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

Carla M. Pugh, Katherine E. Law, Elaine R. Cohen, Anne Lise D. D'Angelo, Jacob A. Greenberg, Caprice C. Greenberg, Douglas A. Wiegmann

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)214-220
Number of pages7
JournalAmerican Journal of Surgery
Issue number2
StatePublished - Feb 2020
Externally publishedYes


  • Error management
  • Human factors
  • Laparoscopic ventral hernia repair
  • Simulation
  • Surgical error
  • Surgical performance

ASJC Scopus subject areas

  • Surgery


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