Relationship Between Technical Errors and Decision-Making Skills in the Junior Resident.
OBJECTIVE
The purpose of this study is to coevaluate resident technical errors and decision-making capabilities during placement of a subclavian central venous catheter (CVC). We hypothesize that there would be significant correlations between scenario-based decision-making skills and technical proficiency in central line insertion. We also predict residents would face problems in anticipating common difficulties and generating solutions associated with line placement.


METHODS
Participants were asked to insert a subclavian central line on a simulator. After completion, residents were presented with a real-life patient photograph depicting CVC placement and asked to anticipate difficulties and generate solutions. Error rates were analyzed using chi-square tests and a 5% expected error rate. Correlations were sought by comparing technical errors and scenario-based decision-making skills.


METHODS
This study was performed at 7 tertiary care centers.


METHODS
Study participants (N = 46) largely consisted of first-year research residents who could be followed longitudinally. Second-year research and clinical residents were not excluded.


RESULTS
In total, 6 checklist errors were committed more often than anticipated. Residents committed an average of 1.9 errors, significantly more than the 1 error, at most, per person expected (t(44) = 3.82, p < 0.001). The most common error was performance of the procedure steps in the wrong order (28.5%, p < 0.001). Some of the residents (24%) had no errors, 30% committed 1 error, and 46 % committed more than 1 error. The number of technical errors committed negatively correlated with the total number of commonly identified difficulties and generated solutions (r (33) = -0.429, p = 0.021, r (33) = -0.383, p = 0.044, respectively).


CONCLUSIONS
Almost half of the surgical residents committed multiple errors while performing subclavian CVC placement. The correlation between technical errors and decision-making skills suggests a critical need to train residents in both technique and error management.
Division of General Surgery, University of Wisconsin, Madison, Wisconsin.
Jay N
JN
Nathwani
Division of General Surgery, University of Wisconsin, Madison, Wisconsin.
Rebekah M
RM
Fiers
Division of General Surgery, University of Wisconsin, Madison, Wisconsin.
Rebecca D
RD
Ray
Division of General Surgery, University of Wisconsin, Madison, Wisconsin.
Anna K
AK
Witt
Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin.
Katherine E
KE
Law
Division of General Surgery, University of Wisconsin, Madison, Wisconsin.
ShannonM
S
DiMarco
Division of General Surgery, University of Wisconsin, Madison, Wisconsin. Electronic address: pugh@surgery.wisc.edu.
Carla M
CM
Pugh
D000328:Adult; D002405:Catheterization, Central Venous / Q000379:methods*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D003162:Competency-Based Education / Q000379:methods*; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D019300:Medical Errors; D000066908:Simulation Training / Q000379:methods*; D013348:Subclavian Artery; D014922:Wisconsin
Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; performance assessment; simulation; surgical education
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