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Branstetter R, Piedy E, Rajendra R, Bronstone A, Dasa V. Navigating the Intersection of Technology and Surgical Education: Advancements, Challenges, and Ethical Considerations in Orthopedic Training. Orthop Clin North Am 2025; 56:21-28. [PMID: 39581642 DOI: 10.1016/j.ocl.2024.07.003] [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] [Indexed: 11/26/2024]
Abstract
The emergence of technological advancements such as artificial intelligence, virtual reality, and robotics may offer new solutions to address crucial deficiencies in surgical residency training. However, these technologies also introduce ethical dilemmas and practical complexities. Achieving a balance between embracing innovation and refining traditional surgical techniques is essential in molding well-rounded, proficient surgeons. Addressing concerns such as disparities in access to technology and the risk of excessive automated system dependence demands thorough deliberation and the establishment of universal guidelines. By approaching these challenges with care and insight, surgeons can utilize new technology to elevate both surgical training and outcomes.
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Affiliation(s)
- Robert Branstetter
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center School of Medicine, 2020 Gravier Street, New Orleans, LA 70112, USA.
| | - Erik Piedy
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center School of Medicine, 2020 Gravier Street, New Orleans, LA 70112, USA
| | - Ravi Rajendra
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, 2021 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Amy Bronstone
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, 2021 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Vinod Dasa
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, 2021 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
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2
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Watkins SC, Hensley NB. Team Dynamics in the Operating Room: How Is Team Performance Optimized? Anesthesiol Clin 2023; 41:775-787. [PMID: 37838383 DOI: 10.1016/j.anclin.2023.05.004] [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] [Indexed: 10/16/2023]
Abstract
Health care requires the effort of a team, and nowhere is this more evident than in the care of the surgical patient. No single clinician can perform all aspects of the continuum of surgical care. The basic operating room (OR) team consists of nurses, technicians, surgeons, and anesthesiologists with unique and well-defined roles and expertise in perioperative care. The modern OR team continues to grow and evolve in size, diversity, and complexity to meet the needs of growing patient and procedural complexity. This growing complexity makes achieving optimal team performance paramount and challenging.
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Affiliation(s)
- Scott C Watkins
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Johns Hopkins All Children's Hospital, 501 6th Street South, Suite 707, Saint Petersburg, FL 33701, USA.
| | - Nadia B Hensley
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care Medicine, 1800 Orleans Avenue, Sheik Zayed Tower Suite 6212, Baltimore, MD 21287, USA
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Sutcliffe KM. Building Cultures of High Reliability: Lessons from the High Reliability Organization Paradigm. Anesthesiol Clin 2023; 41:707-717. [PMID: 37838378 DOI: 10.1016/j.anclin.2023.03.012] [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] [Indexed: 10/16/2023]
Abstract
Safety models from disciplines outside of health care have begun to diffuse into the health care safety arena. This article explores high reliability organizing (HRO) theory, which privileges culture as means to adaptively learn and reliably perform. A brief history of the HRO paradigm and factors that contribute to cultures of high reliability is provided, followed by review of existing research to discern which HRO ideas have diffused into research on anesthesiology and perioperative care. High reliability research is growing and concepts seem useful; but there is a long way to go before the benefits of HRO are fully realized.
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Affiliation(s)
- Kathleen M Sutcliffe
- Johns Hopkins University, Carey Business School, 100 International Drive, Room 1217, Baltimore, MD 21202, USA.
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4
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Kotarba JA, Molldrem S, Smith E, Spratt H, Bhavnani SK, Farroni JS, Wooten K. Exploring team dynamics during the development of a multi-institutional cross-disciplinary translational team: Implications for potential best practices. J Clin Transl Sci 2023; 7:e220. [PMID: 38028346 PMCID: PMC10643934 DOI: 10.1017/cts.2023.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction A recent literature review revealed no studies that explored teams that used an explicit theoretical framework for multiteam systems in academic settings, such as the increasingly important multi-institutional cross-disciplinary translational team (MCTT) form. We conducted an exploratory 30-interview grounded theory study over two rounds to analyze participants' experiences from three universities who assembled an MCTT in order to pursue a complex grant proposal related to research on post-acute sequelae of COVID-19, also called "long COVID." This article considers activities beginning with preliminary discussions among principal investigators through grant writing and submission, and completion of reviews by the National Center for Advancing Translational Sciences, which resulted in the proposal not being scored. Methods There were two stages to this interview study with MCTT members: pre-submission, and post-decision. Round one focused on the process of developing structures to collaborate on proposal writing and assembly, whereas round two focused on evaluation of the complete process. A total of 15 participants agreed to be interviewed in each round. Findings The first round of interviews was conducted prior to submission and explored issues during proposal writing, including (1) importance of the topic; (2) meaning and perception of "team" within the MCTT context; and (3) leadership at different levels of the team. The second round explored best practices-related issues including (1) leadership and design; (2) specific proposal assembly tasks; (3) communication; and (4) critical events. Conclusion We conclude with suggestions for developing best practices for assembling MCTTs involving multi-institutional teams.
