World Journal of Surgery

, Volume 31, Issue 9, pp 1843–1853

Multidisciplinary Crisis Simulations: The Way Forward for Training Surgical Teams

  • Shabnam Undre
  • Maria Koutantji
  • Nick Sevdalis
  • Sanjay Gautama
  • Nowlan Selvapatt
  • Samantha Williams
  • Parvinderpal Sains
  • Peter McCulloch
  • Ara Darzi
  • Charles Vincent
Article

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.

References

  1. 1.
    Flin RH, O’Connor P, Mearns K. (2002) Crew resource management: improving safety in high reliability industries. Team Perform Manage 8:68–78CrossRefGoogle Scholar
  2. 2.
    Helmreich RL, Merritt AC, Wilhelm JA. (1999) The evolution of crew resource management training in commercial aviation. Int J Aviat Psychol 9:19–32PubMedCrossRefGoogle Scholar
  3. 3.
    Donchin Y, Gopher D, Olin M, et al. (2003) A look into the nature and causes of human errors in the intensive care unit. Qual Saf Health Care 12:143–147PubMedCrossRefGoogle Scholar
  4. 4.
    Sexton JB, Helmreich RL. (2003) Communication and team work in the surgical operating room. Panel presentation at 2000 Aerospace Medical Association conference, Houston, TexasGoogle Scholar
  5. 5.
    Ludbrook GL, Webb RK, Fox MA, et al. (1993) The Australian Incident Monitoring Study. Problems before induction of anaesthesia: an analysis of 2000 incident reports. Anaesth Intensive Care 21:593–595PubMedGoogle Scholar
  6. 6.
    Lingard L, Espin S, Whyte S, et al. (2004) Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 13:330–334PubMedCrossRefGoogle Scholar
  7. 7.
    Vincent C, Moorthy K, Sarker SK, et al. (2004) Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg 239:475–482PubMedCrossRefGoogle Scholar
  8. 8.
    Duffy FD, Gordon GH, Whelan G, et al. (2004) Assessing competence in communication and interpersonal skills: the Kalamazoo II report. Acad Med 79:495–507PubMedCrossRefGoogle Scholar
  9. 9.
    General Medical Council U (2001) Good Medical PracticeGoogle Scholar
  10. 10.
    Baldwin PJ, Paisley AM, Brown SP. (1999) Consultant surgeons’ opinion of the skills required of basic surgical trainees. Br J Surg 86:1078–1082PubMedCrossRefGoogle Scholar
  11. 11.
    Grantcharov TP, Kristiansen VB, Bendix J, et al. (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91:146–150PubMedCrossRefGoogle Scholar
  12. 12.
    Salas E, Burke CS, Bowers CA, et al. (2001) Team training in the skies: does crew resource management (CRM) training work? Hum Factors 43:641–674PubMedCrossRefGoogle Scholar
  13. 13.
    Gaba DM, Howard SK, Flanagan B, et al. (1998) Assessment of clinical performance during simulated crises using both technical and behavioral ratings. Anesthesiology 89:8–18PubMedCrossRefGoogle Scholar
  14. 14.
    Holzman RS, Cooper JB, Gaba DM, et al. (1995) Anesthesia crisis resource management: real-life simulation training in operating room crises. J Clin Anesth 7:675–687PubMedCrossRefGoogle Scholar
  15. 15.
    Morey JC, Simon R, Jay GD, et al. (2002) Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 37:1553–1581PubMedCrossRefGoogle Scholar
  16. 16.
    Moorthy K, Munz Y, Adams S, et al. (2005) A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre. Ann Surg 242:631–639PubMedCrossRefGoogle Scholar
  17. 17.
    Moorthy K, Munz Y, Forrest D, et al. (2004) Face validity and participants’ perceptions of the value of surgical crisis management (SCM) training. Br J Surg 91(Suppl 1):79Google Scholar
  18. 18.
    Martin JA, Regehr G, Reznick R, et al. (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84:273–278PubMedCrossRefGoogle Scholar
  19. 19.
    Moorthy K, Munz Y, Forrest D, et al. (2006) Surgical crisis management skills training and assessment: a simulation[corrected]-based approach to enhancing operating room performance. Ann Surg 244:139–147PubMedCrossRefGoogle Scholar
  20. 20.
    Healey AN, Undre S, Vincent CA. (2004) Developing observational measures of performance in surgical teams. Qual Saf Health Care 13(Suppl 1):i33–i40PubMedCrossRefGoogle Scholar
  21. 21.
    Undre S, Healey AN, Darzi A, et al. (2006) Observational assessment of surgical teamwork: a feasibility study. World J Surg 30:1774–1783PubMedCrossRefGoogle Scholar
  22. 22.
    Undre S, Sevdalis N, Healey AN, et al. (2007) The Observational Teamwork Assessment for Surgery (OTAS): refinement and application in urological surgery. World J Surg (Epub ahead of print)Google Scholar
  23. 23.
    Salas E, Wilson KA, Burke CS, et al. (2006) Does crew resource management training work? An update, an extension, and some critical needs. Hum Factors 48:392–412PubMedCrossRefGoogle Scholar
  24. 24.
    Reznek M, Smith-Coggins R, Howard S, et al. (2003) Emergency medicine crisis resource management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine. Acad Emerg Med 10:386–389PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Shabnam Undre
    • 1
    • 2
  • Maria Koutantji
    • 1
  • Nick Sevdalis
    • 1
  • Sanjay Gautama
    • 1
  • Nowlan Selvapatt
    • 1
  • Samantha Williams
    • 1
  • Parvinderpal Sains
    • 1
  • Peter McCulloch
    • 1
  • Ara Darzi
    • 1
  • Charles Vincent
    • 1
  1. 1.Department of Bio-Surgery and Surgical TechnologyImperial College and St, Mary’s HospitalLondonUnited Kingdom
  2. 2.Department of AnaesthesiaSt. Mary’s HospitalLondonUnited Kingdom

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