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Nazir A, Shore EM, Keown-Stoneman C, Grantcharov T, Nolan B. Enhancing patient safety in trauma: Understanding adverse events, assessment tools, and the role of trauma video review. Am J Surg 2024; 234:74-79. [PMID: 38719680 DOI: 10.1016/j.amjsurg.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/11/2024] [Accepted: 04/26/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES This study aimed to investigate adverse events (AEs) in trauma resuscitation, evaluate contributing factors, and assess methods, such as trauma video review (TVR), to mitigate AEs. BACKGROUND Trauma remains a leading cause of global mortality and morbidity, necessitating effective trauma care. Despite progress, AEs during trauma resuscitation persist, impacting patient outcomes and the healthcare system. Identifying and analyzing AEs and their determinants are crucial for improving trauma care. METHODS This narrative review explored the definition, identification, and assessment of AEs associated with trauma resuscitation within the trauma system. It includes various studies and assessment tools such as STAT Taxonomy and T-NOTECHs. Additionally, it assessed the role of TVR in detecting AEs and strategies to enhance patient safety. CONCLUSION Integrated with standardized tools, TVR shows promise for identifying AEs. Challenges include ensuring reporting consistency and integrating approaches into existing protocols. Future research should prioritize linking trauma team performance to patient outcomes, and develop sustainable TVR programs to enhance patient safety.
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Affiliation(s)
- Anisa Nazir
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Eliane M Shore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, ON, Canada
| | - Charles Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Teodor Grantcharov
- Department of Surgery, Clinical Excellence Research Center, Stanford University, USA
| | - Brodie Nolan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Emergency Medicine, St. Michael's Hospital Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada
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Schulze M, Streith L, Wiseman SM. Intraoperative teaching methods, models, and frameworks: A scoping review for surgical resident education. Am J Surg 2024; 231:24-40. [PMID: 38342713 DOI: 10.1016/j.amjsurg.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND This review aimed to consolidate the existing literature on intraoperative teaching strategies and highlight areas for future research. OBJECTIVE The objective is to review the research conducted regarding the implementation of various teaching frameworks for surgical learners and to present their feasibility, benefits, and limitations within surgical residencies, as well as areas for future research. METHODS Two independent investigators searched MEDLINE, EMBASE, and ERIC and reviewed articles on intraoperative teaching strategies for surgical resident education. RESULTS 3050 abstracts were reviewed, and 66 studies (2.2%) were included. The most common study type was single cohort studies (33%), followed by survey studies (17%). The majority of articles were carried out in General Surgery (50%), or a combination of surgical specialties (17%). CONCLUSIONS The BID model encompasses perioperative teaching time points and suggests a universal organizational approach to intraoperative teaching that would likely be compatible with documented competency assessments for residents.
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Affiliation(s)
- Marie Schulze
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - Lucas Streith
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, Canada.
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Pakkasjärvi N, Anttila H, Pyhältö K. What are the learning objectives in surgical training - a systematic literature review of the surgical competence framework. BMC MEDICAL EDUCATION 2024; 24:119. [PMID: 38321437 PMCID: PMC10848354 DOI: 10.1186/s12909-024-05068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To map the landscape of contemporary surgical education through a competence framework by conducting a systematic literature review on learning outcomes of surgical education and the instructional methods applied to attain the outcomes. BACKGROUND Surgical education has seen a paradigm shift towards competence-based training. However, a gap remains in the literature regarding the specific components of competency taught and the instructional methods employed to achieve these outcomes. This paper aims to bridge this gap by conducting a systematic review on the learning outcomes of surgical education within a competence framework and the instructional methods applied. The primary outcome measure was to elucidate the components of competency emphasized by modern surgical curricula. The secondary outcome measure was to discern the instructional methods proven effective in achieving these competencies. METHODS A search was conducted across PubMed, Medline, ProQuest Eric, and Cochrane databases, adhering to PRISMA guidelines, limited to 2017-2021. Keywords included terms related to surgical education and training. Inclusion criteria mandated original empirical studies that described learning outcomes and methods, and targeted both medical students and surgical residents. RESULTS Out of 42 studies involving 2097 participants, most concentrated on technical skills within competency-based training, with a lesser emphasis on non-technical competencies. The effect on clinical outcomes was infrequently explored. CONCLUSION The shift towards competency in surgical training is evident. However, further studies on its ramifications on clinical outcomes are needed. The transition from technical to clinical competence and the creation of validated assessments are crucial for establishing a foundation for lifelong surgical learning.
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Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
- Department of Pediatric Surgery, Section of Urology, University Children's Hospital, Uppsala, Sweden.
| | - Henrika Anttila
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Kirsi Pyhältö
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
- Centre for Higher and Adult Education, Faculty of Education, Stellenbosch University, Stellenbosch, South Africa
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Pasquer A, Ducarroz S, Lifante JC, Skinner S, Poncet G, Duclos A. Operating room organization and surgical performance: a systematic review. Patient Saf Surg 2024; 18:5. [PMID: 38287316 PMCID: PMC10826254 DOI: 10.1186/s13037-023-00388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Organizational factors may influence surgical outcomes, regardless of extensively studied factors such as patient preoperative risk and surgical complexity. This study was designed to explore how operating room organization determines surgical performance and to identify gaps in the literature that necessitate further investigation. METHODS We conducted a systematic review according to PRISMA guidelines to identify original studies in Pubmed and Scopus from January 1, 2000 to December 31, 2019. Studies evaluating the association between five determinants (team composition, stability, teamwork, work scheduling, disturbing elements) and three outcomes (operative time, patient safety, costs) were included. Methodology was assessed based on criteria such as multicentric investigation, accurate population description, and study design. RESULTS Out of 2625 studies, 76 met inclusion criteria. Of these, 34 (44.7%) investigated surgical team composition, 15 (19.7%) team stability, 11 (14.5%) teamwork, 9 (11.8%) scheduling, and 7 (9.2%) examined the occurrence of disturbing elements in the operating room. The participation of surgical residents appeared to impact patient outcomes. Employing specialized and stable teams in dedicated operating rooms showed improvements in outcomes. Optimization of teamwork reduced operative time, while poor teamwork increased morbidity and costs. Disturbances and communication failures in the operating room negatively affected operative time and surgical safety. CONCLUSION While limited, existing scientific evidence suggests that operating room staffing and environment significantly influences patient outcomes. Prioritizing further research on these organizational drivers is key to enhancing surgical performance.
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Affiliation(s)
- Arnaud Pasquer
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France.
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, 5 Place d' Arsonval, 69003, Lyon, France.
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France.
| | - Simon Ducarroz
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
| | - Jean Christophe Lifante
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France
- Department of Endocrine Surgery, Hospices Civils de Lyon, Lyon, France
| | - Sarah Skinner
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
| | - Gilles Poncet
- Department of Digestive and Colorectal Surgery, Edouard Herriot University Hospital, 5 Place d' Arsonval, 69003, Lyon, France
- INSERM, UMR 1052-UMR5286, UMR 1032 Lyon Cancer Research Center, Faculté Laennec, Lyon, France
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Antoine Duclos
- Research On Healthcare Performance RESHAPE, Université Claude Bernard, Inserm U1290, Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
- Lyon University, Claude Bernard Lyon 1 University, Villeurbanne, France
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Mommers L, Verstegen D, Dolmans D, van Mook WNKA. Observation of behavioural skills by medical simulation facilitators: a cross-sectional analysis of self-reported importance, difficulties, observation strategies and expertise development. Adv Simul (Lond) 2023; 8:28. [PMID: 38031197 PMCID: PMC10685611 DOI: 10.1186/s41077-023-00268-x] [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: 05/11/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The association between team performance and patient care was an immense boost for team-based education in health care. Behavioural skills are an important focus in these sessions, often provided via a mannikin-based immersive simulation experience in a (near) authentic setting. Observation of these skills by the facilitator(s) is paramount for facilitated feedback with the team. Despite the acknowledgement that trained facilitators are important for optimal learning, insight into this observation process by facilitators is limited. OBJECTIVES What are the self-reported current practices and difficulties regarding the observation of behavioural skills amongst facilitators during team training and how have they been trained to observe behavioural skills? METHODS This cross-sectional study used a pilot-tested, content-validated, multi-linguistic online survey within Europe, distributed through a non-discriminative snowball sampling method. Inclusion was limited to facilitators observing behavioural skills within a medical team setting. RESULTS A total of 175 persons filled in the questionnaire. All aspects of behavioural skill were perceived as very important to observe. The self-perceived difficulty of the behavioural skill aspects ranged from slightly to moderately difficult. Qualitative analysis revealed three major themes elaborating on this perceived difficulty: (1) not everything can be observed, (2) not everything is observed and (3) interpretation of observed behavioural skills is difficult. Additionally, the number of team members health care facilitators have to observe, outnumbers their self-reported maximum. Strategies and tools used to facilitate their observation were a blank notepad, co-observers and predefined learning goals. The majority of facilitators acquired observational skills through self-study and personal experience and/or observing peers. Co-observation with either peers or experts was regarded as most learn some for their expertise development. Overall, participants perceived themselves as moderately competent in the observation of behavioural skills during team training. CONCLUSIONS Observation of behavioural skills by facilitators in health care remains a complex and challenging task. Facilitators' limitations with respect to attention, focus and (in)ability to perform concomitant tasks, need to be acknowledged. Although strategies and tools can help to facilitate the observation process, they all have their limitations and are used in different ways.
