Patient Safety and Surgical Education

  • S. D. Marshall
  • R. M. Nataraja
Part of the Innovation and Change in Professional Education book series (ICPE, volume 17)


In recent times, simulation has played an increasingly prominent role in the acquisition of surgical skills. The association of patient safety with a surgeon’s optimal technical operative skills is self-evident. However an educational experience in a simulation setting adds more than just skills training to enhance patient safety. Simulation is also valuable for developing the essential non-technical skills required working as part of a multidisciplinary team. Leadership skills, situation awareness and decision-making are all enhanced by simulation, particularly when uncommon, life-threatening events are replicated. Simulation allows the testing of both processes and protocols that leads to a system change. It also allows the duplication of situations from previous clinical events requiring further investigation. A more comprehensive understanding of the events and processes leading to adverse events allows training and redesign for future prevention. Measuring the effects of simulation-based interventions to improve safety can be challenging. Nevertheless, there is a growing evidence base of improved patient outcomes related to this.


Safety Surgery Simulation Education 


  1. 1.
    Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (1999). To err is human: Building a safer health care system. Washington, DC: National Academy Press.Google Scholar
  2. 2.
    Reason, J. T. (2000). Human error: Models and management. BMJ, 320, 768–770.CrossRefGoogle Scholar
  3. 3.
    Haynes, A. B., Weiser, T. G., Berry, W. R., et al. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. The New England Journal of Medicine, 360, 491–499.CrossRefGoogle Scholar
  4. 4.
    Treadwell, J. R., Lucas, S., & Tsou, A. Y. (2014). Surgical checklists: A systematic review of impacts and implementation. BMJ Quality and Safety, 23, 299–318.CrossRefGoogle Scholar
  5. 5.
    Goldhaber-Fiebert, S. N., & Howard, S. K. (2013). Implementing emergency manuals: Can cognitive aids help translate best practices for patient care during acute events? Anesthesia and Analgesia, 117, 1149–1161.CrossRefGoogle Scholar
  6. 6.
    Marshall, S. D. (2017). Helping experts and expert teams perform under duress: An agenda for cognitive aid research. Anaesthesia, 73, 289–295.CrossRefGoogle Scholar
  7. 7.
    Keane, M., & Marshall, S. D. (2010). Implementation of the WHO surgical safety checklist: Implications for anaesthetists. Anaesthesia and Intensive Care, 38, 397–398.Google Scholar
  8. 8.
    Nataraja, R. M., Webb, N., & Lopez, P. J. (2018). Simulation in paediatric urology and surgery, part 2: An overview of simulation modalities and their applications. Journal of Pediatric Urology, 14, 125–131.CrossRefGoogle Scholar
  9. 9.
    Ljuhar, D., Alexander, S., Martin, S., & Nataraja, R. M. (2018). The laparoscopic inguinal and diaphragmatic defect (LIDD) model: A validation study of a novel box trainer model. Surgical Endoscopy, 32, 4813–4819.CrossRefGoogle Scholar
  10. 10.
    Fonseca, A. L., Evans, L. V., & Gusberg, R. J. (2013). Open surgical simulation in residency training: A review of its status and a case for its incorporation. Journal of Surgical Education, 70, 129–137.CrossRefGoogle Scholar
  11. 11.
    Hamdorf, J. M., & Hall, J. C. (2000). Acquiring surgical skills. British Journal of Surgery, 87, 28–37.CrossRefGoogle Scholar
  12. 12.
    Hennessey, I. A. M., & Hewett, P. (2013). Construct, concurrent, and content validity of the eoSim laparoscopic simulator. Journal of Laparoendoscopic & Advanced Surgical Techniques Part A, 23, 855–860.CrossRefGoogle Scholar
  13. 13.