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Affiliation(s)
- Joseph A. Kotarba
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Sociology, Texas State University, San Marcos, TX, USA
| | - Stephen Molldrem
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, TX, USA
| | - Elise Smith
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, TX, USA
| | - Heidi Spratt
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA
| | - Suresh K. Bhavnani
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA
| | - Jeffrey S. Farroni
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, TX, USA
| | - Kevin Wooten
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
- University of Houston Clear Lake, Houston, TX, USA
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5
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Auschra C, Asaad E, Sydow J, Hinkelmann J. Interventions Into Reliability-Seeking Health Care Organizations: A Systematic Review of Their Goals and Measuring Methods. J Patient Saf 2022; 18:e1211-e1218. [PMID: 35948320 DOI: 10.1097/pts.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES Within the last 2 decades, numerous interventions making use of high-reliability theory have been implemented to increase reliability in healthcare organizations. This systematic literature review first explores the concrete goals on which such interventions focus. Second, the review captures how the achievement of these goals, or alternatively a change, generally an increase in organizational reliability, is measured across different contexts. METHODS Searches were conducted in PubMed, Academic Search Ultimate, Business SourcePremier, CINAHL, Communication Source, EconLit, ERIC, Medline, Political Science Complete, PsycArticles, APA PsycInfo, PSYNDEX, SocINDEX (via the resource hosterEbscoHost), and Web of Science (through November 22, 2021). Peer-reviewed, English language studies were included, reporting on the implementation of a concrete intervention to increase reliability in a medical context and referring to high-reliability theory. RESULTS The search first yielded 8896 references, from which 75 studies were included in the final sample. Important healthcare goals stated by the seminal report "Crossing the Quality Chasm" guided the analysis of the included studies. Most of the studies originated from the United States and report on interventions to increase reliability of either organizational units or whole organizations when aiming for safety (n = 65). Other goals reported on include effectiveness, and much less frequently timeliness, patient centeredness, and efficiency. Fifty-eight studies use quantitative measurement exclusively to account for the achievement of these goals; 7 studies use qualitative measurement exclusively, and 10 studies use a mixed-method approach. The operationalization of goals, including the operationalization of organizational reliability, and measurement methods do not follow a unified approach, despite claiming to be informed by a coherent theory. Instead, such operationalizations strongly depend on the overall objective of the study and the respective context. CONCLUSIONS Measuring the outcomes of high-reliability interventions into healthcare organizations is challenging for different reasons, including the difficult operationalization of partly overlapping goals, the complex, processual nature of achieving reliability, and the limited ability of organizations striving for more reliability if they are already performing on a high level. This review critically assesses the adoption of the goals stated in the seminal report "Crossing the Quality Chasm" and provides insights for organizations and funding providers that strive to evaluate more reliable service provision.
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Affiliation(s)
- Carolin Auschra
- From the Department of Management, Freie Universität Berlin, Berlin, Germany
| | | | - Jörg Sydow
- From the Department of Management, Freie Universität Berlin, Berlin, Germany
| | - Jürgen Hinkelmann
- Department for Anesthesiology, Intensive Care and Emergency Medicine, St Josefs Hospital, Dortmund, Germany
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Thiong'o GM, Kulkarni A, Drake JM. Moderate procedural confidence improvement following hands-on practice using the hemispherectomy simulator. Childs Nerv Syst 2022; 38:1777-1782. [PMID: 35902416 DOI: 10.1007/s00381-022-05628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pediatric hemispherectomy is a technically demanding procedure with significant risk. There are relatively few opportunities for surgeon trainees to gain confidence in this nuanced surgery solely through traditional apprenticeship prior to independent practice. Surgeon confidence has been linked to better intraoperative performance and surgical simulation has, according to literature, resulted in improved surgeon confidence. This manuscript measures the effect of epilepsy simulation on the procedural confidence of neurosurgical trainees as a marker of future improved intraoperative performance. METHODS Eleven neurosurgery residents and fellows were allowed to practice on a novel hemispherectomy simulator. Pre- and post-simulation procedural confidence was measured using a 10-item questionnaire, with total scores ranging from 10 (least confident) to 50 (most confident). Matched pair t-testing was performed to determine participant mean difference between the pre- and post-procedural data sets. RESULTS The assessment tool bore a high reliability coefficient (Cronbach's α = 0.93). The procedural confidence of all the study participants increased following simulation (p value < 0.001). The overall mean increase in confidence was 7.2 ± 4.0 (mean ± standard deviation), 7.5 ± 4.7 among fellows and 6.8 ± 3.6 among residents. Procedural confidence values were higher among the fellows (26.9 ± 8.1) compared to the residents (19.0 ± 7.4). This difference in means was statistically significant (p value 0.03). A positive association was calculated between the perceived confidence and the postgraduate year of training (p value 0.005, r = 0.57). CONCLUSION The hemispherectomy simulator moderately improves perceived confidence among neurosurgical trainees and may augment pre-operative surgical practice opportunities.
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Affiliation(s)
- Grace M Thiong'o
- Posluns Center for Image Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Abhaya Kulkarni
- Posluns Center for Image Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - James M Drake
- Posluns Center for Image Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
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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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de Malleray H, Cardinale M, Avaro JP, Meaudre E, Monchal T, Bourgouin S, Vasse M, Balandraud P, de Lesquen H. Emergency department thoracotomy in a physician-staffed trauma system: the experience of a French Military level-1 trauma center. Eur J Trauma Emerg Surg 2022; 48:4631-4638. [PMID: 35633378 DOI: 10.1007/s00068-022-01995-y] [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: 01/18/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate survival after emergency department thoracotomy (EDT) in a physician-staffed emergency medicine system. METHODS This single-center retrospective study included all in extremis trauma patients who underwent EDT between 2013 and 2021 in a military level 1 trauma center. CPR time exceeding 15 minutes for penetrating trauma of 10 minutes for blunt trauma, and identified head injury were the exclusion criteria. RESULTS Thirty patients (73% male, 22/30) with a median age of 42 y/o [27-64], who presented mostly with polytrauma (60%, 18/30), blunt trauma (60%, 18/30), and severe chest trauma with a median AIS of 4 3-5 underwent EDT. Mean prehospital time was 58 min (4-73). On admission, the mean ISS was 41 29-50, and 53% (16/30) of patients had lost all signs of life (SOL) before EDT. On initial work-up, Hb was 9.6 g/dL [7.0-11.1], INR was 2.5 [1.7-3.2], pH was 7.0 [6.8-7.1], and lactate level was 11.1 [7.0-13.1] mmol/L. Survival rates at 24 h and 90 days after penetrating versus blunt trauma were 58 and 41% versus 16 and 6%, respectively. If SOL were present initially, these values were 100 and 80% versus 22 and 11%. CONCLUSION Among in extremis patients supported in a physician-staffed emergency medicine system, implementation of a trauma protocol with EDT resulted in overall survival rates of 33% at 24 h and 20% at 90 days. Best survival was observed for penetrating trauma or in the presence of SOL on admission.
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Affiliation(s)
| | | | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Eric Meaudre
- ICU, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Tristan Monchal
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Stéphane Bourgouin
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Mathieu Vasse
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Paul Balandraud
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France.
