Law Katherine E, Ray Rebecca D, D'Angelo Anne-Lise D, Cohen Elaine R, DiMarco Shannon M, Linsmeier Elyse, Wiegmann Douglas A, Pugh Carla M
Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
J Surg Educ. 2016 Nov-Dec;73(6):e64-e70. doi: 10.1016/j.jsurg.2016.05.016. Epub 2016 Jun 29.
The study aim was to determine whether residents' error management strategies changed across 2 simulated laparoscopic ventral hernia (LVH) repair procedures after receiving feedback on their initial performance. We hypothesize that error detection and recovery strategies would improve during the second procedure without hands-on practice.
Retrospective review of participant procedural performances of simulated laparoscopic ventral herniorrhaphy. A total of 3 investigators reviewed procedure videos to identify surgical errors. Errors were deconstructed. Error management events were noted, including error identification and recovery.
Residents performed the simulated LVH procedures during a course on advanced laparoscopy. Participants had 30 minutes to complete a LVH procedure. After verbal and simulator feedback, residents returned 24 hours later to perform a different, more difficult simulated LVH repair.
Senior (N = 7; postgraduate year 4-5) residents in attendance at the course participated in this study.
In the first LVH procedure, residents committed 121 errors (M = 17.14, standard deviation = 4.38). Although the number of errors increased to 146 (M = 20.86, standard deviation = 6.15) during the second procedure, residents progressed further in the second procedure. There was no significant difference in the number of errors committed for both procedures, but errors shifted to the late stage of the second procedure. Residents changed the error types that they attempted to recover (χ=24.96, p<0.001). For the second procedure, recovery attempts increased for action and procedure errors, but decreased for strategy errors. Residents also recovered the most errors in the late stage of the second procedure (p < 0.001).
Residents' error management strategies changed between procedures following verbal feedback on their initial performance and feedback from the simulator. Errors and recovery attempts shifted to later steps during the second procedure. This may reflect residents' error management success in the earlier stages, which allowed further progression in the second simulation. Incorporating error recognition and management opportunities into surgical training could help track residents' learning curve and provide detailed, structured feedback on technical and decision-making skills.
本研究旨在确定住院医师在收到关于其首次操作的反馈后，其错误管理策略在2次模拟腹腔镜腹疝（LVH）修复手术过程中是否发生变化。我们假设在没有实际操作练习的情况下，第二次手术期间错误检测和恢复策略会有所改善。
对模拟腹腔镜腹疝修补术参与者的手术操作表现进行回顾性研究。共有3名研究人员查看手术视频以识别手术错误。对错误进行解构。记录错误管理事件，包括错误识别和恢复。
住院医师在高级腹腔镜课程中进行模拟LVH手术。参与者有30分钟时间完成一次LVH手术。在收到口头和模拟器反馈后，住院医师24小时后返回进行另一次更困难的模拟LVH修复手术。
参加该课程的高年级（N = 7；研究生4 - 5年级）住院医师参与了本研究。
在第一次LVH手术中，住院医师出现了121个错误（均值 = 17.14，标准差 = 4.38）。虽然在第二次手术期间错误数量增加到146个（均值 = 20.86，标准差 = 6.15），但住院医师在第二次手术中有更大进展。两次手术中出现的错误数量没有显著差异，但错误转移到了第二次手术的后期。住院医师改变了他们试图恢复的错误类型（χ = 24.96，p < 0.001）。对于第二次手术，针对操作和程序错误的恢复尝试增加，但针对策略错误的恢复尝试减少。住院医师在第二次手术后期也恢复了最多的错误（p < 0.001）。
住院医师的错误管理策略在收到关于其首次操作的口头反馈和模拟器反馈后的两次手术之间发生了变化。错误和恢复尝试在第二次手术期间转移到了后期步骤。这可能反映了住院医师在早期阶段的错误管理成功，从而使得在第二次模拟中能够进一步推进。将错误识别和管理机会纳入外科培训可以帮助跟踪住院医师学习曲线，并提供关于技术和决策技能的详细、结构化反馈。
