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Chan YY, Zhong J, Jacobs MA, Peters CA. Response to correspondence regarding "Emergent robot-to-open conversion-multidisciplinary simulation training in crisis management". J Pediatr Urol 2024; 20:1017-1018. [PMID: 39043509 DOI: 10.1016/j.jpurol.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Affiliation(s)
- Yvonne Y Chan
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA; Department of Urology, Division of Pediatric Urology, University of Texas Southwestern/Children's Medical Center Dallas, Dallas, TX, USA.
| | - John Zhong
- Department of Anesthesiology and Pain Management, University of Texas Southwestern/Children's Medical Center Dallas, Dallas, TX, USA.
| | - Micah A Jacobs
- Department of Urology, Division of Pediatric Urology, University of Texas Southwestern/Children's Medical Center Dallas, Dallas, TX, USA.
| | - Craig A Peters
- Department of Urology, Division of Pediatric Urology, University of Texas Southwestern/Children's Medical Center Dallas, Dallas, TX, USA.
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Ritchie A, Pacilli M, Nataraja RM. Simulation-based education in urology - an update. Ther Adv Urol 2023; 15:17562872231189924. [PMID: 37577030 PMCID: PMC10413896 DOI: 10.1177/17562872231189924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.
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Affiliation(s)
- Angus Ritchie
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, Melbourne, Australia
| | - Ramesh M. Nataraja
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, 246 Clayton Road, Clayton, Melbourne 3168, Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3168, Australia
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West E, Singer-Chang G, Ryznar R, Ross D, Czekajlo M, Hoang T, Alson R, Berbel G, Moloff A, Safaoui M, Nevins N, LaPorta AJ. The Effect of Hyper-Realistic Trauma Training on Emotional Intelligence in Second Year Military Medical Students. JOURNAL OF SURGICAL EDUCATION 2020; 77:1422-1428. [PMID: 32624450 DOI: 10.1016/j.jsurg.2020.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/18/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
INTRO This project expanded upon previous exploration of emotional intelligence during the habituation for military second year medical students undergoing high-stress simulation with trauma and surgical skill training. The objective was to interpret emotional intelligence data before and after hyper-realistic immersion trauma training and to include a larger sample size than previously investigated. METHODS Fifty increasingly intense mass casualty scenarios with simulated Emergency Department (ED) and Operating Room (OR) procedures were performed while students lived as if deployed in an Afghan village. Students rotated through a variety of roles in both the ED and the OR throughout the weeklong program. Second year medical students completed the EQ-i 2.0 Model for Emotional Intelligence on the first and last day of the intensive surgical skills week. Three different cohorts from three different graduating classes were followed with a total sample size of 96. Emotional intelligence in this model is defined as a combination of 5 domains each with three subdomains. RESULTS A statistical analysis of the EQ data shows significant improvement in almost every subdomain of Emotional Intelligence from pre to post testing. The total EQ score was significantly higher with an average improvement of 3.95 points. All of the subdomains, except for emotional expression, empathy, and problem solving significantly improved following the intensive skills course. A 3 factor ANOVA including year and gender was also performed. R2 of the change in pre to post scores was around 90%, indicating practical significance in the score improvements. CONCLUSION AND IMPACT Total emotional intelligence significantly improved from pre to post scores as well as each of the 5 domains and most subdomains. Scores improved an average of 4 points after only a 5-day training course. This training led to the most improvement in the self-perception and stress management categories. Medicine, especially high stress specialties like surgery and trauma, require physicians who are able to make decisions at a moment's notice and cope well with stressful situations. It is essential that individuals develop these intangible skills, which can be measured by emotional intelligence. Further research is needed to determine the long-term impacts of the increased emotional intelligence seen with hyper-realistic training. Some specific areas to investigate include physician performance and emotional wellbeing.
