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Balu GBS, Gupta S, Ravilla RD, Ravilla TD, Mertens H, Webers C, Vasudeva Rao S, van Merode F. Impact of practicing internal benchmarking on continuous improvement of cataract surgery outcomes: a retrospective observational study at Aravind Eye Hospitals, India. BMJ Open 2023; 13:e071860. [PMID: 37349104 PMCID: PMC10314652 DOI: 10.1136/bmjopen-2023-071860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE We aim to assess the effectiveness of a cataract surgery outcome monitoring tool used for continuous quality improvement. The objectives are to study: (1) the quality parameters, (2) the monitoring process followed and (3) the impact on outcomes. DESIGN AND PROCEDURES In this retrospective observational study we evaluated a quality improvement (QI) method which has been practiced at the focal institution since 2012: internal benchmarking of cataract surgery outcomes (CATQA). We evaluated quality parameters, procedures followed and clinical outcomes. We created tables and line charts to examine trends in key outcomes. SETTING Aravind Eye Care System, India. PARTICIPANTS Phacoemulsification surgeries performed on 718 120 eyes at 10 centres (five tertiary and five secondary eye centres) from 2012 to 2020 were included. INTERVENTIONS An internal benchmarking of surgery outcome parameters, to assess variations among the hospitals and compare with the best hospital. OUTCOME MEASURES Intraoperative complications, unaided visual acuity (VA) at postoperative follow-up visit and residual postoperative refractive error (within ±0.5D). RESULTS Over the study period the intraoperative complication rate decreased from 1.2% to 0.6%, surgeries with uncorrected VA of 6/12 or better increased from 80.8% to 89.8%, and surgeries with postoperative refractive error within ±0.5D increased from 76.3% to 87.3%. Variability in outcome measures across hospitals declined. Additionally, benchmarking was associated with improvements in facilities, protocols and processes. CONCLUSION Internal benchmarking was found to be an effective QI method that enabled the practice of evidence-based management and allowed for harnessing the available information. Continuous improvement in clinical outcomes requires systematic and regular review of results, identifying gaps between hospitals, comparisons with the best hospital and implementing lessons learnt from peers.
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Affiliation(s)
- Ganesh-Babu Subburaman Balu
- LAICO, Aravind Eye Care System, Madurai, India
- Care and Public Health Research Institute (CAPHRI), Maastricht Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Sachin Gupta
- SC Johnson College of Business, Cornell University, Ithaca, New York, USA
| | | | | | - Helen Mertens
- Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Carroll Webers
- Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Shyam Vasudeva Rao
- Maastricht University Medical Centre+, Maastricht, The Netherlands
- Forus Health, Bengaluru, India
| | - Frits van Merode
- Care and Public Health Research Institute (CAPHRI), Maastricht Medical Centre+, Maastricht University, Maastricht, The Netherlands
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Dyre L, Grierson L, Rasmussen KMB, Ringsted C, Tolsgaard MG. The concept of errors in medical education: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:761-792. [PMID: 35190892 DOI: 10.1007/s10459-022-10091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this scoping review was to explore how errors are conceptualized in medical education contexts by examining different error perspectives and practices. This review used a scoping methodology with a systematic search strategy to identify relevant studies, written in English, and published before January 2021. Four medical education journals (Medical Education, Advances in Health Science Education, Medical Teacher, and Academic Medicine) and four clinical journals (Journal of the American Medical Association, Journal of General Internal Medicine, Annals of Surgery, and British Medical Journal) were purposively selected. Data extraction was charted according to a data collection form. Of 1505 screened studies, 79 studies were included. Three overarching perspectives were identified: 'understanding errors') (n = 31), 'avoiding errors' (n = 25), 'learning from errors' (n = 23). Studies that aimed at'understanding errors' used qualitative methods (19/31, 61.3%) and took place in the clinical setting (19/31, 61.3%), whereas studies that aimed at 'avoiding errors' and 'learning from errors' used quantitative methods ('avoiding errors': 20/25, 80%, and 'learning from errors': 16/23, 69.6%, p = 0.007) and took place in pre-clinical (14/25, 56%) and simulated settings (10/23, 43.5%), respectively (p < 0.001). The three perspectives differed significantly in terms of inclusion of educational theory: 'Understanding errors' studies 16.1% (5/31),'avoiding errors' studies 48% (12/25), and 'learning from errors' studies 73.9% (17/23), p < 0.001. Errors in medical education and clinical practice are defined differently, which makes comparisons difficult. A uniform understanding is not necessarily a goal but improving transparency and clarity of how errors are currently conceptualized may improve our understanding of when, why, and how to use and learn from errors in the future.
