Journal of Surgical Simulation 2017; 4: 52 - 56

Published: 29 December 2017


Original article

Simulation as an adjunct to didactics to increase acquired knowledge retention of learning how to avoid a "never event" of unintended retained foreign objects: 6-month and 1-year follow-up study

Roberto Rivero-Soto, Bogdan Ionescu, Duane Patterson, Rodney Grim, Ted Bell and Vanita Ahuja
Corresponding author: Vanita Ahuja, Department of Surgery, Sinai Hospital, Baltimore, MD, USA. Email:


Purpose: Previous research has identified multiple risk factors implicated in unintended retained foreign objects (URFOs), which were incorporated into our community hospital's URFO policy. The purpose of this quality improvement study was to use simulation along with didactics to improve retention of learned knowledge and implementation of the policy changes.

Methods: An initial didactic session was performed followed by a survey at 3 months. Results indicated the need for improvement in retention of learned information. In addition to didactics, a multidisciplinary simulation curriculum with scenarios susceptible to URFO of an emergency operation was performed followed by debriefing. A survey was performed at 6 months and 1 year to measure follow-up retention of acquired knowledge.

Results: Survey results showed that knowledge retention improved significantly, with 96.7% correct identification of URFOs as a sentinel event and 100% choosing crew resource management as an important strategy in preventing URFOs. Furthermore, at 6 months, 93.5% indicated that “finding the individual responsible for the mistake” was not the goal, and 91.9% correctly identified the primary root cause analysis for this scenario was failure of appropriate “system design.”

Conclusions: Simulation provides the opportunity to learn the concept of root cause analysis and identification of factors that lead to URFOs. Simulation as an adjunct to didactics can help increase retention of patient safety policies.



root cause analysis; retained object; simulation; didactic; debrief

Additional Information

This paper was presented at the 31st Society for Surgery of the Alimentary Tract Resident and Fellows Research Conference on 21 May 2016 and at Digestive Diseases Week 2016 Plenary Session on Small Bowel and Colorectal I on 23 May 2016.