Viewpoint: Realistic medical training will improve safety in teaching hospitals

New interns — physicians who finished four years of medical school — are especially prone to making medication errors, signaling a need for better training to improve patient safety in teaching hospitals, a fourth-year emergency medicine resident writes in a STAT op-ed.

Five insights from the op-ed, written by Christopher Taicher, MD, fourth-year emergency medicine resident at Boston-based Massachusetts General Hospital and Brigham and Women's Hospital:

1. As the senior emergency medicine resident supervising new interns at the two Harvard-affiliated hospitals, Dr. Taicher frequently sees interns make medication errors.

"These observations of mine feed into the longstanding question of whether a cause-effect relationship exists between new interns and in-hospital deaths," Dr. Taicher writes.  

2. Adjusted mortality within teaching hospitals increases 4 percent in July — the month interns first start in hospital wards and emergency departments, according to the National Bureau of Economic Research. A separate study found a 10 percent rise in fatal medication errors in July in counties with teaching hospitals, but did not find a spike was in counties without teaching hospitals.

3. After asking interns in multiple specialties why they feel unprepared during their first week of residency, Dr. Taicher found many feel underprepared because they have not had to put in computer orders by themselves for laboratory tests, imaging or medications.

"The short explanation for why interns have difficulty selecting orders — and thus managing their patients — is that they had limited opportunities in medical school for active engagement in patient care, including working side by side with experienced physicians to understand why they selected particular tests and treatments," Dr. Taicher says.

4. It is critical for medical students to work closely with experienced physicians to understand the reasons certain tests and treatments are ordered, Dr. Taicher says. "Without sufficient experience placing orders during medical school, interns are able to apply rote knowledge, like a medication name, but will be deficient in important details of clinical decision-making, such as dosing and identifying the severity of an illness," Dr. Taicher writes.

5. Another way to improve intern preparedness is to have boot camps in medical school before starting internships in July where medical students can practice the skills needed for their upcoming residency or specialty training.

"Requiring medical students to be more engaged with their supervisors while placing orders will undoubtedly improve interns' clinical effectiveness when it comes time for them to begin placing orders for blood tests and medications," Dr. Taicher says.

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