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Association of Pediatric Resident Physician Depression and Burnout With Harmful Medical Errors on Inpatient Services

Brunsberg, Katherine A. MD; Landrigan, Christopher P. MD, MPH; Garcia, Briana M.; Petty, Carter R. MA; Sectish, Theodore C. MD; Simpkin, Arabella L. MD, MMSc; Spector, Nancy D. MD; Starmer, Amy J. MD, MPH; West, Daniel C. MD; Calaman, Sharon MD

doi: 10.1097/ACM.0000000000002778
Research Reports

Purpose To determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians.

Method The authors conducted a prospective cohort study from 2011 to 2013 in seven pediatric academic medical centers in the United States and Canada. Resident physicians were screened for burnout and depression using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS) and Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS). A two-step surveillance methodology, involving a research nurse and two physician reviewers, was used to measure and categorize errors. Bivariate and mixed-effects regression models were used to evaluate the relationship between burnout, depression, and rates of harmful, nonharmful, and total errors.

Results A total of 388/537 (72%) resident physicians completed the MBI-HSS and HANDS surveys. Seventy-six (20%) and 178 (46%) resident physicians screened positive for depression and burnout, respectively. Screening positive for depression was associated with a 3.0-fold higher rate of harmful errors (incidence rate ratio = 2.99 [95% CI 1.40–6.36], P = .005). However, there was no statistically significant association between depression and total or nonharmful errors or between burnout and harmful, nonharmful, or total errors.

Conclusions Resident physicians with a positive depression screen were three times more likely than those who screened negative to make harmful errors. This association suggests resident physician mental health could be an important component of patient safety. If further research confirms resident physician depression increases the risk of harmful errors, it will become imperative to determine what interventions might mitigate this risk.

K.A. Brunsberg is pediatric hospitalist, Children’s Hospitals and Clinics of Minnesota, Minneapolis and St. Paul, Minnesota, and adjunct assistant professor, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.

C.P. Landrigan is professor of pediatrics, Harvard Medical School, chief of general pediatrics, Boston Children’s Hospital, and director of the sleep and patient safety program, Brigham and Women’s Hospital, Boston, Massachusetts.

B.M. Garcia is a second-year medical student, University of California, San Francisco School of Medicine, San Francisco, California.

C.R. Petty is a biostatistician, Boston Children’s Hospital, Boston, Massachusetts.

T.C. Sectish is professor of pediatrics, Harvard Medical School, vice chair for education, Department of Pediatrics, Harvard Medical School, and program director, Boston Combined Residency Program, Boston Children’s Hospital, Boston, Massachusetts.

A.L. Simpkin is associate director, Center for Educational Innovation and Scholarship, Massachusetts General Hospital, associate program director, Education and Curriculum, Internal Medicine Residency, Massachusetts General Hospital, and instructor in medicine, Harvard Medical School, Boston, Massachusetts.

N.D. Spector is professor of pediatrics and associate dean of faculty development, Drexel University College of Medicine, Philadelphia, Pennsylvania, and executive director, Executive Leadership in Academic Medicine, Philadelphia, Pennsylvania.

A.J. Starmer is assistant professor of pediatrics, Harvard Medical School, and associate medical director of quality, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts.

D.C. West is professor of pediatrics, University of California, San Francisco School of Medicine, and UCSF Benioff Children’s Hospital, San Francisco, California.

S. Calaman is professor of pediatrics and director of the pediatric residency program, Department of Pediatrics, Drexel University College of Medicine and St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania.

Funding/Support: The I-PASS study was previously funded by the following for the collection of data: grant number R18AE000029 from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation; grant number 1K12HS019456 from the Oregon Comparative Effectiveness Research K12 Program, Agency for Healthcare Research and Quality; Medical Research Foundation (of Oregon); Physicians’ Services Incorporated Foundation (of Ontario); and Pfizer (unrestricted medical education grant). This current study was also funded by a Fred Lovejoy Resident Research and Education Award and Harvard Catalyst.

Other disclosures: C.P. Landrigan, T.C. Sectish, N.D. Spector, A.J. Starmer, S. Calaman, and D.C. West have consulted with and hold equity in the I-PASS Institute, which seeks to train institutions in best handoff practices and aid in their implementation. T.C. Sectish, N.D. Spector, A.J. Starmer, and D.C. West have received monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for teaching and consulting on physician performance and handoffs. The I-PASS Institute has no interest in and did not support this study. C.P. Landrigan is supported in part by the Children’s Hospital Association for his work as an executive council member of the Pediatric Research in Inpatient Settings (PRIS) Network. C.P. Landrigan has also served as a paid consultant to Virgin Pulse to help develop a sleep and health program. In addition, C.P. Landrigan has received monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for teaching and consulting on sleep deprivation, physician performance, handoffs, and safety, and has served as an expert witness in cases regarding patient safety and sleep deprivation.

Ethical approval: Ethical approval was granted by the Boston Children’s Hospital Institutional Review Board, which served as the study’s coordinating center (protocol X10-08-0392, approved August 5, 2010). Additional approval was granted by the institutional review boards of each participating study site.

Previous presentations: This information was presented at the Pediatric Academic Society Conference on May 9, 2017, in San Francisco, California.

Supplemental digital content for this article is available at

Correspondence should be addressed to Katherine A. Brunsberg, 2525 Chicago Ave. S., STE 32-1024, Minneapolis, MN 55404; telephone: (612) 813-7155; email:

© 2019 by the Association of American Medical Colleges