High-fidelity simulation as an experiential model for teaching root cause analysis.

PURPOSE The purpose of this study was to assess the effectiveness of high-fidelity simulation for teaching root cause analysis (RCA) in graduate medical education. METHODS Thirty clinical anesthesiology-1 through clinical anesthesiology-3 residents were randomly assigned to 2 groups: group A participants received a 10-minute lecture on RCA and participated in a simulation exercise where a medical error occurs, and group B participants received the 10-minute lecture on RCA only. Participants completed baseline, postintervention, and 6-month follow-up assessments, and they were evaluated on their attitude toward as well as understanding of RCA and "systems-based" care. RESULTS All 30 residents completed the surveys. Baseline attitudes and knowledge scores were similar between groups. Postintervention knowledge scores were also similar between groups; however, group B was significantly more skeptical (P < .001) about the use of RCA and "systems improvement" strategies. Six months later, group A demonstrated retained knowledge scores and unchanged attitude, whereas group B demonstrated significantly worse knowledge scores (P  =  .001) as well as continued skepticism toward a systems-based approach (P < .001) to medical error reduction. CONCLUSION High-fidelity simulation in conjunction with focused didactics is an effective strategy for teaching RCA and systems theory in graduate medical education. Our findings also suggest that there is greater retention of knowledge and increased positive attitude toward systems improvement when focused didactics are coupled with a high-fidelity simulation exercise.