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Affiliation(s)
- Liv Dyre
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University, Rigshospitalet, Ryesgade 53B, DK-2100, Copenhagen, Denmark.
| | - Lawrence Grierson
- Department of Family Medicine, Health Sciences Education Program, McMaster University, Toronto, Canada
| | - Kasper Møller Boje Rasmussen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University, Rigshospitalet, Ryesgade 53B, DK-2100, Copenhagen, Denmark
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | | | - Martin G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University, Rigshospitalet, Ryesgade 53B, DK-2100, Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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Mohamadipanah H, Wise B, Witt A, Goll C, Yang S, Perumalla C, Huemer K, Kearse L, Pugh C. Performance assessment using sensor technology. J Surg Oncol 2021; 124:200-215. [PMID: 34245582 DOI: 10.1002/jso.26519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/10/2022]
Abstract
Over the past 30 years, there have been numerous, noteworthy successes in the development, validation, and implementation of clinical skills assessments. Despite this progress, the medical profession has barely scratched the surface towards developing assessments that capture the true complexity of hands-on skills in procedural medicine. This paper highlights the development implementation and new discoveries in performance metrics when using sensor technology to assess cognitive and technical aspects of hands-on skills.
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Affiliation(s)
- Hossein Mohamadipanah
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brett Wise
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Anna Witt
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cassidi Goll
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Su Yang
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Calvin Perumalla
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kayla Huemer
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - LaDonna Kearse
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Carla Pugh
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
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Gabrysz-Forget F, Young M, Zahabi S, Nepomnayshy D, Nguyen LHP. Surgical Errors Happen, but Are Learners Trained to Recover from Them? A Survey of North American Surgical Residents and Fellows. JOURNAL OF SURGICAL EDUCATION 2020; 77:1552-1561. [PMID: 32694084 DOI: 10.1016/j.jsurg.2020.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Surgical training necessitates graded supervision and supported independence in order to reach competence. In developing surgical skills, trainees can, and will, make mistakes. A key skill required for independent practice is the ability to recover from an error or unexpected complication. Error recovery includes recognizing and managing a technical error in order to ensure patient safety and may be underrepresented in current educational approaches. OBJECTIVE The purpose of this study is to explore residents' experiences and perceptions of error recovery training in surgical procedures. METHOD An online survey was sent to surgical program directors in the United States and Canada using the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada distribution lists. Participating programs distributed the survey to their residents and fellows. The survey was composed of Likert-scale items, yes/no questions as well as open-ended questions focused on perceptions, experiences, and factors that influence to error recovery training in the operating room. RESULTS A total of 206 surveys were completed. Overall, 99% (n = 203) agreed or strongly agreed that error recovery is an important competency for future practice. This was reflected in free-text response: "Errors can be minimized but they are inevitable, so certainly believe a surgical curriculum that addresses error recovery is of paramount importance." While 83% (n = 170) feel confident recovering from minor errors, only 34% (n = 68) feel confident that they could recover from major errors that are likely to have serious consequences on patient safety. Overall, residents do not consider that they have adequate training in error recovery, with only 37% (n = 72) felt they were adequately trained to recover from major errors. It was also mentioned "The quality of learning regarding error recovery depends entirely on the attending." CONCLUSIONS Opportunities to learn to recover from technical errors in the operating room are valued by surgical trainees, but they perceive their training to be both inadequate and variable. This contributes to a lack of confidence in error recovery skills throughout their surgical training. There is a need to explore how best to integrate error recovery into more formal surgical curricula in order to better support learners and, ultimately, contribute to increased surgical safety.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Center for Professional Development and Simulation, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Meredith Young
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sarah Zahabi
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Dmitry Nepomnayshy
- Center for Professional Development and Simulation, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts; Department of Surgery, Lahey Health, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Lily H P Nguyen
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada; Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada.
