'Sorry I meant the patient's left side': impact of distraction on right/left discrimination

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    Context Medical students can have difficulty in distinguishing left from right. Many infamous medical errors have occurred when a procedure has been performed on the wrong side, such as in the removal of the wrong kidney. Clinicians encounter many distractions during their work. There is limited information on how these affect performance. 
    Objectives Using a neuropsychological paradigm, we aim to elucidate the impacts of different types of distraction on left–right (LR) discrimination ability. 
    Methods Medical students were recruited to a study with four arms: (i) control arm (no distraction); (ii) auditory distraction arm (continuous ambient ward noise); (iii) cognitive distraction arm (interruptions with clinical cognitive tasks), and (iv) auditory and cognitive distraction arm. Participants’ LR discrimination ability was measured using the validated Bergen Left–Right Discrimination Test (BLRDT). Multivariate analysis of variance was used to analyse the impacts of the different forms of distraction on participants’ performance on the BLRDT. Additional analyses looked at effects of demographics on performance and correlated participants’ self-perceived LR discrimination ability and their actual performance. 
    Results A total of 234 students were recruited. Cognitive distraction had a greater negative impact on BLRDT performance than auditory distraction. Combined auditory and cognitive distraction had a negative impact on performance, but only in the most difficult LR task was this negative impact found to be significantly greater than that of cognitive distraction alone. There was a significant medium-sized correlation between perceived LR discrimination ability and actual overall BLRDT performance. 
    Distraction has a significant impact on performance and multifaceted approaches are required to reduce LR errors. Educationally, greater emphasis on the linking of theory and clinical application is required to support patient safety and human factor training in medical school curricula. Distraction has the potential to impair an individual's ability to make accurate LR decisions and students should be trained from undergraduate level to be mindful of this.


    • 'Sorry I meant the patient's left side': impact of distraction on right/left discrimination

      Rights statement: © 2015 John Wiley & Sons Ltd This is the accepted version of the following article: 'Sorry I meant the patient's left side': impact of distraction on right/left discrimination, Medical Education 2015: 49: 427–435 doi: 10.1111/medu.12658, which has been published in final form at http://dx.doi.org/10.1111/medu.12658

      Accepted author manuscript, 267 KB, PDF-document


    Original languageEnglish
    Number of pages9
    Pages (from-to)427-435
    JournalMedical Education
    Journal publication dateApr 2015
    Issue number4
    Early online date20 Mar 2015
    Publication statusPublished - Apr 2015

    ID: 13020531