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Affiliation(s)
- Erin West
- Rocky Vista University COM, Parker, Colorado.
| | | | | | - David Ross
- Rocky Vista University COM, Parker, Colorado
| | - Michael Czekajlo
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Tuan Hoang
- Rocky Vista University COM, Parker, Colorado
| | - Roy Alson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - German Berbel
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | - Alan Moloff
- Rocky Vista University COM, Parker, Colorado
| | - Marian Safaoui
- Western University of Health Sciences, Pomona, California
| | - Natalie Nevins
- Western University of Health Sciences, Pomona, California
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Aydın A, Griffin CM, Brunckhorst O, Al-Jabir A, Raison N, Aya H, McIlhenny C, Brewin J, Shabbir M, Palou Redorta J, Khan MS, Dasgupta P, Ahmed K. Non-technical skills for urological surgeons (NoTSUS): development and evaluation of curriculum and assessment scale. World J Urol 2020; 39:2231-2237. [PMID: 32809178 PMCID: PMC8217036 DOI: 10.1007/s00345-020-03406-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022] Open
Abstract
Objective In the last decade non-technical skills (NTS) have emerged as a vital area for improvement within surgery. This study aims to develop and evaluate a Non-technical Skills for Urological Surgeons (NoTSUS) training curriculum and assessment scale. Methods This international, longitudinal and observational study began with a 3-round Delphi methodology to refine curriculum contents and rating scale. Sessions with up to four participants were delivered where each candidate undertook an independent scenario within the validated full immersion simulation environment. Candidates were assessed using both the NoTSS (Non-technical Skills for Surgeons) and NoTSUS rating scales by NTS-trained and non-trained experts. A post-training evaluation survey was distributed. Results 62 participants comprising trainees (n = 43) and specialists (n = 19) undertook the NoTSUS course. The NoTSS and NoTSUS scales correlated well, with a mean difference of 3.3 in the overall total (p = 0.10, r = 0.53). However, there was significant differences in scores between the NoTSS-trained and non-trained raters (n = 28, p = 0.03). A one-way ANOVA test revealed significant improvement throughout the four simulation scenarios in each session (p = 0.02). The NoTSUS curriculum received positive feedback from participants and demonstrated educational value and acceptability. Conclusions The NoTSUS curriculum has demonstrated high educational value for NTS training aimed at urologists, with marked improvement throughout sessions. Correlation of NoTSUS and NoTSS scales proves its suitability for evaluating NTS in future training. Demonstration of inter-rater reliability indicates that the scale is reliable for use in assessment by expert faculty members. Furthermore, qualitative feedback from participants suggests gain of transferrable skills over the course. Electronic supplementary material The online version of this article (10.1007/s00345-020-03406-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdullatif Aydın
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK.
| | - Cora M Griffin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Ahmed Al-Jabir
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Nicholas Raison
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Haleema Aya
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | | | - James Brewin
- Department of Urology, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Majid Shabbir
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
- Department of Urology, Guy's and St, Thomas' NHS Foundation Trust, London, UK
| | - Joan Palou Redorta
- European School of Urology, European Association of Urology, Amsterdam, The Netherlands
- Dept. of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
- Department of Urology, Guy's and St, Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
- Department of Urology, Guy's and St, Thomas' NHS Foundation Trust, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
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Kozan AA, Chan LH, Biyani CS. Current Status of Simulation Training in Urology: A Non-Systematic Review. Res Rep Urol 2020; 12:111-128. [PMID: 32232016 PMCID: PMC7085342 DOI: 10.2147/rru.s237808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Simulation has emerged as an effective solution to increasing modern constraints in surgical training. It is recognized that a larger proportion of surgical complications occur during the surgeon's initial learning curve. The simulation takes the learning curve out of the operating theatre and facilitates training in a safe and pressure-free environment whilst focusing on patient safety. The cost of simulation is not insignificant and requires commitment in funding, human resources and logistics. It is therefore important for trainers to have evidence when selecting various simulators or devices. Our non-systematic review aims to provide a comprehensive up-to-date picture on urology simulators and the evidence for their validity. It also discusses emerging technologies and future directions. Urologists should embed evidence-based simulation in training programs to shorten learning curves while maintaining patient safety and work should be directed toward a validated and agreed curriculum.
