Driven to distraction: a prospective controlled study of a simulated ward round experience to improve patient safety teaching for medical students

Ian Thomas*, Laura Nicol, Luke Regan, Jennifer Cleland, Drieka Maliepaard, Lindsay Clark, Kenneth Walker, John Duncan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)
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Background Distraction and interruption are endemic in the clinical environment and contribute to error. This study assesses whether simulation-based training with targeted feedback can improve undergraduate management of distractions and interruptions to reduce error-making.

Design A prospective non-randomised controlled study.

Methods 28 final year medical students undertook a simulated baseline ward round. 14 students formed an intervention group and received immediate feedback on distractor management and error. 14 students in a control group received no feedback. After 4 weeks, students participated in a post-intervention ward round of comparable rigour. Changes in medical error and distractor management between simulations were assessed with Mann-Whitney U tests using SPSS V.21.

Results At baseline, error rates were high. The intervention group committed 72 total baseline errors (mean of 5.1 errors/student; median 5; range 3-7). The control group exhibited a comparable number of errors-with a total of 76 observed (mean of 5.4 errors/student; median 6; range 4-7). Many of these errors were life-threatening. At baseline distractions and interruptions were poorly managed by both groups. All forms of simulation training reduced error-making. In the intervention group the total number of errors post-intervention fell from 72 to 17 (mean 1.2 errors/student; median 1; range 0-3), representing a 76.4% fall (p

Conclusions Medical students are not inherently equipped to manage common ward-based distractions to mitigate error. These skills can be taught-with simulation and feedback conferring the greatest benefit. Curricular integration of simulated ward round experiences is recommended.

Original languageEnglish
Pages (from-to)154-161
Number of pages8
JournalBMJ Quality & Safety
Issue number2
Early online date24 Nov 2014
Publication statusPublished - Feb 2015


  • operating-room
  • performance
  • interruptions
  • stress
  • errors
  • impact
  • task
  • care

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