Publications (2)6.17 Total impact
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Article: The Association Between Frequency of Self-Reported Medical Errors and Anesthesia Trainee Supervision: A Survey of United States Anesthesiology Residents-in-Training.
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ABSTRACT: BACKGROUND:Poor supervision of physician trainees can be detrimental not only to resident education but also to patient care and safety. Inadequate supervision has been associated with more frequent deaths of patients under the care of junior residents. We hypothesized that residents reporting more medical errors would also report lower quality of supervision scores than the ones with lower reported medical errors. The primary objective of this study was to evaluate the association between the frequency of medical errors reported by residents and their perceived quality of faculty supervision.METHODS:A cross-sectional nationwide survey was sent to 1000 residents randomly selected from anesthesiology training departments across the United States. Residents from 122 residency programs were invited to participate, the median (interquartile range) per institution was 7 (4-11). Participants were asked to complete a survey assessing demography, perceived quality of faculty supervision, and perceived causes of inadequate perceived supervision. Responses to the statements "I perform procedures for which I am not properly trained," "I make mistakes that have negative consequences for the patient," and "I have made a medication error (drug or incorrect dose) in the last year" were used to assess error rates. Average supervision scores were determined using the De Oliveira Filho et al. scale and compared among the frequency of self-reported error categories using the Kruskal-Wallis test.RESULTS:Six hundred four residents responded to the survey (60.4%). Forty-five (7.5%) of the respondents reported performing procedures for which they were not properly trained, 24 (4%) reported having made mistakes with negative consequences to patients, and 16 (3%) reported medication errors in the last year having occurred multiple times or often. Supervision scores were inversely correlated with the frequency of reported errors for all 3 questions evaluating errors. At a cutoff value of 3, supervision scores demonstrated an overall accuracy (area under the curve) (99% confidence interval) of 0.81 (0.73-0.86), 0.89 (0.77-0.95), and 0.93 (0.77-0.98) for predicting a response of multiple times or often to the question of performing procedures for which they were not properly trained, reported mistakes with negative consequences to patients, and reported medication errors in the last year, respectively.CONCLUSIONS:Anesthesiology trainees who reported a greater incidence of medical errors with negative consequences to patients and drug errors also reported lower scores for supervision by faculty. Our findings suggest that further studies of the association between supervision and patient safety are warranted.Anesthesia and analgesia 02/2013; · 3.08 Impact Factor -
Article: Publication bias in the anesthesiology literature.
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ABSTRACT: Publication bias occurs because positive finding studies are more likely to be published. The dearth of studies of negative or equivalence findings can erroneously affect future research and potentially clinical care of patients. We hypothesized that positive studies were more likely to be published than negative studies in anesthesiology journals with a higher impact and circulation. A PubMed search for controlled trials in humans published in peer-reviewed anesthesiology journals during 2008 and 2009 was performed. Fourteen anesthesiology journals and 1163 studies were evaluated. The average clinical trial impact factor (average citations per article) for each journal was determined. The quartiles for the clinical trial impact factor for the journals included in the analysis were 4, 6.1, and 9.1. Studies were scored by 2 raters as positive or negative results of the primary stated outcome. Factors previously associated with publication were also extracted. The primary outcome, the proportion of positive and negative studies in the journals in the upper quartile of the clinical trial impact factor to the lower quartiles was compared using the Fisher exact test. The odds ratio for the effect of positive study results adjusted for other characteristics associated with publication was determined using binary logistic regression. A multinomial logistic regression model was fitted for the journals with an impact factor in the upper quartile with adjustment for study trial registration, origin of publication, positive study findings, reporting of treatment blinding, reporting of subject withdrawals, study sponsorship, and description of the randomization method. Positive finding studies were identified in 72% (425 of 588) of articles in journals with a clinical trial impact factor >9.1 compared with 53% (308 of 575) in journals <9.1 (P < 0.001). After adjusting for factors associated with publication, positive study results had an odds ratio (95% confidence interval) of 2.28 (1.76-3.01) for publication in an anesthesiology journal in the upper quartile. Multinomial logistic regression identified positive study findings associated with an increased likelihood of publication in 3 of the 4 anesthesiology journals with a clinical trial impact factor >9.1. This study reports the presence of publication bias in the anesthesiology literature especially in higher clinical trial impact factor journals. Publication bias can have potential implications for future research and the clinical care of patients. Authors should be encouraged to submit negative studies to high impact journals and the journals should be encouraged to evaluate the editorial process as the cause of publication bias.Anesthesia and analgesia 02/2012; 114(5):1042-8. · 3.08 Impact Factor