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Affiliation(s)
- Andrei Adrian Kozan
- Department of Urology, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Luke Huiming Chan
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Chandra Shekhar Biyani
- Department of Urology, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
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McMullan RD, Urwin R, Sunderland N, Westbrook J. Observational Tools That Quantify Nontechnical Skills in the Operating Room: A Systematic Review. J Surg Res 2020; 247:306-322. [DOI: 10.1016/j.jss.2019.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/18/2019] [Accepted: 10/01/2019] [Indexed: 12/14/2022]
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Non-technical skills: a review of training and evaluation in urology. World J Urol 2019; 38:1653-1661. [PMID: 31529246 PMCID: PMC7303051 DOI: 10.1007/s00345-019-02920-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/20/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE With non-technical skills (NTS) deficits being recognised as a major cause for error in surgery, there is an increasing interest in their training and evaluation. A growing number of training courses are emerging and some NTS curricula have also been created. Many different training methods are described in the literature but there is still uncertainty with regards to their optimum combination within a curriculum. METHODS A literature review of the electronic database Medline was performed. All articles published before December 2018 were screened by abstract and included if deemed relevant by the author. The included articles' reference lists were also screened for further relevant studies. RESULTS Simulation training is accepted as the most effective way to train NTS. Within simulation training, it is shown that the 'igloo' full immersion/distributed simulation environment is appropriate for teaching NTS in urological scenarios where a designated operating room or space is not available. The use of multiple settings, for example wards and clinics as well as the operating room, is advantageous, as is training in an interprofessional team. Classroom teaching also plays a role in NTS training as an adjunct to simulation, with evidence that it improves some parameters of NTS. All levels, including qualified surgeons, benefit from NTS training; however, adaptation to both trainee level and specialty is important. Although less time consuming, training juniors and seniors together mainly benefits juniors, and training NTS at the same time as technical skills detracts from the quality of teaching. Debriefing is an important part of training and should be well structured; there are many debriefing models in existence, allowing for choice of method based on examiner preference and participant demographic. Furthermore, examiners should be well briefed in their task and trained in NTS assessment. CONCLUSION To move forward, studies should combine tried and tested learning techniques into a curriculum covering all training levels, which should then be validated and followed up long term to ensure a positive impact on patient safety.
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Nontechnical Skill Assessment of the Collective Surgical Team Using the Non-Technical Skills for Surgeons (NOTSS) System. Ann Surg 2019; 272:1158-1163. [DOI: 10.1097/sla.0000000000003250] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ounounou E, Aydin A, Brunckhorst O, Khan MS, Dasgupta P, Ahmed K. Nontechnical Skills in Surgery: A Systematic Review of Current Training Modalities. JOURNAL OF SURGICAL EDUCATION 2019; 76:14-24. [PMID: 30122636 DOI: 10.1016/j.jsurg.2018.05.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/16/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The complexity of the operating room requires a surgeon to have both technical ability and an array of nontechnical skills. The emphasis on technical skills during surgical training is well established, however it is deficiencies in nontechnical skills that have been identified as the main cause of errors in the operating room. OBJECTIVE This systematic review aims to identify current methods used to teach nontechnical skills and how these methods are assessed to determine their validity, evidence, and role in training. METHODS MEDLINE and Embase databases were searched for English language articles between 2000 and 2017 for nontechnical surgical skills training. Original research articles were included if they described non-technical surgical skills training modalities and their assessment. Results were assessed for the level of evidence and each modality was awarded a level of recommendation, using a modified educational Oxford Centre for Evidence-Based Medicine classification, as adapted by the European Association of Endoscopic Surgery. RESULTS A total of 19 studies were identified pertaining to high fidelity simulation (n = 8), low fidelity simulation (n = 6), didactic teaching (n = 2) and crisis resource management (n = 3). Of the included studies 1 was classified Level 1b, 1 level 2b, 7 level 2b, 2 level 2c, and 8 level 3. CONCLUSION With the importance of nontechnical skills being increasingly recognized, it is essential for surgeons to receive adequate training in nontechnical skills. Therefore the most valuable teaching modalities such as high and low fidelity simulation needs to be implemented into surgical training curricula.
