However, less than 1% of all claims resulting in a payment actually had a named resident as a defendant, as it is common for residents to be dropped as named defendants, which means they are not reported to the National Practitioner Data Bank when covered by a medical school or hospital.

Therefore, payments made on behalf of a resident are generally as a result of resident participation in patient care and are likely to be greater. Further, recent emergency medicine data from the Physician Insurers Association of America (PIAA) showed that the percentage of paid claims rose from 22.6% to 33.8% when a resident was involved, and the average indemnity paid went from $223,373 to $280,347.

Additionally, observations from a study that appeared in the Journal of General Internal Medicine in 2010 showed that errors are more common in early summer, when new residents and interns begin their training – the so-called “July effect.”

In this study, the authors found that the number of hospital patients who died from medication errors spiked 10% in July, but only in counties with teaching hospitals.

In an Archives of Internal Medicine article titled “Medical Errors Involving Trainees,” the authors reviewed 240 malpractice claims and found that the types of medical errors affecting trainees included:

• Judgment error (72% of cases)
• Memory or vigilance error (57% of cases)
• Lack of technical competence or knowledge (58% of cases)
• Lack of supervision (54% of cases)
• Handoff problems (19% of cases)
• Excessive workload (19% of cases).

Common high-risk misses included failure to:

• Correctly time onset of acute stroke
• Recognize serious injury in geriatric trauma patients
• Recognize the presentation of aortic dissection
• Recognize surgical pathology in elderly patient who have abdominal pain
• Appreciate the significance of a patient who presents multiple times with the same complaint
• Initiate timely consultation or transfer for critically ill patients.

Important to note in these malpractice cases is that a resident is generally held to the same standard as other residents with similar training, a general practitioner, or an attending specialist, depending on the locale and circumstances of the case.

It is highly likely, however, that the supervising physician will be held liable if a bill is submitted for which the supervising physician claims to have overseen the resident and agrees with the documentation and plan.

Discussing the balance between supervision and autonomy is important. Direct supervision comes at a cost because it (1) requires increased manpower, (2) impacts patient flow, (3) takes attending physicians away from direct care, and (4) affects residents’ decision-making.