G G Youngson

NHS Grampian, Aberdeen, Scotland, United Kingdom

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Publications (83)171.96 Total impact

  • George G. Youngson
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    ABSTRACT: Technical competence is an essential aspect of intraoperative performance but is in itself insufficient to ensure an optimal surgical outcome. A list of other skills complement technical ability and these relate, among others, to surgical judgment and intraoperative decision-making processes as well as the role of the operating surgeon as leader of the surgical team. This article outlines the composite set of nontechnical skills (NTS) and the factors which influence surgical performance by virtue of this skill set. A framework has been developed to allow identification, teaching, and assessment of NTS known as Nontechnical Skills for Surgeons (NOTSS), and the relevance and influence of NOTSS during the intraoperative performance of pediatric surgery is presented.
    No preview · Article · Nov 2015 · Journal of Pediatric Surgery
  • George G Youngson
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    ABSTRACT: The provision of clinical care in the United Kingdom now requires the acquisition of a licence to practise from the regulatory authority. A review process-revalidation has been put in place to ensure that standards of care are maintained by the medical workforce, and that all doctors remain up-to-date and fit for purpose so that this licence can be retained. This article outlines how this new statutory requirement pertains to paediatric surgery and highlights those areas where adjudication of competence remains imprecise and where progress in this process of revalidation needs to be made.
    No preview · Article · Feb 2014 · Journal of Pediatric Surgery
  • George G Youngson
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    ABSTRACT: Whilst the steps for reacting to and communicating following a surgical error should be clear to all, actual practice is punctuated by a range of failures which lead to the harm done by the error being compounded by inadequacies in the disclosure and subsequent processes. This article outlines best practice at the current time within the United Kingdom when responding to a surgical error and it also reports the type of behaviours which result in poor levels of satisfaction from the patients' perspective - often resulting in litigation being invoked.
    No preview · Article · Dec 2013 · The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
  • L.A. McIntosh · D Scrimgeour · G G Youngson · C P Driver
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    ABSTRACT: Objective: To review the primary orchidopexy failure rate and outcome of repeat orchidopexy in a tertiary paediatric surgical centre and identify risk factors. Methods: A prospectively collected and validated audits system was used to identify all boys having a repeat orchidopexy from August 1990 to December 2008 (18 years). Results: In total, 1538 boys underwent orchidopexy with 1886 testicles operated on. Of these 348 (22.6%) patients had bilateral cryptorchidism. A need for repeat orchidopexy was identified in 31 boys resulting in a primary failure rate of 1.6% over the 18 years. Unilateral orchidopexy as the primary operation had a 1.5% failure rate. The failure rate for bilateral cryptorchidism was 1.87% per testicle rising to 1.93% per testicle when the primary operation was synchronous bilateral orchidopexy. Orchidopexy failure occurred in 9 patients (1.97%) who were under 24 months, 15 (2.67%) who were between 24 and 72 months and 7 (0.8%) over 72 months at time of first operation. Conclusion: Possible risk factors for primary orchidopexy failure are bilateral operation and older age at time of operation. Failure in achieving a satisfactory scrotal position (and testicular loss) following orchidopexy has been postulated as a potential surgical standard for revalidation of paediatric surgeons. This study adds important contemporary data to inform that process.
    No preview · Article · Sep 2012 · Journal of pediatric urology
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    ABSTRACT: Rationale, aims and objectives  Adverse events still occur despite ongoing efforts to reduce harm to patients. Contributory factors to adverse events are often due to limitations in clinicians' non-technical skills (e.g. communication, situation awareness), rather than deficiencies in technical competence. We developed a behavioural rating system to provide a structured means for teaching and assessing scrub practitioners' (i.e. nurse, technician, operating department practitioner) non-technical skills. Method  Psychologists facilitated focus groups (n = 4) with experienced scrub practitioners (n = 16; 4 in each group) to develop a preliminary taxonomy. Focus groups reviewed lists of non-technical-skill-related behaviours that were extracted from an interview study. The focus groups labelled skill categories and elements and also provided examples of good and poor behaviours for those skills. An expert panel (n = 2 psychologists; n = 1 expert nurse) then used an iterative process to individually and collaboratively review and refine those data to produce a prototype skills taxonomy. Results  A preliminary taxonomy containing eight non-technical skill categories with 28 underlying elements was produced. The expert panel reduced this to three categories (situation awareness, communication and teamwork, task management), each with three underlying elements. The system was called the Scrub Practitioners' List of Intraoperative Non-Technical Skills system. A scoring system and a user handbook were also developed. Conclusion  A prototype behavioural rating system for scrub practitioners' non-technical skills was developed, to aid in teaching and providing formative assessment. This important aspect of performance is not currently explicitly addressed in any educational route to qualify as a scrub practitioner.
