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Traditionally, medical training has centered around teaching trainees to make optimal decisions and perform procedures correctly, thereby avoiding errors. The focus on error avoidance was also echoed by experts in the fields of learning and training.[1][2] However, this training method does not support trainee’s needs for learning how to recognize and manage errors when they occur.[3] The ability to identify, manage, and prevent errors is a critical skill in providing patient care as medical errors occur frequently.[4][5] In contrast to error avoidance training (EAT), error management training (EMT) promotes a learning environment where trainees are encouraged to explore and make errors.[1][6] Errors are considered an expected consequence of active learning and can inform instructors and learners where there are gaps in knowledge and skill. EMT was developed in the field of human factors engineering and applied to teach software skills in the early 1990s,[1] however, it has gained popularity and moved into a wide array of fields including medical and surgical training.[7][6][8][9][10][2][11][12][13][3] In a field such as medicine, where errors negatively impact human lives, integrating EMT into the simulation environment is critical. Simulation allows the trainee to commit errors and learn from them without harming patients.[14][15] This activity discusses the theory of EMT, the application of EMT to medical education in the simulation environment, and the impact of EMT on healthcare education.

In summary, the major teaching points are as follows: 1) The traditional assessment of procedural skill has through checklists, global rating scales, and final product analysis.[22] However, each of these assessment tools may only capture a component of performance and may not be sufficient to evaluate performance holistically without using other assessment modalities.[23][24] 2) Errors act to provide feedback and identify specific areas that one’s mental model is not adequate. Error management training sees errors not just as negative feedback indicating failed performance, but rather as an impetus for active learning and exploration to further develop one’s mental model.[1] 3) The two key elements of error management training based learning are that firstly learners are “given only minimal guidance and otherwise are encouraged to actively explore and experiment on their own”; and secondly “EMT creates a learning environment in which errors are likely to occur.”[1]

Although the majority of research on error management training in medical simulation has focused on surgical and procedural skill acquisition amongst individual trainees, the educational method applies to team-based training and multiple disciplines throughout medicine.[21] Learning in a simulated environment that encourages error management strategies and the discussion of errors within teams may promote communication and shared cognition among team members.[27] Additionally, EMT has been demonstrated to improve emotional regulation in the setting of errors,[16] and this type of training may be particularly crucial in high-stress fields such as medicine.[27] There is an excellent opportunity to integrate EMT into both individual and team-based training in the simulation environment for a wide array of healthcare providers and specialties. Both trainees and practicing clinicians could benefit from this training. Overall, EMT has great potential to change the culture of training and communication in healthcare, and more instructors should familiarize themselves with the theoretical underpinnings that support EMT-based curricula. [Level III]