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Affiliation(s)
- Lars Mommers
- Department of Simulation in Healthcare, Maastricht University Medical Centre, PO 5800, NL-6202 AZ, Maastricht, The Netherlands.
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Daniëlle Verstegen
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Diana Dolmans
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Walther N K A van Mook
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Artificial Intelligence in Surgical Learning. SURGERIES 2023. [DOI: 10.3390/surgeries4010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
(1) Background: Artificial Intelligence (AI) is transforming healthcare on all levels. While AI shows immense potential, the clinical implementation is lagging. We present a concise review of AI in surgical learning; (2) Methods: A non-systematic review of AI in surgical learning of the literature in English is provided; (3) Results: AI shows utility for all components of surgical competence within surgical learning. AI presents with great potential within robotic surgery specifically (4) Conclusions: Technology will evolve in ways currently unimaginable, presenting us with novel applications of AI and derivatives thereof. Surgeons must be open to new modes of learning to be able to implement all evidence-based applications of AI in the future. Systematic analyses of AI in surgical learning are needed.
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Managing a Team in the Operating Room: The Science of Teamwork and Non-Technical Skills for Surgeons. Curr Probl Surg 2022; 59:101172. [DOI: 10.1016/j.cpsurg.2022.101172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 11/19/2022]
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Graffeo CS, Perry A, Carlstrom LP, Peris-Celda M, Alexander A, Dickens HJ, Holroyd MJ, Driscoll CLW, Link MJ, Morris J. 3D Printing for Complex Cranial Surgery Education: Technical Overview and Preliminary Validation Study. Skull Base Surg 2022; 83:e105-e112. [DOI: 10.1055/s-0040-1722719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Background 3D printing—also known as additive manufacturing—has a wide range of applications. Reproduction of low-cost, high-fidelity, disease- or patient-specific models presents a key developmental area in simulation and education research for complex cranial surgery.
Methods Using cadaveric dissections as source materials, skull base models were created, printed, and tested for educational value in teaching complex cranial approaches. In this pilot study, assessments were made on the value of 3D printed models demonstrating the retrosigmoid and posterior petrosectomy approaches. Models were assessed and tested in a small cohort of neurosurgery resident subjects (n = 3) using a series of 10 radiographic and 2 printed case examples, with efficacy determined via agreement survey and approach selection accuracy.
Results All subjects indicated agreement or strong agreement for all study endpoints that 3D printed models provided significant improvements in understanding of neuroanatomic relationships and principles of approach selection, as compared to 2D dissections or patient cross-sectional imaging alone. Models were not superior to in-person hands-on teaching. Mean approach selection accuracy was 90% (±13%) for 10 imaging-based cases, or 92% (±7%) overall. Trainees strongly agreed that approach decision-making was enhanced by adjunctive use of 3D models for both radiographic and printed cases.
Conclusion 3D printed models incorporating skull base approaches and/or pathologies provide a compelling addition to the complex cranial education armamentarium. Based on our preliminary analysis, 3D printed models offer substantial potential for pedagogical value as dissection guides, adjuncts to preoperative study and case preparation, or tools for approach selection training and evaluation.
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Affiliation(s)
| | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Lucas P Carlstrom
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Amy Alexander
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Hunter J Dickens
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J Holroyd
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Colin L W Driscoll
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jonathan Morris
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
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Cohen-Bearak A, Meyer EC, Mednick L, Varrin P, Burgess L, Kuhlmann PH, Bell S, Lillehei C. Aligning Family-Clinician Expectations During Pediatric Surgical Informed Consent: Development and Implementation of an Innovative Communication Skills Workshop. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2021; 41:279-285. [PMID: 34609349 DOI: 10.1097/ceh.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Aligning expectations during the informed consent process before a child's surgery is an important element of good communication that benefits both surgical staff and families. We developed and evaluated a 2-hour pilot interprofessional workshop to improve the communication and relational skills of pediatric surgeons and nurse practitioners. METHODS Focus groups with families identified key challenges in the process of informed consent. An interprofessional team, including parents whose children had experienced complex surgeries, developed the workshop collaboratively. A realistic simulation with professional actors portraying parents allowed surgical staff to practice communication skills and receive feedback about the parent perspective. Participants completed a postworkshop evaluation to determine whether the workshop met its objectives and whether they would change practice. RESULTS Five key themes identified for the workshop included customize communication; align expectations; share clinical uncertainty; recognize/attend to emotions; and identify team members. Thirty-five clinicians participated in a workshop, and 89% completed evaluations. Three-quarters reported the learning to be valuable, and 64% were likely to change practice. Eighty-seven percent would recommend the workshop to other colleagues, and 58 to 74% felt more prepared to achieve each of eight specific skills. DISCUSSION An innovative workshop for pediatric surgical practitioners to align family-clinician expectations can help improve clinician communication skills and comfort with informed consent. Keys to workshop development included involving parents to identify themes and participate as workshop co-faculty; enlisting leadership and recruiting surgical champions; and using pre-existing meetings to ease scheduling challenges of busy practitioners. Booster sessions may facilitate the desired cultural changes.
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Affiliation(s)
- Adena Cohen-Bearak
- Ms. Cohen-Bearak: Project Manager, Center for Healthcare Organization and Implementation Research, Bedford VA Healthcare System, Bedford, MA. Dr. Meyer: Boston Children's Hospital, Center for Bioethics, and Associate Professor of Psychology, Harvard Medical School, Boston, MA. Dr. Mednick: Clinical Psychologist, Boston Children's Hospital, and Assistant Professor of Psychology, Harvard Medical School, Boston, MA. Dr. Varrin: Clinical Psychologist, Family Support Coordinator, Cotting School, Lexington, MA. Ms. Burgess: AA, Advisor Emeritus-Family Advisory Council, Boston Children's Hospital, Boston, MA. Dr. Kuhlmann: Chair for Pediatrics, Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany, and Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany. Dr. Bell: Associate Professor, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Dr. Lillehei: Associate Professor of Surgery, Harvard Medical School; Chair of Surgical Education, Boston Children's Hospital, Boston, MA
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Yule S, Gupta A, Blair PG, Sachdeva AK, Smink DS. Gathering Validity Evidence to Adapt the Non-technical Skills for Surgeons (NOTSS) Assessment Tool to the United States Context. JOURNAL OF SURGICAL EDUCATION 2021; 78:955-966. [PMID: 33041250 DOI: 10.1016/j.jsurg.2020.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nontechnical skills are of increasing focus for safe and effective performance in the operating room. Assessment tools have been developed in Europe, Africa, and Asia but not adapted to the unique aspects of surgical delivery in the United States. Our objective was to use the Non-Technical Skills for Surgeons (NOTSS) assessment tool as a basis to establish consensus on essential nontechnical skills for surgical trainees and practicing surgeons in the U.S surgical context. STUDY DESIGN A mixed-methods research design was used in the form of a modified Delphi process to build consensus on essential NOTSS. A panel of surgical experts from hospitals across the U.S used this iterative process in 4 rounds to generate, rate, and classify behaviors. The primary outcome was consensus on behaviors as being essential for surgeons to achieve the best patient outcomes in the operating room, with a median rating of ≥6 on a 7-point scale for inclusion. RESULTS A total of 10 surgical experts participated. One hundred and thirty eight behaviors were generated in Round 1, and reduced to 100 behaviors in Rounds 2 and 3 based on application of inclusion criteria. The final skill list consisted of behaviors in Situation Awareness (n = 26), Decision Making (n = 18), Teamwork (n = 25), and Leadership (n = 31). No additional NOTSS categories or elements emerged from the analysis. In Round 4, all 100 behaviors were successfully grouped into 12 nontechnical skills elements. Labels and definitions were reworded to reflect the U.S. context, and an appropriate assessment scale was selected. CONCLUSIONS A panel of surgical experts from across the U.S. reached consensus on the essential NOTSS to achieve the best patient outcomes in the operating room. These behaviors form an empirical basis for the first context-specific nontechnical skills assessment and training tool for practicing surgeons in the U.S.
