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Research Letter |

Ophthalmic Resident Education on Preventable Surgical Errors FREE

Allison J. Chen, BA1,2,3; Jimmy J. Chan, BS2,3; Ingrid U. Scott, MD, MPH4; Paul B. Greenberg, MD2,3
[+] Author Affiliations
1Program in Liberal Medical Education, Brown University, Providence, Rhode Island
2Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island
3Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
4Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
JAMA Ophthalmol. 2013;131(9):1238-1240. doi:10.1001/jamaophthalmol.2013.1691.
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Published online

An important objective of ophthalmic graduate medical education (GME) is to provide surgical training to residents so they are competent to enter comprehensive ophthalmic practice.1 Training to reduce the risk of surgical errors is central to this objective. Errors involving the wrong patient, wrong site, or wrong procedure can have devastating consequences2,3 and are largely preventable by adherence to specific protocols.4,5 Hence, the importance of training in the prevention of surgical errors is to inculcate a culture of safety in ophthalmology practice.

Currently, the nature of resident training in the prevention of surgical errors in US ophthalmology GME programs is not known. To our knowledge and based on a literature search of the Medline database, there are no published reports of similar surveys regarding resident training in the prevention of surgical errors that exist in other subspecialties. This information would help benchmark current practices and assist ophthalmology GME programs to formulate effective strategies to educate residents on how to deliver health care safely and effectively. To this end, we surveyed US ophthalmology GME program directors (PDs) to determine current practices regarding resident education in the prevention of surgical errors.

After receiving a study exemption from the Providence VA Medical Center Institutional Review Board, an anonymous survey including multiple-choice and Likert-style questions (Table 1 and Table 2) was created through DatStat Illume version 5.1 software. The survey link was emailed to all 117 US ophthalmology GME PDs.

Table Graphic Jump LocationTable 1.  Survey Results Regarding Graduate Medical Education on Preventable Surgical Errors
Table Graphic Jump LocationTable 2.  Survey Results Regarding Graduate Medical Education on Preventable Surgical Errors

Results are summarized in Table 1 and Table 2. The response rate was 33.3% (39 of 117); 36 of 39 PDs (92%) reported that their program had an established surgical skills curriculum. Among PDs at programs with a surgical skills curriculum, approximately half (20 of 39 [51%]) reported that their program provided specific training regarding preventable surgical errors. Methods used to train residents in preventable surgical errors included observing attending physicians (17 of 18 PDs [94%]), lectures (15 of 18 PDs [83%]), web courses (4 of 18 PDs [22%]), or a combination of these (16 of 18 PDs [89%]). Program directors noted that the most effective way to train residents in minimizing surgical errors was a combination of the previously listed methods as well as hands-on training, morbidity and mortality conferences, medical errors ethics seminars, and hospital operating room protocols (ie, surgical time-outs). About half of PDs (17 of 35 [49%]) agreed that ophthalmology GME programs should have specific curricula on preventable surgical errors, and 23 of 35 (66%) agreed that patients and the public expect residents to receive special training regarding preventable surgical errors. In the free-response section of the survey, PDs emphasized that programs should provide training regarding preventable surgical errors, but logistics should be left to each program’s discretion.

In this study, while most PDs (92%) reported that their program has a surgical skills curriculum and most PDs (66%) agreed that patients and the public expect residents to receive training regarding preventable surgical errors, only half of the PDs reported that their program provides such training. This elucidates an area of deficiency in surgical skills training, even among programs with an established surgical skills curriculum. Furthermore, most PDs believe that using a combination of methods and giving each program the flexibility to work this topic into their training program, as opposed to mandating specific training strategies, would be most effective in teaching residents safe surgical practices. In addition, although 49% of PDs responded that their program did not include specific resident training regarding preventable surgical errors, the free-response comments suggest that many training programs incorporate this topic in everyday practices (eg, operating room protocols and morbidity and mortality conferences). Whether this on-the-job exposure to the topic provides sufficient and effective teaching regarding preventable surgical errors remains to be determined.

The study has several limitations. The survey response rate of 33.3% may limit generalizability of results; however, this rate is comparable to the response rates of 32% and 48% in 2 recent surveys of US ophthalmology PDs.6,7 Second, the survey may have been biased by the multiple-choice format; however, inclusion of an “other” category permitted a more comprehensive set of responses. Third, the survey did not attempt to relate teaching practices to outcomes.