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9
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Abildgren L, Lebahn-Hadidi M, Mogensen CB, Toft P, Nielsen AB, Frandsen TF, Steffensen SV, Hounsgaard L. The effectiveness of improving healthcare teams' human factor skills using simulation-based training: a systematic review. Adv Simul (Lond) 2022; 7:12. [PMID: 35526061 PMCID: PMC9077986 DOI: 10.1186/s41077-022-00207-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/05/2022] [Indexed: 01/08/2023] Open
Abstract
Background Simulation-based training used to train healthcare teams’ skills and improve clinical practice has evolved in recent decades. While it is evident that technical skills training is beneficial, the potential of human factor training has not been described to the same extent. Research on human factor training has been limited to marginal and acute care scenarios and often to validate instruments. This systematic review aimed to investigate the effectiveness of simulation-based training in improving in-hospital qualified healthcare teams’ human factor skills. Method A review protocol outlining the study was registered in PROSPERO. Using the PRISMA guidelines, the systematic search was conducted on September 28th, 2021, in eight major scientific databases. Three independent reviewers assessed title and abstract screening; full texts were evaluated by one reviewer. Content analysis was used to evaluate the evidence from the included studies. Results The search yielded 19,767 studies, of which 72 were included. The included studies were published between 2004 and 2021 and covered research from seven different in-hospital medical specialisms. Studies applied a wide range of assessment tools, which made it challenging to compare the effectiveness of human factor skills training across studies. The content analysis identified evidence for the effectiveness. Four recurring themes were identified: (1) Training human factor skills in qualified healthcare teams; (2) assessment of human factor skills; (3) combined teaching methods, and (4) retention and transfer of human factor skills. Unfortunately, the human factor skills assessments are variable in the literature, affecting the power of the result. Conclusion Simulation-based training is a successful learning tool to improve qualified healthcare teams’ human factor skills. Human factor skills are not innate and appear to be trainable similar to technical skills, based on the findings of this review. Moreover, research on retention and transfer is insufficient. Further, research on the retention and transfer of human factor skills from simulation-based training to clinical practice is essential to gain knowledge of the effect on patient safety. Supplementary Information The online version contains supplementary material available at 10.1186/s41077-022-00207-2.
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Affiliation(s)
- Lotte Abildgren
- Anesthesiology and Intensive Care Unit, Odense University Hospital, Odense, Denmark. .,OPEN, Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Emergency Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Odense, Denmark.
| | - Malte Lebahn-Hadidi
- Emergency Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Odense, Denmark.,Centre for Human Interactivity, Department of Language and Communication, University of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Emergency Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Odense, Denmark
| | - Palle Toft
- Anesthesiology and Intensive Care Unit, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Bo Nielsen
- OPEN, Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,SimC, Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark
| | - Tove Faber Frandsen
- Department of Design and Communication, University of Southern Denmark, Kolding, Denmark
| | - Sune Vork Steffensen
- Centre for Human Interactivity, Department of Language and Communication, University of Southern Denmark, Odense, Denmark.,Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark.,Center for Ecolinguistics, South China Agricultural University, Guangzhou, People's Republic of China.,College of International Studies, Southwest University, Chongqing, People's Republic of China
| | - Lise Hounsgaard
- OPEN, Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Institute of Nursing & Health Science, Ilisimartusarfik, University of Greenland, Nuuk, Greenland.,Center for Mental Health Nursing and Health Research (CPS), Mental Health Services, Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
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L’Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanie A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C, Pour les membres de la commission des référentiels. Recommandations de pratiques professionnelles : Intérêts de l’apprentissage par simulation en soins critiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee A, Finstad A, Tipney B, Lamb T, Rahman A, Devenny K, Abou Khalil J, Kuziemsky C, Balaa F. Exploring human factors in the operating room: scoping review of training offerings for healthcare professionals. BJS Open 2022; 6:zrac011. [PMID: 35348608 PMCID: PMC8963294 DOI: 10.1093/bjsopen/zrac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Human factors (HF) integration can improve patient safety in the operating room (OR), but the depth of current knowledge remains unknown. This study aimed to explore the content of HF training for the operative environment. METHODS We searched six bibliographic databases for studies describing HF interventions for the OR. Skills taught were classified using the Chartered Institute of Ergonomics and Human Factors (CIEHF) framework, consisting of 67 knowledge areas belonging to five categories: psychology; people and systems; methods and tools; anatomy and physiology; and work environment. RESULTS Of 1851 results, 28 studies were included, representing 27 unique interventions. HF training was mostly delivered to interdisciplinary groups (n = 19; 70 per cent) of surgeons (n = 16; 59 per cent), nurses (n = 15; 56 per cent), and postgraduate surgical trainees (n = 11; 41 per cent). Interactive methods (multimedia, simulation) were used for teaching in all studies. Of the CIEHF knowledge areas, all 27 interventions taught 'behaviours and attitudes' (psychology) and 'team work' (people and systems). Other skills included 'communication' (n = 25; 93 per cent), 'situation awareness' (n = 23; 85 per cent), and 'leadership' (n = 20; 74 per cent). Anatomy and physiology were taught by one intervention, while none taught knowledge areas under work environment. CONCLUSION Expanding HF education requires a broader inclusion of the entirety of sociotechnical factors such as contributions of the work environment, technology, and broader organizational culture on OR safety to a wider range of stakeholders.