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Affiliation(s)
- Steven Yule
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland.
| | - Avni Gupta
- Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Center for Surgery & Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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11
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Pradarelli JC, Gupta A, Hermosura AH, Murayama KM, Delman KA, Shabahang MM, Havens JM, Lipsitz S, Smink DS, Yule S. Non-technical skill assessments across levels of US surgical training. Surgery 2021; 170:713-718. [PMID: 33814190 DOI: 10.1016/j.surg.2021.02.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To ensure safe patient care, regulatory bodies worldwide have incorporated non-technical skills proficiency in core competencies for graduation from surgical residency. We describe normative data on non-technical skill ratings of surgical residents across training levels using the US-adapted Non-Technical Skills for Surgeons (NOTSS-US) assessment tool. METHODS We undertook an exploratory, prospective cohort study of 32 residents-interns (postgraduate year 1), junior residents (postgraduate years 2-3), and senior residents (postgraduate years 4-5)-across 3 US academic surgery residency programs. Faculty went through online training to rate residents, directly observed residents while operating together, then submitted NOTSS-US ratings on specific resident's intraoperative performance. Mean NOTSS-US ratings (total range 4-20, sum of category scores; situation awareness, decision-making, communication/teamwork, leadership each ranged 1-5, with 1=poor, 3=average, 5=excellent) were stratified by residents' training level and adjusted for resident-, rater-, and case-level variables, using mixed-effects linear regression. RESULTS For 80 operations, the overall mean total NOTSS-US rating was 12.9 (standard deviation, 3.5). The adjusted mean total NOTSS-US rating was 16.0 for senior residents, 11.6 for junior residents, and 9.5 for interns. Adjusted differences for total NOTSS-US ratings were statistically significant across the following training levels: senior residents to interns (6.5; 95% confidence interval, 4.3-8.7; P < .001), senior to junior residents (4.4; 95% confidence interval, 2.5-6.2; P < .001), and junior residents to interns (2.1; 95% confidence interval, 0.3-3.9; P = .017). Differences in adjusted NOTSS-US ratings across residents' training levels persisted for individual NOTSS-US behavior categories. CONCLUSION These data and online training materials can support US residency programs in determining competency-based performance milestones to develop surgical trainees' non-technical skills.
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Affiliation(s)
- Jason C Pradarelli
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Avni Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrea H Hermosura
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Kenric M Murayama
- Department of Surgery, The Queen's Medical Center, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Keith A Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohsen M Shabahang
- Department of General Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Joaquim M Havens
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Stuart Lipsitz
- Ariadne Labs, Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven Yule
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland.
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12
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Walsh CM, Scaffidi MA, Khan R, Arora A, Gimpaya N, Lin P, Satchwell J, Al-Mazroui A, Zarghom O, Sharma S, Kamani A, Genis S, Kalaichandran R, Grover SC. Non-technical skills curriculum incorporating simulation-based training improves performance in colonoscopy among novice endoscopists: Randomized controlled trial. Dig Endosc 2020; 32:940-948. [PMID: 31912560 DOI: 10.1111/den.13623] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/26/2019] [Accepted: 01/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Non-technical skills (NTS), involving cognitive, social and interpersonal skills that complement technical skills, are important for the completion of safe and efficient procedures. We investigated the impact of a simulation-based curriculum with dedicated NTS training on novice endoscopists' performance of clinical colonoscopies. METHODS A single-blinded randomized controlled trial was conducted at a single center. Novice endoscopists were randomized to a control curriculum or a NTS curriculum. The control curriculum involved a didactic session, virtual reality (VR) simulator colonoscopy training, and integrated scenario practice using a VR simulator, a standardized patient, and endoscopy nurse. Feedback and training were provided by experienced endoscopists. The NTS curriculum group received similar training that included a small-group session on NTS, feedback targeting NTS, and access to a self-reflective NTS checklist. The primary outcome was performance during two clinical colonoscopies, assessed using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) tool. RESULTS Thirty-nine participants completed the study. The NTS group (n = 21) had superior clinical performance during their first (P < 0.001) and second clinical colonoscopies (P < .0.001), compared to the control group (n = 18). The NTS group performed significantly better on the VR simulator (P < 0.05) and in the integrated scenario (P < 0.05). CONCLUSION Our findings demonstrate that dedicated NTS training led to improved performance of clinical colonoscopies among novices.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, Learning Institute and Research Institute, Hospital for Sick Children, Toronto, Canada.,Faculty of Medicine, The Wilson Centre, University of Toronto, Toronto, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Rishad Khan
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Anuj Arora
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Peter Lin
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Joshua Satchwell
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Ahmed Al-Mazroui
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Omid Zarghom
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Suraj Sharma
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Alya Kamani
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Shai Genis
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Ruben Kalaichandran
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Samir C Grover
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, Toronto, Canada
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13
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Boet S, Etherington N, Crnic A, Kenna J, Jung J, Cairns M, Posner G, Grantcharov T. La définition des moments critiques et non critiques en salle d'opération : une étude de consensus Delphi modifiée. Can J Anaesth 2020; 67:949-958. [PMID: 32377936 DOI: 10.1007/s12630-020-01688-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/17/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While the operating room (OR) has significantly benefited from aviation strategies to improve safety, the rate of avoidable human errors remains relatively high. One key aviation strategy that has yet to be formally established in the OR is the "sterile cockpit" rule, which prohibits all non-essential behaviours during critical moments of a flight. Applying this rule to the OR may enhance patient safety, but the critical moments of surgery need to be defined first. METHODS This study used a modified Delphi methodology to determine critical moments during surgery according to OR team members across institutions, professions, and specialties. Analysis occurred after each round. The stopping criterion was consensus on 80% of survey items or no change in the mean score for any individual item between two consecutive rounds. RESULTS The first round included 304 respondents. Of these, 115 completed the second-round survey, and 75 completed all three rounds (27 nurses, 29 anesthesiologists, 19 surgeons). Critical moments obtained by consensus were: induction of anesthesia; emergence from anesthesia; preoperative briefing; final counts at the end of the procedure; anesthesiologist- or surgeon-relevant intraoperative event; handovers; procedure-specific high-risk surgical moments; crisis resource management situations; medication and equipment preparation; and key medication administration. CONCLUSIONS By defining the most critical moments of surgery, future research can determine the relative importance of behaviour and actions at each stage and target interventions to these stages.
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Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute - Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.,Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Etherington
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute - Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Julie Kenna
- The Ottawa Hospital, Main Operating Room, Ottawa, ON, Canada
| | - James Jung
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Martin Cairns
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Glen Posner
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, ON, Canada
| | - Teodor Grantcharov
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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14
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Walshe NC, Crowley CM, OʼBrien S, Browne JP, Hegarty JM. Educational Interventions to Enhance Situation Awareness: A Systematic Review and Meta-Analysis. Simul Healthc 2020; 14:398-408. [PMID: 31116171 DOI: 10.1097/sih.0000000000000376] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
STATEMENT We conducted a systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals' situation awareness (SA). We searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library. Articles that reported a targeted SA intervention or a broader intervention incorporating SA, and an objective outcome measure of SA were included. Thirty-nine articles were eligible for inclusion, of these 4 reported targeted SA interventions. Simulation-based education (SBE) was the most prevalent educational modality (31 articles). Meta-analysis of trial designs (19 articles) yielded a pooled moderate effect size of 0.61 (95% confidence interval = 0.17 to 1.06, P = 0.007, I = 42%) in favor of SBE as compared with other modalities and a nonsignificant moderate effect in favor of additional nontechnical skills training (effect size = 0.54, 95% confidence interval = 0.18 to 1.26, P = 0.14, I = 63%). Though constrained by the number of articles eligible for inclusion, our results suggest that in comparison with other modalities, SBE yields better SA outcomes.
