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Pediatric Anesthesiology Fellows’ Perception of Quality of Attending Supervision and Medical Errors

Benzon, Hubert A. MD, MPH*; Hajduk, John BS*; De Oliveira, Gildasio Jr MD, MSCI, MBA; Suresh, Santhanam MD*; Nizamuddin, Sarah L. MD; McCarthy, Robert PharmD; Jagannathan, Narasimhan MD*

doi: 10.1213/ANE.0000000000002445
Medical Education: Original Clinical Research Report

BACKGROUND: Appropriate supervision has been shown to reduce medical errors in anesthesiology residents and other trainees across various specialties. Nonetheless, supervision of pediatric anesthesiology fellows has yet to be evaluated. The main objective of this survey investigation was to evaluate supervision of pediatric anesthesiology fellows in the United States. We hypothesized that there was an indirect association between perceived quality of faculty supervision of pediatric anesthesiology fellow trainees and the frequency of medical errors reported.

METHODS: A survey of pediatric fellows from 53 pediatric anesthesiology fellowship programs in the United States was performed. The primary outcome was the frequency of self-reported errors by fellows, and the primary independent variable was supervision scores. Questions also assessed barriers for effective faculty supervision.

RESULTS: One hundred seventy-six pediatric anesthesiology fellows were invited to participate, and 104 (59%) responded to the survey. Nine of 103 (9%, 95% confidence interval [CI], 4%–16%) respondents reported performing procedures, on >1 occasion, for which they were not properly trained for. Thirteen of 101 (13%, 95% CI, 7%–21%) reported making >1 mistake with negative consequence to patients, and 23 of 104 (22%, 95% CI, 15%–31%) reported >1 medication error in the last year. There were no differences in median (interquartile range) supervision scores between fellows who reported >1 medication error compared to those reporting ≤1 errors (3.4 [3.0–3.7] vs 3.4 [3.1–3.7]; median difference, 0; 99% CI, −0.3 to 0.3; P = .96). Similarly, there were no differences in those who reported >1 mistake with negative patient consequences, 3.3 (3.0–3.7), compared with those who did not report mistakes with negative patient consequences (3.4 [3.3–3.7]; median difference, 0.1; 99% CI, −0.2 to 0.6; P = .35).

CONCLUSIONS: We detected a high rate of self-reported medication errors in pediatric anesthesiology fellows in the United States. Interestingly, fellows’ perception of quality of faculty supervision was not associated with the frequency of reported errors. The current results with a narrow CI suggest the need to evaluate other potential factors that can be associated with the high frequency of reported errors by pediatric fellows (eg, fatigue, burnout). The identification of factors that lead to medical errors by pediatric anesthesiology fellows should be a main research priority to improve both trainee education and best practices of pediatric anesthesia.

Published ahead of print July 4, 2017.

From the *Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois; Department of Anesthesiology, Northwestern University, Chicago, Illinois; and University of Chicago Medical Center, University of Chicago, Chicago, Illinois.

Published ahead of print August 31, 2017.

Accepted for publication July 27, 2017.

Funding: This study was funded by the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Hubert A. Benzon, MD, MPH, Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, PO Box 19, Chicago, IL 60611. Address e-mail to hbenzon@luriechildrens.org.

© 2018 International Anesthesia Research Society
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