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Original Investigation |

Practice Gaps in Patient Safety Among Dermatology Residents and Their Teachers:  A Survey Study of Dermatology Residents

Jillian Havey Swary, MD1; Erik J. Stratman, MD1
[+] Author Affiliations
1Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin
JAMA Dermatol. 2014;150(7):738-742. doi:10.1001/jamadermatol.2013.7541.
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Importance  Curriculum and role modeling adjustments are necessary to address patient safety gaps occurring during dermatology residency.

Objective  To identify the source of clinical practices among dermatology residents that affect patient safety and determine the best approach for overcoming gaps in knowledge and practice patterns that contribute to these practices.

Design, Setting, and Participants  A survey-based study, performed at a national medical dermatology meeting in Itasca, Illinois, in 2012, included 142 dermatology residents from 44 residency programs in the United States and Canada.

Main Outcomes and Measures  Self-reported rates of dermatology residents committing errors, identifying local systems errors, and identifying poor patient safety role modeling.

Results  Of surveyed dermatology residents, 45.2% have failed to report needle-stick injuries incurred during procedures, 82.8% reported cutting and pasting a previous author’s patient history information into a medical record without confirming its validity, 96.7% reported right-left body part mislabeling during examination or biopsy, and 29.4% reported not incorporating clinical photographs of lesions sampled for biopsy in the medical record at their institution. Residents variably perform a purposeful pause (“time-out”) when indicated to confirm patient, procedure, and site before biopsy, with 20.0% always doing so. In addition, 59.7% of residents work with at least 1 attending physician who intimidates the residents, reducing the likelihood of reporting safety issues they witness. Finally, 78.3% have witnessed attending physicians purposefully disregarding required safety steps.

Conclusions and Relevance  Our data reinforce the need for modified curricula, systems, and teacher development to reduce injuries, improve communication with patients and between physicians, residents, and other members of the health care team, and create an environment free of intimidation.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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