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Affiliation(s)
- Nuala C Walshe
- From the Clinical Skills Simulation Resource Centre (N.C.W., C.M.C., SO'B), School of Nursing and Midwifery (J.M.H.); and School of Public Health (J.P.B.), University College Cork, Cork, Ireland
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Abstract
Traditional surgical training has focused on the acquisition of technical skills and knowledge with minimal focus on teaching nontechnical skills. Patient safety depends on both technical and nontechnical skills, with a higher rate of non-technical skills failure leading to patient harm. Many surgical training and regulatory bodies have incorporated nontechnical skills in the required competencies of a surgeon, but few have introduced formal training in nontechnical skills. Emerging research shows simulation-based education to be a powerful tool to teach nontechnical skills to individual surgeons and surgeons in training, and to interprofessional surgical teams with subsequent improvement of patient safety outcomes.
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Affiliation(s)
- A Lynch
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, 246 Clayton Road Clayton, Melbourne, Australia.
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16
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Ahmed FUA, Ijaz Haider S, Ashar A, Muzamil A. Non-technical skills training to enhance performance of obstetrics and gynaecology residents in the operating room. J OBSTET GYNAECOL 2019; 39:1123-1129. [PMID: 31328599 DOI: 10.1080/01443615.2019.1587602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The importance of incorporating non-technical skills in surgical training cannot be understated, however, these remain non-core components of training. The aim of our study was to evaluate the effectiveness of a training course in improving residents' non-technical skills performance in the operating room. Twenty-eight eligible Obstetrics and Gynaecology residents were divided into conventional and experimental groups by using blocked randomisation. The experimental group received a training course comprising of 20 h over 5 weeks as an educational intervention. A blinded assessor assessed non-technical skill performance by using non-technical skill for surgeons rating system while performing two procedures evacuation and curettage and elective caesarean section in pretest and post-test phase. The post-test results of experimental training group improved significantly in all four categories: situational awareness, decision-making, communication and leadership than the conventional training group demonstrating the effectiveness of a training course. Participants found the course useful and relevant to their practices and strongly recommended the incorporation of similar courses in early years of training. Impact Statement What is already known on this subject? Operating room is the mainstay of surgeons and the majority of the studies done in the operating room relate to structured courses to teach residents about non-technical skills, with training and evaluation done on the same day. These either explores the perception of trainees, expansion of the cognitive component and/or feasibility of training for non-technical skills. To date, there is a lack of evidence in the literature to address questions regarding the appropriate time to incorporate non-technical skills in the curriculum, due to study designs. This highlights the need for more randomised control trials with different curricular designs to evaluate effectiveness. What do the results of this study add? The results of our study enable a comparative analysis between learning curves of conventional training, with the experimental group demonstrating the effectiveness of a training course. This strongly supports implementation of non-technical training in postgraduate competency-based curricula. What are the implications of these findings for clinical practice and/or further research? This study shall be used as an evidence-based source to design curricula for teaching non-technical skills to residents.
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Affiliation(s)
- Farhat-Ul-Ain Ahmed
- Department of Obstetrics & Gynaecology, Fatima Memorial Hospital , Lahore , Punjab , Pakistan
| | - Sonia Ijaz Haider
- Department of Education, Agha Khan University , Karachi , Sindh , Pakistan
| | - Abid Ashar
- Department of Medical Education, Fatima Memorial Hospital , Lahore , Punjab , Pakistan
| | - Attiqa Muzamil
- Department of Obstetrics & Gynaecology, Fatima Memorial Hospital , Lahore , Punjab , Pakistan
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17
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Hénaux PL, Jannin P, Riffaud L. Nontechnical Skills in Neurosurgery: A Systematic Review of the Literature. World Neurosurg 2019; 130:e726-e736. [DOI: 10.1016/j.wneu.2019.06.204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 01/10/2023]
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18
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Trivedi DB. Educational Value of Surgical Multidisciplinary Team Meetings for Learning Non-Technical Skills - A Pilot Survey of Trainees From Two UK Deaneries. JOURNAL OF SURGICAL EDUCATION 2019; 76:1034-1047. [PMID: 30792161 DOI: 10.1016/j.jsurg.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/04/2019] [Accepted: 02/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This prospective survey study aimed to identify trainee surgeons' views on the educational potential of multi-disciplinary team (MDT) meetings for learning non-technical skills and relevant issues around using MDT meetings as an educational instrument. DESIGN An online survey questionnaire containing eight closed and three open-ended questions; was developed based on established educational theories. Responses were anonymous. SETTING This survey study was designed as professional project for masters in medical education degree at Warwick University. The study received ethical approval from the Biomedical Science Research and Ethics Committee of Warwick University. PARTICIPANTS Trainee surgeons and non-trainee junior surgical doctors within two regions (Health Education Kent Surrey and Sussex, Health Education Wessex) in the UK were invited through an email to take the survey with the help of regional heads of surgery and coordinators. RESULTS Twenty eight (28) out of 420 invitees completed the survey. High internal consistency was observed for questionnaire (Cronbach's α = 0.924). 71.42% (20/28) respondents attended MDT at least once a week. 75.9% of participants indicated the importance of attendance to MDT meetings with any level of involvement; passive attendance considered the least important (5/28, 17.9%, p=0.005). Trainees felt included in the team by attendance to MDT meetings (Median score 5, p=0.027). MDT meetings were considered important for learning all domains of non-technical skills for surgeons taxonomy (cumulative mean score 2.4, p=001). Respondents considered MDT as a valuable tool for learning non-technical skills for surgeons on Miller's pyramid for learning (Cumulative mean 5.6, p=0.025). Free text answers indicated agreement to the learning opportunity provided by MDT meetings. Consistent suggestions of increasing trainee participation were obtained. CONCLUSION Results indicate consistently positive views from trainees about the educational value of MDT meeting in general and for non-technical skills. Trainee participation, in the form of case-preparation, presentation, and discussion are recommended by respondents.
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Affiliation(s)
- Dharmadev B Trivedi
- Warwick Medical School, Warwickshire, United Kingdom; Department of Upper Gastro-Intestinal Surgery, Queen Alexandra Hospital, Portsmouth, Hampshire, United Kingdom.
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19
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Roberts L, Cornell C, Bostrom M, Goldsmith S, Ologhobo T, Roberts T, Robbins L. Communication Skills Training for Surgical Residents: Learning to Relate to the Needs of Older Adults. JOURNAL OF SURGICAL EDUCATION 2018; 75:1180-1187. [PMID: 29609892 DOI: 10.1016/j.jsurg.2018.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/18/2018] [Accepted: 02/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND It is vital for physicians and surgeons to communicate successfully with older adults, who will constitute one-fifth of the US population by 2030. Older adults often perceive themselves as stigmatized and powerless in healthcare settings. Effective communication leads to better patient compliance and satisfaction, which is now a component of Medicare hospital reimbursement and physician and surgeon compensation from hospitals and networks. OBJECTIVE To increase orthopaedic surgery resident understanding of the unique needs of older adults in order to maintain effective and sensitive communication with this vulnerable population. DESIGN A two-part training program (ongoing for 8 years) comprised of: 1) small-group interactive didactic sessions on aging issues; and 2) workshop demonstrations given by the residents to a group of older adults, followed by a Question & Answer session. Residents were assessed using a 22-item pre-post questionnaire covering medical knowledge of aging, attitudes toward older adults, and personal anxiety about aging. Older adult participants were surveyed for perceptions of residents' sensitivity toward them. SETTING Hospital for Special Surgery in New York City, a specialized urban academic center, with a 5-year Orthopedic Surgery Residency program. PARTICIPANTS 70 PGY3 residents, for whom the program is a requirement, and 711 older adult participants recruited from a community convenience sample. RESULTS Older adult participants: Of 711 participants, 672 (95%) responded; 96% strongly agreed/agreed that the residents had demonstrated sensitivity toward them. Residents: Of 70 residents, 35 (50%) were assessed. Mean knowledge scores increased significantly (p ≤ 0.001); five of nine attitude items (p ≤ 0.05) and one of four anxiety items improved significantly (p ≤ 0.001). CONCLUSIONS Significant change was seen in residents' attitudes and anxiety levels toward older adults, attributes that are usually deep seated and hard to change. Residents moved along the Accreditation Council for Graduate Medical Education Milestones continuum for three core competencies.
