Multidisciplinary Crisis Simulations: The Way Forward for Training Surgical Teams

Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, London, United Kingdom.
World Journal of Surgery (Impact Factor: 2.64). 10/2007; 31(9):1843-53. DOI: 10.1007/s00268-007-9128-x
Source: PubMed


High-reliability organizations have stressed the importance of non-technical skills for safety and of regularly providing such training to their teams. Recently safety skills training has been applied in the practice of medicine. In this study, we developed and piloted a module using multidisciplinary crisis scenarios in a simulated operating theatre to train entire surgical teams.
Twenty teams participated (n = 80); each consisted of a trainee surgeon, anesthetist, operating department practitioner (ODP), and scrub nurse. Crisis scenarios such as difficult intubation, hemorrhage, or cardiac arrest were simulated. Technical and non-technical skills (leadership, communication, team skills, decision making, and vigilance), were assessed by clinical experts and by two psychologists using relevant technical and human factors rating scales. Participants received technical and non-technical feedback, and the whole team received feedback on teamwork.
Trainees assessed the training favorably. For technical skills there were no differences between surgical trainees' assessment scores and the assessment scores of the trainers. However, nurses overrated their technical skill. Regarding non-technical skills, leadership and decision making were scored lower than the other three non-technical skills (communication, team skills, and vigilance). Surgeons scored lower than nurses on communication and teamwork skills. Surgeons and anesthetists scored lower than nurses on leadership.
Multidisciplinary simulation-based team training is feasible and well received by surgical teams. Non-technical skills can be assessed alongside technical skills, and differences in performance indicate where there is a need for further training. Future work should focus on developing team performance measures for training and on the development and evaluation of systematic training for technical and non-technical skills to enhance team performance and safety in surgery.

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    • "NOTSS identifies ''behaviour markers'' by breaking down competencies into 3–4 component behaviours and providing examples of ''good'' or ''poor'' nontechnical performances of these (Flin, Yule, Paterson-Brown, Rowley, & Maran, 2006). Of the non-technical competencies defined by RACS, four in particular (communicator, collaborator, manager-leader and scholar-teacher) encompass interpersonal skills, cognizant that surgeons' professional environment lies within a complex healthcare system comprised of multiple players (Undre et al., 2007). Such competencies, put forward by ''silo-based'' uniprofessional training programmes, aid in defining surgeons' role identities within the OT (Kitto, Gruen, & Smith, 2009), where surgeons are branded as having cognitive expertise equipping them in the areas of ''focus, problem solving, commitments to standards and leadership'' (Gruen et al., 2003, p. 607). "

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    • "Performance compared between experienced and inexperienced trainees on non-technical skills at individual level Construct validity for SA training at individual level Powers et al. 30 (2009) 12 surgeons Surgical crisis training for MIS surgeons in HF simulator Prospective cohort study. Performance compared between experienced and 'seasoned' surgeons on non-technical skills at individual level Inadequate design for conclusions on validity for SA training at individual level Undre et al. 31 (2007) 17 surgeons, 17 anaesthetists, 13 ODPs, 18 nurses "
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    ABSTRACT: Background Surgical errors result from faulty decision-making, misperceptions and the application of suboptimal problem-solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim of this review was to assess the validity of methods for improving situational awareness in the surgical theatre.MethodsA search was conducted in PubMed, Embase, the Cochrane Library and PsycINFO® using predefined inclusion criteria, up to June 2014. All study types were considered eligible. The primary endpoint was validity for improving situational awareness in the surgical theatre at individual or team level.ResultsNine articles were considered eligible. These evaluated surgical team crisis training in simulated environments for minimally invasive surgery (4) and open surgery (3), and training courses focused at training non-technical skills (2). Two studies showed that simulation-based surgical team crisis training has construct validity for assessing situational awareness in surgical trainees in minimally invasive surgery. None of the studies showed effectiveness of surgical crisis training on situational awareness in open surgery, whereas one showed face validity of a 2-day non-technical skills training course.Conclusion To improve safety in the operating theatre, more attention to situational awareness is needed in surgical training. Few structured curricula have been developed and validation research remains limited. Strategies to improve situational awareness can be adopted from other industries.
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    • "Members of these worlds differ in their perceptions of the same task. Indeed, some studies show strong disagreement and even aggression between professional groups (Undre et al. 2007, Coe & Gould 2008). "
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    ABSTRACT: AimsTo investigate the extent of variability in individuals' and multidisciplinary groups' decisions about the most appropriate setting in which to support people with dementia in different European countries.Background Professionals' views of appropriate care depend on care systems, cultural background and professional discipline. It is not known to what extent decisions made by individual experts and multidisciplinary groups coincide.DesignA modified nominal group approach was employed in eight countries (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the UK) as part of the RightTimePlaceCare Project.Methods Detailed vignettes about 14 typical case types of people with dementia were presented to experts in dementia care (n = 161) during November and December 2012. First, experts recorded their personal judgements about the most appropriate settings (home care, assisted living, care home, nursing home) in which to support each of the depicted individuals. Second, participants worked in small groups to reach joint decisions for the same vignettes.ResultsConsiderable variation was seen in individuals' recommendations for more than half the case types. Cognitive impairment, functional dependency, living situation and caregiver burden did not differentiate between case types generating high and low degrees of consensus. Group-based decisions were more consistent, but country-specific patterns remained.ConclusionsA multidisciplinary approach would standardize the decisions made about the care needed by people with dementia on the cusp of care home admission. The results suggest that certain individuals could be appropriately diverted from care home entry if suitable community services were available.
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