    Marshall, S. D., & McKarney, L. (2015). Section 1: A focused review of simulation to improve patient outcomes. In Simulation, patient outcomes and mental health review (pp. 1–9). Melbourne: Victorian State Government, Department of Health and Human Services.Google Scholar
  14. 14.
    Aggarwal, R., & Darzi, A. (2006). Technical-skills training in the 21st century. The New England Journal of Medicine, 355, 2695–2696.CrossRefGoogle Scholar
  15. 15.
    Nagendran, M., Toon, C. D., Davidson, B. R., & Gurusamy, K. S. (2014). Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience. The Cochrane Library (pp. 1–75). Chichester: Wiley.Google Scholar
  16. 16.
    Okrainec, A., Soper, N. J., Swanstrom, L. L., & Fried, G. M. (2011). Trends and results of the first 5 years of Fundamentals of Laparoscopic Surgery (FLS) certification testing. Surgical Endoscopy, 25, 1192–1198.CrossRefGoogle Scholar
  17. 17.
    Flin, R., O’Conner, P., & Crichton, M. (2008). Safety at the sharp end. Aldershot: Ashgate.Google Scholar
  18. 18.
    Manser, T., Harrison, T. K., Gaba, D. M., & Howard, S. K. (2009). Coordination patterns related to high clinical performance in a simulated anesthetic crisis. Anesthesia and Analgesia, 108, 1606–1615.CrossRefGoogle Scholar
  19. 19.
    Cadogan, M. P., Franzi, C., Osterweil, D., & Hill, T. (1999). Barriers to effective communication in skilled nursing facilities: Differences in perception between nurses and physicians. Journal of the American Geriatrics Society, 47, 71–75.CrossRefGoogle Scholar
  20. 20.
    Fischer, U., McDonnell, L., & Orasanu, J. (2007). Linguistic correlates of team performance: Toward a tool for monitoring team functioning during space missions. Aviation, Space, and Environmental Medicine, 78, B86–B95.Google Scholar
  21. 21.
    Entin, E. E., & Serfaty, D. (1999). Adaptive team coordination. Human Factors, 41, 312–325.CrossRefGoogle Scholar
  22. 22.
    Hall, P. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, 19, 188–196.CrossRefGoogle Scholar
  23. 23.
    Dickinson, T. L., & RM, M. I. (1997). A conceptual framework for teamwork measurement. In M. T. Brannick, E. Salas, & C. Prince (Eds.), Team performance assessment and measurement (pp. 19–43). Mahwah: Lawrence Erlbaum Associates.Google Scholar
  24. 24.
    Cohen, S. G., & Bailey, D. E. (1997). What makes teams work: Group effectiveness research from the shop floor to the executive suite. Journal of Management, 23, 239–290.CrossRefGoogle Scholar
  25. 25.
    Salas, E., Sims, D. E., & Burke, C. S. (2005). Is there “big five” in teamwork? Small Group Research, 36, 555–599.CrossRefGoogle Scholar
  26. 26.
    Kuhlmann, S., Piel, M., & Wolf, O. T. (2005). Impaired memory retrieval after psychosocial stress in healthy young men. Journal of Neuroscience, 25, 2977–2982.CrossRefGoogle Scholar
  27. 27.
    deLeval, M. R., Carthey, J., Wright, D. J., Farewell, V. T., & Reason, J. T. (2000). Human factors and cardiac surgery: A multicenter study. Journal of Thoracic and Cardiovascular Surgery, 119, 661–672.CrossRefGoogle Scholar
  28. 28.
    Endsley, M. R. (1995). Measurement of situation awareness in dynamic systems. Human Factors, 37, 65–84.CrossRefGoogle Scholar
  29. 29.
    Fioratou, E., Flin, R., & Glavin, R. (2010). No simple fix for fixation errors: Cognitive processes and their clinical applications. Anaesthesia, 65, 61–69.CrossRefGoogle Scholar
  30. 30.
    Cox, T. (1987). Stress, coping and problem solving. Work and Stress, 1, 5–14.CrossRefGoogle Scholar
  31. 31.
    Serfaty, D., Entin, E. E., & Volpe, C. E. (1993). Adaptation to stress in team decision-making and coordination. Human Factors and Ergnomics Society 37th annual meeting (pp. 1228–1232). Santa Monica: Human Factors and Ergonomics Society.Google Scholar
  32. 32.
    Greenberg, C. C., Regenbogen, S. E., Studdert, D. M., et al. (2007). Patterns of communication breakdowns resulting in injury to surgical patients. Journal of the American College of Surgeons, 204, 533–540.CrossRefGoogle Scholar
