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Driven to distraction: a prospective controlled study of a simulated ward round experience to improve patient safety teaching for medical students
  1. Ian Thomas1,
  2. Laura Nicol2,
  3. Luke Regan1,
  4. Jennifer Cleland3,
  5. Drieka Maliepaard1,
  6. Lindsay Clark1,
  7. Kenneth Walker4,
  8. John Duncan4
  1. 1Highland Medical Education Centre, University of Aberdeen, Centre for Health Sciences, Inverness, UK
  2. 2Surgical Academic Unit, University of Stirling, Inverness campus, Inverness, UK
  3. 3Division of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
  4. 4Department of General Surgery, NHS Highland, Raigmore Hospital, Inverness, UK
  1. Correspondence to Ian Thomas, Highland Medical Education Centre, University of Aberdeen, Centre for Health Sciences, Old Perth Road, Inverness IV2 3UJ, UK; ianthomas1{at}nhs.net

Abstract

Background Distraction and interruption are endemic in the clinical environment and contribute to error. This study assesses whether simulation-based training with targeted feedback can improve undergraduate management of distractions and interruptions to reduce error-making.

Design A prospective non-randomised controlled study.

Methods 28 final year medical students undertook a simulated baseline ward round. 14 students formed an intervention group and received immediate feedback on distractor management and error. 14 students in a control group received no feedback. After 4 weeks, students participated in a post-intervention ward round of comparable rigour. Changes in medical error and distractor management between simulations were assessed with Mann-Whitney U tests using SPSS V.21.

Results At baseline, error rates were high. The intervention group committed 72 total baseline errors (mean of 5.1 errors/student; median 5; range 3–7). The control group exhibited a comparable number of errors—with a total of 76 observed (mean of 5.4 errors/student; median 6; range 4–7). Many of these errors were life-threatening. At baseline distractions and interruptions were poorly managed by both groups. All forms of simulation training reduced error-making. In the intervention group the total number of errors post-intervention fell from 72 to 17 (mean 1.2 errors/student; median 1; range 0–3), representing a 76.4% fall (p<0.0001). In the control group the total number of errors also fell—from 76 to 44 (mean of 3.1 errors/student; median 3; range 1–5), representing a 42.1% reduction (p=0.0003).

Conclusions Medical students are not inherently equipped to manage common ward-based distractions to mitigate error. These skills can be taught—with simulation and feedback conferring the greatest benefit. Curricular integration of simulated ward round experiences is recommended.

  • Human factors
  • Medical education
  • Patient safety
  • Simulation
  • Medical error, measurement/epidemiology

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