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Menekse Dalveren GG, Cagiltay NE. Distinguishing Intermediate and Novice Surgeons by Eye Movements. Front Psychol 2020; 11:542752. [PMID: 33013592 PMCID: PMC7511664 DOI: 10.3389/fpsyg.2020.542752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023] Open
Abstract
Surgical skill-level assessment is key to collecting the required feedback and adapting the educational programs accordingly. Currently, these assessments for the minimal invasive surgery programs are primarily based on subjective methods, and there is no consensus on skill level classifications. One of the most detailed of these classifications categorize skill levels as beginner, novice, intermediate, sub-expert, and expert. To properly integrate skill assessment into minimal invasive surgical education programs and provide skill-based training alternatives, it is necessary to classify the skill levels in as detailed a way as possible and identify the differences between all skill levels in an objective manner. Yet, despite the existence of very encouraging results in the literature, most of the studies have been conducted to better understand the differences between novice and expert surgical skill levels leaving out the other crucial skill levels between them. Additionally, there are very limited studies by considering the eye-movement behaviors of surgical residents. To this end, the present study attempted to distinguish novice- and intermediate-level surgical residents based on their eye movements. The eye-movement data was recorded from 23 volunteer surgical residents while they were performing four computer-based simulated surgical tasks under different hand conditions. The data was analyzed using logistic regression to estimate the skill levels of both groups. The best results of the estimation revealing a 91.3% recognition rate of predicting novice and intermediate surgical residents on one scenario were selected from four under the dominant hand condition. These results show that the eye-movements can be potentially used to identify surgeons with intermediate and novice skills. However, the results also indicate that the order in which the scenarios are provided, and the design of the scenario, the tasks, and their appropriateness with the skill levels of the participants are all critical factors to be considered in improving the estimation ratio, and hence require thorough assessment for future research.
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Affiliation(s)
- Gonca Gokce Menekse Dalveren
- Department of Computer Science, Norwegian University of Science and Technology, Gjøvik, Norway.,Department of Information Systems Engineering, Atılım University, Ankara, Turkey
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Translating motion tracking data into resident feedback: An opportunity for streamlined video coaching. Am J Surg 2020; 219:552-556. [DOI: 10.1016/j.amjsurg.2020.01.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/30/2019] [Accepted: 01/19/2020] [Indexed: 11/21/2022]
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Mohamadipanah H, Perrone KH, Peterson K, Nathwani J, Huang F, Garren A, Garren M, Witt A, Pugh C. Sensors and Psychomotor Metrics: A Unique Opportunity to Close the Gap on Surgical Processes and Outcomes. ACS Biomater Sci Eng 2020; 6:2630-2640. [DOI: 10.1021/acsbiomaterials.9b01019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hossein Mohamadipanah
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Kenneth H. Perrone
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Katherine Peterson
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53726, United States
| | - Jay Nathwani
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53726, United States
| | - Felix Huang
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, #1022, Chicago, Illinois 60611, United States
| | - Anna Garren
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53726, United States
| | - Margaret Garren
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, Wisconsin 53726, United States
| | - Anna Witt
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, United States
| | - Carla Pugh
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, United States
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Pugh CM, Law KE, Cohen ER, D’Angelo ALD, Greenberg JA, Greenberg CC, Wiegmann DA. Use of error management theory to quantify and characterize residents’ error recovery strategies. Am J Surg 2020; 219:214-220. [DOI: 10.1016/j.amjsurg.2019.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/10/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
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Kim K, Lee I. Medication error encouragement training: A quasi-experimental study. NURSE EDUCATION TODAY 2020; 84:104250. [PMID: 31698293 DOI: 10.1016/j.nedt.2019.104250] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/17/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Medication errors are the most common clinical errors in healthcare practice and can lead to serious consequences. Medication error encouragement training (MEET) brings students face-to-face with potential errors in the medication process, in a safe environment where they are encouraged to understand both the error and the context in which it occurred. OBJECTIVES The study aimed to examine the effects of a MEET intervention on medication safety confidence among nursing undergraduates. DESIGN This was a quasi-experimental