  33. 33.
    Mishra, A., Catchpole, K., Dale, T., & McCilloch, P. (2008). The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy. Surgical Endoscopy, 22, 68–73.CrossRefGoogle Scholar
  34. 34.
    Andreatta, P. (2009). A typology for healthcare teams. SimTect Health. Melbourne: SIAA.Google Scholar
  35. 35.
    Crosskerry, P., Singhal, G., & Mamede, S. (2013). Cognitive debiasing 2: Impediments to and strategies for change. BMJ Quality and Safety, 22, ii65–ii72.CrossRefGoogle Scholar
  36. 36.
    Klein, G. (1999). Sources of power: How people make decisions. Cambridge, MA: MIT Press.Google Scholar
  37. 37.
    Tversky, A., & Kahneman, D. (1974). Judgement under uncertainty: Heuristics and biases. Science, 185, 1124–1130.CrossRefGoogle Scholar
  38. 38.
    Lingard, L., Espin, S., Whyte, S., et al. (2004). Communication failures in the operating room: An observational classification of recurrent types and effects. Quality and Safety in Health Care, 13, 330–334.CrossRefGoogle Scholar
  39. 39.
    Yule, S., Flin, R., Paterson-Brown, S., Maran, N., & Rowley, D. (2006). Development of a rating system for surgeons’ non-technical skills. Medical Education, 40, 1098–1104.CrossRefGoogle Scholar
  40. 40.
    Undre, S., Healey, A. N., Darzi, A., & Vincent, C. A. (2006). Observational assessment of surgical teamwork: A feasibility study. World Journal of Surgery, 30, 1774–1783.CrossRefGoogle Scholar
  41. 41.
    Marshall, S. D., & Flanagan, B. (2010). Simulation-based education for building clinical teams. Journal of Emergencies, Trauma and Shock, 3, 360–368.CrossRefGoogle Scholar
  42. 42.
    Weller, J., Nestel, D., Marshall, S. D., Brooks, P. M., & Conn, J. J. (2012). Simulation in clinical teaching and learning. MJA, 196, 594.Google Scholar
  43. 43.
    Schmutz, J., & Manser, T. (2013). Do team processes really have an effect on clinical performance? A systematic literature review. British Journal of Anaesthesia, 110, 529–544.CrossRefGoogle Scholar
  44. 44.
    Salas, E., DiazGranados, D., Klein, C., Shawn-Burke, C., Stagl, K. C., & Goodwin, G. F. (2008). Does team training improve team performance? A meta-analysis. Human Factors, 50, 903–933.CrossRefGoogle Scholar
  45. 45.
    Gaba, D. M., Howard, S. K., Fish, K. J., Smith, B. E., & Sowb, Y. A. (2001). Simulation-based training in anesthesia crisis resource management (ACRM): A decade of experience. Simulation and Gaming, 32, 175–193.CrossRefGoogle Scholar
  46. 46.
    Auguste, T. C., Boswick, J. A., Loyd, M. K., & Battista, A. (2011). The simulation of an ex utero intrapartum procedure to extracorporeal membrane oxygenation. Journal of Pediatric Surgery, 46, 395–398.CrossRefGoogle Scholar
  47. 47.
    Draycott, T., Sibanda, T., Owen, L., Akande, V., Winter, C., & Reading, S. (2006). Does training in obstetric emergencies improve neonatal outcome? BJOG: An International Journal of Obstetrics and Gynaecology, 113, 177–182.CrossRefGoogle Scholar
  48. 48.
    McGaghie, W. C., Draycott, T. J., Dunn, W. F., Lopez, C. M., & Stefanidis, D. (2011). Evaluating the impact of simulation on translational patient outcomes. Simulation in Healthcare, 6(supp), S42–S47.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • S. D. Marshall
    • 1
    • 2
    • 3
  • R. M. Nataraja
    • 4
    • 5
  1. 1.Department of Anaesthesia and Perioperative Medicine, Central Clinical SchoolMonash UniversityMelbourneAustralia
  2. 2.Department of Medical EducationUniversity of MelbourneMelbourneAustralia
  3. 3.Australian Centre for Health InnovationAlfred HealthMelbourneAustralia
  4. 4.Department of Paediatric SurgeryMonash Children’s HospitalMelbourneAustralia
  5. 5.Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia

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