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Affiliation(s)
- Esther Ounounou
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom.
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
| | - M Shamim Khan
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
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Non-Technical Skills for Surgeons (NOTSS): Critical appraisal of its measurement properties. Am J Surg 2018; 216:990-997. [DOI: 10.1016/j.amjsurg.2018.02.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 11/19/2022]
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Fecso AB, Kuzulugil SS, Babaoglu C, Bener AB, Grantcharov TP. Relationship between intraoperative non-technical performance and technical events in bariatric surgery. Br J Surg 2018; 105:1044-1050. [DOI: 10.1002/bjs.10811] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The operating theatre is a unique environment with complex team interactions, where technical and non-technical performance affect patient outcomes. The correlation between technical and non-technical performance, however, remains underinvestigated. The purpose of this study was to explore these interactions in the operating theatre.
Methods
A prospective single-centre observational study was conducted at a tertiary academic medical centre. One surgeon and three fellows participated as main operators. All patients who underwent a laparoscopic Roux-en-Y gastric bypass and had the procedures captured using the Operating Room Black Box® platform were included. Technical assessment was performed using the Objective Structured Assessment of Technical Skills and Generic Error Rating Tool instruments. For non-technical assessment, the Non-Technical Skills for Surgeons (NOTSS) and Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) tools were used. Spearman rank-order correlation and N-gram statistics were conducted.
Results
Fifty-six patients were included in the study and 90 procedural steps (gastrojejunostomy and jejunojejunostomy) were analysed. There was a moderate to strong correlation between technical adverse events (rs = 0·417–0·687), rectifications (rs = 0·380–0·768) and non-technical performance of the surgical and nursing teams (NOTSS and SPLINTS). N-gram statistics showed that after technical errors, events and prior rectifications, the staff surgeon and the scrub nurse exhibited the most positive non-technical behaviours, irrespective of operator (staff surgeon or fellow).
Conclusion
This study demonstrated that technical and non-technical performances are related, on both an individual and a team level. Valuable data can be obtained around intraoperative errors, events and rectifications.
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Affiliation(s)
- A B Fecso
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- International Centre for Surgical Safety, Keenan Research Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - S S Kuzulugil
- Data Science Laboratory, Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, Ontario, Canada
| | - C Babaoglu
- Data Science Laboratory, Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, Ontario, Canada
| | - A B Bener
- Data Science Laboratory, Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, Ontario, Canada
| | - T P Grantcharov
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- International Centre for Surgical Safety, Keenan Research Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Wood TC, Raison N, Haldar S, Brunckhorst O, McIlhenny C, Dasgupta P, Ahmed K. Training Tools for Nontechnical Skills for Surgeons-A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:548-578. [PMID: 28011262 DOI: 10.1016/j.jsurg.2016.11.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/11/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Development of nontechnical skills for surgeons has been recognized as an important factor in surgical care. Training tools for this specific domain are being created and validated to maximize the surgeon's nontechnical ability. This systematic review aims to outline, address, and recommend these training tools. DESIGN A full and comprehensive literature search, using a systematic format, was performed on ScienceDirect and PubMed, with data extraction occurring in line with specified inclusion criteria. SETTING Systematic review was performed fully at King's College London. RESULTS A total of 84 heterogeneous articles were used in this review. Further, 23 training tools including scoring systems, training programs, and mixtures of the two for a range of specialities were identified in the literature. Most can be applied to surgery overall, although some tools target specific specialities (such as neurosurgery). Interrater reliability, construct, content, and face validation statuses were variable according to the specific tool in question. CONCLUSIONS Study results pertaining to nontechnical skill training tools have thus far been universally positive, but further studies are required for those more recently developed and less extensively used tools. Recommendations can be made for individual training tools based on their level of validation and for their target audience. Based on the number of studies performed and their status of validity, NOTSS and Oxford NOTECHS II can be considered the gold standard for individual- and team-based nontechnical skills training, respectively, especially when used in conjunction with a training program.
