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Rates of medication errors among depressed and burnt out residents: prospective cohort study

BMJ 2008; 336 doi: (Published 28 February 2008) Cite this as: BMJ 2008;336:488
  1. Amy M Fahrenkopf, instructor of paediatrics1,
  2. Theodore C Sectish, associate professor of paediatrics2,
  3. Laura K Barger, research fellow3,
  4. Paul J Sharek, assistant professor of paediatrics2,
  5. Daniel Lewin, assistant professor of psychiatry and paediatrics4,
  6. Vincent W Chiang, assistant professor of paediatrics1,
  7. Sarah Edwards, project coordinator3,
  8. Bernhard L Wiedermann, associate professor of paediatrics4,
  9. Christopher P Landrigan, assistant professor of paediatrics and medicine13
  1. 1Harvard Medical School, Department of Medicine, Children’s Hospital Boston, Boston, MA 02115, USA
  2. 2Stanford Medical School, Lucile Packard Children’s Hospital, Palo Alto, CA, USA
  3. 3Division of Sleep Medicine, Brigham and Women’s Hospital, Boston, MA, USA
  4. 4George Washington University Medical School, Children’s National Medical Center, Washington, DC, USA
  1. Correspondence to: A M Fahrenkopf amy.fahrenkopf{at}
  • Accepted 8 December 2007


Objective To determine the prevalence of depression and burnout among residents in paediatrics and to establish if a relation exists between these disorders and medication errors.

Design Prospective cohort study.

Setting Three urban freestanding children’s hospitals in the United States.

Participants 123 residents in three paediatric residency programmes.

Main outcome measures Prevalence of depression using the Harvard national depression screening day scale, burnout using the Maslach burnout inventory, and rate of medication errors per resident month.

Results 24 (20%) of the participating residents met the criteria for depression and 92 (74%) met the criteria for burnout. Active surveillance yielded 45 errors made by participants. Depressed residents made 6.2 times as many medication errors per resident month as residents who were not depressed: 1.55 (95% confidence interval 0.57 to 4.22) compared with 0.25 (0.14 to 0.46, P<0.001). Burnt out residents and non-burnt out residents made similar rates of errors per resident month: 0.45 (0.20 to 0.98) compared with 0.53 (0.21 to 1.33, P=0.2).

Conclusions Depression and burnout are major problems among residents in paediatrics. Depressed residents made significantly more medical errors than their non-depressed peers; however, burnout did not seem to correlate with an increased rate of medical errors.


  • We thank the residents for their time and the nurses and doctors who helped us in our efforts to collect the data.

  • Ethical approval: This study was approved by the institutional review boards at the three participating hospitals.

  • Contributors: AMF and CPL conceptualised and designed the study, rated all medication errors, analysed and interpreted the data, drafted the paper, and approved the final version. PJS, DL, and CPL supervised collection of data on participants at the three sites. SE assisted in data analysis. All authors participated in designing the study, revising the manuscript critically for important intellectual content, and approving the final versio. AMF is the guarantor.

  • Funding: This study was supported by grants from the Agency for Healthcare Research and Quality (K08 HS13333) and from the Departments of Pediatrics at the Lucile Packard Children’s Hospital, the Children’s National Medical Center, and the Children’s Hospital Boston.

  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

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