Association for surgical education
A role for error training in surgical technical skill instruction and evaluation

Presented at Surgical Education Week, Nashville, Tennessee, March 27–31, 2001
https://doi.org/10.1016/S0002-9610(02)00798-5Get rights and content

Abstract

Background: During the evaluation of many instances of the same basic surgical skill, we observed that there were several errors that occurred frequently. Two studies were undertaken to examine the use of these errors for improving the instruction and evaluation of the skill.

Material and methods: For both studies, two types of rater training videotapes were developed. One involved the use of examples of common errors (error) and the other demonstrated the skill being performed correctly (correct). A testing videotape was created consisting of 24 performances of the skill that ranged in quality of the performance. The first study was designed to assess the impact of error instruction on skill acquisition. In this study, a group of 30 senior medical students were randomly assigned to one of four different training groups: none, error only, correct only, and error+correct. Subjects were videotaped performing the skill before and after the training and three experts evaluated these performances independently using a 7-point rating scale. The second study was designed to assess the impact of error training on skill evaluation and was done using both novice and expert raters. The same group of 30 senior medical students used in the first study was used as novice raters. Following training in one of the four training groups, each subject rated the 24 performances on the testing videotape and interrater reliability was assessed for each group. Surgical faculty served as expert raters in this study and were randomly assigned to receive either error training or no training. Each subject viewed the testing videotape, rating the performances and giving “feedback” commentary. Interrater reliability was calculated for the two groups and the precision of the feedback was assessed.

Results: Significant improvement in posttest performance scores was seen only in the “error+correct” training group. Interrater reliability was somewhat lower for the “correct only” and “error only” training groups in both the student and faculty studies. Faculty raters receiving error training had a higher proportion of specific comments than the group that received no training although this difference was not statistically significant.

Conclusions: Instruction about common errors, when combined with instruction about the correct performance enhanced the acquisition of this surgical skill. This suggests a role for the use of errors in surgical technical skill instruction. Our study provides no support for a role for error training in improving skill evaluation.

Section snippets

Methods

Approval was obtained from the IRB at the Medical College of Georgia. Initially, a task analysis was done by evaluating the videotapes of subjects performing the skill of tying a two-handed square knot. These were performances that had taken place in the context of other studies that were designed to evaluate the effect of various forms of instruction on skill performance [11], [12], [13]. From these videotaped performances, two different training videotapes were created. The “error training”

Task analysis

A total of 306 instances of an error were observed in 260 performances. In 70 of the performances no major error was identified and in 84 of the performances multiple errors were identified. Eleven error types were identified with four of the errors accounting for 75% of the total. These four most frequent errors included the following (with frequency listed in parentheses); too much motion in right hand (38%), failure to maintain consistent tension throughout the formation of the knot (17%),

Comments

We were interested in examining the effect of error training on subject performance of the task. The concept that individuals use errors in the acquisition of motor skills appears well established although the theories of how this occurs are not [15]. There are examples, in the surgical literature where the description of errors is used for the instruction of surgical technique [16], [17]. These are usually descriptions of errors that occur at the level of operative procedure and can involve

References (24)

  • J DesCoteaux et al.

    Learning surgical technical skills

    Can J Surg

    (1995)
  • H Faulkner et al.

    Validation of an objective structured assessment of technical skill for surgical residents

    Acad Med

    (1996)
  • Cited by (57)

    • Learning to plan self-controlled physical education: Good vs. problematic teaching examples

      2018, Teaching and Teacher Education
      Citation Excerpt :

      Looking at professional skills in less-structured domains, fire-fighters who used case studies containing management errors and their severe consequences during their training performed better than fire-fighters using only case studies that included best practice (Joung et al., 2006). In the field of medical surgery, reflecting on both unsatisfactory and satisfactory surgical procedures improved medical students' performance more than reflecting on correct or incorrect surgical procedures only (Rogers, Regehr, & MacDonald, 2002). The learner's prior knowledge is a factor that may affect learning from examples: Learners with high prior knowledge sometimes benefited more from reflecting on incorrect examples, whereas students with less prior knowledge benefited more from reflecting on correct examples (Heemsoth & Heinze, 2014; Groβe & Renkl, 2007).

    • Training and Assessment in Pediatric Endoscopy

      2016, Gastrointestinal Endoscopy Clinics of North America
    • Embracing Errors in Simulation-Based Training: The Effect of Error Training on Retention and Transfer of Central Venous Catheter Skills

      2015, Journal of Surgical Education
      Citation Excerpt :

      Frequently, faculty spend so much time teaching residents the correct way to perform a procedure that they neglect to explicitly discuss how to recognize and manage errors.2 Increasingly, however, educators are concluding that errors play a valuable role in medical training.1,3-6 When trainees are explicitly encouraged to make, discuss, and reflect on errors during the initial acquisition of skills, it is believed that they would have a deeper understanding of the procedure, subsequently affecting retention and transfer of skills.4

    • Needs assessment for an errors-based curriculum on thoracoscopic lobectomy

      2012, Annals of Thoracic Surgery
      Citation Excerpt :

      The ability to detect surgical errors has also been shown to correlate with surgical skill [11]. Curricula that include the correct version of a procedure and examples of possible errors have been shown to improve the quality of task performance [12–14]. Simulation curricula have the unique ability to provide controlled variation in the situations presented to enhance learning in contrast to the traditional learning method of exposure in the operating room, which is limited to the random variability of patients and situations encountered.

    View all citing articles on Scopus

    Funded by a Grant from the Association for Surgical Education Foundation.

    View full text