Medical errors are associated with feelings of distress in physicians, but little
is known about the magnitude and direction of these associations.
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.
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.
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.
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).
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.