Judgment mistakes, teamwork problems, and insufficient technical skill contribute to the majority of medical errors that involve trainees, reports the Archives of Internal Medicine. 

Researchers examined malpractice claims (surgery, obstetrics, and internal medicine) from five U.S. insurers. Overall, 240 errors involving residents, interns, or fellows and causing adverse outcomes (death in one-third of cases) occurred from 1979 through 2001. The researchers found that: 

• errors in judgment contributed to 72% of the cases;
• breakdowns in teamwork — particularly lack of supervision by attending physicians and problematic handoffs between trainees or between trainee and attending — were involved in 70%;
• poor technical competence, most often concerning diagnostic decision-making, contributed to 58%.

Seventy percent of the errors occurred among inpatients. To improve safety in this setting, editorialists propose an approach to “translational patient care” in which teams comprising house officers, hospitalists, and nurses care for the same patient from admission to discharge.