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Affiliation(s)
- Thomas Charles Wood
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Nicholas Raison
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
| | - Shreya Haldar
- Department of Opthalmology, Stoke Mandeville Hospital, Aylesbury, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Craig McIlhenny
- Department of Urology, NHS Forth Valley, Larbert, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
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13
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Nontechnical skill training and the use of scenarios in modern surgical education. Curr Opin Urol 2017; 27:330-336. [DOI: 10.1097/mou.0000000000000402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Aydin A, Fisher R, Khan MS, Dasgupta P, Ahmed K. Training, assessment and accreditation in surgery. Postgrad Med J 2017; 93:441-448. [DOI: 10.1136/postgradmedj-2016-134701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/06/2017] [Accepted: 04/02/2017] [Indexed: 12/16/2022]
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Aydin A, Shafi AM, Shamim Khan M, Dasgupta P, Ahmed K. Current Status of Simulation and Training Models in Urological Surgery: A Systematic Review. J Urol 2016; 196:312-20. [DOI: 10.1016/j.juro.2016.01.131] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Abdullatif Aydin
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Ahmed M.A. Shafi
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, King’s College London, Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, and King’s Health Partners, London, United Kingdom
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Meyer CP, Salem J, Kluth LA, Sanatgar N, Borgmann H, Grange P, Chun F. Das GeSRU Endo-Training – Strategien zur Optimierung der endourologischen Ausbildung. Urologe A 2015; 55:253-6. [DOI: 10.1007/s00120-015-0015-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Phitayakorn R, Minehart RD, Hemingway MW, Pian-Smith MCM, Petrusa E. The relationship between intraoperative teamwork and management skills in patient care. Surgery 2015; 158:1434-40. [PMID: 25999257 DOI: 10.1016/j.surg.2015.03.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Optimal team performance in the operating room (OR) requires a combination of interactions among OR professionals and adherence to clinical guidelines. Theoretically, it is possible that OR teams could communicate very well but fail to follow acceptable standards of patient care and vice versa. OR simulations offer an ideal research environment to study this relationship. The goal of this study was to determine the relationship between ratings of OR teamwork and communication with adherence to patient care guidelines in a simulated scenarios of malignant hyperthermia (MH). METHODS An interprofessional research team (2 anesthesiologists, 1 surgeon, an OR nurse, and a social scientist) reviewed videos of 5 intraoperative teams managing a simulated patient who manifested MH while undergoing general anesthesia for an epigastric herniorraphy in a high-fidelity, in situ OR. Participant teams consisted of 2 residents from anesthesiology, 1 from surgery, 1 OR nurse, and 1 certified surgical technician. Teamwork and communication were assessed with 4 published tools: Anesthesiologists' Non-Technical Skills (ANTS), Scrub Practitioners List of Intra-operative Non-Technical Skills (SPLINTS), Non-Technical Skills for Surgeons (NOTSS), and Objective Teamwork Assessment System (OTAS). We developed an evidence-based MH checklist to assess overall patient care. RESULTS Interrater agreement for teamwork tools was moderate. Average rater agreement was 0.51 For ANTS, 0.67 for SPLINTS, 0.51 for NOTSS, and 0.70 for OTAS. Observer agreement for the MH checklist was high (0.88). Correlations between teamwork and MH checklist were not significant. Teams were different in percent of the MH actions taken (range, 50-91%; P = .006). CONCLUSION In this pilot study, intraoperative teamwork and communication were not related to overall patient care management. Separating nontechnical and technical skills when teaching OR teamwork is artificial and may even be damaging, because such an approach could produce teams with excellent communication skills as they unsuccessfully manage the patient. OR simulations offer a unique opportunity to research how to best integrate both of these domains to improve patient care.