    No preview · Article · Apr 2012 · Journal of Evaluation in Clinical Practice
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    ABSTRACT: The Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) system is a new tool for training and assessing scrub practitioner (nurse, technician) behaviours during surgical operations. The aim of the study was to test the psychometric properties including inter-rater reliability of the prototype SPLINTS behavioural rating system. Experienced scrub practitioners (n=34) attended a one-day session where they received background training in human factors and non-technical skills and were also trained to use the SPLINTS system. They then used SPLINTS to rate the scrub practitioners' non-technical skill performance in seven standardized simulated, surgical scenarios. Reliability, measured by within-group agreement (r(wg)) for the three skill categories and six out of nine elements, was acceptable (r(wg)>0.7). Participants were within one scale point of expert ratings in >90% of skill categories and elements, and could use SPLINTS to score performance with a reasonable level of accuracy. There was good internal consistency of the system: absolute mean difference was M<0.2 of a scale point for all three categories. Participants were surveyed and they indicated that the system was complete and usable as an assessment tool. The reliability of the SPLINTS system was deemed to be adequate for assessing scrub practitioners' non-technical skills in simulated, standardized, video scenarios. On the basis of these results, the system can now move on to usability testing in the real operating theatre.
    No preview · Article · Feb 2012 · International journal of nursing studies
  • George G Youngson
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    ABSTRACT: The terms human factors and non-technical skills have recently been introduced to the language of surgical education. Both tend to be used interchangeably and yet each has a specific definition. More importantly, however, is the fact that the attributes and qualities contained within these headings relate to behaviours, attitudes and cognitive skills. They are recognised as crucially important in the practice of surgery, but are often poorly articulated during surgical performance, during training, during any assessment process and, indeed, seldom measured with reference to any metric in any of these activities. Most research in this area addresses non-technical skills in the operating theatre and it remains to be seen whether the same attributes and skills are used outwith theatre, particularly in the ward setting. However, the contribution that these aspects of performance make to a safe and successful outcome following surgery is being increasingly appreciated and there is increasing recognition of the need to train and assess.
    No preview · Article · Dec 2011 · The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
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    ABSTRACT: Background: The Scrub Practitioners’ List of Intraoperative NonTechnical Skills (SPLINTS) system is a new tool for training and assessing scrub practitioner behaviours during surgical operations. Method: Experienced scrub practitioners (n = 34) attended a single day session where they received background training in human factors and nontechnical skills and were trained to use the SPLINTS system. They then rated the scrub practitioners’ nontechnical skill performance in seven videorecorded simulated scenarios and completed a posttraining questionnaire. Results: Withingroup agreement for all three skill categories, and for six of the nine elements, was acceptable (r wg>.70). Participants could use SPLINTS to accurately score performance compared with expert ratings and were within one scale point of expert ratings in > 90% of skill categories and elements. There was good internal consistency between elements and their categories (M<.2 of a scale point) and participants reported that the system was complete. Conclusion: The SPLINTS system was deemed adequately reliable, for rating scrub practitioners’ nontechnical skills, using standardized filmed scenarios. Usability of the SPLINTS system in the real operating theatre environment is still to be assessed.
    No preview · Article · Sep 2011
  • Keryn Pauley · Rhona Flin · Steven Yule · George Youngson
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    ABSTRACT: Surgical research on decision making and risk management usually focuses on perioperative care, despite the magnitude and frequency of intraoperative risks. The aim of this study was to examine surgeons' intraoperative decisions and risk management strategies to explore differences in cognitive processes. Critical decision method interviews were conducted with 24 consultant surgeons who recalled cases and selected important decisions during the operations. These decision were then discussed in detail in relation to decision-making style and risk management. The key decision in each case was made using either a rapid, intuitive mode (46%) or a more deliberate comparison of alternative courses of action (50%). Decision strategy was not related to surgical approach (endoscopic vs open), context (elective vs emergency), perceived time pressure, or situational threats. Risk management involved perceiving threats and assessing impact but also indicated the role of personal risk tolerance. Surgeons described making key intraoperative decisions using either an intuitive or an analytic mode of thinking. Surgeons' risk assessment, risk tolerance, and decision strategies appear to be influenced by their personalities.