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Affiliation(s)
- Alex Lee
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Tyler Lamb
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Alvi Rahman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kirsten Devenny
- Saegis, Canadian Medical Protective Association, Ottawa, ON, Canada
| | - Jad Abou Khalil
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Craig Kuziemsky
- Office of Research Services and School of Business, MacEwan University, AB, Canada
| | - Fady Balaa
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
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12
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Picard J, Evain JN, Douron C, Maussion É, Stihle X, Manhes P, Romegoux P, Baron A, Chapuis C, Vermorel C, Garel B, Faucheron JL, Bouzat P, Bosson JL, Albaladejo P. Impact of a large interprofessional simulation-based training course on communication, teamwork, and safety culture in the operating theatre: a mixed-methods interventional study. Anaesth Crit Care Pain Med 2021; 41:100991. [PMID: 34863967 DOI: 10.1016/j.accpm.2021.100991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication and teamwork are critical non-technical skills in the operating theatre. However, prevention of events associated with communication failures by large simulation-based programs remains to be evaluated. The objective was to assess the impact of an interprofessional simulation-based training course on communication, teamwork, checklist adherence, and safety culture. METHODS We aimed to assess the impact of an interprofessional simulation-based training course on communication, teamwork, checklist adherence, and safety culture. We conducted a before-and-after interventional study based on a mixed-methods approach combining qualitative and quantitative evaluation criteria. The study was performed in a University Hospital with 39 operating theatres operated by 300 providers before (period 1) and after (period 2) an interprofessional simulation-based training course. Surgical procedures were observed, and the primary outcome measure was the rate of procedures with at least one communication failure associated with adverse event. Additional outcomes measured included the rate of or other communication failures, checklist adherence, while teamwork and safety culture as assessed by questionnaires. RESULTS In total, 46 970 communication episodes were analysed during 131 (period 1) and 122 (period 2) surgical procedures. One hundred sixty-four professionals attended 40 simulation-based sessions. The rate of procedures with at least one communication failure associated with adverse events was not significantly different between the 2 periods (38% in period 1 and 43% in period 2; P = 0.47). Nevertheless, the rate of communication failures reduced between period 1 and 2 (8117/28 303 (29%) vs. 3868/18 667 (21%), respectively; P < 0.01). Teamwork scores and checklist adherence increased significantly after the intervention (8.1 (7.2 to 8.7) in period 1 vs. 8.6 (8.0 to 9.2) in period 2; P < 0.01 and 17% (0-35%) in period 1 vs. 44% (26-57%) in period 2; P < 0.01). Safety culture ratings did not change significantly. CONCLUSION This study shows that although the rate of procedures with at least one communication failure associated with adverse event (primary endpoint) was not significantly different, a large interprofessional simulation-based training course has a positive effect on communication failures, teamwork, and checklist adherence.
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Affiliation(s)
- Julien Picard
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France; ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France.
| | - Jean-Noël Evain
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France; ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France
| | - Charlène Douron
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Éloïse Maussion
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Xavier Stihle
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pauline Manhes
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pauline Romegoux
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Aline Baron
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Claire Chapuis
- ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France; Department of Pharmacy, Grenoble-Alpes University Hospital, Grenoble, France
| | - Céline Vermorel
- ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France; Department of Biostatistics, Grenoble-Alpes University Hospital, Grenoble, France
| | - Benjamin Garel
- Hospital Administrator, Grenoble-Alpes University Hospital, Grenoble, France
| | - Jean-Luc Faucheron
- Department of Surgery, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pierre Bouzat
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Jean-Luc Bosson
- ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France; Department of Biostatistics, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care Medicine and Simulation Centre, Grenoble-Alpes University Hospital, Grenoble, France; ThEMAS, TIMC, UMR, CNRS 5525, Grenoble-Alpes University, Grenoble, France
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13
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Baste JM, Bottet B, Selim J, Sarsam M, Lefevre-Scelles A, Dusseaux MM, Franchina S, Palenzuela AS, Chagraoui A, Peillon C, Thouroude A, Henry JP, Coq JMM, Sibert L, Damm C. Implementation of simulation-based crisis training in robotic thoracic surgery: how to improve safety and performance? J Thorac Dis 2021; 13:S26-S34. [PMID: 34447589 PMCID: PMC8371544 DOI: 10.21037/jtd-2020-epts-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Marc Baste
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France.,MTC (Medical Training Center) Rouen, Normandie, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Jean Selim
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Antoine Lefevre-Scelles
- MTC (Medical Training Center) Rouen, Normandie, France.,Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Marie-Melody Dusseaux
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Sébastien Franchina
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Anne-Sophie Palenzuela
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Abdeslam Chagraoui
- INSERM, U1239, Department of Medical Biochemistry, Rouen University Hospital, Normandie University, Rouen, France
| | - Christophe Peillon
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | | | - Jean-Pierre Henry
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Jean-Michel M Coq
- MTC (Medical Training Center) Rouen, Normandie, France.,Psychology Department, UFR Human and Social Sciences, EA 7475, Normandie University, Rouen, France
| | - Louis Sibert
- MTC (Medical Training Center) Rouen, Normandie, France
| | - Cédric Damm
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
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14
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Anton NE, Huffman EM, Ahmed RA, Cooper DD, Athanasiadis DI, Cha J, Stefanidis D, Lee NK. Stress and resident interdisciplinary team performance: Results of a pilot trauma simulation program. Surgery 2021; 170:1074-1079. [PMID: 33867169 DOI: 10.1016/j.surg.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Excessive stress negatively impacts surgical residents' technical performance. The effect of stress on trainee nontechnical skills, however, is less well studied. Given that nontechnical skills are known to impact clinical performance, the purpose of this study was to assess the relationship between residents' perceived stress and nontechnical skills during multidisciplinary trauma simulations. METHODS First-year surgery and emergency medicine residents voluntarily participated in this study. Residents participated in 3 trauma simulations across 2 training sessions in randomly assigned teams. Each team's nontechnical skills were evaluated by faculty using the Trauma Nontechnical Skills scale. The Trauma Nontechnical Skills scale consists of 5 items: leadership, cooperation, communication, assessment, and situation awareness/coping with stress. After each scenario, residents completed the 6-item version of the State-Trait Anxiety Inventory and the Surgery Task Load Index to detail their perceived stress and workload during scenarios. Linear regressions were run to assess relationships between stress, workload, and nontechnical skills. RESULTS Twenty-five residents participated in the first simulation day, and 24 residents participated in the second simulation day. Results from regressions revealed that heightened stress and workload predicted significantly lower nontechnical skills performance during trauma scenarios. In regard to specific aspects of nontechnical skills, residents' heightened stress and workload predicted statistically significant lower situation awareness and decision-making during trauma scenarios. CONCLUSION Residents' perceived stress and workload significantly impaired their nontechnical skills during trauma simulations. This finding highlights the need to offer stress management and performance-optimizing mental skills training to trainees to lower their stress and optimize nontechnical skills performance during challenging situations.
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Affiliation(s)
- Nicholas E Anton
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
| | - Elizabeth M Huffman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/BetsyHuffmanMD
| | - Rami A Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/RamiAhmedDO
| | - Dylan D Cooper
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/dimitrios_iu
| | - Jackie Cha
- Department of Industrial Engineering, Purdue University, West Lafayette, IN. https://twitter.com/J_Chahaha
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/dstefanidis1
| | - Nicole K Lee
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
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15
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Barnes T, Rennie SC. Leadership and surgical training part 1: preparing to lead the way? ANZ J Surg 2021; 91:1068-1074. [PMID: 33825315 DOI: 10.1111/ans.16685] [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: 08/13/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Every day surgeons lead teams on the wards, in clinics and operating theatres, but most trainees and some surgeons do not consider themselves as leaders. Leadership skills are increasingly important for surgeons, who need knowledge of organizational structure and policy, management strategy and team dynamics to deliver and improve health care in resource-constrained environments. The Royal Australasian College of Surgeons recognizes leadership as one of 10 core surgical competencies but leadership curricula within surgical training programmes are not well defined. There is limited opportunity for formal leadership training and development prior to becoming a consultant.
