{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:18:27Z","timestamp":1788153507628,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cognit."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The accurate distinction between left and right is a critical cognitive function. A failure to correctly distinguish left and right during surgery can lead to a so-called Never Event, a preventable medical error that leads to death or severe injury of the patient. Unfortunately, such wrong-site surgeries still happen every year. Thus, understanding left-right confusion during surgery is critical for patient safety. However, current Left-Right Confusion (LRC) tests have low ecological validity for the complex, time-critical demands of a surgical environment. This study introduces the Never Events in Surgery Test (NEST), a novel, ecologically valid behavioural paradigm designed to simulate the cognitive dynamics during surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants (\n                      <jats:italic>N<\/jats:italic>\n                      = 108) completed the NEST alongside established LRC tasks: the Bergen Left-Right Discrimination Task (BLRDT), the Left-Right Commands Task (LRCT), and the Left-Right Questionnaire (LRQ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      NEST performance was significantly modulated by the posture of the training doll. Error rates were lowest in the prone position compared to lateral orientations (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05), while the supine position resulted in the shortest reaction times, significantly outperforming both prone and lateral positions (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) without a significant increase in error rates. Crucially, the study established a cognitive dissociation: while reaction times across tasks were correlated, reflecting a shared component of general processing speed, the error rates from the established LRC measures (BLRDT, LRCT, LRQ) failed to predict the error rate observed in the applied NEST paradigm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The lack of predictive power for errors suggests that LRC susceptibility in applied contexts is an independent, context-specific risk factor for laterality errors not captured by traditional assessments. The findings argue for a paradigm shift in training and screening toward tailored, context-specific approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcogn.2026.1802120","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:28:31Z","timestamp":1788150511000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding never events: developing an ecologically valid behavioral test for left-right confusion during surgery"],"prefix":"10.3389","volume":"5","author":[{"given":"Moritz","family":"Thaler","sequence":"first","affiliation":[{"name":"Department of Psychology, MSH Medical School Hamburg","place":["Hamburg, Germany"]},{"name":"Institute for Safety of Patients and Health Professionals (ISPP), MSH Medical School Hamburg","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Parschau","sequence":"additional","affiliation":[{"name":"Department of Psychology, MSH Medical School Hamburg","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janne","family":"Carstensen","sequence":"additional","affiliation":[{"name":"Department of Psychology, MSH Medical School Hamburg","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz","family":"M\u00fchlig","sequence":"additional","affiliation":[{"name":"Department of Psychology, MSH Medical School Hamburg","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Kirner","sequence":"additional","affiliation":[{"name":"Department of Psychology, MSH Medical School Hamburg","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00fcmeyra","family":"Altunkaynak","sequence":"additional","affiliation":[{"name":"Department of Psychology, MSH Medical School Hamburg","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"K\u00e4ndler","sequence":"additional","affiliation":[{"name":"Department of Psychology, MSH Medical School Hamburg","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Petzina","sequence":"additional","affiliation":[{"name":"Institute for Safety of Patients and Health Professionals (ISPP), MSH Medical School Hamburg","place":["Hamburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Ocklenburg","sequence":"additional","affiliation":[{"name":"Department of Psychology, MSH Medical School Hamburg","place":["Hamburg, Germany"]},{"name":"Institute for Safety of Patients and Health Professionals (ISPP), MSH Medical School Hamburg","place":["Hamburg, Germany"]},{"name":"Institute of Cognitive Neuroscience, Biopsychology, Faculty of Psychology, Ruhr University Bochum","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1016\/S0031-3955(16)32174-5","article-title":"Right-left discrimination","volume":"15","author":"Benton","year":"1968","journal-title":"Pediatr. 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