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’ 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 language | English (US) |
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Pages (from-to) | 214-220 |
Number of pages | 7 |
Journal | American Journal of Surgery |
Volume | 219 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2020 |
Externally published | Yes |
Keywords
- Error management
- Human factors
- Laparoscopic ventral hernia repair
- Simulation
- Surgical error
- Surgical performance
ASJC Scopus subject areas
- Surgery