Residents’ reported overtime and perceptions on safety climate, supervisor support and medical errors

Abstract

Background The Dutch healthcare system relies heavily on residents. This group is thought to be especially susceptible because of the system of hierarchy and dependence in which they work. Multiple studies have related overtime, safety climate, and supervisory support to medical errors. The aim of this study was to examine these themes and their correlations. Methods This cross-sectional questionnaire included multiple validated scales, and demographic and employment data. Correlations between themes were calculated using linear regression analysis. Between-group analyses concerning residents’ current position, department, clinical setting, and experience level compared the mean composite scores. The survey was distributed through Dutch physician associations and social media platforms between February and April 2020. 492 medical residents were included. Results Weekly average overtime was 7.8 hours, which was mostly uncompensated. Residents who were not in a training program, surgical residents, and those working in hospitals reported significantly more overtime. Over one in three felt they had fallen short in the quality of care they delivered. One-third of the respondents did not have a designated supervisor, and supervisor support scored mediocre overall. Medical errors were associated with a poorer safety climate, but other associations were not observed. Conclusions Overtime is abundant in residents, especially in surgical specialties. Safety is a priority but has a tendency to crumble under pressure. Strikingly, a substantial part of the residents felt that they had performed medical procedures that they were not properly trained for and that they had fallen short in the quality of care they delivered. Supervisor support was mostly present in the development of competencies and work-related problems, but residents reported poor rewarding behaviors, and a third did not have a designated mentor. Medical training programs should acknowledge the importance of these themes and make tangible efforts to monitor the needs and experiences of residents.