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Many dermatology doctors-in-training don't report errors

By Andrew M. Seaman

NEW YORK (Reuters Health) - Many doctors who are training to be dermatologists have committed errors or seen other doctors commit errors, according to a new study.

What's more, those doctors-in-training, known as residents, don't often report the errors or speak up to prevent them, researchers found.

"What can be taken from this paper isn't gloom and doom," Dr. Erik Stratman told Reuters Health.

"Part of medicine in today's world is finding where you can improve and working on those areas to get better," he said.

Stratman is the study's senior author from the Marshfield Clinic in Marshfield, Wisconsin.

The Institute of Medicine put a spotlight on medical errors in a 1999 report. Errors can range from doctors incorrectly diagnosing patients to providing people with substandard follow-up care.

At the same time as that report, the Accreditation Council for Graduate Medical Education, which oversees medical education, issued new safety requirements, Stratman and his colleague, Dr. Jillian Havey Swary, note in JAMA Dermatology.

They write that residents are now required to work in teams to enhance patient safety, improve care and improve the system to prevent errors.

While many studies have been devoted to medical errors since the 1999 report, little is known about the behaviors of dermatology residents and their supervising doctors, known as attendings.

For the new study, the researchers surveyed 142 dermatology residents from 44 programs in the U.S. and Canada. The residents took the survey while attending a session on patient safety sponsored by the American Academy of Dermatology.

Of those who had accidentally stuck themselves with a patient's needle in the past, about 45 percent said they did not report it through the proper channels.

Almost 97 percent of residents reported mislabeling right or left body parts during examinations or biopsies.

And about 83 percent said they had copied and pasted information from a patient's previous visit into his or her medical record without checking if it was accurate.

"We know that that is one of the downsides of the electronic era of charting and documentation - the ease with which cutting and pasting can occur," Stratman said. "That's not new information. It just hasn't been specifically looked at in dermatology training."

He and Swary also asked about the residents' attendings.

About 60 percent said they didn't report errors because they worked with an intimidating attending doctor. And about 78 percent said they had witnessed an attending disregard safety steps.

"What was most alarming was why residents were not reporting their needle stick or why they weren't speaking up if they saw things going not well," Stratman said.

He said dermatology programs will read the new study and improve their local culture of safety.

"I think that studies are very good for prompting things to get better," he said.

Stratman also said that he doesn't think patients should be concerned when they see a dermatologist or a dermatology resident, but they also shouldn't be afraid to speak up.

"I think that there are already actions being taken around the country to heighten the stage of patient safety and residency education programs," he said. "That work preceded this publication."

SOURCE: http://bit.ly/1lQKH9D JAMA Dermatology, online April 9, 2014.

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