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High-fidelity simulation effectively replicated hierarchy-related medication errors in training. However, teams struggled to identify and correct errors, indicating potential deficits in communication self-assessment.

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Area of Science:

  • Medical Education
  • Patient Safety
  • Healthcare Simulation

Background:

  • Hierarchy and authority gradients in clinical settings can cause patient harm.
  • High-fidelity simulation offers a reproducible method to address hierarchy issues.
  • Ensuring participant psychological safety is crucial for effective simulation.

Purpose of the Study:

  • To discuss the implementation and outcomes of hierarchy-related medication error simulations.
  • To evaluate the effectiveness of simulation in addressing authority gradients.
  • To assess participant psychological safety during simulation exercises.

Main Methods:

  • Developed scripts and flowcharts to replicate a specific hierarchy-related medication error.
  • Incorporated faculty misdirection to trigger the error during simulation.
  • Ensured psychological safety through structured briefing and debriefing.
  • Assessed team performance using the Team Performance During Simulated Crises Instrument.
  • Utilized gap analysis for team self-insight and video review for content analysis.

Main Results:

  • Eighty percent of simulation sessions (4 out of 5) failed to resolve the simulated hierarchy-related error.
  • Unsuccessful sessions showed trends toward lower communication scores and poor team self-assessment of communication skills.
  • Learners reported a positive experience with the simulation case.

Conclusions:

  • Simulation is a valuable tool for replicating hierarchy errors in an educational context.
  • Positive learner feedback suggests psychological safety was maintained during the simulations.
  • Teams failing to resolve errors may exhibit impaired self-assessment of communication abilities.