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Affiliation(s)
- Tracey Barnes
- Department of General Surgery, Dunedin Hospital, Dunedin, New Zealand.,Department of Surgical Sciences, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand
| | - Sarah C Rennie
- Education Unit, The University of Otago, Wellington, New Zealand
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16
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Passauer-Baierl S, Stumpf U, Weigl M. [Teamwork and stress in routine interventions: an observational study of multiprofessional OR teams]. Unfallchirurg 2021; 125:130-137. [PMID: 33666678 PMCID: PMC8813711 DOI: 10.1007/s00113-021-00977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/12/2022]
Abstract
Hintergrund Effektive interprofessionelle Teamarbeit im Operationssaal (OP) und intraoperativer Stress sind von großer Bedeutung für Patientensicherheit und Versorgungsqualität. Dennoch gibt es nur wenige systematische Studien zum Zusammenhang von Teamarbeit im OP und Arbeitsstress. Ziele der Arbeit Untersuchung des Zusammenhangs von Teamarbeit und empfundenem Stress bei Routineeingriffen – für das OP-Team als Gesamtheit sowie für die einzelnen Professionen Chirurgie, Anästhesie und Pflege. Material und Methoden Durchgeführt wurde eine Mehrmethodenstudie bestehend aus Expertenbeobachtungen mittels eines standardisierten Beobachtungsinstruments (OTAS-D) und systematischer Selbstberichte des gesamten OP-Teams. Erfasst wurden 64 elektive Routineeingriffe unterschiedlicher chirurgischer Fachbereiche. Die statistischen Zusammenhangsanalysen unter Kontrolle prozeduraler Einflussfaktoren wurden mit „Mixed-effects“-Regressionsmodellen berechnet. Ergebnisse Die Güte der intraoperativen Teamarbeit lag auf mittlerem Niveau. Der situative Stress während des Eingriffs wurde durch die Befragten eher auf niedrigerem Niveau berichtet, mit signifikanten Unterschieden zwischen den Professionen Chirurgie, Pflege und Anästhesie. Mitglieder des chirurgischen Teams berichteten im Durchschnitt die höchsten Stressniveaus. Ein genereller Zusammenhang zwischen Teamarbeit und Stresserleben konnte nicht beobachtet werden, allerdings für die einzelnen Professionen: Für das chirurgische Team ergaben sich signifikante, positive Zusammenhänge, sowie für die Teamarbeitsdimensionen Zusammenarbeit und Führung. Signifikante negative Zusammenhänge ergaben sich für das Pflegeteam hinsichtlich der Qualität der interdisziplinären Teamarbeit insgesamt sowie für die Teamarbeitsdimension Team-Monitoring. Diskussion Die Effekte interprofessioneller Zusammenarbeit im OP auf subjektives Stressempfinden bei Routineeingriffen hängen von Professionszugehörigkeit, Aufgabe und Tätigkeit ab. Weitere Forschungsarbeit ist notwendig, inwiefern gute Teamarbeit bei Routineeingriffen innerhalb und über die Professionen hinweg intraoperativen Stress beeinflusst. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00113-021-00977-w) enthält eine vollständige Liste mit Kurzbeschreibungen der beobachteten Eingriffe. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de/link/10.1007/s00113-021-00977-w zur Verfügung. ![]()
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Affiliation(s)
- Stefanie Passauer-Baierl
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland. .,Beratung und Training, Human Factors und Patientensicherheit, Parkstetten, Deutschland.
| | - Ulla Stumpf
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - Matthias Weigl
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland.,Institut für Patientensicherheit, Universitätsklinikum Bonn, Bonn, Deutschland
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17
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Truong H, Sullivan AM, Abu-Nuwar MR, Therrien S, Jones SB, Pawlowski J, Parra JM, Jones DB. Operating room team training using simulation: Hope or hype? Am J Surg 2021; 222:1146-1153. [PMID: 33933207 DOI: 10.1016/j.amjsurg.2021.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study sought to determine the long-term impact of multidisciplinary simulated operating room (OR) team training. METHOD Two-wave survey study (immediate post-training survey 2010-2017, follow-up 2018). Differences across time, specialty, and experience with adverse events were assessed using chi-square and t -tests. RESULTS Immediately after training, more than 90% of respondents found simulation scenarios realistic and reported team training would provide safer patient care. However, follow-up participants reported less enthusiasm toward training, with 58% stating they would like to take similar training again. A majority of participants (77%) experienced adverse events after training; those reporting adverse events reported more positive long-term evaluations. CONCLUSIONS Simulated OR team training is initially highly valued by participants and is perceived as contributing to patient safety. Diminution of participant enthusiasm over time suggests that repeat training requirements be reconsidered, and less costly, alternative methods (such as asynchronous learning or virtual reality) should be explored.
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Affiliation(s)
- Hung Truong
- Beth Israel Deaconess Medical Center Division of Bariatric and Minimally Invasive Surgery, United States.
| | - Amy M Sullivan
- Carl J. Shapiro Institute for Research and Education, Beth Israel Deaconess Medical Center, United States; Beth Israel Deaconess Medical Center Department of Medicine, United States.
| | - Mohamad Rassoul Abu-Nuwar
- Beth Israel Deaconess Medical Center Division of Bariatric and Minimally Invasive Surgery, United States.
| | - Stephanie Therrien
- Beth Israel Deaconess Medical Center Division of Bariatric and Minimally Invasive Surgery, United States.
| | | | - John Pawlowski
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care and Pain Medicine, United States.
| | - Jose M Parra
- Carl J. Shapiro Institute for Research and Education, Beth Israel Deaconess Medical Center, United States.
| | - Daniel B Jones
- Beth Israel Deaconess Medical Center Division of Bariatric and Minimally Invasive Surgery, United States.
