title: Exploring error in team-based acute care scenarios:  an observational study from the United kingdom.
abstract: OBJECTIVE
  To investigate the errors made by junior doctors (first year after primary medical qualification) in simulated acute care settings, using (and, for some purposes, amplifying) a previously published generic error-modeling system (GEMS). Possible error types were skill-based slips and lapses, rule-based mistakes, knowledge-based mistakes, and violations.
  
  
  METHODS
  In August 2010, 38 junior doctors participated in high-fidelity simulated acute care scenarios in NHS Lothian, Scotland. Each video-recorded scenario was immediately followed by an audio-recorded debrief that encouraged articulation of underlying cognitive processes. Two researchers used evidence from the scenario, debrief, and field notes to determine which errors were attributable to a single underlying cause. In such cases, the errors were coded by template analysis into the GEMS framework. Errors for which a single cause could be identified but which did not fit the framework were coded inductively.
  
  
  RESULTS
  A total of 243 errors were identified, with sufficient evidence available to identify a single cause in 190. Skill-based slips and lapses, rule-based mistakes, and knowledge-based mistakes were all clearly identified within the data. Two error types not originally included in the GEMS framework were identified: compound errors and submission errors.
  
  
  CONCLUSIONS
  Amplification of GEMS provides a valid framework for categorization of the errors made by junior doctors in simulated acute care contexts. In addition, the amplified framework may be transferable to other, team-based contexts. An improved understanding of the knowledge and skills that are most vulnerable to each specific type of error will allow tailored educational strategies to be developed.
authors.affiliation: Centre for Medical Education, University of Edinburgh, Edinburgh, United Kingdom. Vicky.Tallentire@ed.ac.uk
authors.forename: Victoria R
authors.initials: VR
authors.lastname: Tallentire
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Smith
authors.forename: Janet
authors.initials: J
authors.lastname: Skinner
authors.forename: Helen S
authors.initials: HS
authors.lastname: Cameron
mesh_terms: D002983:Clinical Competence; D003422:Critical Care / Q000592:standards*; D006801:Humans; D008348:Manikins; D019300:Medical Errors / Q000145:classification / Q000706:statistics & numerical data; D008962:Models, Theoretical; D010348:Patient Care Team / Q000592:standards*; D010820:Physicians / Q000592:standards*; D012606:Scotland; D013222:State Medicine; D014741:Video Recording