study with a nonequivalent control group design. PARTICIPANTS Our sample was recruited from the nursing education department of a university, with 47 participants randomly assigned to the experimental group, and 50 to the control group. METHODS Both groups received theoretical training, followed by applied training. The experimental group received the MEET intervention developed specifically for this study, while the control group received traditional error avoidance training. Participants' medication administration confidence was measured pre- and post-intervention. RESULTS Following training, the experimental group's confidence was significantly higher than that of the control group. With regard to individual medication administration procedures, the experimental groups' medication safety confidence increased significantly after training compared to the control group in patient identification, drug information confirmation, and drug preparation. CONCLUSIONS Introducing MEET into nursing curricula could reduce medication errors and related complications in healthcare institutions. Further studies are needed to investigate the long-term effects of MEET interventions, as well as the generalizability of our findings.
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Affiliation(s)
- Kyoungja Kim
- Department of Nursing, Hannam University, Daejeon, South Korea.
| | - Insook Lee
- Department of Nursing, Hannam University, Daejeon, South Korea
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Screening surgical residents’ laparoscopic skills using virtual reality tasks: Who needs more time in the sim lab? Surgery 2019; 166:218-222. [DOI: 10.1016/j.surg.2019.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/01/2019] [Accepted: 04/13/2019] [Indexed: 11/24/2022]
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Mohamadipanah H, Nathwani J, Peterson K, Forsyth K, Maulson L, DiMarco S, Pugh C. Shortcut assessment: Can residents’ operative performance be determined in the first five minutes of an operative task? Surgery 2018; 163:1207-1212. [DOI: 10.1016/j.surg.2018.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 11/27/2022]
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Enhancing Clinical Performance and Improving Patient Safety Using Digital Health. HEALTH INFORMATICS 2018. [DOI: 10.1007/978-3-319-61446-5_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Law Forsyth K, DiMarco SM, Jenewein CG, Ray RD, D'Angelo ALD, Cohen ER, Wiegmann DA, Pugh CM. Do errors and critical events relate to hernia repair outcomes? Am J Surg 2017; 213:652-655. [DOI: 10.1016/j.amjsurg.2016.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022]
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Law KE, Ray RD, D'Angelo ALD, Cohen ER, DiMarco SM, Linsmeier E, Wiegmann DA, Pugh CM. Exploring Senior Residents' Intraoperative Error Management Strategies: A Potential Measure of Performance Improvement. JOURNAL OF SURGICAL EDUCATION 2016; 73:e64-e70. [PMID: 27372272 DOI: 10.1016/j.jsurg.2016.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/10/2016] [Accepted: 05/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The study aim was to determine whether residents' error management strategies changed across 2 simulated laparoscopic ventral hernia (LVH) repair procedures after receiving feedback on their initial performance. We hypothesize that error detection and recovery strategies would improve during the second procedure without hands-on practice. DESIGN Retrospective review of participant procedural performances of simulated laparoscopic ventral herniorrhaphy. A total of 3 investigators reviewed procedure videos to identify surgical errors. Errors were deconstructed. Error management events were noted, including error identification and recovery. SETTING Residents performed the simulated LVH procedures during a course on advanced laparoscopy. Participants had 30 minutes to complete a LVH procedure. After verbal and simulator feedback, residents returned 24 hours later to perform a different, more difficult simulated LVH repair. PARTICIPANTS Senior (N = 7; postgraduate year 4-5) residents in attendance at the course participated in this study. RESULTS In the first LVH procedure, residents committed 121 errors (M = 17.14, standard deviation = 4.38). Although the number of errors increased to 146 (M = 20.86, standard deviation = 6.15) during the second procedure, residents progressed further in the second procedure. There was no significant difference in the number of errors committed for both procedures, but errors shifted to the late stage of the second procedure. Residents changed the error types that they attempted to recover (χ25=24.96, p<0.001). For the second procedure, recovery attempts increased for action and procedure errors, but decreased for strategy errors. Residents also recovered the most errors in the late stage of the second procedure (p < 0.001). CONCLUSION Residents' error management strategies changed between procedures following verbal feedback on their initial performance and feedback from the simulator. Errors and recovery attempts shifted to later steps during the second procedure. This may reflect residents' error management success in the earlier stages, which allowed further progression in the second simulation. Incorporating error recognition and management opportunities into surgical training could help track residents' learning curve and provide detailed, structured feedback on technical and decision-making skills.
