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Cognition, Technology & Work. 01/2008; 10:265-274.
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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.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 05/2007; 5(2):86-9. · 1.41 Impact Factor
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ABSTRACT: Analyses of adverse events in surgery reveal that many underlying causes are behavioural, such as communication failure, rather than technical. Non-technical (i.e. cognitive and interpersonal) skills are not addressed explicitly in surgical training. However, surgeons need to demonstrate these skills, which underpin their technical excellence, to maximise patient safety in the operating theatre. This paper describes the method used to identify surgeons' non-technical skills, and the development of a skills taxonomy and behavioural rating system to structure observation and feedback in surgical training.
Cognitive task analyses (critical incident interviews) were conducted with 27 consultant surgeons in general, cardiac and orthopaedic surgery. The interviews were coded and a multidisciplinary group of surgeons and psychologists used an iterative process to develop a skills taxonomy. This was supported by data gathered from an attitude survey, literature review, analysis of surgical mortality reports and observations in theatre.
Five categories of non-technical skills were identified, including situation awareness, decision making, task management, leadership and communication and teamwork. This provided a structure for a prototype skill taxonomy (v1.1), which comprised 14 non-technical skill elements. Observable behaviours (markers) indicative of good and poor performance were developed for each element by 16 consultant surgeons to form a prototype behaviour rating system.
The prototype skills taxonomy and behaviour rating system are grounded empirically in surgery. The reliability of the system is currently being tested using standardised scenarios. If this evaluation proves successful, the system could be used to structure feedback and guide non-technical skills training.
Medical Education 12/2006; 40(11):1098-104. · 3.18 Impact Factor
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ABSTRACT: A survey was undertaken to assess surgical team members' attitudes to safety and teamwork in the operating theatre.
The Operating Room Management Attitudes Questionnaire (ORMAQ) measures attitudes to leadership, teamwork, stress and fatigue and error. A version of the ORMAQ was distributed to surgical teams in 17 hospitals in Scotland. A total of 352 responses were analysed, 138 from consultant surgeons, 93 from trainee surgeons and 121 from theatre nurses.
Respondents generally demonstrated positive attitudes to behaviours associated with effective teamwork and safety. Attitudes indicating a belief in personal invulnerability to stress and fatigue were evident in both nurses and surgeons. Consultant surgeons had more positive views on the quality of surgical leadership and communication in theatre than trainees and theatre nurses. While the ubiquity of human error was well recognised, attitudes to error management strategies (incident reporting, procedural compliance) suggest that they may not be fully functioning across hospitals. While theatre staff placed a clear priority on patient safety against other business objectives (e.g. waiting lists, cost cutting), not all of them felt that this was endorsed by their hospital management.
Attitude surveys can provide useful diagnostic information relating to behaviour and safety in surgical units. Discrepancies were found between the views of consultants compared with trainees and nurses, in relation to leadership and teamwork. While attitudes to safety were generally positive, there were several areas where theatre staff did not seem to appreciate the impact of psychological factors on technical performance.
The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 07/2006; 4(3):145-51. · 1.41 Impact Factor
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ABSTRACT: This review examines the surgical and psychological literature on surgeons' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons' non-technical skills.
A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect.
A number of "core" categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons.
Further work is required to develop a valid taxonomy of individual surgeons' non-technical skills for training and feedback.
Surgery 03/2006; 139(2):140-9. · 3.10 Impact Factor
