Surgical Crisis Management Skills Training and Assessment: A Stimulation-Based Approach to Enhancing Operating Room Performance

Department of Surgical Oncology and Technology, Imperial College, London, UK.
Annals of Surgery (Impact Factor: 8.33). 08/2006; 244(1):139-47. DOI: 10.1097/01.sla.0000217618.30744.61
Source: PubMed


Intraoperative surgical crisis management is learned in an unstructured manner. In aviation, simulation training allows aircrews to coordinate and standardize recovery strategies. Our aim was to develop a surgical crisis simulation and evaluate its feasibility, realism, and validity of the measures used to assess performance.
Surgical trainees were exposed to a bleeding crisis in a simulated operating theater. Assessment of performance consisted of a trainee's technical ability to control the bleeding and of their team/human factors skills. This assessment was performed in a blinded manner by 2 surgeons and one human factors expert. Other measures consisted of time measures such as time to diagnose the bleeding (TD), inform team members (TT), achieve control (TC), and close the laceration (TL). Blood loss was used as a surrogate outcome measures.
There were considerable variations within both senior (n = 10) and junior (n = 10) trainees for technical and team skills. However, while the senior trainees scored higher than the juniors for technical skills (P = 0.001), there were no differences in human factors skills. There were also significant differences between the 2 groups for TD (P = 0.01), TC (P = 0.001), and TL (0.001). The blood loss was higher in the junior group.
We have described the development of a novel simulated setting for the training of crisis management skills and the variability in performance both in between and within the 2 groups.

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Available from: Charles A Vincent, Dec 24, 2013
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    • "Performance compared at individual level between junior, intermediate and senior trainees on non-technical skills Construct validity for leadership training; no construct validity for SA training at individual level Moorthy et al. 28 (2006) "
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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.
    Full-text · Article · Jan 2015 · British Journal of Surgery
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    • "Other innovations aimed at preparing trainees to perform necessary procedural skills are based in the simulation lab. Studies using simulation devices to train physicians in bedside procedures such as central venous line insertion and thoracentesis, crisis resource management, as well as laparascopic and endoscopic skills are well established in the literature [13-20]. Assessment tools to measure proficiency in procedural skills have been created relying on methods such as the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) and the Imperial College Surgical Assessment Device (ICSAD) [21,22]. "
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    ABSTRACT: Background Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. Little is known about resident experiences of acquiring procedural skills proficiency, of practicing these techniques, or of being assessed on their proficiency. The purpose of this study was to qualitatively investigate resident 1) experiences of the acquisition of procedural skills and 2) perceptions of procedural skills assessment methods available to them. Methods Focus groups were conducted in the weeks following an assessment of procedural skills incorporated into an objective structured clinical examination (OSCE). Using fundamental qualitative description, emergent themes were identified and analyzed. Results Residents perceived procedural skills assessment on the OSCE as a useful formative tool for direct observation and immediate feedback. This positive reaction was regularly expressed in conjunction with a frustration with available assessment systems. Participants reported that proficiency was acquired through resident directed learning with no formal mechanism to ensure acquisition or maintenance of skills. Conclusions The acquisition and assessment of procedural skills in Internal Medicine programs should move toward a more structured system of teaching, deliberate practice and objective assessment. We propose that directed, self-guided learning might meet these needs.
    Full-text · Article · May 2013 · BMC Medical Education
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    • "Im Simulationszentrum oder im Skillslab lässt sich die VR-Laparoskopie zum Training von Operationsteams einsetzen. [30] [31] [32] Technische Ergebnisse können dann zusammen mit der Teamleistung beurteilt werden. Zusätzliche Informationen zu sogenannten " soft skills " (Stressbewältigung, Krisenmanagement) können dokumentiert und archiviert werden, um anschließend für eine gemeinsame Auswertung (debriefing) in der Trainingsgruppe benutzt zu werden (Video C). "
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