170 Risk-Management and Medical Malpractice Curriculum for Emergency Medicine Residency

Abstract

Lawsuits frequently name resident physicians as co-defendants along with attending physicians and the hospital. Many residents are not aware of the full extent of their exposure to medical malpractice liability nor do they understand the medical liability coverage they are provided by their training programs. Our efforts as a medical profession to prepare resident physicians to navigate the current legal system are either lacking or deficient. According to one large Northeast malpractice insurer, from 1994 to 2003, in the graduate medical education setting, residents were named in 22% of medical malpractice lawsuits. Between 1990 and 2004, the National Practitioner Database reported 1530 claims awarded in suits involving residents, a number regarded as low due to underreporting. The purpose of this study is to review the current literature regarding emergency medicine (EM) resident physician medical malpractice education and to make recommendations based on this literature to develop a model medical malpractice program for EM residents. A PubMed search was performed using the combined keywords “resident liability,” “resident lawsuits,” and “resident medical malpractice.” The search yielded 24 citations. These were reviewed along with the bibliographies of relevant articles. A search was also performed of the Cochrane Database of Systemic Reviews using the same strategy, which yielded only 1 relevant review. Seven articles were selected for review that directly addressed medical malpractice education in residency programs. Two of the articles specifically described elements of an EM resident medical malpractice education program. All selected articles discussed how residency programs recognize the need for more in-depth medicolegal education but lack a curriculum for such. The article review revealed that some programs invite hospital attorneys to discuss such topics as pitfalls inherent to charting, and explain the format of a medical malpractice trial and the pre-trial litigation process. The timing of such training appears to be an obstacle. The most relevant article discussed how a mock trial involving emergency medicine residents improved their communication skills and expanded their knowledge of documentation pitfalls, problems with staff interaction, and consequences of medical errors. Medicolegal curriculum allowed residents to learn how the lay public and patients view the care that they deliver. It taught residents how they are perceived, both positively and negatively, while they are administering medical care. Malpractice risk is serious concern for residents and a financial liability for hospitals but there is a paucity of organized education programs during residency. Physician-defendants have been forced to become educated on the subject of medical malpractice first hand instead of having a dedicated education program in residency. Although there is consensus on the importance of medicolegal education during residency there is limited information in the literature on residency programs having a dedicated educational program for such.