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Evaluation of an Error-Reduction Training Program for Surgical Residents

Brannick, Michael T. PhD; Fabri, Peter J. MD, PhD; Zayas-Castro, Jose PhD; Bryant, Rebecca H.

Academic Medicine:
doi: 10.1097/ACM.0b013e3181bf36b0
Quality and Safety

Purpose: To reduce errors in surgery using a resident training program based on a taxonomy that highlights three kinds of errors: judgment, inattention to detail, and problem understanding.

Method: The training program module at the University of South Florida incorporated a three-item situational judgment test, video training (which included a lecture and behavior modeling), and role-plays (in which residents participated and received feedback from faculty). Two kinds of outcome data were collected from 33 residents during 2006–2007: (1) behaviors during the training and (2) on-the-job surgical complication records 12 months before and 6 months after training. For the data collected during training, participants were assigned to a condition (19 video condition, 13 control condition); for the data collected on the job, an interrupted time series design was used.

Results: Data from 32 residents were analyzed (one resident's data were excluded). One of the situational judgment items improved significantly over time (d = 0.45); the other two did not (d = 0.36, 0.25). Surgical complications and errors decreased over the course of the study (the correlation between complications and time in months was r = −0.47, for errors and time, r = −0.55). Effects of video behavior modeling on specific errors measured during role-plays were not significant (effect sizes for binary outcomes were phi = −0.05 and phi = 0.01, and for continuous outcomes, d ranged from −0.02 to 0.34).

Conclusions: The training seemed to reduce errors in surgery, but the training had little effect on the specific kinds of errors targeted during training.

Author Information

Dr. Brannick is professor and interim chair, Psychology Department, University of South Florida, Tampa, Florida.

Dr. Fabri is associate dean for graduate medical education, University of South Florida, Tampa, Florida.

Dr. Zayas-Castro is professor and chair, Industrial and Management Systems Engineering Department, University of South Florida, Tampa, Florida.

Ms. Bryant is a doctoral candidate, Psychology Department, University of South Florida, Tampa, Florida.

Correspondence should be addressed to Dr. Brannick, Psychology Department PCD 4118G, University of South Florida, Tampa FL 33620-7200; telephone: (813) 974-0478; e-mail: (

© 2009 Association of American Medical Colleges