Flin, R. et al. Teaching surgeons about non-technical skills. Surgeon 5, 86-89
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.
Available from: Maurits Graafland
- "Prospective cohort study. Non-technical skills of junior and senior urology residents compared during simulated laparoscopic partial nephrectomy (at individual level) Construct validity for training SA at individual level Flin et al. 24 (2007) Surgeons (21 licensed surgeons) Non-technical skills course for surgeons (lectures, videos), including SA Cross-sectional survey. Course evaluation on attitudes, relevance and usefulness Face validity for improving non-technical skills (including SA) at individual level Gettman et al. 25 (2009) "
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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.
Available from: Sindre Høyland
- "We suggest that one approach is to gather all operating room staff at the particular section/department at regular weekly or monthly meetings, where experiences on combining knowledge in the operating room can be discussed and reflected upon in plenum, to benefit the overall section/department and thus also the surgical teams. We believe such an approach could create a bridge to overcome the difficulty surgeons have of appreciating the value of interpersonal skills in patient safety [38,39], i.e. in this paper the sharing/communication of insights across disciplines on how to combine different types of knowledge in surgery. "
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Within existing research in health and medicine, the nature of knowledge on how teams conduct safe work practices has yet to be properly explored.
We address this concern by exploring the varieties in which knowledge is expressed during interdisciplinary surgical operations. Specifically, the study was conducted in a surgical section of a Norwegian regional general hospital, between January and April of 2010, by means of an ethnographic design combining detailed non-participant observations, conversations and semi-structured interviews.
Based on an analysis of the gathered data, we identify three particular themes in how knowledge is expressed by operating room personnel: (i) the ability and variety individuals demonstrate in handling multiple sources of information, before reaching a particular decision, (ii) the variety of ways awareness or anticipation of future events is expressed, and (iii) the different ways sudden and unexpected situations are handled by the individual team members.
We conclude that these facets of knowledge bring different insights into how safe work practices are achieved at an individual and team level in surgical operations, thus adding to the existing understanding of the nature of knowledge in safe work practices in surgical operations. Future research should focus on exploring and documenting the relationships between various elements of knowledge and safe work practices, in different surgical settings and countries.
Available from: Luca Pietrantoni
- "Questi studi hanno permesso di identificare le competenze non tecniche dalla letteratura chirurgica e psicologica, cercando di stabilire se ci fosse una tassonomia valida e affidabile e un sistema di marcatori comportamentali associati per la valutazione delle competenze non tecniche. In particolare, le competenze non tecniche dei chirurghi sono definite come gli " aspetti comportamentali della performance nella sala operatoria che si basano su expertise medica, uso di attrezzature e di farmaci " (Flin et al., 2007). Le prove raccolte dimostrano la necessità di porre l'attenzione alle competenze relazionali, sociali, cognitive che vanno di pari passo con l'expertise tecnica, ma pochi studi hanno tentato di scomporre le principali categorie di base (ad esempio la capacità di prendere decisioni) nei loro elementi comporta- mentali. "
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ABSTRACT: Riassunto L'errore umano costituisce un problema significativo in ambito chirurgico che comporta tassi di morbilità, mortalità e costi sociali evitabili. In letteratu-ra, le evidenze empiriche mostrano che le competenze non tecniche dei chi-rurghi si rivelano particolarmente importante per incrementare la prestazio-ne e la sicurezza del paziente. Le competenze non tecniche rappresentano tut-te quelle abilità a livello cognitivo e interpersonale che sostengono e rinfor-zano le competenze cliniche e costituiscono un requisito per la professiona-lità del chirurgo. Lo scopo di questo articolo è quello di passare in rassegna le evidenze empiriche riguardanti la sicurezza del paziente in ambito chirurgi-co e di introdurre il sistema NOTSS (Non-Technical Skills for Surgeons), un sistema di marcatori comportamentali. Tale sistema, realizzato tramite un'at-tenta task analisi con esperti del settore, comprende quattro categorie di com-petenze rilevanti ai fini della sicurezza in ambito chirurgico: Situation Awa-reness, Decision Making, Comunicazione & Teamwork, e Leadership. Gli stu-di di valutazione indicano che le competenze incluse nel sistema sono esau-stive, osservabili e che possono essere oggetto di valutazione con un buon gra-do di accordo fra valutatori. Il sistema NOTSS può essere usato per osservare, valutare e offrire feedback ai comportamenti messi in atto dai chirurghi in sa-la operatoria allo scopo di aumentarne la prestazione e la sicurezza. Abstract (Non-Technical Skills for Surgeons: the NOTSS system) Humar error represents a significant problem in surgery that results in pre-ventable morbidity, mortality, and costs of care. There is growing evidence that surgeons' intraoperative non-technical skills are related to surgical out-comes and patient safety. Non-technical skills are cognitive and interper-sonal skills which underpin clinical and technical skills and are require-ments for a competent surgeon. The aim of this article is to review the ev-idences concerning patient safety in surgery and to introduce the proto-type NOTSS (Non-Technical Skills for Surgeons), a behavior rating system for surgeons. Based on cognitive task analysis with subject matter experts, this system incorporates four categories of skills for safe surgical practice: Situation Awareness, Decision Making, Communication & Teamwork, and Leadership. Evaluation studies indicate that the system is complete, the skills are observable, and can be rated with approaching acceptable levels of agreement. The NOTSS system may be used to observe, rate and provide feedback on surgeons' behaviors in the operating theatre to increment pa-tient safety.
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