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18
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Anton NE, Athanasiadis DI, Karipidis T, Keen AY, Karim A, Cha J, Walke N, Stefanidis D. Surgeon stress negatively affects their non-technical skills in the operating room. Am J Surg 2021; 222:1154-1157. [PMID: 33549296 DOI: 10.1016/j.amjsurg.2021.01.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Poor surgeons' non-technical skills (NTS) and excessive stress and workload are known contributors to surgical errors. Our aim was to examine the relationship between surgeons' stress and workload, and their observed NTS intraoperatively. METHODS Surgeon's NTS were rated in the operating room (OR) by trained observers. Surgeon stress, workload, familiarity with the OR team, prior experience, and case difficulty were captured. Relationships between variables were assessed. RESULTS Fifteen surgeons participated in our study. Agreement among raters was high for NTS observations (ICC range = 0.56-0.96). Stress was negatively correlated with situation awareness, and workload was negatively correlated with decision making. Less familiarity among the team was correlated with higher stress. CONCLUSIONS Surgeons' stress and workload negatively affected their NTS in the OR. Further, unfamiliarity with the surgical team contributed to surgeon's stress. Methods to reduce surgeons' stress and workload such as mental skills training should be considered.
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Affiliation(s)
- Nicholas E Anton
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 111, Indianapolis, IN, 46202, USA.
| | - Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 111, Indianapolis, IN, 46202, USA.
| | - Theoklitos Karipidis
- Department of Counseling Psychology, Indiana University School of Education, 201 N Rose Ave, ED, 4000, Bloomington, IN, 47405, USA.
| | - Alyson Y Keen
- Perioperative Services, Indiana University Health Physicians, 1701 N Senate Ave, Indianapolis, IN, 46202, USA.
| | - Amani Karim
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA.
| | - Jackie Cha
- Purdue University School of Industrial Engineering, 610 Purdue Mall, West Lafayette, IN, 47907, USA.
| | - Nikki Walke
- Perioperative Services, Indiana University Health Physicians, 1701 N Senate Ave, Indianapolis, IN, 46202, USA.
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 111, Indianapolis, IN, 46202, USA.
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Cantu J, Tolk J, Fritts S, Gharehyakheh A. Interventions and measurements of highly reliable/resilient organization implementations: A literature review. APPLIED ERGONOMICS 2021; 90:103241. [PMID: 32977145 DOI: 10.1016/j.apergo.2020.103241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/22/2020] [Accepted: 08/06/2020] [Indexed: 06/11/2023]
Abstract
Since the inception of High Reliability Theory in 1981, researchers and practitioners have theorized about the questions, "How do you know if you're an HRO, and how do you validate it?" Evidence now exists that organizations seeking high reliability and resilience have moved away from the theoretical phase, and into the application phase where organizations adopt the HRO hallmarks plus culture as operational targets and create interventions to effect change. The evidence of high reliability operations in organizations is key for validating that HRO is implementable and is also beneficial. After collecting over 1400 artifacts, we found 34 scholarly efforts published which purposefully targeted implementation measures toward achieving an HRO state and measured the outcomes. From that evidence, we concluded that three specific interventions have been used which were useful and generalizable to guide practitioners in moving toward an HRO state: process redesign, training, and organization redesign. We suggest that this evidence may assert that organizations which are not functioning as an HRO can be redesigned to do so.
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Affiliation(s)
- Jaime Cantu
- University of Texas at Arlington, Arlington, TX, 76019, USA.
| | - Janice Tolk
- University of Tennessee Space Institute, Tullahoma, TN, 37388, USA.
| | - Steve Fritts
- Principal Researcher, eTransformation.net, 124870 Pleasant Green Way, Boynton Beach, FL, 33437, USA.
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20
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Management of Bleeding Complications in Virtual Reality Laparoscopy. Int Surg 2020. [DOI: 10.9738/intsurg-d-15-00190.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to compare the impact of induced bleeding complication training with regular training on a virtual reality laparoscopic (VRL) simulator. Although bleeding complications occur rarely during laparoscopic surgery, they usually arise without warning and may have severe consequences for the patient because complication management training is not currently widespread. Third-year medical students (n = 41) were randomly selected for 2 curricular courses on how to perform a bimanual task on a VRL simulator. Both the regular training group (RTG) and the induced bleeding complication training (ICT) group performed 2 regular training sessions and 9 training sessions. For the ICT group the training sessions were with a bleeding complication. The 2 groups were comparable regarding their initial performance levels and improved significantly in task time and handling economics throughout the course (P < 0.001). When a bleeding complication occurred during the initial phase, performance parameters were significantly worse (P < 0.05). During a bleeding complication, the ICT group showed a significant improvement in time, handling economics, and blood loss (P < 0.001) throughout the training course, whereas the RTG group showed no improvement. Induced complication training has a positive influence on the management of bleeding on the VRL simulator. Structured laparoscopic complication management training should be implemented during surgical education as an add-on to regular procedural training.
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21
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Beyer-Berjot L, Patel V, Sirimanna P, Hashimoto DA, Berdah S, Darzi A, Aggarwal R. Implementation of a Surgical Simulation Care Pathway Approach to Training in Emergency Abdominal Surgery. World J Surg 2020; 44:696-703. [PMID: 31659411 DOI: 10.1007/s00268-019-05242-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Simulation-based care pathway approach (CPA) training is a novel approach in surgical education. The objective of the present study was to determine whether CPA was feasible for training surgical residents and could improve efficiency in patients' management. A common disease was chosen: acute appendicitis. METHODS All five junior residents of our department were trained in CPA: preoperative CPA consisted in virtual patients (VPs) presenting with acute right iliac fossa pain; intraoperative CPA involved a virtual competency-based curriculum for laparoscopic appendectomy (LAPP); finally, post-operative VP were reviewed after LAPP. Thirty-eight patients undergoing appendectomy were prospectively included before (n = 21) and after (n = 17) the training. All demographic and perioperative data were prospectively collected from their medical records, and time taken from admission to management was measured. RESULTS All residents had performed less than 10 LAPP as primary operator. Pre- and intraoperative data were comparable between pretraining and post-training patients. Times to liquid and solid diet were significantly reduced after training [7 h (2-20) vs. 4 (4-6); P = 0.004, and 17 h (4-48) vs. 6 (4-24); P = 0.005] without changing post-operative morbidity [4 (19%) vs. 0 (0); P = 0.11] and length of stay [48 h (30-264) vs. 44 (21-145); P = 0.22]. CONCLUSIONS CPA training is feasible in abdominal surgery. In the current study, it improved patients' management in terms of earlier oral intake.
