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Use of error management theory to quantify and characterize residents' error recovery strategies.

Publication ,  Journal Article
Pugh, CM; Law, KE; Cohen, ER; D'Angelo, A-LD; Greenberg, JA; Greenberg, CC; Wiegmann, DA
Published in: Am J Surg
February 2020

BACKGROUND: Traditional checklist metrics for surgical performance can miss key intraoperative decisions that impact procedural outcomes. Error-based assessments may help identify important metrics for evaluating operative performance and resident readiness for independent practice. METHODS: This study utilized human factors error analysis and error management theory to investigate a previously collected video database of resident performance during a simulated laparoscopic ventral hernia (LVH) repair on a table-top simulator using standard laparoscopic tools and mesh. Errors were deconstructed and coded using a structured observation tool and video analysis software. Error detection events and error recovery events were categorized for each operative step of the ventral hernia repair. RESULTS: Residents made a total of 314 errors (M = 15.7, SD = 4.96). There were more technical errors (63%) than cognitive errors (37%) and more commission errors (69%) than omission errors (30%). Almost half (47%) of all errors went completely undetected by the residents for the entire LVH repair. Of the errors that residents attempted to recover (n = 136), 86.0% were successfully recovered. Technical errors were four times more likely to be successfully recovered than cognitive errors (p = .020). CONCLUSIONS: Our results revealed specific details regarding residents' error management strategies and provides validity evidence for the use of human factors error frameworks in surgical performance assessments. Practice in simulation-based learning environments may improve resident decision-making and error management opportunities by providing a structured experience where errors are explicitly characterized and used for training and feedback. Error management training may play a major role in equipping residents and junior faculty with the skills required for independent, high-quality operative performance.

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Published In

Am J Surg

DOI

EISSN

1879-1883

Publication Date

February 2020

Volume

219

Issue

2

Start / End Page

214 / 220

Location

United States

Related Subject Headings

  • Video Recording
  • United States
  • Surgery
  • Simulation Training
  • Risk Assessment
  • Retrospective Studies
  • Medical Errors
  • Male
  • Laparoscopy
  • Internship and Residency
 

Citation

APA
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ICMJE
MLA
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Pugh, C. M., Law, K. E., Cohen, E. R., D’Angelo, A.-L., Greenberg, J. A., Greenberg, C. C., & Wiegmann, D. A. (2020). Use of error management theory to quantify and characterize residents' error recovery strategies. Am J Surg, 219(2), 214–220. https://doi.org/10.1016/j.amjsurg.2019.11.013
Pugh, Carla M., Katherine E. Law, Elaine R. Cohen, Anne-Lise D. D’Angelo, Jacob A. Greenberg, Caprice C. Greenberg, and Douglas A. Wiegmann. “Use of error management theory to quantify and characterize residents' error recovery strategies.Am J Surg 219, no. 2 (February 2020): 214–20. https://doi.org/10.1016/j.amjsurg.2019.11.013.
Pugh CM, Law KE, Cohen ER, D’Angelo A-LD, Greenberg JA, Greenberg CC, et al. Use of error management theory to quantify and characterize residents' error recovery strategies. Am J Surg. 2020 Feb;219(2):214–20.
Pugh, Carla M., et al. “Use of error management theory to quantify and characterize residents' error recovery strategies.Am J Surg, vol. 219, no. 2, Feb. 2020, pp. 214–20. Pubmed, doi:10.1016/j.amjsurg.2019.11.013.
Pugh CM, Law KE, Cohen ER, D’Angelo A-LD, Greenberg JA, Greenberg CC, Wiegmann DA. Use of error management theory to quantify and characterize residents' error recovery strategies. Am J Surg. 2020 Feb;219(2):214–220.
Journal cover image

Published In

Am J Surg

DOI

EISSN

1879-1883

Publication Date

February 2020

Volume

219

Issue

2

Start / End Page

214 / 220

Location

United States

Related Subject Headings

  • Video Recording
  • United States
  • Surgery
  • Simulation Training
  • Risk Assessment
  • Retrospective Studies
  • Medical Errors
  • Male
  • Laparoscopy
  • Internship and Residency