    No preview · Article · Apr 2011 · American journal of surgery
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    ABSTRACT: Efforts to reduce adverse event rates in healthcare have revealed the importance of identifying the essential non-technical (cognitive and social) skills for safe and effective performance. Previous research on non-technical skills for operating theatre staff has concentrated on doctors rather than nursing professionals. The aim of the study was to identify the critical non-technical skills that are essential for safe and effective performance as an operating theatre scrub nurse. Experienced scrub nurses (n = 25) and consultant surgeons (n = 9) from four Scottish hospitals were interviewed using a semi-structured format. The protocols were designed to identify the main social and cognitive skills required by scrub nurses. Interviews were digitally recorded, transcribed verbatim and independently coded to extract behaviours in order to produce a list of the main non-technical skills for safe and effective scrub nurse performance. The non-technical skills of situation awareness, communication, teamwork, task management and coping with stress were identified as key to successful scrub nurse task performance. Component sets of behaviours for each of these categories were also noted. The interviews with subject matter experts from scrub nursing and surgery produced preliminary evidence that situation awareness, communication, teamwork and coping with stress are the principal non-technical skills required for effective performance as a scrub nurse.
    Full-text · Article · Dec 2010 · International journal of nursing studies
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    ABSTRACT: Efforts to reduce adverse event rates in healthcare have revealed the importance of identifying the essential non-technical (cognitive and social) skills for safe and effective performance and developing tools for rating and training those skills. The focus of studies to date has been surgeons, anaesthetists, or the whole team, with less attention paid to other professionals. The aim of the study was to develop a behavioural rating system for non-technical skills of the scrub practitioner (nurse/technician). This paper reports an interview study, as part of a task analysis, to identify the critical non-technical skills for this role, and the development of a prototype behavioural rating system. Experienced scrub practitioners (n = 25) and consultant surgeons (n = 9), from four Scottish teaching hospitals, were interviewed using a semi-structured design. Data that described generic non-technical skills were extracted from the interview transcripts and thereafter, psychologists and panels of perioperative practitioners (n = 4) used an iterative process to develop a skills taxonomy. Three categories of non-technical skills were identified as critical for safe and effective scrub practitioner performance. These were; situation awareness, communication and teamwork, task management. Three underlying skill elements for each of the three categories were labeled by the expert panels and they provided examples of good and poor behaviours for each of these skill elements, drawing on their domain knowledge. The reliability and psychometric properties of the prototype skills taxonomy and behaviour rating system are currently being tested using standardized, simulated scenarios. Copyright 2010 by Human Factors and Ergonomics Society. Inc. All rights reserved.
    No preview · Article · Sep 2010 · Human Factors and Ergonomics Society Annual Meeting Proceedings
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    George G Youngson · Rhona Flin
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    ABSTRACT: The performance of operative surgery has an understandable focus placed on dexterity, technical precision, as well as the choice of procedure. There is less appreciation of the cognitive and social skills of the individual surgeon and the effect that these have on the surgical team and on patient outcome. This article highlights that impact and explores the contribution of non-technical skills to safe practice within the operating room.
    Preview · Article · Mar 2010 · Patient Safety in Surgery
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    ABSTRACT: The editorial titled "For the Protection of the Public and the Good of the Specialty: Maintenance of Certification" (published in the February 2009 issue of the Archives of Surgery) has prompted us to offer the following article to inform the debate about how assessing surgical care and sorting out the variables to be included in maintenance of certification may develop worldwide. The proposals for revalidation of UK physicians involve the relicensing of all physicians and recertification of all specialists on the specialist register of the General Medical Council. The process will be on a 5-year cycle and is currently under development by the General Medical Council. The Royal Colleges have been charged with creating the standards for recertification, and the responsibility will fall on the Royal Colleges to support their fellows and members as the new regulation is introduced and as it develops. This article outlines developments so far, with particular reference to surgeons.
    No preview · Article · Jan 2010 · Archives of surgery (Chicago, Ill.: 1960)
  • Lynne Anne Holmes · George G Youngson
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    ABSTRACT: The optimal operative management of babies with necrotizing enterocolitis (NEC) remains uncertain. We report the case of a premature neonate with advanced NEC where areas of necrotic small bowel were successfully managed by intussusception into adjacent distal intestine and we discuss the merits of therapeutic intussusception as an option in the surgical management of advanced NEC.
    No preview · Article · Dec 2009 · Pediatric Surgery International
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    ABSTRACT: There is growing evidence that non-technical skills (NTS) are related to surgical outcomes and patient safety. The aim of this study was to further evaluate a behaviour rating system (NOTSS: Non-Technical Skills for Surgeons) which can be used for workplace assessment of the cognitive and social skills which are essential components of NTS. A novice group composed of consultant surgeons (n = 44) from five Scottish hospitals attended one of six experimental sessions and were trained to use the NOTSS system. They then used NOTSS to rate surgeons' behaviors in six simulated scenarios filmed in the operating room. The behaviours demonstrated in each scenario were compared to expert ratings to determine accuracy. The mode rating from the novice group (who received a short training session in behaviour assessment) was the same as the expert group in 50% of ratings. Where there was disagreement, novice raters tended to provide lower ratings than the experts. Novice raters require significant training in this emerging area of competence in order to accurately rate non-technical skills.
