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The Journal of the American Board of Family Medicine 19:627-632 (2006)
© 2006 American Board of Family Medicine

Special Communication

Aviation Model Cognitive Risk Factors Applied to Medical Malpractice Cases

Stephen C. Stripe, MD, FAAFP, Lyle G. Best, MD, Shirley Cole-Harding, PhD, Bryce Fifield, PhD and Farzin Talebdoost, MD, MPH

Center for Family Medicine Minot, University of North Dakota, School of Medicine and Health Sciences (SCS, LGB, FT), Minot, ND
Department of Psychology (SC-H), Minot State University, Minot, ND
Department of Special Education (BF), Minot State University, Minot, ND

Correspondence: Corresponding author: Stephen C. Stripe MD, FAAFP, Assistant Professor of Family Medicine, Center for Family Medicine, University of North Dakota School of Medicine and Health Sciences, 1201 11th Avenue SW, Minot, ND 58701 (E-mail: sstripe{at}medicine.nodak.edu)

Objective: Aviation accidents have been reduced substantially by training pilots to avoid high-risk behaviors caused by cognitive errors. To determine whether similar cognitive cause factors or errors are involved in medical malpractice cases, and to evaluate the reliability of identifying such factors, physicians reviewed state and federal malpractice cases in a legal database.

Method: Reviewing physicians evaluated 30 cases meeting inclusion criteria from state and federal malpractice cases for the year 2004 in the 8th US Circuit Court of Appeals region, using criteria for cognitive factors derived from aviation. The cases were categorized into three classes based on the degree of agreement between the reviewers. The results as to prevalence of the factors and reliability of identifying the factors were then analyzed statistically.

Results: Fifty-nine percent of the cases met criteria for strong and good correlation with the factors. Cognitive factors involving IMSAFE (illness, medications, stress, alcohol, physiogical (f), and emotional) and medical team management/leadership can be reliably identified. Other factors, such as hazardous attitudes and loss of situational awareness, were identified with minimal reliability.

Conclusion: The aeronautical cognitive causative approach can be translated into a medical approach to reliably identify cognitive causes of errors in a significant proportion of medical malpractice cases from a legal database.






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Copyright © 2006 by the American Board of Family Medicine.