title: Resident physicians' clinical training and error rate: the roles of autonomy, consultation, and familiarity with the literature.
abstract: Resident physicians' clinical training poses unique challenges for the delivery of safe patient care. Residents face special risks of involvement in medical errors since they have tremendous responsibility for patient care, yet they are novice practitioners in the process of learning and mastering their profession. The present study explores the relationships between residents' error rates and three clinical training methods (1) progressive independence or level of autonomy, (2) consulting the physician on call, and (3) familiarity with up-to-date medical literature, and whether these relationships vary among the specialties of surgery and internal medicine and between novice and experienced residents. 142 Residents in 22 medical departments from two hospitals participated in the study. Results of hierarchical linear model analysis indicated that lower levels of autonomy, higher levels of consultation with the physician on call, and higher levels of familiarity with up-to-date medical literature were associated with lower levels of resident's error rates. The associations varied between internal and surgery specializations and novice and experienced residents. In conclusion, the study results suggested that the implicit curriculum that residents should be afforded autonomy and progressive independence with nominal supervision in accordance with their relevant skills and experience must be applied cautiously depending on specialization and experience. In addition, it is necessary to create a supportive and judgment free climate within the department that may reduce a resident's hesitation to consult the attending physician.
authors.affiliation: Faculty of Industrial Engineering and Management, Technion - Israel Institute of Technology, 32000, Haifa, Israel, naveh@ie.technion.ac.il.
authors.forename: Eitan
authors.initials: E
authors.lastname: Naveh
authors.forename: Tal
authors.initials: T
authors.lastname: Katz-Navon
authors.forename: Zvi
authors.initials: Z
authors.lastname: Stern
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007557:Israel; D008091:Literature; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D017009:Professional Autonomy; D012017:Referral and Consultation; D013038:Specialization; D011795:Surveys and Questionnaires