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  • A Simulation-based, cognitive assessment of resident decision making during complex urinary catheterization scenarios. American journal of surgery Nathwani, J. N., Law, K. E., Witt, A. K., Ray, R. D., DiMarco, S. M., Pugh, C. M. 2017; 213 (4): 622–26


    This study explores general surgery residents' decision making skills in uncommon, complex urinary catheter scenarios.40 residents were presented with two scenarios. Scenario A was a male with traumatic urethral injury and scenario B was a male with complete urinary blockage. Residents verbalized whether they would catheterize the patient and described the workup and management of suspected pathologies. Residents' decision paths were documented and analyzed.In scenario A, 45% of participants chose to immediately consult Urology. 47.5% named five diagnostic tests to decide if catheterization was safe. In scenario B, 27% chose to catheterize with a 16 French Coude. When faced with catheterization failure, participants randomly upsized or downsized catheters. Chi-square analysis revealed no measurable consensus amongst participants.Residents need more training in complex decision making for urinary catheterization. The decision trees generated in this study provide a useful blueprint of residents' learning needs.Exploration of general surgery residents' decision making skills in uncommon, complex urinary catheter scenarios revealed major deficiencies. The resulting decision trees reveal residents' learning needs.

    View details for DOI 10.1016/j.amjsurg.2017.01.007

    View details for PubMedID 28089342

    View details for PubMedCentralID PMC5485835

  • Relationship Between Technical Errors and Decision-Making Skills in the Junior Resident. Journal of surgical education Nathwani, J. N., Fiers, R. M., Ray, R. D., Witt, A. K., Law, K. E., DiMarco, S., Pugh, C. M. 2016; 73 (6): e84–e90


    The purpose of this study is to coevaluate resident technical errors and decision-making capabilities during placement of a subclavian central venous catheter (CVC). We hypothesize that there would be significant correlations between scenario-based decision-making skills and technical proficiency in central line insertion. We also predict residents would face problems in anticipating common difficulties and generating solutions associated with line placement.Participants were asked to insert a subclavian central line on a simulator. After completion, residents were presented with a real-life patient photograph depicting CVC placement and asked to anticipate difficulties and generate solutions. Error rates were analyzed using chi-square tests and a 5% expected error rate. Correlations were sought by comparing technical errors and scenario-based decision-making skills.This study was performed at 7 tertiary care centers.Study participants (N = 46) largely consisted of first-year research residents who could be followed longitudinally. Second-year research and clinical residents were not excluded.In total, 6 checklist errors were committed more often than anticipated. Residents committed an average of 1.9 errors, significantly more than the 1 error, at most, per person expected (t(44) = 3.82, p < 0.001). The most common error was performance of the procedure steps in the wrong order (28.5%, p < 0.001). Some of the residents (24%) had no errors, 30% committed 1 error, and 46 % committed more than 1 error. The number of technical errors committed negatively correlated with the total number of commonly identified difficulties and generated solutions (r (33) = -0.429, p = 0.021, r (33) = -0.383, p = 0.044, respectively).Almost half of the surgical residents committed multiple errors while performing subclavian CVC placement. The correlation between technical errors and decision-making skills suggests a critical need to train residents in both technique and error management.

    View details for DOI 10.1016/j.jsurg.2016.08.004

    View details for PubMedID 27671618

    View details for PubMedCentralID PMC5485830