Article

World Journal of Surgery

, Volume 31, Issue 9, pp 1843-1853

Multidisciplinary Crisis Simulations: The Way Forward for Training Surgical Teams

  • Shabnam UndreAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s HospitalDepartment of Anaesthesia, St. Mary’s Hospital Email author 
  • , Maria KoutantjiAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s Hospital
  • , Nick SevdalisAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s Hospital
  • , Sanjay GautamaAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s Hospital
  • , Nowlan SelvapattAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s Hospital
  • , Samantha WilliamsAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s Hospital
  • , Parvinderpal SainsAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s Hospital
  • , Peter McCullochAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s Hospital
  • , Ara DarziAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s Hospital
    • , Charles VincentAffiliated withDepartment of Bio-Surgery and Surgical Technology, Imperial College and St, Mary’s Hospital

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Abstract

Background

High-reliability organizations have stressed the importance of nontechnical skills for safety and of regularly providing such training to their teams. Recently safety skills training has been applied in the practice of medicine. In this study, we developed and piloted a module using multidisciplinary crisis scenarios in a simulated operating theatre to train entire surgical teams.

Methods

Twenty teams participated (n = 80); each consisted of a trainee surgeon, anesthetist, operating department practitioner (ODP), and scrub nurse. Crisis scenarios such as difficult intubation, hemorrhage, or cardiac arrest were simulated. Technical and nontechnical skills (leadership, communication, team skills, decision making, and vigilance), were assessed by clinical experts and by two psychologists using relevant technical and human factors rating scales. Participants received technical and nontechnical feedback, and the whole team received feedback on teamwork.

Results

Trainees assessed the training favorably. For technical skills there were no differences between surgical trainees’ assessment scores and the assessment scores of the trainers. However, nurses overrated their technical skill. Regarding nontechnical skills, leadership and decision making were scored lower than the other three nontechnical skills (communication, team skills, and vigilance). Surgeons scored lower than nurses on communication and teamwork skills. Surgeons and anesthetists scored lower than nurses on leadership.

Conclusions

Multidisciplinary simulation-based team training is feasible and well received by surgical teams. Nontechnical skills can be assessed alongside technical skills, and differences in performance indicate where there is a need for further training. Future work should focus on developing team performance measures for training and on the development and evaluation of systematic training for technical and nontechnical skills to enhance team performance and safety in surgery.