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Affiliation(s)
- Linda Roberts
- Education Institute, Hospital for Special Surgery, New York, New York.
| | - Charles Cornell
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York
| | - Mathias Bostrom
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York
| | - Sandra Goldsmith
- Education Institute, Hospital for Special Surgery, New York, New York
| | - Titilayo Ologhobo
- Education Institute, Hospital for Special Surgery, New York, New York
| | - Timothy Roberts
- Education Institute, Hospital for Special Surgery, New York, New York
| | - Laura Robbins
- Education Institute, Hospital for Special Surgery, New York, New York
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20
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Skinner A, Diller D, Kumar R, Cannon-Bowers J, Smith R, Tanaka A, Julian D, Perez R. Development and application of a multi-modal task analysis to support intelligent tutoring of complex skills. INTERNATIONAL JOURNAL OF STEM EDUCATION 2018; 5:14. [PMID: 30631704 PMCID: PMC6310465 DOI: 10.1186/s40594-018-0108-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/20/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND Contemporary work in the design and development of intelligent training systems employs task analysis (TA) methods for gathering knowledge that is subsequently encoded into task models. These task models form the basis of intelligent interpretation of student performance within education and training systems. Also referred to as expert models, they represent the optimal way(s) of performing a training task. Within Intelligent Tutoring Systems (ITSs), real-time comparison of trainee task performance against the task model drives automated assessment and interactive support (such as immediate feedback) functionality. However, previous task analysis (TA) methods, including various forms of cognitive task analysis (CTA), may not be sufficient to support identification of the detailed design specifications required for the development of an ITS for a complex training task incorporating multiple underlying skill components, as well as multi-modal information presentation, assessment, and feedback modalities. Our current work seeks to develop an ITS for training Robotic Assisted Laparoscopic Surgery (RALS), a complex task domain that requires a coordinated utilization of integrated cognitive, psychomotor, and perceptual skills. RESULTS In this paper, we describe a methodological extension to CTA, referred to as multi-modal task analysis (MMTA) that elicits and captures the nuances of integrated and isolated cognitive, psychomotor, and perceptual skill modalities as they apply to training and performing complex operational tasks. In the current case, we illustrate the application of the MMTA method described here to RALS training tasks. The products of the analysis are quantitatively summarized, and observations from a preliminary qualitative validation are reported. CONCLUSIONS We find that iterative use of the described MMTA method leads to sufficiently complete and robust task models to support encoding of cognitive, psychomotor, and perceptual skills requisite to training and performance of complex skills within ITS task models.
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Affiliation(s)
| | | | | | | | - Roger Smith
- Florida Hospital Nicholson Center, Celebration, USA
| | | | | | - Ray Perez
- Office of Naval Research, Arlington, USA
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21
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Yule S, Gupta A, Gazarian D, Geraghty A, Smink DS, Beard J, Sundt T, Youngson G, McIlhenny C, Paterson-Brown S. Construct and criterion validity testing of the Non-Technical Skills for Surgeons (NOTSS) behaviour assessment tool using videos of simulated operations. Br J Surg 2018; 105:719-727. [DOI: 10.1002/bjs.10779] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/06/2017] [Accepted: 11/04/2017] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Surgeons' non-technical skills are an important part of surgical performance and surgical education. The most widely adopted assessment tool is the Non-Technical Skills for Surgeons (NOTSS) behaviour rating system. Psychometric analysis of this tool to date has focused on inter-rater reliability and feasibility rather than validation.
Methods
NOTSS assessments were collected from two groups of consultant/attending surgeons in the UK and USA, who rated behaviours of the lead surgeon during a video-based simulated crisis scenario after either online or classroom instruction. The process of validation consisted of assessing construct validity, scale reliability and concurrent criterion validity, and undertaking a sensitivity analysis. Central to this was confirmatory factor analysis to evaluate the structure of the NOTSS taxonomy.
Results
Some 255 consultant surgeons participated in the study. The four-category NOTSS model was found to have robust construct validity evidence, and a superior fit compared with alternative models. Logistic regression and sensitivity analysis revealed that, after adjusting for technical skills, for every 1-point increase in NOTSS score of the lead surgeon, the odds of having a higher versus lower patient safety score was 2·29 times. The same pattern of results was obtained for a broad mix of surgical specialties (UK) as well as a single discipline (cardiothoracic, USA).
Conclusion
The NOTSS tool can be applied in research and education settings to measure non-technical skills in a valid and efficient manner.
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Affiliation(s)
- S Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - A Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - D Gazarian
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A Geraghty
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
| | - D S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - J Beard
- Faculty of Medicine, University of Sheffield, Sheffield, UK
| | - T Sundt
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - G Youngson
- Department of Paediatric Surgery, Royal Aberdeen Children's Hospital, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - C McIlhenny
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
| | - S Paterson-Brown
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Franco CAGDS, Franco RS, Lopes JMC, Severo M, Ferreira MA. Clinical communication skills and professionalism education are required from the beginning of medical training - a point of view of family physicians. BMC MEDICAL EDUCATION 2018; 18:43. [PMID: 29558914 PMCID: PMC5859538 DOI: 10.1186/s12909-018-1141-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/06/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND The Brazilian undergraduate medical course is six years long. As in other countries, a medical residency is not obligatory to practice as a doctor. In this context, this paper aims to clarify what and when competencies in communication and professionalism should be addressed, shedding light on the role of university, residency and post-residency programmes. METHODS Brazilian family physicians with diverse levels of medical training answered a questionnaire designed to seek a consensus on the competencies that should be taught (key competencies) and when students should achieve them during their medical training. The data were analysed using descriptive statistics and correlation tests. RESULTS A total of seventy-four physicians participated; nearly all participants suggested that the students should achieve communication and professionalism competencies during undergraduate study (twenty out of thirty competencies - 66.7%) or during residency (seven out of thirty competencies - 23.33%). When competencies were analysed in domains, the results were that clinical communication skills and professionalism competencies should be achieved during undergraduate medical education, and interpersonal communication and leadership skills should be reached during postgraduate study. CONCLUSION The authors propose that attainment of clinical communication skills and professionalism competencies should be required for undergraduate students. The foundation for Leadership and Interpersonal Abilities should be particularly formed at an undergraduate level and, furthermore, mastered by immersion in the future workplace and medical responsibilities in residency.
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Affiliation(s)
- Camila Ament Giuliani dos Santos Franco
- School of Medicine (discipline of Family Medicine), Pontifical University of Paraná, Curitiba, Brazil
- Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Renato Soleiman Franco
- Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- School of Medicine (discipline of Introduction to the Medical Practice), Pontifical University of Paraná, Curitiba, Brazil
| | - José Mauro Ceratti Lopes
- Department of Public Health, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Community Health Service of the Conceição Hospital Group, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre, RS 90050-170 Brazil
| | - Milton Severo
- Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal
- Institute of Public Health, University of Porto, Portugal. Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Maria Amélia Ferreira
- Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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23
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Surr CA, Gates C, Irving D, Oyebode J, Smith SJ, Parveen S, Drury M, Dennison A. Effective Dementia Education and Training for the Health and Social Care Workforce: A Systematic Review of the Literature. REVIEW OF EDUCATIONAL RESEARCH 2017; 87:966-1002. [PMID: 28989194 PMCID: PMC5613811 DOI: 10.3102/0034654317723305] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Ensuring an informed and effective dementia workforce is of international concern; however, there remains limited understanding of how this can be achieved. This review aimed to identify features of effective dementia educational programs. Critical interpretive synthesis underpinned by Kirkpatrick's return on investment model was applied. One hundred and fifty-two papers of variable quality were included. Common features of more efficacious educational programs included the need for educational programs to be relevant to participants' role and experience, involve active face-to-face participation, underpin practice-based learning with theory, be delivered by an experienced facilitator, have a total duration of at least 8 hours with individual sessions of 90 minutes or more, support application of learning in practice, and provide a structured tool or guideline to guide care practice. Further robust research is required to develop the evidence base; however, the findings of this review have relevance for all working in workforce education.
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Alken A, Luursema JM, Weenk M, Yauw S, Fluit C, van Goor H. Integrating technical and non-technical skills coaching in an acute trauma surgery team training: Is it too much? Am J Surg 2017; 216:369-374. [PMID: 28882359 DOI: 10.1016/j.amjsurg.2017.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/28/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Research on effective integration of technical and non-technical skills in surgery team training is sparse. In a previous study we found that surgical teachers predominantly coached on technical and hardly on non-technical skills during the Definitive Surgical and Anesthetic Trauma Care (DSATC) integrated acute trauma surgery team training. This study aims to investigate whether the priming of teachers could increase the amount of non-technical skills coaching during such a training. DESIGN Coaching activities of 12 surgical teachers were recorded on audio and video. Six teachers were primed on non-technical skills coaching prior to the training. Six others received no priming and served as controls. Blind observers reviewed the recordings of 2 training scenario's and scored whether the observed behaviors were directed on technical or non-technical skills. We compared the frequency of the non-technical skills coaching between the primed and the non-primed teachers and analyzed for differences according to the trainees' level of experience. SETTING Surgical teachers coached trainees during the highly realistic DSATC integrated acute trauma surgery team training. Trainees performed damage control surgery in operating teams on anesthetized porcine models during 6 training scenario's. PARTICIPANTS Twelve experienced surgical teachers participated in this study. RESULTS Coaching on non-technical skills was limited to about 5%. The primed teachers did not coach more often on non-technical skills than the non-primed teachers. We found no differences in the frequency of non-technical skills coaching based on the trainees' level of experience. CONCLUSION Priming experienced surgical teachers does not increase the coaching on non-technical skills. The current DSATC acute trauma surgery team training seems too complex for integrating training on technical and non-technical skills. COMPETENCIES Patient care, Practice based learning and improvement.