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Affiliation(s)
- Laura Beyer-Berjot
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK. .,Centre for Surgical Teaching and Research (CERC), Faculté de Médecine Secteur Nord, Aix-Marseille University, 51 Boulevard Pierre Dramard, 13015, Marseille, France.
| | - Vishal Patel
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK
| | - Pramudith Sirimanna
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK
| | | | - Stéphane Berdah
- Centre for Surgical Teaching and Research (CERC), Faculté de Médecine Secteur Nord, Aix-Marseille University, 51 Boulevard Pierre Dramard, 13015, Marseille, France
| | - Ara Darzi
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK
| | - Rajesh Aggarwal
- Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK.,Division of Minimally Invasive, Metabolic, and Bariatric Surgery, Department of Surgery, Thomas Jefferson University and Jefferson Health, Philadelphia, USA
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22
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Effects of surgical flow disruptions on surgeons' resources: a pilot study. Surg Endosc 2020; 34:4525-4535. [PMID: 31720810 DOI: 10.1007/s00464-019-07239-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Minimally invasive surgery requires surgeons to allocate more attention and efforts than open surgery. A surgeon's pool of resource is affected by the multiple occurrences of interruptions and distractions in the operating room. Surgical flow disruption has been addressed from a quantitative perspective. However, little is known on its impact on the surgeons' physiological resources. METHODS Three physiological markers, heat flux (HF), energy expenditure in metabolic equivalent of tasks and galvanic skin response were recorded using body sensor monitoring during the 21 surgical operations. The three markers, respectively, represent: stress, energy mobilization and task engagement. A total of 8 surgeons with different levels of expertise (expert vs. novice) were observed performing 21 surgical procedures categorized as short versus long. Factors of distractions were time-stamped, and triangulated with physiological markers. Two cases illustrate the impact of surgical flow disruptions on the surgeons. RESULTS The results indicate that expert surgeons' mental schemata are better organized than novices. Additionally, the physiological markers indicate that novice surgeons display a higher HF at the start (tendency p = .059) and at the end of procedures (p = .001) when compared to experts. However, during longer procedures, expert surgeons have higher HF at the start (p = .041) and at the end (p = .026), than at the start and end of a short procedure. CONCLUSION Data collected during this pilot study showed that interruptions and disruptions affect novice and expert surgeons differently. Surgical flow disruption appears to be taxing on the surgeons' mental, emotional and physiological resources; as a function of the length and nature of the disruptions. Several training curricula have incorporated the use of virtual reality programs to train surgeons to cope with the new technology and equipment. We recommend integrating interruptions and distractions in virtual reality training programs as these impact the surgeons' pool of resources.
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23
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Igwe AO, Talabi AO, Adumah CC, Ogundele IO, Adisa AO, Sowande OA, Adejuyigbe O. Mitigating the challenges of laparoscopic paediatric surgery in Ile Ife: The trend so far and lessons learnt. Afr J Paediatr Surg 2020; 17:68-73. [PMID: 33342837 PMCID: PMC8051637 DOI: 10.4103/ajps.ajps_32_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Paediatric laparoscopic surgery is fast growing worldwide, with many pathologies now being treated even in the youngest of patients. We hereby report our experience with the first 114 cases. OBJECTIVES Our aim was to highlight our progress and lessons learnt practicing laparoscopic paediatric surgery in our institution. MATERIALS AND METHODS This is a retrospective study of the first 114 children who underwent laparoscopic surgery in our hospital. We focussed on demographics, indications, procedures performed, rate of conversion to open and complications. Records were retrieved from January 2011 to December 2019. Data were analysed using the SPSS software version 23 (SPSS Inc., Chicago, Illinois, USA). RESULTS There were 83 males and 31 females (ratio of 3:1). Age groups included infants (13.2%), 1-5 years (21.9%), 5-10 years (33.3%) and > 10 years (31.6%). There was a remarkable increase in the frequency and complexity of cases performed from an average of 5 per year between 2011 and 2015 to an average of 23.5 per year between 2016 and 2019. The conversion rate was 6%, 5 appendectomies, 1 Swenson pull-through, 1 diagnostic laparoscopy and 1 Ladd's procedure. Four complications were noted; one recurrent adhesive intestinal obstruction, one residual intra-abdominal abscess, one port site abscess and one excessive bleeding from liver biopsy requiring conversion to open surgery. CONCLUSION We have demonstrated that the routine use of laparoscopy in children is feasible and safe in our environment. However, the need for training, endurance through a steep learning curve and the willingness to battle the technical challenges are necessary for success.
