Introduction: Significant reforms, including mandated duty hour restrictions and the implementation of the Milestone Project, have been introduced within U.S. neurosurgery residency training programs to enhance patient safety and to reduce the incidence of resident error. However, there is little data describing the basis for these errors, or outlining recent trends in neurosurgical resident error.
Methods: An online questionnaire was distributed to program directors of all U.S. neurosurgery residency training programs to assess the most common forms of resident error, the causes of resident error, resulting patient outcomes, and steps taken by residency programs to address these errors.
Results: Thirty-one (29%) responses were received. Procedural/surgical error was the most commonly observed type of error. Transient injury to the patient or no injury to the patient, were the two most frequent outcomes. Inexperience or resident mistake despite adequate training were cited as the most common causes of error. Thirty (97%) programs have protocols in place to encourage error reporting. Twenty-three (74.2%) programs affirmed that a lower PGY status correlated with an increased incidence of errors. Seven (22.6%) program directors have observed the “July Phenomenon” at their institution, with only two (6.5%) reporting having noticed a correlation between a reduction in duty hour limitations and the incidence of resident error. There was a trend towards an association between an increased number of residents within a program and the number of errors attributable to a lack of supervision (r = 0.36; p = 0.06).
Conclusions: Procedural error was the most commonly observed form of error. PGY status is believed to be an important predictor of error frequency. Most program directors do not believe mandated reductions in duty hours has decreased the incidence of resident errors. Closer attending supervision in the OR for junior residents, and for residents in larger training programs, may be considered.
Patient Care: Given the increasing financial and social burden of medical errors on the healthcare system, an understanding of the basis for these errors is needed. This is perhaps most important at the level of resident education. Here, we provide the results from a recent survey sent to the program directors of all the U.S. neurosurgery residency training programs. We hope that the results from this study may be used to guide institutional and departmental decision-making to reduce the incidence of resident error. We also hope that such data will allow for increased transparency on a topic that is rarely discussed, but is especially important to consider.
Learning Objectives: By the conclusion of this session, participants should be able to: (1) understand the basis for resident error and the most frequent clinical outcomes that result, (2) discern current trends and correlations in resident error, and (3) identify how programs/program directors deal with resident error at their respective institutions.