Practice Makes Perfect: Behavioral Fluency as a Paradigm for Reducing Pediatric Prehospital Dosing Errors

Date of Award

5-2026

Degree Name

Doctor of Philosophy

Department

Psychology

First Advisor

Heather McGee, Ph.D.

Second Advisor

Ron Van Houten, Ph.D.

Third Advisor

Jessica Van Stratton, Ph.D., BCBA-D

Fourth Advisor

John Hoyle, M.D.

Keywords

Behavioral fluency, dosing errors, patient safety, pediatric prehospital, rate-building

Abstract

The Institute of Medicine (1999) documented widespread human errors in American hospitals, suggesting these errors resulted in significant patient harm and mortality. Subsequent research identified comparable error rates globally, and recent studies show that pediatric prehospital patients may be especially vulnerable to harm caused by error (Hoyle et al., 2019; Ramadanov et al., 2019; Rappaport et al., 2022). Investigations of pediatric prehospital errors suggest that emergency medical personnel face barriers such as cognitive overload, systematic or equipment obstructions, and limited practice and contact with pediatric patients (Hoyle et al., 2012; Hoyle et al., 2017; Lammers et al., 2012). In the applied behavioral sciences, behavioral fluency is a paradigm commonly referred to when defining the parameters indicative of expertise (Binder, 1996; Munson, 1998). Proponents of behavioral fluency assert that instruction targeting specific performance rates leads to rapid skill acquisition and enduring, error-free performance across novel and distracting conditions (Lindsley, 1995). The current study aimed to assess whether behavioral fluency approaches promote skill acquisition and error reduction among emergency medicine residents. While only a small number of participants demonstrated mastery by the end the intervention, results suggest that the practice package reduced overall error rates committed during clinical scenarios and improved epinephrine dosing skills across participants.

Access Setting

Dissertation-Abstract Only

Restricted to Campus until

5-1-2028

This document is currently not available here.

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