title: Exploring Senior Residents' Intraoperative Error Management Strategies: A Potential Measure of Performance Improvement.
abstract: OBJECTIVE
  The study aim was to determine whether residents' error management strategies changed across 2 simulated laparoscopic ventral hernia (LVH) repair procedures after receiving feedback on their initial performance. We hypothesize that error detection and recovery strategies would improve during the second procedure without hands-on practice.
  
  
  METHODS
  Retrospective review of participant procedural performances of simulated laparoscopic ventral herniorrhaphy. A total of 3 investigators reviewed procedure videos to identify surgical errors. Errors were deconstructed. Error management events were noted, including error identification and recovery.
  
  
  METHODS
  Residents performed the simulated LVH procedures during a course on advanced laparoscopy. Participants had 30 minutes to complete a LVH procedure. After verbal and simulator feedback, residents returned 24 hours later to perform a different, more difficult simulated LVH repair.
  
  
  METHODS
  Senior (N = 7; postgraduate year 4-5) residents in attendance at the course participated in this study.
  
  
  RESULTS
  In the first LVH procedure, residents committed 121 errors (M = 17.14, standard deviation = 4.38). Although the number of errors increased to 146 (M = 20.86, standard deviation = 6.15) during the second procedure, residents progressed further in the second procedure. There was no significant difference in the number of errors committed for both procedures, but errors shifted to the late stage of the second procedure. Residents changed the error types that they attempted to recover (χ25=24.96, p<0.001). For the second procedure, recovery attempts increased for action and procedure errors, but decreased for strategy errors. Residents also recovered the most errors in the late stage of the second procedure (p < 0.001).
  
  
  CONCLUSIONS
  Residents' error management strategies changed between procedures following verbal feedback on their initial performance and feedback from the simulator. Errors and recovery attempts shifted to later steps during the second procedure. This may reflect residents' error management success in the earlier stages, which allowed further progression in the second simulation. Incorporating error recognition and management opportunities into surgical training could help track residents' learning curve and provide detailed, structured feedback on technical and decision-making skills.
authors.affiliation: Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Law
authors.affiliation: Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Ray
authors.affiliation: Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Anne-Lise D
authors.initials: AD
authors.lastname: D'Angelo
authors.affiliation: Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.affiliation: Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: DiMarco
authors.affiliation: Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Elyse
authors.initials: E
authors.lastname: Linsmeier
authors.affiliation: Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Wiegmann
authors.affiliation: Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin. Electronic address: pugh@surgery.wisc.edu.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Pugh
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery; D059685:Herniorrhaphy / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000193:education*; D008297:Male; D019300:Medical Errors; D061646:Operative Time; D012189:Retrospective Studies; D000066908:Simulation Training / Q000379:methods; D014743:Videotape Recording
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; error management; error recovery; laparoscopy; simulation; surgical education