Background Effective non-technical skills can reduce healthcare error1, including the use of decision making tools (cognitive aids2) and communication in raising concerns3. A local survey suggested that 81% of medical students would use cognitive aids in decision making and 78% would raise concerns with a senior. This study considered whether students actually did so in simulated scenarios and to what extent this was affected by teaching interventions.
Methodology Final year medical students were observed during three high-fidelity cardiac arrest scenarios. Behaviour coding frames with a checklist of behaviours, developed through observations of previous scenarios, were used to assess use of the ALS algorithm and the ability to raise concerns when given incorrect advice. A one-way between groups design was used to investigate the effect of presentations, with Group A taught about both the use of cognitive aids and the process of raising concerns, Group B about cognitive aids only and Group C about raising concerns only.
Results Cognitive Aid: Eleven scenarios were observed by a faculty member using the behaviour coding frame. In no scenario was the cognitive aid physically used; only Group B mentioned the ALS algorithm. However the behaviours on the algorithm were still present; Group B completed the specified behaviours most often and in better time.
Raising concerns Conclusions and recommendations Findings suggest that despite students often stating that they would use physical cognitive aids and raise concerns, the reality (despite simulated) does not meet their belief. These findings, however, do suggest that an educational intervention improves performance. Such interventions could therefore improve safety behaviours with the eventual aim of reducing error rates.
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White AA, Bell SK, Krauss MJ, et al, (2011). How trainees would disclose medical errors: educational implications for training programmes. Medical Education. 2011;45 (4):372–80
- Category: Course or curriculum evaluation/innovation/integration
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