Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Department of Medicine, Montreal, Quebec, Canada.
Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University, London Health Sciences Centre, London, Ontario, Canada.
J Surg Educ. 2021 Nov-Dec;78(6):2020-2029. doi: 10.1016/j.jsurg.2021.03.015. Epub 2021 Apr 19.
The burden of surgical error is high - errors threaten patient safety, lead to increased economic costs to society, and contribute to physician and resident burnout. To date, the majority of work has focused on strategies for reducing the incidence of surgical error, however, total error eradication remains unrealistic. Errors are, to some extent, unavoidable. Adequate preparation for practice should include optimal ways to manage and recover from errors; yet, these skills are rarely taught or assessed.
This study aims to explore residents' perceptions and experiences of surgical error recovery. More specifically, we documented participant definitions of error recovery, and explored factors that were perceived to influence error recovery experiences and training in the operating room.
Guided by a qualitative descriptive approach, we conducted semi-structured interviews with residents and fellows in surgical specialties in Canada and the United States. Purposive and snowball sampling were used to recruit residents and fellows in postgraduate year 1 to 5. Interviews were transcribed, analyzed and inductively coded.
A total of 15 residents and fellows participated. When exploring the importance of error recovery for the trainees, competency and safety emerged as main themes, with error recovery being considered an indicator of overall surgical competency. Data concerning factors perceived to influence error recovery training were grouped under 4 major themes: (1) supervision (supervisor-related factors such as attending behaviors and reactions to errors), (2) self (factors such as self-assessed competency), (3) surgical context (factors related to the specific surgery or patient), and (4) situation safeness. Situational safeness was identified as a transversal theme describing factors to be considered when balancing between patient safety and the learning benefits of error recovery training.
Error recovery was considered to be an important skill for safe surgical practice and was considered an important educational target for learners during surgical training. Trainees' opportunities to learn to recover from technical errors in the OR are perceived to be influenced by several factors, leading to variable experiences and inconsistent opportunities to practice error recovery skills. Focusing on factors related to "supervision," "self," "surgery," and "situational safeness" may be an initial framework on which to build initial educational interventions to support the development of error recovery skills to better support safe surgical practice.
手术失误的负担很高——失误威胁患者安全，导致社会经济成本增加，并导致医生和住院医师倦怠。迄今为止，大多数工作都集中在减少手术失误发生率的策略上，但完全消除失误仍然不切实际。在某种程度上，失误是不可避免的。充分准备实践应包括从失误中管理和恢复的最佳方法；然而，这些技能很少被教授或评估。
本研究旨在探讨住院医师对手术失误恢复的看法和经验。更具体地说，我们记录了参与者对失误恢复的定义，并探讨了影响失误恢复体验和手术室培训的因素。
本研究采用定性描述方法，对加拿大和美国外科专业的住院医师和研究员进行了半结构式访谈。采用目的抽样和滚雪球抽样招募住院医师和研究员，从第 1 年到第 5 年。访谈记录、分析和归纳编码。
共有 15 名住院医师和研究员参与了研究。当探讨失误恢复对受训者的重要性时，能力和安全是主要主题，失误恢复被认为是整体手术能力的指标。数据涉及被认为影响失误恢复培训的因素，被归类为 4 个主要主题：（1）监督（与主管相关的因素，如主管的行为和对失误的反应）；（2）自我（如自我评估能力等因素）；（3）手术环境（与特定手术或患者相关的因素）；（4）情况安全性。情况安全性被确定为一个跨主题，描述了在平衡患者安全和从失误恢复培训中获得学习收益之间的因素。
失误恢复被认为是安全手术实践的重要技能，并且被认为是住院医师外科培训中的重要教育目标。学习者在手术室中从技术失误中恢复的学习机会被认为受到多种因素的影响，导致体验不同，实践失误恢复技能的机会不一致。关注与“监督”、“自我”、“手术”和“情况安全性”相关的因素可能是构建初始教育干预措施的初始框架，以支持发展失误恢复技能，从而更好地支持安全手术实践。
