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Related Experiment Video

Updated: Mar 14, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Relationship Between Technical Errors and Decision-Making Skills in the Junior Resident.

Jay N Nathwani1, Rebekah M Fiers1, Rebecca D Ray1

  • 1Division of General Surgery, University of Wisconsin, Madison, Wisconsin.

Journal of Surgical Education
|September 28, 2016
PubMed
Summary

Surgical residents made more technical errors than expected during subclavian central venous catheter (CVC) insertion. Improved decision-making skills correlated with fewer technical errors, highlighting the need for integrated training in technique and error management.

Keywords:
Medical KnowledgePractice-Based Learning and ImprovementSystems-Based Practiceperformance assessmentsimulationsurgical education

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Area of Science:

  • Medical Education
  • Surgical Simulation
  • Patient Safety

Background:

  • Central venous catheter (CVC) placement is a common but complex procedure.
  • Technical errors and suboptimal decision-making can lead to complications during CVC insertion.
  • Assessing resident proficiency in both technical skills and clinical judgment is crucial for improving patient outcomes.

Purpose of the Study:

  • To coevaluate technical errors and decision-making capabilities of residents during subclavian central venous catheter (CVC) placement.
  • To investigate the correlation between scenario-based decision-making skills and technical proficiency in CVC insertion.
  • To identify common difficulties and solutions residents anticipate during line placement.

Main Methods:

  • Residents (N=46) performed subclavian CVC insertion on a simulator.
  • Following the simulation, participants analyzed a patient photograph to anticipate difficulties and propose solutions for CVC placement.
  • Technical errors were analyzed, and correlations between errors and decision-making skills were assessed.

Main Results:

  • Residents committed an average of 1.9 errors, significantly exceeding the expected maximum of 1 error per person.
  • The most frequent error was performing procedure steps in the incorrect order (28.5%).
  • A negative correlation was observed between the number of technical errors and the ability to identify difficulties and generate solutions (r = -0.429, p = 0.021).

Conclusions:

  • Nearly half of the residents made multiple errors during subclavian CVC placement.
  • The correlation between technical errors and decision-making skills underscores the necessity of training residents in both procedural technique and error management strategies.
  • Enhancing resident training in CVC insertion should encompass both technical proficiency and cognitive skills for error mitigation.