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Affiliation(s)
- Alexander Alken
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Jan-Maarten Luursema
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mariska Weenk
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Simon Yauw
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Cornelia Fluit
- Radboud Health Academy, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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What Are the Principles That Guide Behaviors in the Operating Room?: Creating a Framework to Define and Measure Performance. Ann Surg 2017; 265:255-267. [PMID: 27611618 DOI: 10.1097/sla.0000000000001962] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify the core principles that guide expert intraoperative behaviors and to use these principles to develop a universal framework that defines intraoperative performance. BACKGROUND Surgical outcomes are associated with intraoperative cognitive skills. Yet, our understanding of factors that control intraoperative judgment and decision-making are limited. As a result, current methods for training and measuring performance are somewhat subjective-more task rather than procedure-oriented-and usually not standardized. They thus provide minimal insight into complex cognitive processes that are fundamental to patient safety. METHODS Cognitive task analyses for 6 diverse surgical procedures were performed using semistructured interviews and field observations to describe the thoughts, behaviors, and actions that characterize and guide expert performance. Verbal data were transcribed, supplemented with content from published literature, coded, thematically analyzed using grounded-theory by 4 independent reviewers, and synthesized into a list of items. RESULTS A conceptual framework was developed based on 42 semistructured interviews lasting 45 to 120 minutes, 5 expert panels and 51 field observations involving 35 experts, and 135 sources from the literature. Five domains of intraoperative performance were identified: psychomotor skills, declarative knowledge, advanced cognitive skills, interpersonal skills, and personal resourcefulness. Within the advanced cognitive skills domain, 21 themes were perceived to guide the behaviors of surgeons: 18 for surgical planning and error prevention, and 3 for error/injury recognition, rescue, and recovery. The application of these thought patterns was highly case-specific and variable amongst subspecialties, environments, and individuals. CONCLUSIONS This study provides a comprehensive definition of intraoperative expertise, with greater insight into the complex cognitive processes that seem to underlie optimal performance. This framework provides trainees and other nonexperts with the necessary information to use in deliberate practice and the creation of effective thought habits that characterize expert performance. It may help to identify gaps in performance, and to isolate root causes of surgical errors with the ultimate goal of improving patient safety.
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Davis WA, Jones S, Crowell-Kuhnberg AM, O'Keeffe D, Boyle KM, Klainer SB, Smink DS, Yule S. Operative team communication during simulated emergencies: Too busy to respond? Surgery 2017; 161:1348-1356. [DOI: 10.1016/j.surg.2016.09.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/09/2016] [Accepted: 09/16/2016] [Indexed: 11/30/2022]
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Gostlow H, Marlow N, Thomas MJW, Hewett PJ, Kiermeier A, Babidge W, Altree M, Pena G, Maddern G. Non-technical skills of surgical trainees and experienced surgeons. Br J Surg 2017; 104:777-785. [DOI: 10.1002/bjs.10493] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/09/2016] [Accepted: 12/18/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
In addition to technical expertise, surgical competence requires effective non-technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non-technical skills considered essential for a competent surgeon. This study sought to compare the non-technical skills of experienced surgeons who completed their training before the introduction of SET with the non-technical skills of more recent trainees.
Methods
Surgical trainees and experienced surgeons undertook a simulated scenario designed to challenge their non-technical skills. Scenarios were video recorded and participants were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring system. Participants were divided into subgroups according to years of experience and their NOTSS scores were compared.
Results
For most NOTSS elements, mean scores increased initially, peaking around the time of Fellowship, before decreasing roughly linearly over time. There was a significant downward trend in score with increasing years since being awarded Fellowship for six of the 12 NOTSS elements: considering options (score −0·015 units per year), implementing and reviewing decisions (−0·020 per year), establishing a shared understanding (−0·014 per year), setting and maintaining standards (−0·024 per year), supporting others (−0·031 per year) and coping with pressure (−0·015 per year).
Conclusion
The drop in NOTSS score was unexpected and highlights that even experienced surgeons are not immune to deficiencies in non-technical skills. Consideration should be given to continuing professional development programmes focusing on non-technical skills, regardless of the level of professional experience.
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Affiliation(s)
- H Gostlow
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - N Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - M J W Thomas
- Westwood-Thomas Associates, Norton Summit, South Australia, Australia
| | - P J Hewett
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
| | - A Kiermeier
- Statistical Process Improvement Consulting and Training, Gumeracha, South Australia, Australia
| | - W Babidge
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - M Altree
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - G Pena
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - G Maddern
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
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Doumouras AG, Engels PT. Early crisis nontechnical skill teaching in residency leads to long-term skill retention and improved performance during crises: A prospective, nonrandomized controlled study. Surgery 2016; 162:174-181. [PMID: 28011009 DOI: 10.1016/j.surg.2016.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medical error is common in crises, and the majority of observed errors are nontechnical in nature. The long-term impact of teaching crisis nontechnical skills to residents has not been evaluated. The objective of this study was to determine the effect of simulation-based teaching of crisis nontechnical skills compared to controls one year after initial teaching. METHODS This was a prospective study using both historical controls and a before-and-after methodology to evaluate the effect of a high-fidelity simulation curriculum that used crisis resource management principles to teach nontechnical skills. Postgraduate year 2 and 3 residents were invited to take part in a prospective training course over 2 years. The primary outcome was leader performance evaluated by expert raters using the previously validated 7-point Ottawa Global Rating Scale. RESULTS Overall, 23 residents performed 30 simulations over the 2 years with the intervention group of 7 residents being assessed in both years. After adjustment, the postgraduate year 3 intervention group who received training the previous year had significantly higher overall performance scores than all postgraduate year 2 scores (1.09 95% confidence interval 0.70-1.47, P < .001) and the historical postgraduate year 3 cohort who received no prior training (1.20, 95% confidence interval 0.37-2.03, P = .005). There was no decay of skills noted over the course of the study. CONCLUSION Postgraduate year 3 residents who had prior training had significantly improved crisis performance compared to historical postgraduate year 3 controls and untrained postgraduate year 2 residents. There were no significant differences between the crisis performance of postgraduate year 2 residents and the untrained postgraduate year 3 controls. This confirms the beneficial effect and long-term retention after crisis nontechnical skill training.
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Affiliation(s)
| | - Paul T Engels
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, McMaster University, Hamilton, Ontario, Canada.
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Development of an evidence-based training program for laparoscopic hysterectomy on a virtual reality simulator. Surg Endosc 2016; 31:2474-2482. [PMID: 27655379 DOI: 10.1007/s00464-016-5249-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substantial evidence in the scientific literature supports the use of simulation for surgical education. However, curricula lack for complex laparoscopic procedures in gynecology. The objective was to evaluate the validity of a program that reproduces key specific components of a laparoscopic hysterectomy (LH) procedure until colpotomy on a virtual reality (VR) simulator and to develop an evidence-based and stepwise training curriculum. METHODS This prospective cohort study was conducted in a Marseille teaching hospital. Forty participants were enrolled and were divided into experienced (senior surgeons who had performed more than 100 LH; n = 8), intermediate (surgical trainees who had performed 2-10 LH; n = 8) and inexperienced (n = 24) groups. Baselines were assessed on a validated basic task. Participants were tested for the LH procedure on a high-fidelity VR simulator. Validity evidence was proposed as the ability to differentiate between the three levels of experience. Inexperienced subjects performed ten repetitions for learning curve analysis. Proficiency measures were based on experienced surgeons' performances. Outcome measures were simulator-derived metrics and Objective Structured Assessment of Technical Skills (OSATS) scores. RESULTS Quantitative analysis found significant inter-group differences between experienced intermediate and inexperienced groups for time (1369, 2385 and 3370 s; p < 0.001), number of movements (2033, 3195 and 4056; p = 0.001), path length (3390, 4526 and 5749 cm; p = 0.002), idle time (357, 654 and 747 s; p = 0.001), respect for tissue (24, 40 and 84; p = 0.01) and number of bladder injuries (0.13, 0 and 4.27; p < 0.001). Learning curves plateaued at the 2nd to 6th repetition. Further qualitative analysis found significant inter-group OSATS score differences at first repetition (22, 15 and 8, respectively; p < 0.001) and second repetition (25.5, 19.5 and 14; p < 0.001). CONCLUSIONS The VR program for LH accrued validity evidence and allowed the development of a training curriculum using a structured scientific methodology.
