"In addition to the obvious negative effects of errors on patients, studies have shown that the physicians involved often experience guilt, shame, distress and depression," said Tait Shanafelt, author of the study appearing Wednesday in the Journal of the American Medical Association, "and those who are distressed appear more likely to make an error in the next three months."

The three-year study of 184 medical residents in training at the Mayo Clinic in Rochester, Minn., found that 34 percent of participants reported making at least one major error. Those who reported an error experienced substantially higher levels of burnout and were more than three times more likely to have a screening test indicate possible depression.

The connection between errors and various measures of distress also operated in reverse: Those who scored high on burnout measures were twice as likely to report an error in the next three months as those with low burnout.

"Medical trainees relatively frequently have experience with errors," Thomas Gallagher, a professor of medical ethics at the University of Washington, told United Press International. "They tend to find them deeply upsetting, which leads to a cycle of stress and subsequent errors."

A large part of the problem: Only about half of residents involved in a major error discuss the error with a supervisor, preventing them from getting help dealing with the difficult experience, Gallagher said.

"Keeping errors to oneself is associated with responses to errors that are not constructive," he said. "When residents come forward, they're in a much better position to get some support."

Even worse, often what the resident thinks is an error was either not actually a mistake, not a serious mistake, or caused by a system breakdown and not the doctor, he added.

What is needed to help mitigate the consequences of inevitable mistakes during training, Gallagher said, is a change in the culture of medicine so that admitting mistakes is not considered a sign of weakness and healthcare providers are prepared to deal with them ahead of time -- both for the patients' and doctors' sake.

Resident training programs have already taken some steps to help residents. In general, they are more closely supervised, which can help prevent errors from happening in the first place. The Accreditation Council for Graduate Medical Education has defined patient communication -- even of mistakes -- to be a core competency and requires that counseling be available to residents. A few programs have also taken an interest in the issue.

But the bulk of medical students are still not prepared for the aftermath of errors, Jay Bhatt, president of the American Medical Student Association, told UPI.

"Ideally you wouldn't want to make mistakes, but we wouldn't be human if we didn't," he said. But when it comes to preparation in medical school for dealing with those mistakes, "we didn't get taught how to do that."

That absence of preparation is then compounded by the grinding schedule that residents are forced to maintain, he said. The association is lobbying to limit the resident work week to 80 hours, with no more than 24 hours per shift.

The lack of time for rest and recreation increases the likelihood of both errors and depression, and allows for virtually no time to recover from the upset of making an error, Bhatt said. "We need to care for ourselves in order to care for patients. Fewer hours would give residents time to relax, reflect and do other things that help them avoid burnout."

The problem of coping with the trauma of making an error is not limited to residents, Carol Haraden, vice president of the Institute for Healthcare Improvement, told UPI.

"It can happen to anybody who's at the sharp end of care," she said, including nurses and pharmacists, and the rate reported by the study could easily be an underestimate.

In the case of residents, the schedule is a likely culprit for at least some of the depression and burnout, and in turn, medical errors, she said. "It certainly can't make depression any better."

However, medical students -- who tend to be perfectionists -- also tend to be hard on themselves for any kind of mistake, leading to more depression, Haraden said. "These (students) have enormous expectations of themselves and they don't want anything to go wrong."

Given the likelihood of making mistakes, and the possibility that it will lead to burnout and other mistakes, schools should be proactive, she said. "This should be a clarion call for medical schools to say, 'How are we going to address this?' We should anticipate that all students, by the time they finish medical school, will be involved in an adverse event, and we should tell them how to manage these events right off the bat."

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