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Simulation as an Adjunct to Didactics to Increase Knowledge Retention: One Year Follow-up
Bogdan Ionescu*1, Natalee Young1, Duane Patterson3,4, Rodney Grim2, Theodore Bell2, Vanita Ahuja1,4
1Surgery, Wellspan York Hospital, York, PA; 2Population Health Management and Research, Wellspan York Hospital, York, PA; 3Medical Simulation Center, Wellspan York Hospital, York, PA; 4Surgery, Sidney Kimmel Medical College, Philadelphia, PA
Purpose: Previous research has identified intra-operative high blood loss, unplanned emergencies in operation, and multi-operative teams increases the risk of an unidentified retained foreign object (URFO). Our community hospital’s URFO policy was revised to incorporate changes that mandate a “full stop for counts� prior to closure of incision. An initial didactic session was held to educate the staff and residents on the new policy. Three months later a survey indicated a need for improvement in retention. A simulation was then created as an adjunct to didactics to educate on systematic approaches to preventing URFO in the operating room (OR) and utilizing root cause analysis to analyze the simulated sentinel event and highlight the new URFO policy. A survey was subsequently done at the one year interval to measure follow up retention of knowledge.
Methods: The “baseline knowledge� and “knowledge retention� was assessed by pre (before simulation) and post (1 year) survey. Education on policy was conducted at the onset and six month interval with simulation incorporated in the latter. A multi-disciplinary team including residents, OR and anesthesia staff, designed and simulated a scenario with an emergency operation that is susceptible to URFO error. The Patient Safety Officer (PSO) gave a report that 5 days after abdominal closure a retained sponge was found on abdominal x-ray. A root cause analysis was then performed allowing the residents to verify the role of our new URFO policy on preventing such events (Figure 1).
Results: Using a survey (n=62), the majority of trainees improved in recognizing crew resource management as the primary way of preventing a sentinel event during a simulation at one year follow-up (78.6% to 98.4%) (Figure 2). Retention had improved, with 91.3% correctly indicated that standardized method (debrief, closed loop, sponge counting) were a better check than varying practices for preventing URFOs. The trainees correctly indicated (93.5%) from baseline of 75% that “finding the individual responsible for the mistake� was not the goal, and 91.9% correctly identified the primary focus of the root cause analysis of this scenario was failure in “system design.� However only 71% of trainees at one year indicated confidence in their understanding of the URFO policy and could assist others in performing URFO-related roles.
Conclusions: Simulation can be integrated into the residency curriculum as an adjunct to increase retention in teaching safety policy. The trainees were given the opportunity to learn the concept of root cause analysis and identify factors that lead to URFO. Simulation is a methodology that needs to be explored further to develop a framework for a patient safety curriculum in graduate medical education.
Figure 1. Timeline of Retained Foreign Object Teaching Curriculum
Figure 2. Comparison of Pre and Post Simulation Surveys
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