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Gotlib Conn L, Haas B, Rubenfeld GD, Scales DC, Amaral AC, Ferguson ND, Nathens AB. Exclusion of Residents From Surgery-Intensive Care Team Communication: A Qualitative Study. JOURNAL OF SURGICAL EDUCATION 2016; 73:639-47. [PMID: 26992941 DOI: 10.1016/j.jsurg.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Communication competency is an important aspect of postgraduate training and patient care delivery in all specialties and clinical domains. This study explored staff surgeon and intensivist perceptions of and experiences with residents' communication with a view toward fostering high quality interspecialty team communication in the surgical intensive care unit. DESIGN A qualitative study using semistructured interviews. Data were analyzed iteratively and inductively as per standard qualitative thematic approach. SETTING University of Toronto, Toronto, Canada. PARTICIPANTS A total of 15 staff surgeons and intensivists who collaborate in patient care in the surgical intensive care unit. RESULTS The phenomenon of "resident bypass" emerged, resulting from staff surgeon and intensivist perceptions that residents threaten the quality of interspecialty team communication. Clear patterns and preferences for resident exclusion from this communication were present. A total of 5 interrelated drivers of resident bypass were discovered: lack of trust, lack of specialized knowledge, poor system design, need for timely communication, and residents' inadequate contribution to decision-making. Surgical and intensive care staff were dissatisfied with the structure of residents' roles in interspecialty team communication. Concerns about communication gaps, patient care continuity, and patient safety were expressed. CONCLUSIONS Surgical and intensive care staff exclude residents from interspecialty team communication for the benefit of patient safety and care continuity, but this limits opportunities for residents to develop communication skill and competence. Efforts are needed to effectively integrate surgery and intensive care residents in interspecialty attending-resident communication in ways that are meaningful for both patient care and postgraduate training. The implications for medical education are discussed.
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Affiliation(s)
| | - Barbara Haas
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Gordon D Rubenfeld
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Damon C Scales
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Andre C Amaral
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Niall D Ferguson
- Critical Care Medicine, University Health Network, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Avery B Nathens
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Non-technical skills in minimally invasive surgery teams: a systematic review. Surg Endosc 2016; 30:5185-5199. [PMID: 27066972 DOI: 10.1007/s00464-016-4890-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/23/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Root cause analyses show that up to 70 % of adverse events are caused by human error. Strong non-technical skills (NTS) can prevent or reduce these errors, considerable numbers of which occur in the operating theatre. Minimally invasive surgery (MIS) requires manipulation of more complex equipment than open procedures, likely requiring a different set of NTS for each kind of team. The aims of this study were to identify the MIS teams' key NTS and investigate the effect of training and assessment of NTS on MIS teams. METHODS The databases of PubMed, Cochrane Library, Embase, PsycINFO, and Scopus were systematically searched according to Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles containing outcome measures related to MIS teams' key NTS, training, or assessment of NTS were included. RESULTS The search yielded 1984 articles, 11 of which were included. All were observational studies without blinding, and they differed in aims, types of evaluation, and outcomes. Only two studies evaluated patient outcomes other than operative time, and overall, the studies' quality of evidence was low. Different communication types were encountered in MIS compared to open surgery, mainly due to equipment- and patient-related challenges. Fixed teams improved teamwork and safety levels, while deficient planning and poor teamwork were found to obstruct workflow and increase errors. Training NTS mitigates these issues and improves staff attitudes towards NTS. CONCLUSIONS MIS teams' NTS are important for workflow and prevention of errors and can be enhanced by working in fixed teams. In the technological complex sphere of MIS, communication revolves around equipment- and patient-related topics, much more so than in open surgery. In all, only a few heterogeneous-design studies have examined this. In the future, the focus should shift to systematically identifying key NTS and developing effective, evidence-based team training programmes in MIS.
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Structured Training to Improve Nontechnical Performance of Junior Surgical Residents in the Operating Room. Ann Surg 2016; 263:43-9. [DOI: 10.1097/sla.0000000000001186] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kwakye G, Chen XP, Havens JM, Irani JL, Yule S, Smink DS. An Apprenticeship Rotation Teaches Chief Residents Nontechnical Skills and ACGME Core Competencies. JOURNAL OF SURGICAL EDUCATION 2015; 72:1095-1101. [PMID: 26250596 DOI: 10.1016/j.jsurg.2015.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/28/2015] [Accepted: 07/06/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Traditionally, surgical training has used an apprenticeship model but has more recently moved to a service-based model, with groups of residents working with groups of attending surgeons. We developed an apprenticeship rotation to enhance one-on-one interaction between chief residents and selected faculty. We hypothesized that the apprenticeship rotation would be effective for teaching nontechnical skills (NTS) and core competencies. MATERIALS AND METHODS An apprenticeship rotation was created at a university-based surgery residency in which each chief resident selected a single attending surgeon with whom to work exclusively with for a 4-week period. Emphasis was placed on teaching intraoperative NTS as well as the 4 difficult-to-teach Accreditation Council for Graduate Medical Education core competencies (DCC): Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice. Participants were surveyed afterwards about their rotation using a 5-point Likert scale. A Wilcoxon signed rank test was used to compare differences depending on data distribution. RESULTS All (13/13) the chief residents and 67% (8/12) faculty completed the survey. Overall, 85% of residents and 87.5% of faculty would recommend the rotation to other residents/faculty members. Both residents and faculty reported improvement in trainees' technical skills and NTS. Residents reported improvement in all 4 DCC, particularly, Practice-Based Learning and Improvement, Professionalism, and Interpersonal and Communication Skills. CONCLUSION The apprenticeship rotation is an effective means of teaching residents both NTS and DCC essential for independent practice. Consideration should be given to introducing this program into surgical curricula nationally.
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Affiliation(s)
- Gifty Kwakye
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Joaquim M Havens
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer L Irani
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven Yule
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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Yule S, Parker SH, Wilkinson J, McKinley A, MacDonald J, Neill A, McAdam T. Coaching Non-technical Skills Improves Surgical Residents' Performance in a Simulated Operating Room. JOURNAL OF SURGICAL EDUCATION 2015; 72:1124-30. [PMID: 26610355 DOI: 10.1016/j.jsurg.2015.06.012] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 06/16/2015] [Accepted: 06/18/2015] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To investigate the effect of coaching on non-technical skills and performance during laparoscopic cholecystectomy in a simulated operating room (OR). BACKGROUND Non-technical skills (situation awareness, decision making, teamwork, and leadership) underpin technical ability and are critical to the success of operations and the safety of patients in the OR. The rate of developing assessment tools in this area has outpaced development of workable interventions to improve non-technical skills in surgical training and beyond. METHOD A randomized trial was conducted with senior surgical residents (n = 16). Participants were randomized to receive either non-technical skills coaching (intervention) or to self-reflect (control) after each of 5 simulated operations. Coaching was based on the Non-Technical Skills For Surgeons (NOTSS) behavior observation system. Surgeon-coaches trained in this method coached participants in the intervention group for 10 minutes after each simulation. Primary outcome measure was non-technical skills, assessed from video by a surgeon using the NOTSS system. Secondary outcomes were time to call for help during bleeding, operative time, and path length of laparoscopic instruments. RESULTS Non-technical skills improved in the intervention group from scenario 1 to scenario 5 compared with those in the control group (p = 0.04). The intervention group was faster to call for help when faced with unstoppable bleeding in the final scenario (no. 5; p = 0.03). CONCLUSIONS Coaching improved residents' non-technical skills in the simulated OR compared with those in the control group. Important next steps are to implement non-technical skills coaching in the real OR and assess effect on clinically important process measures and patient outcomes.
