title: Driven to distraction: a prospective controlled study of a simulated ward round experience to improve patient safety teaching for medical students.
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.
  
  
  METHODS
  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.
authors.affiliation: Highland Medical Education Centre, University of Aberdeen, Centre for Health Sciences, Inverness, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Thomas
authors.affiliation: Surgical Academic Unit, University of Stirling, Inverness campus, Inverness, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Nicol
authors.affiliation: Highland Medical Education Centre, University of Aberdeen, Centre for Health Sciences, Inverness, UK.
authors.forename: Luke
authors.initials: L
authors.lastname: Regan
authors.affiliation: Division of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cleland
authors.affiliation: Highland Medical Education Centre, University of Aberdeen, Centre for Health Sciences, Inverness, UK.
authors.forename: Drieka
authors.initials: D
authors.lastname: Maliepaard
authors.affiliation: Highland Medical Education Centre, University of Aberdeen, Centre for Health Sciences, Inverness, UK.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Clark
authors.affiliation: Department of General Surgery, NHS Highland, Raigmore Hospital, Inverness, UK.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Walker
authors.affiliation: Department of General Surgery, NHS Highland, Raigmore Hospital, Inverness, UK.
authors.forename: John
authors.initials: J
authors.lastname: Duncan
mesh_terms: D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D061214:Patient Safety; D016544:Patient Simulation; D011446:Prospective Studies; D013337:Students, Medical / Q000706:statistics & numerical data; D056164:Teaching Rounds / Q000379:methods*; D055815:Young Adult
keywords: Human factors; Medical education; Medical error, measurement/epidemiology; Patient safety; Simulation