This study underscores the need for further research to determine which teaching practices are most effective at reducing preventable errors and how to effectively implement them into programs lacking such training. The Accreditation Council for Graduate Medical Education’s Milestone Project8 provides an excellent opportunity to meet both these goals in the coming years.

Corresponding Author: Paul B. Greenberg, MD, Section of Ophthalmology, VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908 (paul_greenberg@brown.edu).

Author Contributions: Greenberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Greenberg.

Acquisition of data: Chen.

Analysis and interpretation of data: All authors.

Drafting of the manuscript: Chen.

Critical revision of the manuscript for important intellectual content: Chan, Scott, Greenberg.

Statistical analysis: Chen, Chan.

Administrative, technical, or material support: Scott, Greenberg.

Study supervision: Greenberg.

Conflict of Interest Disclosures: None reported.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US Department of Veterans Affairs or the US government.

Accreditation Council for Graduate Medical Education. Accreditation Council for Graduate Medical Education program requirements for graduate medical education in ophthalmology. http://www.acgme.org. Accessed March 12, 2011.
Simon  JW, Ngo  Y, Khan  S, Strogatz  D.  Surgical confusions in ophthalmology. Arch Ophthalmol. 2007;125(11):1515-1522.
PubMed   |  Link to Article
Lum  F, Schachat  AP.  The quest to eliminate “never events.” Ophthalmology. 2009;116(6):1021-1022.
PubMed   |  Link to Article
The Joint Commission. Facts about the Universal Protocol. http://www.jointcommission.org/facts_about_the_universal_protocol/. Accessed February 5, 2012.
Scott  IU, Smalley  AD, Kunselman  AR.  Ophthalmology residency program leadership expectations of resident competency in retinal procedures and resident experience with retinal procedures. Retina. 2009;29(2):251-256.
PubMed   |  Link to Article
Chen  AJ, Scott  IU, Greenberg  PB.  Disclosure of resident involvement in ophthalmic surgery. Arch Ophthalmol. 2012;130(7):932-934.
PubMed   |  Link to Article
Weber P. Wrong eye, wrong IOL, wrong patient. http://www.omic.com/wrong-eye-wrong-iol-wrong-patient/. Accessed September 24, 2012.
Swing S. Milestone Project update. http://www.acgme-nas.org/milestones.html. Accessed September 24, 2012.

Figures

Tables

Table Graphic Jump LocationTable 1.  Survey Results Regarding Graduate Medical Education on Preventable Surgical Errors
Table Graphic Jump LocationTable 2.  Survey Results Regarding Graduate Medical Education on Preventable Surgical Errors

References

Accreditation Council for Graduate Medical Education. Accreditation Council for Graduate Medical Education program requirements for graduate medical education in ophthalmology. http://www.acgme.org. Accessed March 12, 2011.
Simon  JW, Ngo  Y, Khan  S, Strogatz  D.  Surgical confusions in ophthalmology. Arch Ophthalmol. 2007;125(11):1515-1522.
PubMed   |  Link to Article
Lum  F, Schachat  AP.  The quest to eliminate “never events.” Ophthalmology. 2009;116(6):1021-1022.
PubMed   |  Link to Article
The Joint Commission. Facts about the Universal Protocol. http://www.jointcommission.org/facts_about_the_universal_protocol/. Accessed February 5, 2012.
Scott  IU, Smalley  AD, Kunselman  AR.  Ophthalmology residency program leadership expectations of resident competency in retinal procedures and resident experience with retinal procedures. Retina. 2009;29(2):251-256.
PubMed   |  Link to Article
Chen  AJ, Scott  IU, Greenberg  PB.  Disclosure of resident involvement in ophthalmic surgery. Arch Ophthalmol. 2012;130(7):932-934.
PubMed   |  Link to Article
Weber P. Wrong eye, wrong IOL, wrong patient. http://www.omic.com/wrong-eye-wrong-iol-wrong-patient/. Accessed September 24, 2012.
Swing S. Milestone Project update. http://www.acgme-nas.org/milestones.html. Accessed September 24, 2012.

Correspondence

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