Medication Errors as a Marker of Resident Competency

TL;DR

This study explores if medication errors made by surgery residents can predict their competency levels, but finds no strong link between error rates and formal competency scores.

Contribution

The study introduces medication error rates as a potential early indicator of resident competency, though it finds no correlation with ACGME milestone scores.

Findings

There was a statistically significant decrease in medication error rates as residents advanced in post-graduate years.

No correlation was found between medication error rates and ACGME core competency scores.

Most medication errors were level 3, indicating minor issues rather than severe mistakes.

Abstract

Introduction

Educators continue to evaluate ways to assess resident performance in conjunction with the Accreditation Council for Graduate Medical Education (ACGME) general surgery milestones. We investigated whether the rate of medication errors could reflect general surgery resident competency. We hypothesized that the identification of increased medication errors made by general surgery residents could be a potential screening tool to identify residents who are academically at risk prior to their formal biannual milestone evaluation by the clinical competency committee.

Methods

This is a retrospective cohort study comparing rates of medication ordering errors against ACGME core competency scores over four years in a general surgery residency program at an academic, university-affiliated, level 1 trauma center in the Northeastern United States.

Results

We identified 95 general surgery residents who inputted 1,164,663 medication orders during the four years studied. There were 1,214 (0.1%) errors identified. Of those, 1,146 (94.4%) were level 3 errors, and 68 (5.6%) were level 4 errors. This represents an error rate of 1.04 errors per 1,000 medication orders. There was a statistically significant decrease in the error rate as the post-graduate year (PGY) level increased (p=0.005). However, there was no correlation between the error rate and individual ACGME milestone competency scores by PGY level.

Conclusions

We explored whether medication errors may be an early measurement of worsening resident performance as demonstrated by a decrease in ACGME core competency scores. However, the rate of errors did not correlate consistently with these measures. This may underscore that medication errors measure an aspect of resident performance that we do not capture with our current assessments.