Needs assessment for an errors-based curriculum on thoracoscopic lobectomy.
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.
Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. smeyerso@nmh.org
Shari L
SL
Meyerson
Betty C
BC
Tong
Stafford S
SS
Balderson
Thomas A
TA
D'Amico
Joseph D
JD
Phillips
Malcolm M
MM
DeCamp
Debra A
DA
DaRosa
D019300:Medical Errors / Q000517:prevention & control*; D020380:Needs Assessment; D011013:Pneumonectomy / Q000193:education* / Q000379:methods*; D018794:Problem-Based Learning; D013906:Thoracoscopy / Q000193:education*