A mixed-methods examination of the nature and frequency of medical error among junior doctors

O’Connor, Paul; Lydon, Sinéad; Mongan, Orla; Connolly, Fergal; McLoughlin, Aiden J.; McVicker, Lyle; Byrne, Dara

doi:10.1136/postgradmedj-2018-135897

Cited by 4 publications

(5 citation statements)

References 27 publications

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“…the need to repeat procedures 18 , ordering unnecessary tests 19 ) as well as to the interns themselves (e.g. stress or burnout 13 ) in terms of this largely on-the-job approach to skill development. These costs are worth considering, and may help to justify the resources required to establish a competency-based approach to education and training.…”

Section: Discussionmentioning

confidence: 99%

“…The rationale for the need to reach this level of entrustability is that interns tend to work autonomously with limited support from more senior doctors-particularly during night and weekend shifts 11,12 . Lack of supervision has been identified as a contributor to more than half of errors made by interns that 'played on their mind' 13 . This issue of limited supervision is further compounded by the fact that junior doctors are also often unwilling to seek guidance and clinical support from seniors 12,14 .…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal survey of self-reported level of entrustment across the first year of clinical practice

et al. 2022

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Background. Newly graduated medical students often report that they lack the skills required to care for patients, and feel unprepared for clinical practice. However, little is known about when, and if, they acquire these skills in practice. The aim of this study was to assess self-reported level of entrustment in, and frequency of performance of, the seven Entrustable Professional Activities (EPAs) comprising the EPA framework for interns in Ireland. EPAs describe discrete activities that are essential to a particular profession. Methods. Self-report survey data were collected from doctors in the Republic of Ireland during their first year of clinical practice at four different time points during 2020/21. Results. Response rates to the survey varied from 73.3% (126/172) at Time 1 to 25.6% (44/172) at Time 4. After three months, the respondents reported that they could execute all of the EPAs, inclusive of 12 essential procedural skills, with indirect supervision. As the year progressed there was an increase in the proportion of respondents reporting that they performed the EPAs at least once a week. However, the proportion of respondents performing five of the essential procedural skills (e.g. nasogastric tube insertion) remained low across all time points. Conclusion. Consideration should be given as to how to better prepare medical students to execute these EPAs, how the interns can be better supported during the first quarter of internship. The findings from this research are positive. However, there is an urgent need to carry out formal assessments of entrustability, rather than relying on self-report.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Longitudinal survey of self-reported level of entrustment across the first year of clinical practice

et al. 2022

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“…• A survey of junior doctors found that 60.5% of respondents reported making an error that “played on their mind” [ 28 ]…”

Section: Resultsmentioning

confidence: 99%

“…The two remaining record reviews were conducted to estimate the economic cost of nurse-sensitive adverse events [ 26 ] and to compare the health system performance of 15 Organisation for Economic Co-operation (OECD) countries across seven patient safety indicators [ 27 ]. Furthermore, one study used a combination of survey and interview methods to examine the nature and frequency of medical error among junior doctors [ 28 ], and one study comprised a review of medico-legal claims to identify current adverse event reporting trends in Irish surgical specialties [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

A scoping review of patient safety research carried out in the Republic of Ireland

et al. 2022

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Maintaining the highest levels of patient safety is a priority of healthcare organisations. However, although considerable resources are invested in improving safety, patients still suffer avoidable harm. The aims of this study are: (1) to examine the extent, range, and nature of patient safety research activities carried out in the Republic of Ireland (RoI); (2) make recommendations for future research; and (3) consider how these recommendations align with the Health Service Executive’s (HSE) patient safety strategy. A five-stage scoping review methodology was used to synthesise the published research literature on patient safety carried out in the RoI: (1) identify the research question; (2) identify relevant studies; (3) study selection; (4) chart the data; and (5) collate, summarise, and report the results. Electronic searches were conducted across five electronic databases. A total of 31 papers met the inclusion criteria. Of the 24 papers concerned with measuring and monitoring safety, 12 (50%) assessed past harm, 4 (16.7%) the reliability of safety systems, 4 (16.7%) sensitivity to operations, 9 (37.5%) anticipation and preparedness, and 2 (8.3%) integration and learning. Of the six intervention papers, three (50%) were concerned with education and training, two (33.3%) with simplification and standardisation, and one (16.7%) with checklists. One paper was concerned with identifying potential safety interventions. There is a modest, but growing, body of patient safety research conducted in the RoI. It is hoped that this review will provide direction to researchers, healthcare practitioners, and health service managers, in how to build upon existing research in order to improve patient safety.

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“…This demonstrates that the combination of formal teaching, informal teaching on the ward, and clinical experience allows interns to reach the desired level of proficiency before the end of the intern year of training. However, there may still be a cost to patient care during this period of learning in terms of a negative impact upon the efficiency of the health service resulting from a need to repeat procedures if the first attempts are unsuccessful [ 15 ], ordering unnecessary tests [ 16 ], as well as negatively impacting the psychological well-being to the interns themselves from failing to perform a procedure successfully [ 17 ]. These are all potential issues that could be addressed through increased practice and assessment during medical school.…”

Section: Discussionmentioning

confidence: 99%

An assessment of the simulated performance of basic clinical procedures by junior doctors during the first year of clinical practice

O’Connor,

Reid,

Mongan

et al. 2023

BMC Med Educ

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Background Upon entering the healthcare system, junior doctors may lack the skills required to care for patients, and feel unprepared for their role, with considerable variation in the level of proficiency in the performance of particular clinical procedures. Objective To compare the performance and proficiency (self-report and observed) of the performance of nine basic clinical procedures. Methods Seventeen interns were observed performing nine clinical procedures in a simulated setting in June 2021 (Assessment 1) and January 2022 (Assessment 2). The observers identified whether each step in the procedure was performed correctly, and provided an overall assessment of proficiency. The participants also rated their own level proficiency. Results At Assessment 1 the number of steps performed correctly ranged from a mean of 41.9–83.5%. At Assessment 2 the number of steps performed correctly ranged from a mean of 41.9–97.8%. The most common median proficiency rating for Assessment 1 was ‘close supervision’, and was ‘indirect supervision’ at Assessment 2. There was a significant and large effect size in the improvement in performance from Assessment 1 to Assessment 2. Low correlations were found between observer and self-reported proficiency in performance of the procedures. Conclusions The large improvement in performance across the two assessments is encouraging. However, there is a need to address the variability in performance on graduation from medical school, and to ensure that any assessment of proficiency is not only reliant on self-report.

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A mixed-methods examination of the nature and frequency of medical error among junior doctors

Cited by 4 publications

References 27 publications

Longitudinal survey of self-reported level of entrustment across the first year of clinical practice

Longitudinal survey of self-reported level of entrustment across the first year of clinical practice

A scoping review of patient safety research carried out in the Republic of Ireland

An assessment of the simulated performance of basic clinical procedures by junior doctors during the first year of clinical practice

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