title: Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.
abstract: BACKGROUND
  Medical errors are associated with feelings of distress in physicians, but little is known about the magnitude and direction of these associations.
  
  
  OBJECTIVE
  To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life, burnout, depression, and empathy using validated metrics.
  
  
  METHODS
  Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester. Data were provided by 184 (84%) of 219 eligible residents. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and linear analog scale assessment of quality of life every 3 months, and the Maslach Burnout Inventory (depersonalization, emotional exhaustion, and personal accomplishment), Interpersonal Reactivity Index, and a validated depression screening tool every 6 months.
  
  
  METHODS
  Frequency of self-perceived medical errors was recorded. Associations of an error with quality of life, burnout, empathy, and symptoms of depression were determined using generalized estimating equations for repeated measures.
  
  
  RESULTS
  Thirty-four percent of participants reported making at least 1 major medical error during the study period. Making a medical error in the previous 3 months was reported by a mean of 14.7% of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life (P = .02) and worsened measures in all domains of burnout (P = .002 for each). Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 (95% confidence interval, 1.90-5.64). In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months (P=.001, P<.001, and P=.02 for depersonalization, emotional exhaustion, and lower personal accomplishment, respectively; P=.02 and P=.01 for emotive and cognitive empathy, respectively).
  
  
  CONCLUSIONS
  Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress. Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. west.colin@mayo.edu
authors.forename: Colin P
authors.initials: CP
authors.lastname: West
authors.forename: Mashele M
authors.initials: MM
authors.lastname: Huschka
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Novotny
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Kolars
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002055:Burnout, Professional; D003863:Depression; D004645:Empathy; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008137:Longitudinal Studies; D008297:Male; D019300:Medical Errors / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D012649:Self Concept; D014481:United States