Table 1 Simulated ward round to support the transition from medical student to junior doctor

Junior doctors are particularly susceptible to error-making within stressful environments. The ward is an excellent example—for it is endemic in distraction [64]. Through overwhelming cognitive load, distraction impairs clinical reasoning [65] and contributes to prescribing error [66]. Despite this, medical graduates receive little training in how to cope with hectic work environments and it is perhaps unsurprising that the early years of a medical career are the most error prone [67]. However, the literature suggests that practice with distraction and interruption can dampen their adverse consequences [68]. In response, Thomas and colleagues investigated whether a simulated ward exercise could improve medical student management of distractions to reduce error-making.

A high-fidelity simulated ward round experience was developed. Students played the part of a junior doctor leading the round and completed a number of error-prone tasks, from patient diagnosis to prescribing. At time-critical points, common distractions were deployed (for example, the doctor’s pager being set off or having to deal with a disgruntled relative) (Fig 1).

A non-randomised controlled study was undertaken with 28 final-year medical students. All students participated in a baseline ward round. Fourteen students formed an intervention group and received immediate feedback on their handling of distractions. The 14 students in a control group received no such feedback. After a lag-time of 1 month, students participated in a post-intervention ward round of comparable rigour. Changes in medical error-making and distractor management between simulations were evaluated.

Baseline error rates were high, with 72 and 76 errors witnessed in the intervention and control groups, respectively. Many errors were life threatening and included prescribing patient-allergic antibiotics, inappropriate thrombolysis, and medication overdoses. Similarly, at baseline, distractions were poorly managed in both groups.

All forms of simulation training resulted in error-reduction post-intervention. In the control group, the total number of errors fell to 44, representing a 42.11 % reduction (p value = 0.0003). In the intervention group, the total number of errors fell to 17, representing a 76.39 % reduction (p value <0.0001). The management of distractions only improved significantly in the intervention group.

Students highly valued the simulations [69], which were deemed high fidelity and built confidence.

“I really hope this is a method of education that catches on because I feel it has been one of my most valuable learning experiences in 5th year so far.”

The research shows that students are not inherently equipped with the skills to manage distractions in order to mitigate error. However, practice with distractions minimises its adverse consequences and targeted feedback is key in achieving the greatest educational utility.