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Multidisciplinary Crisis Simulations: The Way Forward for Training Surgical Teams



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.


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.


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.


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.

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The authors thank Andrew Healey for his contribution while setting up this project and for ongoing support and contribution to the teams’ research. We also thank the entire simulation group for their contribution to the project: Simon Cunniffe, Kausi Rao, Paul Sidebottom, Janet Henry, Elaine Sydney, Charmaine Clovis, Piers Thomas, Anoma Dias, Sara Khan, Brian Dornan, Stephen Dowsett, Katherine Nichols, and the trainees who participated in the research.

We thank the BUPA foundation and Department of Health: Patient Safety Research Programme for partially funding this work.

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Correspondence to Shabnam Undre.


Appendix 1 Scrub nurse identifier (initials) assessor (EXPERT)

Virtual operating theatre technical skills rating scale

Please follow the key given below and circle the number corresponding to the scrub nurse’s performance

Appendix 1  

Appendix 2 Surgeon identifier (initials) assessor (HF expert)

Virtual operating theatre human factors rating scale

Please follow the key given below and circle the number corresponding to the surgeon’s performance

Appendix 2  

Appendix 3 Anesthetist identifier (initials) assessor (HF expert)

Virtual operating theatre human factors rating scale

Please follow the key given below and circle the number corresponding to the anesthetist’s performance

Appendix 3  

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Undre, S., Koutantji, M., Sevdalis, N. et al. Multidisciplinary Crisis Simulations: The Way Forward for Training Surgical Teams. World J Surg 31, 1843–1853 (2007).

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  • Technical Skill
  • Trainee Nurse
  • Team Training
  • Scrub Nurse
  • Trainee Surgeon