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Affiliation(s)
- Steven Yule
- STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Psychology, University of Aberdeen, Aberdeen, Scotland.
| | - Sarah Henrickson Parker
- Department of Psychology, University of Aberdeen, Aberdeen, Scotland; National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia
| | - Jill Wilkinson
- Department of Psychology, University of Aberdeen, Aberdeen, Scotland
| | - Aileen McKinley
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland
| | - Jamie MacDonald
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland
| | - Adrian Neill
- Department of Surgery, Southern Trust, Northern Ireland
| | - Tim McAdam
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland; Department of Surgery, Belfast City Hospital, Belfast, Northern Ireland
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Abstract
The importance of surgeons' nontechnical skills is gaining widespread recognition as a critical element of high-quality and safe surgical care. This article reviews the knowledge base on training and assessing surgeons, and operating room (OR) teams, in nontechnical aspects of their performance. Nontechnical skills are defined in the context of the OR and key assessment instruments that have been developed to capture these skills are reviewed. Key developments that have taken place in the past decade on formal skills training are discussed, and recommendations to further advance nontechnical skills and team-based training and assessment in surgery are presented.
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Affiliation(s)
- Louise Hull
- Department of Surgery and Cancer, Patient Safety Translational Research Center, St Mary's Hospital, Imperial College London, Wright Fleming Building, Norfolk Place, London W2 1PG, UK.
| | - Nick Sevdalis
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, PO29 David Goldberg Centre, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
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Kirkman MA, Sevdalis N, Arora S, Baker P, Vincent C, Ahmed M. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review. BMJ Open 2015; 5:e007705. [PMID: 25995240 PMCID: PMC4442206 DOI: 10.1136/bmjopen-2015-007705] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic. DESIGN A systematic review. DATA SOURCES Embase, Ovid Medline and PsycINFO databases. STUDY SELECTION Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014. DATA EXTRACTION The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions. RESULTS We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation. CONCLUSIONS There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread.
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Affiliation(s)
- Matthew A Kirkman
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Nick Sevdalis
- Health Service and Population Research Department, Centre for Implementation Science, King's College London, London, UK
| | - Sonal Arora
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Baker
- Health Education North West, Manchester, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Maria Ahmed
- Centre for Primary Care, NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Acton RD, Chipman JG, Lunden M, Schmitz CC. Unanticipated teaching demands rise with simulation training: strategies for managing faculty workload. JOURNAL OF SURGICAL EDUCATION 2015; 72:522-529. [PMID: 25467731 DOI: 10.1016/j.jsurg.2014.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/20/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Using simulation to teach and assess learners represents a powerful approach to training, but one that comes with hidden costs in terms of faculty time, even if programs adopt existing curricula. Some simulators are built to be used independently by learners, but much of the surgical simulation curricula developed for cognitive and psychomotor tasks requires active faculty involvement and low learner-to-faculty teaching ratios to ensure sufficient practice with feedback. The authors hypothesize that the added teaching demands related to simulation have resulted in a significant financial burden to surgery training programs. To date, the effect of simulation-based training on faculty workload has not been estimated objectively and reported in the literature. METHODS To test their hypothesis, the authors analyzed data from 2 sources: (1) changes over time (2006-2014) in formal teaching hours and estimated faculty costs at the University of Minnesota, General Surgery Department and (2) a 2014 online survey of general surgery program directors on their use of simulation for teaching and assessment and their perceptions of workload effects. RESULTS At the University of Minnesota, the total number of hours spent by department faculty in resident and student simulation events increased from 81 in annual year 2006 to 365 in annual year 2013. Estimated full-time equivalent faculty costs rose by 350% during the same period. Program directors (n = 48) of Association of Program Directors in Surgery reported either a slight (60%) or a significant (33%) increase in faculty workload with the advent of simulation, and moderate difficulty in finding enough instructors to meet this increase. Calling upon leadership for support, using diverse instructor types, and relying on "the dedicated few" represent the most common strategies. CONCLUSION To avoid faculty burnout and successfully sustain faculty investment in simulation-based training over time, programs need to be creative in building, sustaining, and managing the instructor workforce.
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Affiliation(s)
- Robert D Acton
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
| | - Jeffrey G Chipman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michelle Lunden
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Connie C Schmitz
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Recommendations from the Association of European Paediatric Cardiology for training in diagnostic and interventional cardiac catheterisation. Cardiol Young 2015; 25:438-46. [PMID: 25069005 DOI: 10.1017/s1047951114001309] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiac catheterisation in congenital heart disease is a developing field. Patients' ages range from foetus to adulthood. This document is a revision and update of the previously published recommendations and summarises the requirements for training in diagnostic and interventional cardiac catheterisation.
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Dedy NJ, Szasz P, Louridas M, Bonrath EM, Husslein H, Grantcharov TP. Objective structured assessment of nontechnical skills: Reliability of a global rating scale for the in-training assessment in the operating room. Surgery 2015; 157:1002-13. [PMID: 25704419 DOI: 10.1016/j.surg.2014.12.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/13/2014] [Accepted: 12/18/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nontechnical skills are critical for patient safety in the operating room (OR). As a result, regulatory bodies for accreditation and certification have mandated the integration of these competencies into postgraduate education. A generally accepted approach to the in-training assessment of nontechnical skills, however, is lacking. The goal of the present study was to develop an evidence-based and reliable tool for the in-training assessment of residents' nontechnical performance in the OR. METHODS The Objective Structured Assessment of Nontechnical Skills tool was designed as a 5-point global rating scale with descriptive anchors for each item, based on existing evidence-based frameworks of nontechnical skills, as well as resident training requirements. The tool was piloted on scripted videos and refined in an iterative process. The final version was used to rate residents' performance in recorded OR crisis simulations and during live observations in the OR. RESULTS A total of 37 simulations and 10 live procedures were rated. Interrater agreement was good for total mean scores, both in simulation and in the real OR, with intraclass correlation coefficients >0.90 in all settings for average and single measures. Internal consistency of the scale was high (Cronbach's alpha = 0.80). CONCLUSION The Objective Structured Assessment of Nontechnical Skills global rating scale was developed as an evidence-based tool for the in-training assessment of residents' nontechnical performance in the OR. Unique descriptive anchors allow for a criterion-referenced assessment of performance. Good reliability was demonstrated in different settings, supporting applications in research and education.
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Affiliation(s)
- Nicolas J Dedy
- Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Peter Szasz
- Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Marisa Louridas
- Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Esther M Bonrath
- Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Heinrich Husslein
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Teodor P Grantcharov
- Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Teamwork Mentality in Neurosurgical Teams to Improve Patient Safety. World Neurosurg 2015; 83:41-3. [DOI: 10.1016/j.wneu.2013.08.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
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Le Reste PJ, Henaux PL, Riffaud L, Haegelen C, Morandi X. Influence of cumulative surgical experience on the outcome of poor-grade patients with ruptured intracranial aneurysm. Acta Neurochir (Wien) 2015; 157:1-7. [PMID: 25248329 DOI: 10.1007/s00701-014-2241-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/15/2014] [Indexed: 04/07/2023]
Abstract
BACKGROUND The expansion of endovascular techniques for intracranial aneurysms has led to a global decrease in vascular neurosurgery activity. This situation might impact neurosurgeons' level of expertise, even though they all might have to deal with this surgically challenging pathology. In that context, we wanted to assess the impact of cumulative surgical experience on the outcome of patients with poor-grade subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH) treated by microsurgery. METHODS Sixty-seven patients who underwent surgery for a ruptured aneurysm with SAH and ICH, and a WFNS scale of IV/V, were included. Surgeries were performed by five surgeons, whose experience was judged by the total number of aneurysm surgeries performed. The outcome was assessed by three indicators: intraoperative rupture (IOR), early mortality, and the modified Rankin Scale at last follow-up. The time of IOR was reported on an IOR score. The correlation between surgical experience and outcome was assessed by linear regression. Nonlinear regression was used to assess the correlation of the data with a learning curve model. RESULTS The analysis showed an influence of surgical experience on intraoperative rupture, with no effect on long-term outcome. No influence was found on early mortality. Increased surgical experience seems to reduce IOR during aneurysm dissection and clip repositioning. Intraoperative rupture data fit Wright's learning curve model. CONCLUSION This study suggests a direct impact of cumulative experience on the course of ruptured aneurysm surgery and pleads for the use of training and simulation programmes dedicated to neurovascular surgery.
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Wie lernen wir, Patienten sicher zu versorgen? Patientensicherheit in der Ausbildung der Gesundheitsberufe. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 58:87-94. [DOI: 10.1007/s00103-014-2075-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Radiology Trainees’ Comfort With Difficult Conversations and Attitudes About Error Disclosure: Effect of a Communication Skills Workshop. J Am Coll Radiol 2014; 11:781-7. [DOI: 10.1016/j.jacr.2014.01.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/23/2014] [Indexed: 11/24/2022]
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