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Affiliation(s)
- Katherine E Law
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rebecca D Ray
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Elaine R Cohen
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shannon M DiMarco
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Elyse Linsmeier
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Douglas A Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carla M Pugh
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
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Law KE, Gwillim EC, Ray RD, D'Angelo ALD, Cohen ER, Fiers RM, Rutherford DN, Pugh CM. Error tolerance: an evaluation of residents' repeated motor coordination errors. Am J Surg 2016; 212:609-614. [PMID: 27586850 DOI: 10.1016/j.amjsurg.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/30/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The study investigates the relationship between motor coordination errors and total errors using a human factors framework. We hypothesize motor coordination errors will correlate with total errors and provide validity evidence for error tolerance as a performance metric. METHODS Residents' laparoscopic skills were evaluated during a simulated laparoscopic ventral hernia repair for motor coordination errors when grasping for intra-abdominal mesh or suture. Tolerance was defined as repeated, failed attempts to correct an error and the time required to recover. RESULTS Residents (N = 20) committed an average of 15.45 (standard deviation [SD] = 4.61) errors and 1.70 (SD = 2.25) motor coordination errors during mesh placement. Total errors correlated with motor coordination errors (r[18] = .572, P = .008). On average, residents required 5.09 recovery attempts for 1 motor coordination error (SD = 3.15). Recovery approaches correlated to total error load (r[13] = .592, P = .02). CONCLUSIONS Residents' motor coordination errors and recovery approaches predict total error load. Error tolerance proved to be a valid assessment metric relating to overall performance.
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Affiliation(s)
- Katherine E Law
- Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin-Madison, 3214 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA
| | - Eran C Gwillim
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Rebecca D Ray
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Anne-Lise D D'Angelo
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Elaine R Cohen
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Rebekah M Fiers
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA
| | - Drew N Rutherford
- Department of Health Professions, University of Wisconsin-La Crosse, 3062 Health Science Center, La Crosse, WI, USA
| | - Carla M Pugh
- Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin-Madison, 3214 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA; Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA.
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Rutherford DN, D'Angelo ALD, Law KE, Pugh CM. Advanced Engineering Technology for Measuring Performance. Surg Clin North Am 2015. [PMID: 26210973 DOI: 10.1016/j.suc.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The demand for competency-based assessments in surgical training is growing. Use of advanced engineering technology for clinical skills assessment allows for objective measures of hands-on performance. Clinical performance can be assessed in several ways via quantification of an assessee's hand movements (motion tracking), direction of visual attention (eye tracking), levels of stress (physiologic marker measurements), and location and pressure of palpation (force measurements). Innovations in video recording technology and qualitative analysis tools allow for a combination of observer- and technology-based assessments. Overall the goal is to create better assessments of surgical performance with robust validity evidence.
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Affiliation(s)
- Drew N Rutherford
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 3236 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Anne-Lise D D'Angelo
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 3236 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Katherine E Law
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3215 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA
| | - Carla M Pugh
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 3236 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3215 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA.
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