Teaching surgeons about non-technical skills.
ABSTRACT Analyses of adverse events in surgery reveal that underlying causes are often behavioural, such as communication failures, rather than technical. Non-technical (i.e. cognitive and interpersonal) skills, whilst recognised, are not explicitly addressed in surgical training. However, surgeons need to demonstrate high levels of these skills, as well as technical proficiency, to maximise safety and quality in the operating theatre. This article describes a prototype training course to raise surgeons' awareness of non-technical skills.
The course syllabus was based on a new taxonomy of surgeons' non-technical skills (NOTSS) which has four principal categories: situation awareness, decision-making, communication and teamwork, and leadership. Three, one-day training courses were attended by 21 surgeons.
All surgeons reported that they found explicit review and discussion of these skills and component behaviours helpful for self-reflection. They rated the content as interesting and relevant and the majority declared their intention to make some changes to their behaviour during surgery.
It was concluded that this type of training could enhance the surgical training portfolio and should be an integral feature of the development and assessment of operative skills.
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ABSTRACT: Many areas of acute care medicine have a low error tolerance and demand high levels of cognitive and technical performance. Growing evidence suggests that further improvements in patient outcomes depends on appre-ciating, measuring and improving system factors, in particular, effective team skills. In recent years, the relationship between surgical team behav-iour and patient outcome has been studied by a number of researchers. Teamwork concerns the communication and coordination processes that are required to bring together the individual knowledge, skills and atti-tudes in the service of a common and valued team goal. Individual surgical team members are highly specialized and have their own functional task-work (e.g., anaesthesia, nursing, surgery and perfusion), yet come together as a team towards the common goal of treating the patient. Interventions focusing on teamwork have shown a relationship with improved teamwork and safety climate. The 'working together' of a clinical microsystem is accomplished by a complex suite of 'nontechnical skills'. Teams that score low on independently observed non-technical skills make more technical errors and in cases where teams infrequently display team behaviours, patients are more likely to experience death or major complications. There is a signifi cant correlation between subjective assessment of teamwork by team members themselves and postoperative morbidity. Good teamwork (in terms of both quality and quantity) is associated with shorter duration of operations, fewer adverse events and lower postoperative morbidity.Pediatric and Congenital Cardiac Care: Safety and Improvement, 1st edited by J. Jacobs, S.E. Lipshultz, P. Laussen (Eds, Barach P, 01/2015: chapter Teams, Team Training, and the Role of Simulation: pages 69-90; Springer.
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ABSTRACT: Background Mental practice, the cognitive rehearsal of a task without physical movement, is known to enhance performance in sports and music. Investigation of this technique in surgery has been limited to basic operations. The purpose of this study was to develop mental practice scripts, and to assess their effect on advanced laparoscopic skills and surgeon stress levels in a crisis scenario.Methods Twenty senior surgical trainees were randomized to either conventional training or mental practice groups, the latter being trained by an expert performance psychologist. Participants' skills were assessed while performing a porcine laparoscopic jejunojejunostomy as part of a crisis scenario in a simulated operating room, using the Objective Structured Assessment of Technical Skill (OSATS) and bariatric OSATS (BOSATS) instruments. Objective and subjective stress parameters were measured, as well as non-technical skills using the Non-Technical Skills for Surgeons rating tool.ResultsAn improvement in OSATS (P = 0·003) and BOSATS (P = 0·003) scores was seen in the mental practice group compared with the conventional training group. Seven of ten trainees improved their technical performance during the crisis scenario, whereas four of the ten conventionally trained participants deteriorated. Mental imagery ability improved significantly following mental practice training (P = 0·011), but not in the conventional group (P = 0·083). No differences in objective or subjective stress levels or non-technical skills were evident.Conclusion Mental practice improves technical performance for advanced laparoscopic tasks in the simulated operating room, and allows trainees to maintain or improve their performance despite added stress.British Journal of Surgery 01/2015; 102(1). DOI:10.1002/bjs.9657 · 5.21 Impact Factor
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ABSTRACT: This article describes the method used to develop and test a checklist of behavioural markers designed to support UK military forces during Counter-Improvised Explosive Device (C-IED) training. IEDs represent a significant threat to UK and allied forces. Effective C-IED procedures and techniques are central to reducing risk to life in this safety critical role. Behavioural markers have been developed to characterise and assess non-technical skills which have been shown to be important in maintaining high performance in other safety critical domains.Applied Ergonomics 05/2015; 48. DOI:10.1016/j.apergo.2014.11.015 · 1.33 Impact Factor