title: The use of error analysis to assess resident performance.
abstract: BACKGROUND
  The aim of this study was to assess validity of a human factors error assessment method for evaluating resident performance during a simulated operative procedure.
  
  
  METHODS
  Seven postgraduate year 4-5 residents had 30 minutes to complete a simulated laparoscopic ventral hernia (LVH) repair on day 1 of a national, advanced laparoscopic course. Faculty provided immediate feedback on operative errors and residents participated in a final product analysis of their repairs. Residents then received didactic and hands-on training regarding several advanced laparoscopic procedures during a lecture session and animate lab. On day 2, residents performed a nonequivalent LVH repair using a simulator. Three investigators reviewed and coded videos of the repairs using previously developed human error classification systems.
  
  
  RESULTS
  Residents committed 121 total errors on day 1 compared with 146 on day 2. One of 7 residents successfully completed the LVH repair on day 1 compared with all 7 residents on day 2 (P = .001). The majority of errors (85%) committed on day 2 were technical and occurred during the last 2 steps of the procedure. There were significant differences in error type (P ≤ .001) and level (P = .019) from day 1 to day 2. The proportion of omission errors decreased from day 1 (33%) to day 2 (14%). In addition, there were more technical and commission errors on day 2.
  
  
  CONCLUSIONS
  The error assessment tool was successful in categorizing performance errors, supporting known-groups validity evidence. Evaluating resident performance through error classification has great potential in facilitating our understanding of operative readiness.
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI. Electronic address: amaag@uwhealth.org.
authors.forename: Anne-Lise D
authors.initials: AL
authors.lastname: D'Angelo
authors.affiliation: Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin-Madison, Madison, WI.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Law
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Greenberg
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
authors.forename: Calvin
authors.initials: C
authors.lastname: Kwan
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
authors.forename: Caprice
authors.initials: C
authors.lastname: Greenberg
authors.affiliation: Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin-Madison, Madison, WI.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Wiegmann
authors.affiliation: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Pugh
mesh_terms: D002983:Clinical Competence; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008953:Models, Anatomic; D000066908:Simulation Training; D013043:Specialties, Surgical / Q000193:education*