Ian Thomas1, Laura Nicol2, Luke Regan1, Jennifer Cleland3, Drieka Maliepaard1, Lindsay Clark1, Kenneth Walker4, John Duncan4. 1. Highland Medical Education Centre, University of Aberdeen, Centre for Health Sciences, Inverness, UK. 2. Surgical Academic Unit, University of Stirling, Inverness campus, Inverness, UK. 3. Division of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK. 4. Department of General Surgery, NHS Highland, Raigmore Hospital, Inverness, UK.
Abstract
BACKGROUND: Distraction and interruption are endemic in the clinical environment and contribute to error. This study assesses whether simulation-based training with targeted feedback can improve undergraduate management of distractions and interruptions to reduce error-making. DESIGN: A prospective non-randomised controlled study. METHODS:28 final year medical students undertook a simulated baseline ward round. 14 students formed an intervention group and received immediate feedback on distractor management and error. 14 students in a control group receivedno feedback. After 4 weeks, students participated in a post-intervention ward round of comparable rigour. Changes in medical error and distractor management between simulations were assessed with Mann-Whitney U tests using SPSS V.21. RESULTS: At baseline, error rates were high. The intervention group committed 72 total baseline errors (mean of 5.1 errors/student; median 5; range 3-7). The control group exhibited a comparable number of errors-with a total of 76 observed (mean of 5.4 errors/student; median 6; range 4-7). Many of these errors were life-threatening. At baseline distractions and interruptions were poorly managed by both groups. All forms of simulation training reduced error-making. In the intervention group the total number of errors post-intervention fell from 72 to 17 (mean 1.2 errors/student; median 1; range 0-3), representing a 76.4% fall (p<0.0001). In the control group the total number of errors also fell-from 76 to 44 (mean of 3.1 errors/student; median 3; range 1-5), representing a 42.1% reduction (p=0.0003). CONCLUSIONS:Medical students are not inherently equipped to manage common ward-based distractions to mitigate error. These skills can be taught-with simulation and feedback conferring the greatest benefit. Curricular integration of simulated ward round experiences is recommended. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
RCT Entities:
BACKGROUND: Distraction and interruption are endemic in the clinical environment and contribute to error. This study assesses whether simulation-based training with targeted feedback can improve undergraduate management of distractions and interruptions to reduce error-making. DESIGN: A prospective non-randomised controlled study. METHODS: 28 final year medical students undertook a simulated baseline ward round. 14 students formed an intervention group and received immediate feedback on distractor management and error. 14 students in a control group received no feedback. After 4 weeks, students participated in a post-intervention ward round of comparable rigour. Changes in medical error and distractor management between simulations were assessed with Mann-Whitney U tests using SPSS V.21. RESULTS: At baseline, error rates were high. The intervention group committed 72 total baseline errors (mean of 5.1 errors/student; median 5; range 3-7). The control group exhibited a comparable number of errors-with a total of 76 observed (mean of 5.4 errors/student; median 6; range 4-7). Many of these errors were life-threatening. At baseline distractions and interruptions were poorly managed by both groups. All forms of simulation training reduced error-making. In the intervention group the total number of errors post-intervention fell from 72 to 17 (mean 1.2 errors/student; median 1; range 0-3), representing a 76.4% fall (p<0.0001). In the control group the total number of errors also fell-from 76 to 44 (mean of 3.1 errors/student; median 3; range 1-5), representing a 42.1% reduction (p=0.0003). CONCLUSIONS: Medical students are not inherently equipped to manage common ward-based distractions to mitigate error. These skills can be taught-with simulation and feedback conferring the greatest benefit. Curricular integration of simulated ward round experiences is recommended. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
Human factors; Medical education; Medical error, measurement/epidemiology; Patient safety; Simulation
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