P170: Medical errors education for general surgery students

Abstract

Introduction: According to the Institute of Medicine, medical errors (MEs) are responsible for an estimated 44,000 to 98,000 patient deaths each year in the United States, costing the American health care system more than $37 billion annually. Recognizing the enormous impact that medical errors have on patient morbidity and mortality, as well as their effect on the overall cost of health care delivery, the Department of General Surgery at Henry Ford Hospital recently implemented an educational session on medical errors for the benefit of rotating medical students. Topics addressed in this session include the prevalence and types of MEs, landmark studies, error theory, legal implications, and practicable solutions for error prevention, with particular attention paid to issues facing practicing surgeons. Students are challenged to critically examine their preconceived notions about MEs during these small group discussions moderated by a surgical resident and attending surgeon. Methods: In order to evaluate the efficacy of this two-hour educational session, participating medical students completed a twelve question multiple-choice pretest prior to attending the session. At the conclusion of the session, students completed an identical 12-question posttest and individual student pre- and posttest scores were compared for evidence of enhanced understanding. No personal identifiers were used and students were provided unlimited time to complete the tests. Four groups of combined third and fourth-year medical students (ranging from five to seven students per session) completed this educational session, with a total of 23 students completing both pre- and posttesting. All sessions were moderated by the same surgical resident and attending surgeon, utilizing a standard Microsoft PowerPoint presentation. A test score of 9 (75%) or higher was considered to be satisfactory performance a priori. Test scores were analyzed with SPSS statistical software (version 14.0), employing the paired samples t-test (alpha = 0.05). Results: According to the data, posttest scores increased from a pre-test mean of 3.47 (SD = 1.59) to 8.52 (SD = 1.56) out of 12 possible points, and this difference was statistically significant (p < 0.001). Two students failed to answer all of the questions, with one student answering only nine questions, and another student answering only ten questions. In both cases, questions not answered were counted as wrong answers. No students obtained a satisfactory 75% passing score on the pretest, although a total of 13 students (56%) obtained a satisfactory 75% performance on the posttest. Conclusions: Our results from this retrospective pilot study demonstrated that a brief educational intervention led to improved performance as it relates to a general understanding of medical errors. These educational gains were statistically significant. In the next phase of our study, we intend to improve the psychometric properties of the instrument and refine our curriculum to include more surgical case-based scenarios. This future prospective study will also include a larger sample size, providing adequate power. We anticipate that our efforts at raising awareness of this important issue will result in fewer medical errors, providing safer and more cost-effective health care for those patients cared for by our students as they progress into residency training and beyond.