O18\u2005Can individuals train to be ‘right’?

Abstract

Introduction Left-Right (LR) decisions are made on a daily basis. For some LR decisions are made with ease, while others with great difficulty. In healthcare, LR errors can be catastrophic such as wrong-sided surgery. To reduce LR errors, a number of ‘systems’ have been developed such as the WHO surgical check list.1 However, the question remains, are there more effective human factor based methods to prevent them, for example, could a person-centred teaching system improve accuracy in LR discrimination? The Applied Behavior Analysis based training method, Precision Teaching (PT), has been developed to teach skills to high levels of fluency and been used in medical education.2Precision teaching uses bespoke flashcards, called ‘Say All Fast, Minute Each Day, Shuffle’ (SAFMEDS), in brief-burst training sessions (1-minute timings) focused on speed and accuracy i.e. fluency.3 This study reports on the impact of SAFMEDS on medical students’ LR discrimination ability. Methods 80 LR SAFMEDS Flashcards were developed consisting of a LR photo, a question and the answer on reverse. Year 4 medical students were recruited. A psychometric test, the ‘Bergen Left Right Discrimination Test’ (BLRDT), was used to measure baseline and outcome LR ability of the control and intervention groups. The intervention group aimed to use LR SAFMEDS flashcards supervised 10 times over 5 days. Results 76 and 67 participants completed the study in the intervention and control groups respectively. Statistical analysis used a between-groups Analysis of Variance (ANOVA). The baseline and outcome BLRDT scores were not statistically significant between the control and intervention (p-value=0.363). Analysis of the BLRDT sub-sections ‘facing away’ (p-value=0.203) and ‘facing towards’ (p-value=0.251) were not statistically significant. However, the ‘mixed’ section was statistically significant (p-value=0.005) with a moderate size effect (partial-eta2 =0.053). Discussion and conclusion There are several factors which help explain the results: increased familiarity with the test - (practice effect), participants not sufficiently challenged to differentiate scores - (ceiling effect), and the intervention may not have been performed long or frequent enough. Although overall there was not a statistical difference, sub-analysis revealed in more difficult LR decisions training improved individuals LR ability with the greatest improvement in individuals who had a perceived poor LR discrimination ability. This would suggest LR SAFMEDS flashcard training may have impact in complex LR decisions with the greatest impact in individuals with poor LR discrimination ability. Further research would be advised especially in individuals with poorer LR discrimination ability. References WHO. Surgical Safety Checklist [Internet]. [cited 2017 Nov 10]. Available from: http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Checklist_finalJun08.pdf Lydon S, Burns N, Healy O, O’Connor P, Reid McDermott B, Byrne D. Preliminary evaluation of the efficacy of an intervention incorporating precision teaching to train procedural skills among final cycle medical students. BMJ Simul Technol Enhanc Learn [Internet]. BMJ Specialist Journals; 2017 Feb 13 [cited 2017 Feb 17];bmjstel-2016-000154. Available from: http://stel.bmj.com/lookup/doi/10.1136/bmjstel-2016-000154 Chiesa M, Robertson A. Precision Teaching and Fluency Training: Making maths easier for pupils and teachers. Educ Psychol Pract. 2000;16(3):297–310.