Evaluation of an error-reduction training program for surgical residents

To reduce errors in surgery using a resident training program based on a taxonomy that highlights three kinds of errors: judgment, inattention to detail, and problem understanding.

The training program module at the University of South Florida incorporated a three-item situational judgment test, video training (which included a lecture and behavior modeling), and role-plays (in which residents participated and received feedback from faculty). Two kinds of outcome data were collected from 33 residents during 2006-2007: (1) behaviors during the training and (2) on-the-job surgical complication records 12 months before and 6 months after training. For the data collected during training, participants were assigned to a condition (19 video condition, 13 control condition); for the data collected on the job, an interrupted time series design was used.

Data from 32 residents were analyzed (one resident's data were excluded). One of the situational judgment items improved significantly over time (d = 0.45); the other two did not (d = 0.36, 0.25). Surgical complications and errors decreased over the course of the study (the correlation between complications and time in months was r = -0.47, for errors and time, r = -0.55). Effects of video behavior modeling on specific errors measured during role-plays were not significant (effect sizes for binary outcomes were phi = -0.05 and phi = 0.01, and for continuous outcomes, d ranged from -0.02 to 0.34).

The training seemed to reduce errors in surgery, but the training had little effect on the specific kinds of errors targeted during training.