Learning From Mistakes in Clinical Practice: How VR Can Help

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Although modern medicine is based on scientific evidence, it is practiced by humans who, no matter their expertise, make mistakes. These medical errors exact a substantial burden on patients, clinicians, and the healthcare system. Therefore, identifying and minimizing preventable sources of medical error is of utmost importance — it’s a matter of life or death. This article will break down what medical errors are, where they come from, and how virtual reality (VR) simulation training helps trainees learn from mistakes in clinical practice to improve patient safety.

 

What Is a Medical Error?

Defined simply in a 2000 paper by T. P. Hofer and colleagues, a medical error is any failed process that is clearly linked to an adverse outcome1. However, the simplicity of this definition belies the many nuanced meanings of the term2,3. Some definitions of medical error focus on iatrogenic illness, policy violations, critical incidents, and other metrics3

However, it is somewhat easier to classify medical error into two main categories. The first kind is errors of omission2. An error of omission occurs when an appropriate action is not taken. This could include not asking whether a patient has a family history of clotting disorders or failing to perform a relevant test. In contrast, errors of commission result from actions that are performed. For example, giving one patient another’s medicine or operating on the wrong side of a patient constitutes errors of commission.

How Common Are Medical Errors?

The varying meanings of the term have an obfuscating effect on gauging the true rate of medical errors3. This uncertainty is compounded by inconsistencies in medical records and the unwillingness of some care providers to report mistakes at risk of damaging their reputation and financial wellbeing4. All estimates must therefore be taken with a grain of salt to avoid drawing firm conclusions. 

That said, research indicates that around 400,000 hospitalized patients per year suffer some form of preventable harm2. Other reports suggest that adverse events happen to up to 25% of hospital patients5. Medical errors are most prevalent in ICUs, emergency departments, and operating rooms4. Adverse drug events and iatrogenic infections are the most common kinds of medical errors, followed by fall injuries and birth complications4

The Cost of Medical Errors

Medical errors take a large toll on society. A 2013 study found that somewhere between 210,000 and 400,000 people lost their lives due to medical errors of some source6. The figures from that study place it as the third leading cause of death in the US6,7.

However, death is not the only negative outcome of medical errors. The same study indicated that medical errors cause between 10 and 20-times the amount of serious harm than deaths6. In the state of Massachusetts alone, 1 in 5 patients has experienced a medical error, 19% of which are strongly impactful even a year after the event8

The economic impact of medical errors is similarly staggering. Some studies suggest that medical errors cost around $20 billion every year2. Others, however, indicate that $40 billion is spent in the US on medication errors alone7. These costs are on top of the significant financial drain placed on healthcare institutions and insurers by malpractice suits. Therefore, it is in healthcare institutions’ best moral and financial interest to identify causes of medical error and address them with due diligence. 

What Causes Medical Errors?

The most common source of error is diagnosis4. Missed diagnoses, late diagnoses, and incorrect diagnoses account for a significant degree of medical error. Meanwhile, up to a third of medication errors are related to packaging and product labelling issues7. A substantial amount of serious adverse events associated with medical errors are related to simple mistakes and slip-ups, even in seasoned nurses and doctors7

The underlying causes of these errors are complex. Medical burnout caused by long hours, emotionally draining work, and high patient volume are associated with increased adverse events9. Another cause may be the undue pressure placed upon care providers by understaffing. A retrospective 2011 study published in the New England Journal of Medicine found that patients had an increased mortality rate in hospitals that were understaffed with RNs10. Finally, inadequacies in medical training account for a significant source of medical error, especially when considering medication errors11

Solutions for Medical Errors

Robust training programs using medical simulations have been shown to substantially reduce the mistakes made by healthcare workers12,13. Adult learners typically pick up information better from doing than listening. The hands-on experience of medical simulations tends to suit these learners best12,14. As a result, simulations are associated with increased competence, patient care, and self-confidence. 

Properly executed simulations sharpen trainees’ quick decision-making skills by placing them directly in scenarios they will face in real-life practice9. Importantly, lessons gleaned from simulations do not come with the human and financial cost of medical students and residents learning from mistakes in clinical practice on actual patients. 

The Benefits of Learning From Mistakes in Clinical Practice With VR 

Although simulations offer tangible benefits for patient safety, there is a caveat; realism matters. Research shows that nursing students report better learning experiences with more realistic simulations15. Moreover, students often find it hard to practice interpersonal skills even with high-fidelity medical training manikins16

VR medical simulation training, on the other hand, is much more engaging for most users17. A near-infinite array of scenarios can be performed in VR without harming actual human patients, which makes learning from medical errors risk-free. This is particularly useful in field scenarios and military medicine applications.

Instructors can modify medical VR simulations from SimX to give each trainee a unique learning experience. Our software automatically scores trainees in real-time and produces 3D recordings of the simulations in virtual space, facilitating in-depth learning from mistakes in clinical practice much more effectively than in-person simulations. 

SimX VR can be run on most consumer-grade wireless VR headsets, meaning learners can engage in high-fidelity training for far less than the cost of in-person simulations. In addition, SimX VR is cloud-based and supports local and online multi-user training, encouraging team-building even when miles apart. 

Visit our site and sign up for a free trial of SimX or request a demo by clicking here, and learn how our simulation training can help improve patient care and mitigate medical errors at your institution.

 

References

1. Hofer TP, Kerr EA, Hayward RA. What is an error? Eff Clin Pract. 2000;3(6):261-269.

2. Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. In: StatPearls. Treasure Island (FL)2021.

3. Grober ED, Bohnen JM. Defining medical error. Can J Surg. 2005;48(1):39-44.

4. Carver N, Gupta V, Hipskind JE. Medical Error. In: StatPearls. Treasure Island (FL)2021.

5. Jain KK. Medical Errors. Medlink. https://www.medlink.com/articles/medical-errors. Published 2006. Updated March 2021. Accessed December 23, 2021.

6. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122-128.

7. Arredondo E, Udeani G, Horseman M, Hintze TD, Surani S. Role of Clinical Pharmacists in Intensive Care Units. Cureus. 2021;13(9):e17929.

8. The Financial and Human Cost of Medical Error… and How Massachusetts Can Lead the Way on Patient Safety. Betsy Lehman Center for Patient Safety. https://psnet.ahrq.gov/issue/financial-and-human-cost-medical-error-and-how-massachusetts-can-lead-way-patient-safety. Published 2019. Accessed 2021, December 23.

9. Garrouste-Orgeas M, Philippart F, Bruel C, Max A, Lau N, Misset B. Overview of medical errors and adverse events. Ann Intensive Care. 2012;2(1):2.

10. Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med. 2011;364(11):1037-1045.

11. Likic R, Maxwell SR. Prevention of medication errors: teaching and training. Br J Clin Pharmacol. 2009;67(6):656-661.

12. Durham CF, Alden KR. Enhancing Patient Safety in Nursing Education Through Patient Simulation. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD)2008.

13. In: Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington (DC)2000.

14. DA K. Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall; 1984.

15. Basak T, Unver V, Moss J, Watts P, Gaioso V. Beginning and advanced students’ perceptions of the use of low- and high-fidelity mannequins in nursing simulation. Nurse Educ Today. 2016;36:37-43.

16. Dean S, Williams C, Balnaves M. Practising on plastic people: Can I really care? Contemp Nurse. 2015;51(2-3):257-271.

17. Pottle J. Virtual reality and the transformation of medical education. Future Healthc J. 2019;6(3):181-185.

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