title: Error tolerance: an evaluation of residents' repeated motor coordination errors.
abstract: BACKGROUND
  The study investigates the relationship between motor coordination errors and total errors using a human factors framework. We hypothesize motor coordination errors will correlate with total errors and provide validity evidence for error tolerance as a performance metric.
  
  
  METHODS
  Residents' laparoscopic skills were evaluated during a simulated laparoscopic ventral hernia repair for motor coordination errors when grasping for intra-abdominal mesh or suture. Tolerance was defined as repeated, failed attempts to correct an error and the time required to recover.
  
  
  RESULTS
  Residents (N = 20) committed an average of 15.45 (standard deviation [SD] = 4.61) errors and 1.70 (SD = 2.25) motor coordination errors during mesh placement. Total errors correlated with motor coordination errors (r[18] = .572, P = .008). On average, residents required 5.09 recovery attempts for 1 motor coordination error (SD = 3.15). Recovery approaches correlated to total error load (r[13] = .592, P = .02).
  
  
  CONCLUSIONS
  Residents' motor coordination errors and recovery approaches predict total error load. Error tolerance proved to be a valid assessment metric relating to overall performance.
authors: Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin-Madison, 3214 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA.
authors: Katherine E
authors: KE
authors: Law
authors: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA.
authors: Eran C
authors: EC
authors: Gwillim
authors: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA.
authors: Rebecca D
authors: RD
authors: Ray
authors: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA.
authors: Anne-Lise D
authors: AD
authors: D'Angelo
authors: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA.
authors: Elaine R
authors: ER
authors: Cohen
authors: Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA.
authors: Rebekah M
authors: RM
authors: Fiers
authors: Department of Health Professions, University of Wisconsin-La Crosse, 3062 Health Science Center, La Crosse, WI, USA.
authors: Drew N
authors: DN
authors: Rutherford
authors: Department of Industrial and Systems Engineering, School of Engineering, University of Wisconsin-Madison, 3214 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA; Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Clinical Science Center, K6/100, Madison, WI 53792, USA. Electronic address: pugh@surgery.wisc.edu.
authors: Carla M
authors: CM
authors: Pugh
mesh_terms: D002983:Clinical Competence; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D008348:Manikins; D009048:Motor Skills
keywords: Assessment; Error; Human factors; Simulation; Surgery education; Technical skills