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Affiliation(s)
- Roy Phitayakorn
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Rebecca D Minehart
- MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anesthesia, Critical Care, and Pain Medicine, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Maureen W Hemingway
- MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Perioperative Services, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - May C M Pian-Smith
- MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anesthesia, Critical Care, and Pain Medicine, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Emil Petrusa
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, MA; MGH Learning Laboratory, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
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21
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Komasawa N, Sanuki T, Fujiwara S, Haba M, Ueki R, Kaminoh Y, Minami T. Significance of debriefing methods in simulation-based sedation training courses for medical safety improvement in Japan. SPRINGERPLUS 2014; 3:637. [PMID: 25392805 PMCID: PMC4218926 DOI: 10.1186/2193-1801-3-637] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/20/2014] [Indexed: 12/27/2022]
Abstract
Based on the American Society of Anesthesiologists' Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists (ASA-SED), a sedation training course aimed at improving medical safety was developed by the Japanese Association for Medical Simulation in 2011. This study evaluated the effect of debriefing on participants' perceptions of the essential points of the ASA-SED. A total of 38 novice doctors participated in the sedation training course during the research period. Of these doctors, 18 participated in the debriefing group, and 20 participated in non-debriefing group. Scoring of participants' guideline perceptions was conducted using an evaluation sheet (nine items, 16 points) created based on the ASA-SED. The debriefing group showed a greater perception of the ASA-SED, as reflected in the significantly higher scores on the evaluation sheet (median, 16 points) than the control group (median, 13 points; p < 0.05). No significant differences were identified before or during sedation, but the difference after sedation was significant (p < 0.05). Debriefing after sedation training courses may contribute to better perception of the ASA-SED, and may lead to enhanced attitudes toward medical safety during sedation and analgesia.
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Affiliation(s)
- Nobuyasu Komasawa
- />Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsukishi City, Osaka, 569-8686 Japan
| | - Takuro Sanuki
- />Department of Dental Anesthesiology, Nagasaki University, Sakamoto 1-7-1, Nagasaki City, Nagasaki, 852-8588 Japan
| | - Shunsuke Fujiwara
- />Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsukishi City, Osaka, 569-8686 Japan
| | - Masanori Haba
- />Department of Anesthesiology, Wakayama Red Cross Hospital, Komatsubara 4-20, Wakayama City, Wakayama, 640-8558 Japan
| | - Ryusuke Ueki
- />Department of Anesthesiology, Hyogo College of Medicine, Mukogawa-cho, Nisinomiya City, Hyogo, 663-8501 Japan
| | - Yoshiroh Kaminoh
- />Division of Anesthesiology, Social Insurance Kinan Hospital, Shinjo-cho, Tanabe City, Wakayama, Japan
| | - Toshiaki Minami
- />Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsukishi City, Osaka, 569-8686 Japan
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22
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Graafland M, Schraagen JMC, Boermeester MA, Bemelman WA, Schijven MP. Training situational awareness to reduce surgical errors in the operating room. Br J Surg 2014; 102:16-23. [DOI: 10.1002/bjs.9643] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/20/2014] [Accepted: 08/06/2014] [Indexed: 12/21/2022]
Abstract
Abstract
Background
Surgical errors result from faulty decision-making, misperceptions and the application of suboptimal problem-solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim of this review was to assess the validity of methods for improving situational awareness in the surgical theatre.
Methods
A search was conducted in PubMed, Embase, the Cochrane Library and PsycINFO® using predefined inclusion criteria, up to June 2014. All study types were considered eligible. The primary endpoint was validity for improving situational awareness in the surgical theatre at individual or team level.
Results
Nine articles were considered eligible. These evaluated surgical team crisis training in simulated environments for minimally invasive surgery (4) and open surgery (3), and training courses focused at training non-technical skills (2). Two studies showed that simulation-based surgical team crisis training has construct validity for assessing situational awareness in surgical trainees in minimally invasive surgery. None of the studies showed effectiveness of surgical crisis training on situational awareness in open surgery, whereas one showed face validity of a 2-day non-technical skills training course.
Conclusion
To improve safety in the operating theatre, more attention to situational awareness is needed in surgical training. Few structured curricula have been developed and validation research remains limited. Strategies to improve situational awareness can be adopted from other industries.
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Affiliation(s)
- M Graafland
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - J M C Schraagen
- Netherlands Organization for Applied Scientific Research (TNO), Soesterberg, The Netherlands
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Twente, The Netherlands
| | - M A Boermeester
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - M P Schijven
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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