Are neurology residents in the United States being taught defensive medicine?

Objective: To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents' attitudes. Methods: Neurology residents in the US (n = 25) and, as a control group, Neurology residents training in Germany (n = 42) were asked to rate multiple items regarding litigation, defensive strategies and how often these issues are raised by teaching physicians. Statistic analysis was performed using nonparametric tests. Results: Residents in both countries indicated that litigation is an important problem, although US residents stated this significantly more often (p < 0.001). Initiation of tests motivated mainly by fear of litigation (p = 0.004) and explicit teaching of defensive strategies by teaching physicians (p < 0.02) were reported more often by US residents. Conclusion: Neurology residents in both the US and Germany perceive a litigational threat, but significantly less so in Germany. This difference may result at least in part from teaching of defensive strategies reported more often in US programs. (c) 2005 Elsevier B.V. All rights reserved.