    Full-text · Article · Apr 2009 · ANZ Journal of Surgery

  • No preview · Article · Jan 2009
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    ABSTRACT: Surgical trainees must maximise the educa- tional and developmental opportunities of time spent in the operating theatre. Post-operative debriefing on perfor- mance based on observed skills is one way of achieving this and is regularly done in other high-risk professions. The non-technical skills for surgeons (NOTSS) behaviour rating system allows surgeons to observe trainees' behav- iour in the workplace and provide feedback for skill improvement in a structured manner. This paper describes the process of debriefing using NOTSS and presents the results of a usability trial. Two case studies also illustrate how the system was used. The majority of surgical trainers who participated reported that the NOTSS system provided a common language to discuss non-technical skills and was a valuable adjunct to currently available assessment tools. Some trainers found interpersonal skills more difficult to rate than cognitive skills but 73% (n = 8) felt that routine use of the system would enhance patient safety.
    Preview · Article · Oct 2008 · Cognition Technology and Work
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    ABSTRACT: Limitations exist with the use of computer tomography (CT) in evaluating tumour recurrence at the site of previous chest wall reconstruction due to poor differentiation between inflammatory change and tumour recurrence. This case highlights the value of combined positron emission tomography and CT, which generates detailed anatomical and metabolic profiles in this diagnostic dilemma.
    No preview · Article · May 2008 · Pediatric Surgery International
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    ABSTRACT: Previous research has shown that surgeons' intraoperative non-technical skills are related to surgical outcomes. The aim of this study was to evaluate the reliability of the NOTSS (Non-technical Skills for Surgeons) behavior rating system. Based on task analysis, the system incorporates five categories of skills for safe surgical practice (Situation Awareness, Decision Making, Task Management, Communication & Teamwork, and Leadership). Consultant (attending) surgeons (n = 44) from five Scottish hospitals attended one of six experimental sessions and were trained to use the NOTSS system. They then used the system to rate consultant surgeons' behaviors in six simulated operating room scenarios that were presented using video. Surgeons' ratings of the behaviors demonstrated in each scenario were compared to expert ratings ("accuracy"), and assessed for inter-rater reliability and internal consistency. The NOTSS system had a consistent internal structure. Although raters had minimal training, rating "accuracy" for acceptable/unacceptable behavior was above 60% for all categories, with mean of 0.67 scale points difference from reference (expert) ratings (on 4-point scale). For inter-rater reliability, the mean values of within-group agreement (r (wg)) were acceptable for the categories Communication & Teamwork (.70), and Leadership (.72), but below a priori criteria for other categories. Intra-class correlation coefficients (ICC) indicated high agreement using average measures (values were .95-.99). With the requisite training, the prototype NOTSS system could be used reliably by surgeons to observe and rate surgeons' behaviors. The instrument should now be tested for usability in the operating room.
    Preview · Article · Apr 2008 · World Journal of Surgery
  • C S D Roxburgh · G G Youngson · JA Townend · S W Turner
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    ABSTRACT: The incidence of childhood empyema, a complication of pneumonia, is increasing, and the underlying mechanisms are not understood. Whether a rise in pneumonia incidence could account for the increase in empyema remains to be seen. To report trends for empyema admissions in the context of pneumonia and croup admissions in Scottish children over a 25-year period to 2005. Whole-population study with retrospective analysis using diagnosis codes (International classification of diseases, 9th and 10th revisions). All non-obstetric and non-psychiatric hospitals in Scotland. Patients <15 years admitted with a diagnosis of empyema, pneumonia or croup (the latter included for reference) between 1 January 1981 and 31 December 2005. There were 217 admissions for empyema in children (76 1-4-year olds), 24,312 admissions for pneumonia (11,299 1-4-year olds), and 31 120 (20,332 1-4-year olds) for croup. Empyema admissions increased after 1998 from <10 per million children per annum to reach a peak of 37 per million in 2005. In the 1-4-year age group, empyema admissions rose in the late 1990s and 2000s from an average of 6.5 per million per year between 1981 and 1998 to 66 per million in 2005. Overall annual admission rates for pneumonia remained unchanged in most age groups. However, among 1-4-year olds, admissions rose steadily by an average of 50 per million per year between 1981 and 2005. Admission rates for croup in Scottish children (<15 years) remained stable over the preceding 25 years. This whole-population study shows that the incidence of childhood empyema has risen since 1998 and continues to rise independently of pneumonia. Croup admissions remained stable, suggesting that changes in coding or admission policies are not likely to explain the observed trends. The observations suggest that the rise in empyema is not related to an increase in pneumonia. Changes in bacterial pathogenicity and/or host susceptibility may be important.
    No preview · Article · Apr 2008 · Archives of Disease in Childhood