Iatrogenic Critical Care Procedure Complication Boot Camp: A Simulation‐based Pilot Study

Abstract

Background: Traditional medical education strategies teach learners how to correctly perform procedures while neglecting to provide formal training on iatrogenic error management. Error management training (EMT) requires active exploration as well as explicit encouragement for learners to make and learn from errors during training. Simulation provides an excellent methodology to execute a curriculum on iatrogenic procedural complication management.We hypothesize that a standardized simulation-based EMT curriculum will improve learner's confidence, cognitive knowledge, and performance in iatrogenic injury management.Methods: This was a pilot, prospective, observational study performed in a simulation center using a curriculum developed to educate resident physicians on iatrogenic procedural complication management. Pre-and post-intervention assessments included confidence surveys, cognitive questionnaires, and critical action checklists for six simulated procedure complications. Assessment data were analyzed using medians, interquartile ranges, and the paired change scores were tested for median equality to zero via Wilcoxon signed rank tests with p<0.05 considered statistically significant.Results: Eighteen residents participated in the study curriculum. The median confidence increased significantly by a summed score of 12.5 (8.75 -17.25) (p<0.001). Similarly, the median knowledge significantly increased by 6 points (3 -8) from the pre-to post- Accepted ArticleThis article is protected by copyright. All rights reserved.intervention assessment (p<0.001). For each of the simulation cases, the number of critical actions performed increased significantly (p<0.001 to p=0.002). Conclusion:We demonstrated significant improvement in the confidence, clinical knowledge, and performance of critical actions after the completion of this curriculum. This pilot study provides evidence that a structured EMT curriculum is an effective method to teach management of iatrogenic injuries.

Models of teaching medical errors

“…Encouragement, the ability to make errors without the risk of harming patients, the repetition of the scenarios followed by debriefing, and the provision of direct supervision with hands-on bedside training were the novel characteristics of this model. 26 …”

Error recovery training literature review: Implications for emergency field medicine

“…Some programs present models of human error and provide statistics or case studies illustrating the significance of errors (King, Holder, & Ahmed, 2013;Knecht et al, 2016). Those programs focused on error management training (in contrast to error avoidance training) set the tone of training by instructing learners that training is a safe place to make errors and learn from them (Dyre et al, 2017;Patel, Kannampallil, & Shortliffe, 2015;Riefkohl-Ortiz et al, 2019;Vaughan et al, 2012). Many include an overview of how the simulation session will work and what is expected of the learner (Franklin et al, 2021;King et al, 2013;Sternbach et al, 2017).…”

“…Software developers, for example, may try a number of different strategies for solving the same problem and will be able to see which ones work and which do not, based on the behavior of the resulting software (Carroll, 2014). Some training programs incorporate challenging, errorinducing scenarios as a means to provide practice at recognizing errors and recovering from them (Abrahamson, Canzian, & Brunet, 2006;Riefkohl-Ortiz et al, 2019;Wucherer, Stefan, Weidert, Fallavollita, & Navab, 2014). Some advocate for separating error identification from error recovery, at least at the beginning of training (Dror, 2011).…”

“…This may take the form of an instructor-led discussion with an individual learner (Gardner & Rich, 2014;Knecht et al, 2016). In other contexts, reflection occurs in a group discussion facilitated by an instructor, in which team members are encouraged to reflect on and obtain insights based on their own and others' performance (Puślecki et al, 2018;Riefkohl-Ortiz et al, 2019;Vaughan et al, 2012). Still others use peer-led discussion to facilitate reflection and insights (Ziv et al, 2005).…”

“…Error recovery training has been created and studied in healthcare, but generally with a focus on hospital settings (Dror, 2011;Dyre, Tabor, Ringsted, & Tolsgaard, 2017;Franklin et al, 2021;Gardner & Rich, 2014;Law et al, 2016;Riefkohl-Ortiz et al, 2019;Sternbach, Wang, El Khoury, Teitelbaum, & Meyerson, 2017;Vaughan, Bate, & Round, 2012;Wilkinson, Cauble, & Patel, 2011;Ziv, Ben-David, & Ziv, 2005). Some focus primarily on error recognition; others focus on error mitigation; and still others integrate both error identification and mitigation into training.…”