Driven to distraction: a prospective controlled study of a simulated ward round experience to improve patient safety teaching for medical students

Ian Thomas*, Laura Nicol, Luke Regan, Jennifer Cleland, Drieka Maliepaard, Lindsay Clark, Kenneth Walker, John Duncan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)
8 Downloads (Pure)

Abstract

Background Distraction and interruption are endemic in the clinical environment and contribute to error. This study assesses whether simulation-based training with targeted feedback can improve undergraduate management of distractions and interruptions to reduce error-making.

Design A prospective non-randomised controlled study.

Methods 28 final year medical students undertook a simulated baseline ward round. 14 students formed an intervention group and received immediate feedback on distractor management and error. 14 students in a control group received no feedback. After 4 weeks, students participated in a post-intervention ward round of comparable rigour. Changes in medical error and distractor management between simulations were assessed with Mann-Whitney U tests using SPSS V.21.

Results At baseline, error rates were high. The intervention group committed 72 total baseline errors (mean of 5.1 errors/student; median 5; range 3-7). The control group exhibited a comparable number of errors-with a total of 76 observed (mean of 5.4 errors/student; median 6; range 4-7). Many of these errors were life-threatening. At baseline distractions and interruptions were poorly managed by both groups. All forms of simulation training reduced error-making. In the intervention group the total number of errors post-intervention fell from 72 to 17 (mean 1.2 errors/student; median 1; range 0-3), representing a 76.4% fall (p

Conclusions Medical students are not inherently equipped to manage common ward-based distractions to mitigate error. These skills can be taught-with simulation and feedback conferring the greatest benefit. Curricular integration of simulated ward round experiences is recommended.

Original languageEnglish
Pages (from-to)154-161
Number of pages8
JournalBMJ Quality & Safety
Volume24
Issue number2
Early online date24 Nov 2014
DOIs
Publication statusPublished - Feb 2015

Bibliographical note

Acknowledgments
The authors would like to thank The Clinical Skills Managed Educational Network for its financial support, without which this research would not have taken place.

Ethics approval
Ethics approval for this research study was sought and granted from the University of Aberdeen's College and Ethics Research Board (Application No. CERB/2013/1/837). All participants in the study gave informed written consent before taking part in the research.

Data sharing statement
The research was carried out as part of a Masters in Medical Education degree. The Masters dissertation includes extensive study data—whereas this article contains the most pertinent quantitative data. The full Masters thesis is available from the University of Dundee

Keywords

  • operating-room
  • performance
  • interruptions
  • stress
  • errors
  • impact
  • task
  • care

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