Original article
General thoracic
Needs Assessment for an Errors-Based Curriculum on Thoracoscopic Lobectomy

Presented at the Poster Session of the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28-Feb 1, 2012.
https://doi.org/10.1016/j.athoracsur.2012.04.023Get rights and content

Background

Research suggests a benefit from a skills curriculum emphasizing error prevention, identification, and management. Our purpose was to identify common errors committed by trainees during simulated thoracoscopic lobectomy for use in developing an error-based curriculum.

Methods

Twenty-one residents (postgraduate years 1 to 8) performed a thoracoscopic left upper lobectomy on a previously validated simulator. Videos of the procedure were reviewed in a blinded fashion using a checklist listing 66 possible cognitive and technical errors.

Results

Of the 21 residents, 15 (71%) self-reported completing the anatomic lobectomy; however, only 7 (33%) had actually divided all of the necessary structures correctly. While dissecting the superior pulmonary vein, 16 residents (76%) made at least one error. The most common (n = 13, 62%) was dissecting individual branches rather than the entire vein. On the bronchus, 14 (67%) made at least one error. Again, the most common (n = 9, 43%) was dissecting branches. During these tasks, cognitive errors were more common than technical errors. While dissecting arterial branches, 18 residents (86%) made at least one error. Technical and cognitive errors occurred with equal frequency during arterial dissection. The most common arterial error was excess tension on the vessel (n = 10, 48%).

Conclusions

Curriculum developers should identify skill-specific technical and judgment errors to verify the scope of errors typically committed. For a thoracoscopic lobectomy curriculum, emphasis should be placed on correct identification of anatomic landmarks during dissection of the vein and airway and on proper tissue handling technique during arterial dissection.

Section snippets

Material and Methods

This study was conducted under a protocol approved by the Institutional Review Board and the Animal Care and Use Committee.

Participant Demographics

The study group comprised 11 residents in the first 3 years of clinical training (junior, PGYs 1 to 3) and 10 senior residents (PGYs 4 to 8). Junior residents had limited thoracoscopic surgical experience. Although many had rotated on a thoracic surgery service, only 3 had seen a thoracoscopic lobectomy in a patient and only 1 had attempted any portion of the operation in a patient. The senior residents had all rotated on a thoracic surgery service at a senior level and had all seen and

Comment

There has been significant interest in cardiothoracic surgery in improving preparation of our trainees for their first practice, especially in the setting of reduced educational contact hours and decreased years of training. Some of this interest has focused on the use of errors in training. Teaching error detection and, ultimately, error recovery through an active learning process has been suggested as a technique to help trainees develop robust mental constructs, allowing them to be more

References (16)

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Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.