title: Measuring Error Identification and Recovery Skills in Surgical Residents.
abstract: BACKGROUND
  Although error identification and recovery skills are essential for the safe practice of surgery, they have not traditionally been taught or evaluated in residency training. This study validates a method for assessing error identification and recovery skills in surgical residents using a thoracoscopic lobectomy simulator.
  
  
  METHODS
  We developed a 5-station, simulator-based examination containing the most commonly encountered cognitive and technical errors occurring during division of the superior pulmonary vein for left upper lobectomy. Successful completion of each station requires identification and correction of these errors. Examinations were video recorded and scored in a blinded fashion using an examination-specific rating instrument evaluating task performance as well as error identification and recovery skills. Evidence of validity was collected in the categories of content, response process, internal structure, and relationship to other variables.
  
  
  RESULTS
  Fifteen general surgical residents (9 interns and 6 third-year residents) completed the examination. Interrater reliability was high, with an intraclass correlation coefficient of 0.78 between 4 trained raters. Station scores ranged from 64% to 84% correct. All stations adequately discriminated between high- and low-performing residents, with discrimination ranging from 0.35 to 0.65. The overall examination score was significantly higher for intermediate residents than for interns (mean, 74 versus 64 of 90 possible; p = 0.03).
  
  
  CONCLUSIONS
  The described simulator-based examination with embedded errors and its accompanying assessment tool can be used to measure error identification and recovery skills in surgical residents. This examination provides a valid method for comparing teaching strategies designed to improve error recognition and recovery to enhance patient safety.
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Sternbach
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Kevin
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Rym
authors.initials: R
authors.lastname: El Khoury
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois.
authors.forename: Ezra N
authors.initials: EN
authors.lastname: Teitelbaum
authors.affiliation: Department of Surgery, Northwestern University, Chicago, Illinois. Electronic address: smeyerso@nm.org.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Meyerson
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D011013:Pneumonectomy / Q000193:education* / Q000379:methods; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D013906:Thoracoscopy / Q000193:education*; D014741:Video Recording