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Botelho F, Gerk A, Harley JM, Poenaru D. Improving Pediatric Trauma Education by Teaching Non-technical Skills: A Randomized Controlled Trial. J Pediatr Surg 2024; 59:874-888. [PMID: 38369400 DOI: 10.1016/j.jpedsurg.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pediatric trauma is a significant cause of child mortality, and the absence of non-technical skills (NTS) among health providers is linked with errors in patients' care. In this study, we evaluate the effectiveness of a structured debriefing protocol in enhancing NTS during pediatric trauma simulation. METHODS A total of 45 medical students were successfully recruited from two medical schools, one in Brazil and one in Canada. Medical students were assigned to a control (N = 20) or intervention group (N = 25) in a randomized control trial. Following simulated scenarios, participants in the intervention group underwent NTS debriefing, while the control received standard debriefing based on the Advanced Trauma Life Support (ATLS) protocol. Students' confidence, NTS level, and performance were measured through self-assessment surveys, the Non-Technical Skills for Surgeons (NOTSS) score, and adherence to the trauma protocol, respectively. Baseline characteristics and outcomes were compared using t-tests, Mann-Whitney, Wilcoxon signed-rank Kruskal-Wallis, ANOVA, and a repeated-measures ANCOVA. A significance level was set at p < 0.05. RESULTS The workshop increased students' confidence in leading trauma resuscitation regardless of their assignment to condition. While controlling for covariates, students in the intervention group significantly improved their overall NOTSS compared to those in the control and in all categories: situational awareness, decision-making, communication and teamwork, and leadership. The intervention teams also demonstrated a significant increase in completing trauma protocol steps. CONCLUSION Implementing structured debriefing focusing on NTS enhanced these skills and improved adherence to protocol among medical students managing pediatric trauma-simulated scenarios. These findings support integrating NTS training in pediatric trauma education. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Fabio Botelho
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
| | - Ayla Gerk
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada
| | - Jason M Harley
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Dan Poenaru
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
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Kemper T, van Haperen M, Eberl S, Winkelman T, van Deventer SM, Waller E, Preckel B. Crisis Scenarios for Simulation-Based Nontechnical Skills Training for Cardiac Surgery Teams: A National Survey Among Cardiac Anesthesiologists, Cardiac Surgeons, Clinical Perfusionists, and Cardiac Operating Room Nurses. Simul Healthc 2023; 18:367-374. [PMID: 36877689 DOI: 10.1097/sih.0000000000000715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Nontechnical skills in cardiac surgery are vital in ensuring patient safety in the operating room (OR). To train these skills in a simulation-based scenario, a collection of commonly accepted crisis scenarios is needed to serve as a framework for a simulation-based training program. OBJECTIVE The objective of this study was to identify and reach consensus on a collection of relevant crisis scenarios in cardiac surgery suitable for simulation-based team training focusing on nontechnical skills. METHODS Using the Delphi method, a national assessment was performed among cardiac surgeons, cardiac anesthesiologists, clinical perfusionists, and cardiac OR nurses in the Netherlands. In the first Delphi round, potential crisis scenarios for simulation-based team training in cardiac surgery were identified. In the second round, the identified scenarios were rated using a 5-point Likert scale. Finally, based on consensus (two-thirds majority), scenarios were prioritized and explored for feasibility. RESULTS One hundred fourteen experts participated in the study (26 cardiac anesthesiologists, 24 cardiac surgeons, 25 clinical perfusionists, and 39 OR nurses), representing all 16 cardiac surgical centers in the Netherlands. In the first round, 237 scenarios were identified. After eliminating duplicates and grouping similar scenarios, 44 scenarios were scored in round 2, which finally resulted in 13 relevant crisis scenarios with an expert consensus higher than 67%. CONCLUSIONS Thirteen crisis scenarios relevant to simulation-based team training were identified by an expert panel consisting of all members of the cardiac surgical team. Further research is needed to evaluate the educational value of the respective scenarios.
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Affiliation(s)
- Tom Kemper
- From the Department of Anesthesiology (T.K., M.v.H., S.E., E.W., B.P.), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Cardiothoracic Surgery (T.W.), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Extracorporeal Circulation (S.M.v.D.), St. Antonius Hospital, Nieuwegein, Netherlands; and Center for Simulation-Based Education (T.K., M.v.H., E.W.), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Friendly C, Villacreses C, Mukherjee R, Babilon E, Caraway J, Dieffenbaugher S, Hink A, Mellinger J, Plumblee L, Walters M, Talley C. Leadership skills curriculum development for residents and fellows: A needs-assessment. Am J Surg 2021; 222:1079-1084. [PMID: 34706817 DOI: 10.1016/j.amjsurg.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/11/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Non-technical skills (NTS) curricula have demonstrated success in surgical residencies. The purpose of this study is to examine the need for a structured leadership curriculum at our institution. METHODS A needs-assessment survey analyzing the importance of leadership domains, previously validated by Kazley et al. was delivered to 240 general surgery staff. Respondent groups were broken down into: Attendings, Residents, and Multi-Disciplinary. Statistical analyses were conducted using Cronbach's Alpha (α = 0.9259) and Fisher's exact test (pre-set p-value = 0.05). The importance of each competency was compared among groups and importance was defined as >75% important and very important responses. RESULTS Nineteen of 33 competencies were important for all groups, including 3 with 100% importance: interpersonal communication, team-work, and problem-solving. Several competencies showed statistically significant differences among groups. CONCLUSION A diverse range of surgery staff agreed that 19 leadership domains are important to teach residents, with some variance among respondent groups.
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Affiliation(s)
- Christopher Friendly
- Medical University of South Carolina College of Medicine, 96 Jonathan Lucas St. MSC 623, Charleston, SC, 29425, USA.
| | - Camila Villacreses
- Medical University of South Carolina College of Medicine, 96 Jonathan Lucas St. MSC 623, Charleston, SC, 29425, USA.
| | - Rupak Mukherjee
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Ellen Babilon
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Julie Caraway
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Sean Dieffenbaugher
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Ashley Hink
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - John Mellinger
- Southern Illinois University Department of Medicine, 801 North Rutledge St, Springfield, IL, 62702, USA.
| | - Leah Plumblee
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Megan Walters
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
| | - Cynthia Talley
- Medical University of South Carolina Department of Surgery, 96 Jonathan Lucas St. MSC 613, Charleston, SC, 29425, USA.
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Mitzman B. Commentary: A new "lost" generation. ACTA ACUST UNITED AC 2021; 7:411-412. [PMID: 34401860 PMCID: PMC8358138 DOI: 10.1016/j.xjon.2021.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Brian Mitzman
- Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah
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Zenati MA, Dias RD, Kennedy-Metz LR. Commentary: Nontechnical skills redux. J Thorac Cardiovasc Surg 2021; 163:2164-2165. [PMID: 33773815 DOI: 10.1016/j.jtcvs.2021.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Marco A Zenati
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, and Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Roger D Dias
- STRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Lauren R Kennedy-Metz
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, and Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Fryer ML, Balsam LB. Commentary: Tying NOTSS into cardiothoracic surgery training. J Thorac Cardiovasc Surg 2021; 163:2163-2164. [PMID: 33712235 DOI: 10.1016/j.jtcvs.2021.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Leora B Balsam
- Division of Cardiac Surgery, UMass Memorial Medical Center, Worcester, Mass.
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