@article{aa122e6434ce4aeca53ba7ad05638100,
title = "Use of error management theory to quantify and characterize residents{\textquoteright} error recovery strategies",
abstract = "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{\textquoteright} 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.",
keywords = "Error management, Human factors, Laparoscopic ventral hernia repair, Simulation, Surgical error, Surgical performance",
author = "Pugh, {Carla M.} and Law, {Katherine E.} and Cohen, {Elaine R.} and D'Angelo, {Anne Lise D.} and Greenberg, {Jacob A.} and Greenberg, {Caprice C.} and Wiegmann, {Douglas A.}",
note = "Funding Information: Carla Pugh, Anne-Lise D{\textquoteright}Angelo, Rebecca Ray, Jacob Greenberg, Caprice Greenberg, Douglas Wiegmann, Katherine Law and Elaine Cohen have no conflicts of interest or financial ties to disclose. Funding for this study was provided through the US Army Medical Research Acquisition Activity grant entitled “Psycho-Motor and Error Enabled Simulations: Modeling Vulnerable Skills in the Pre-Mastery Phase” W81XWH-13-1-008 and the National Institutes of Health grant # 1F32EB017084-01 entitled “Automated Performance Assessment System: A New Era in Surgical Skills Assessment”. The funding source had no involvement in study design; collection, analysis, and interpretation of data; in writing of the report; and in the decision to submit the article for publication. Funding Information: Funding for this study was provided through the US Army Medical Research Acquisition Activity grant entitled ?Psycho-Motor and Error Enabled Simulations: Modeling Vulnerable Skills in the Pre-Mastery Phase? W81XWH-13-1-008 and the National Institutes of Health grant #1F32EB017084-01 entitled ?Automated Performance Assessment System: A New Era in Surgical Skills Assessment?. The funding source had no involvement in study design; collection, analysis, and interpretation of data; in writing of the report; and in the decision to submit the article for publication. Funding for this study came from the US Army Medical Research Acquisition Activity grant entitled ?Psycho-Motor and Error Enabled Simulations: Modeling Vulnerable Skills in the Pre-Mastery Phase? W81XWH-13-1-008 awarded to Carla M. Pugh and the National Institutes of Health grant #1F32EB017084-01 entitled ?Automated Performance Assessment System: A New Era in Surgical Skills Assessment? awarded to Anne-Lise D. D'Angelo. Exempt status was granted by the University of Wisconsin Health Sciences Institutional Review Board. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",
year = "2020",
month = feb,
doi = "10.1016/j.amjsurg.2019.11.013",
language = "English (US)",
volume = "219",
pages = "214--220",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "2",
}