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Formalizing the Hidden Curriculum of Performance Enhancing Errors
Fiona M Kerray1, Steven J Yule2, Andrew L Tambyraja1
1Department of Clinical Surgery, The University of Edinburgh, Edinburgh, Scotland; Edinburgh Vascular Service, Royal Infirmary of Edinburgh, Edinburgh, Scotland.
Journal of Surgical Education
|March 2, 2023
Summary
Surgeons need structured ways to discuss errors. Integrating error management theory and human factors science into surgical training can improve performance and reduce the stigma of mistakes.
Area of Science:
- Medical Education
- Human Factors Science
- Surgical Performance
Background:
- Error is an inevitable aspect of surgery, yet remains difficult to discuss due to its link with patient outcomes.
- Current surgical training lacks standardized methods for recognizing and reflecting on critical errors (sentinel events).
- The prevailing educational approach focuses on error avoidance rather than constructive error management.
Purpose of the Study:
- To highlight the need for a standardized tool to guide a safe and constructive response to surgical errors.
- To advocate for the integration of error management theory (EMT) into surgical training.
- To propose the development of a national human factors science/ergonomics (HFE) curriculum within the EMT framework.
Main Methods:
- Reviewing the current educational paradigm in surgical training regarding error.
- Examining the evidence base for incorporating error management theory (EMT) into surgical education.
- Exploring the role of human factors science/ergonomics (HFE) in surgical performance and error reflection.
Main Results:
- Error management theory (EMT) has shown potential to improve long-term skill acquisition and training outcomes.
- Human factors science/ergonomics (HFE) offers a framework for understanding the interplay between psychology, engineering, and performance in surgery.
- A common language through HFE and EMT can facilitate objective performance reflections and reduce the stigma of fallibility.
Conclusions:
- A structured approach to error, incorporating EMT and HFE, is necessary for surgical training.
- Developing a national HFE curriculum within an EMT context can enhance surgical performance and address the stigma of errors.
- Harnessing the performance-enhancing aspects of errors, similar to successes, is crucial for surgical development.
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