Institute of Cognitive Neuroscience, University College London, UK.
Med Teach. 2011;33(1):34-8. doi: 10.3109/0142159X.2011.535047. Epub 2010 Nov 10.
Medical errors are an inevitable outcome of the human cognitive system working within the environment and demands of practicing medicine. Training can play a pivotal role in minimizing error, but the prevailing training is not as effective because it directly focuses on error reduction. Based on an understanding of cognitive architecture and how the brain processes information, a new approach is suggested: focusing training on error recovery. This entails specific training in error detection and error mitigation. Such training will not only enable better responses when errors occur, but it is also a more effective way to achieve error reduction. The suggested design for error recovery training is to begin with detecting errors in others. Starting off with highly visible and even exaggerated errors, and advancing to more challenging detections and finally requiring to detect errors within oneself rather than in others. The error mitigation training starts with providing the learners with the correct remedial actions (after they have detected the error). With training, the learners are required to select the appropriate actions within multiple choice alternatives, and eventually are required to generate the appropriate remedial responses themselves. These can be used for instruction as well as for assessment purposes. Time pressure, distractions, competitions and other elements are included so as to make the training more challenging and interactive.
医疗差错是人类认知系统在医疗实践的环境和要求下工作所不可避免的结果。培训可以在最大程度减少错误方面发挥关键作用,但目前的培训效果并不理想,因为它直接侧重于减少错误。基于对认知架构以及大脑如何处理信息的理解,提出了一种新方法:将培训重点放在错误恢复上。这需要专门进行错误检测和错误缓解的培训。这种培训不仅可以在发生错误时做出更好的反应,而且也是实现错误减少的更有效方法。错误恢复培训的设计建议是从检测他人的错误开始。从高度明显甚至夸张的错误开始,逐步发展到更具挑战性的检测,最后要求在自己而不是他人身上检测错误。错误缓解培训从为学习者提供正确的纠正措施(在他们检测到错误之后)开始。通过培训,学习者需要在多项选择中选择适当的操作,最终需要自己生成适当的纠正响应。这些可以用于教学和评估目的。培训中包括时间压力、干扰、竞争等元素,以增加培训的挑战性和互动性。