors, half (24/48) were identified by attending physicians, with hospital support staff noting most of the remaining errors (43.8%). Errors were ultimately corrected by the first-year resident in over half of the cases (52%); attending physicians corrected 16 of 39 errors (41%) in month one but only one of nine errors (11%) in month six. Errors by first-year residents were primarily attributed to inattention (45.8%) or deficits in clinical knowledge (43.8%). No adverse effects resulted from any of the ordering errors identified. Primary consequences of errors included inconvenience to staff (50%), delay in treatment or diagnosis (31.3%), or receiving unneeded medication (18.8%).
  
  
  CONCLUSIONS
  The number of medical errors decreases with experience. Our results highlight the importance of clinical supervision during the initial months of training.
authors.affiliation: Department of Graduate Medical Education, St. John's Mercy Medical Center, St. Louis, Missouri, USA.
authors.forename: Hobart W
authors.initials: HW
authors.lastname: Walling
authors.forename: Christopher
authors.initials: C
authors.lastname: Veremakis
mesh_terms: D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D019300:Medical Errors / Q000706:statistics & numerical data*; D008499:Medical Records