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Affiliation(s)
- Arua Obasi Igwe
- Department of Surgery, Paediatric Surgery Unit, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
| | - Ademola Olusegun Talabi
- Department of Surgery, Paediatric Surgery Unit, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
| | - Collins Chijioke Adumah
- Department of Surgery, Paediatric Surgery Unit, Babcock University Teaching Hospital, Ilisan, Nigeria
| | - Ibukun Olufemi Ogundele
- Department of Surgery, Paediatric Surgery Unit, Onabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Adewale O Adisa
- Department of Surgery, General Surgery Unit, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
| | - Oludayo Adedapo Sowande
- Department of Surgery, Paediatric Surgery Unit, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
| | - Olusanya Adejuyigbe
- Department of Surgery, Paediatric Surgery Unit, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
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L'Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanié A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Simulation-based teaching in critical care, anaesthesia and emergency medicine. Anaesth Crit Care Pain Med 2020; 39:311-326. [PMID: 32223994 DOI: 10.1016/j.accpm.2020.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erwan L'Her
- Centre Hospitalier Régional Universitaire de Brest, La Cavale-Blanche, Médecine Intensive et Réanimation, LATIM, INSERM, UMR 1101, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - Thomas Geeraerts
- Anesthésie-Réanimation, CHU de Toulouse, Hôpital Pierre-Paul-Riquet, Institut Toulousain de Simulation en Santé (ItSimS), Université Toulouse 3-Paul-Sabatier, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Jean-Philippe Desclefs
- Samu 91, Smur de Corbeil-Essonnes, Centre Hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - Dan Benhamou
- Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, AP-HP, Hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Antonia Blanié
- Département d'anesthésie-réanimation-médecine périopératoire, groupe hospitalo-universitaire, Paris-Saclay, AP-HP, Paris, France; Centre de simulation LabForSIMS, faculté de médecine Paris-Sud, unité de recherche CIAMS, EA4532, UFR STAPS Paris-Sud, Orsay, France
| | - Charles Cerf
- Réanimation Polyvalente, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Véronique Delmas
- Urgences, CHU Le Mans, 194, avenue Rubillard, 72000 Le Mans, France
| | - Mercedes Jourdain
- Réanimation médicale, Hôpital Salengro, rue Émile-Laine, 59037 Lille, France
| | - François Lecomte
- Urgences, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Islem Ouanes
- Réanimation Médicale, Hôpital Fattouma-Bourguiba, avenue Farhat-Hached, Monastir, Tunisia
| | - Marc Garnier
- Département d'anesthésie et réanimation, Pôle Thorax-Voies Aériennes-Anesthésie-Réanimation, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; INSERM, UMR1152, Faculté de médecine X.-Bichat, 16, rue Henri-Huchard, 75018 Paris, France
| | - Chirine Mossadegh
- Hôpital Universitaire La Pitié-Salpêtrière, Service de Réanimation Médicale, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Palagonia E, Mazzone E, De Naeyer G, D'Hondt F, Collins J, Wisz P, Van Leeuwen FWB, Van Der Poel H, Schatteman P, Mottrie A, Dell'Oglio P. The safety of urologic robotic surgery depends on the skills of the surgeon. World J Urol 2019; 38:1373-1383. [PMID: 31428847 DOI: 10.1007/s00345-019-02901-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/02/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess the available literature evidence that discusses the effect of surgical experience on patient outcomes in robotic setting. This information is used to help understand how we can develop a learning process that allows surgeons to maximally accommodate patient safety. METHODS A literature search of the MEDLINE/PubMed and Scopus database was performed. Original and review articles published in the English language were included after an interactive peer-review process of the panel. RESULTS Robotic surgical procedures require high level of experience to guarantee patient safety. This means that, for some procedures, the learning process might be longer than originally expected. In this context, structured training programs that assist surgeons to improve outcomes during their learning processes were extensively discussed. We identified few structured robotic curricula and demonstrated that for some procedures, curriculum trained surgeons can achieve outcomes rates during their initial learning phases that are at least comparable to those of experienced surgeons from high-volume centres. Finally, the importance of non-technical skills on patient safety and of their inclusion in robotic training programs was also assessed. CONCLUSION To guarantee safe robotic surgery and to optimize patient outcomes during the learning process, standardized and validated training programs are instrumental. To date, only few structured validated curricula exist for standardized training and further efforts are needed in this direction.
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Affiliation(s)
- Erika Palagonia
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Elio Mazzone
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.,Division of Experimental Oncology and Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Geert De Naeyer
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Frederiek D'Hondt
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | | | - Pawel Wisz
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Fijs W B Van Leeuwen
- ORSI Academy, Melle, Belgium.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk Van Der Poel
- Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Peter Schatteman
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Paolo Dell'Oglio
- ORSI Academy, Melle, Belgium. .,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. .,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Karsan RB, Powell AG, Nanjaiah P, Mehta D, Valtzoglou V. The top 100 manuscripts in emergency cardiac surgery. Potential role in cardiothoracic training. A bibliometric analysis. Ann Med Surg (Lond) 2019; 43:5-12. [PMID: 31193454 PMCID: PMC6531840 DOI: 10.1016/j.amsu.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 12/15/2022] Open
Abstract
Background Emergency Cardiac Surgery (ECS) is a component of cardiothoracic training. Citations are considered to represent a papers influence. Bibliometric analyses allow us to identify the most influential work, and future research. We aim to highlight the key research themes within ECS and determine their potential impact on cardiothoracic training. Methods Thomas Reuters Web of Science was searched using terms [Emergency AND Card* AND Surg*]. Results were ranked by citation and reviewed by a panel of cardiac surgeons to identify the top 100 cited papers relevant to ECS. Papers were analysed by topic, journal and impact. Regression analysis was used to determine a link between impact factor and scientific impact. Results 3823 papers were identified. Median citations for the top 100 was 88. The paper with the highest impact was by Nashef et al. focusing on the use of EuroSCORE (2043 citations). The Annals of Thoracic Surgery published most papers (n = 18:1778 citations). The European Journal of Cardiothoracic Surgery coveted the most citations (n = 2649). The USA published most papers (n = 55).The most ubiquitous topics were; risk stratification, circulatory support and aortic surgery. A positive relationship between journal impact fact and the scientific impact of manuscripts in ECS (P = 0.043) was deduced. Conclusion This study is the first of its kind and identified the papers which are likely to the contribute most to training and understanding of ECS. A papers influence is partially determined by journal impact factor. Bibliometric analysis is a potent tool to identify surgical training needs.
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Affiliation(s)
- Rickesh B Karsan
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Arfon Gmt Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, CF14 4XW, UK.,Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Prakash Nanjaiah
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Dheeraj Mehta
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Vasileious Valtzoglou
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
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Higham H, Greig PR, Rutherford J, Vincent L, Young D, Vincent C. Observer-based tools for non-technical skills assessment in simulated and real clinical environments in healthcare: a systematic review. BMJ Qual Saf 2019; 28:672-686. [DOI: 10.1136/bmjqs-2018-008565] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022]
Abstract
BackgroundOver the past three decades multiple tools have been developed for the assessment of non-technical skills (NTS) in healthcare. This study was designed primarily to analyse how they have been designed and tested but also to consider guidance on how to select them.ObjectivesTo analyse the context of use, method of development, evidence of validity (including reliability) and usability of tools for the observer-based assessment of NTS in healthcare.DesignSystematic review.Data sourcesSearch of electronic resources, including PubMed, Embase, CINAHL, ERIC, PsycNet, Scopus, Google Scholar and Web of Science. Additional records identified through searching grey literature (OpenGrey, ProQuest, AHRQ, King’s Fund, Health Foundation).Study selectionStudies of observer-based tools for NTS assessment in healthcare professionals (or undergraduates) were included if they: were available in English; published between January 1990 and March 2018; assessed two or more NTS; were designed for simulated or real clinical settings and had provided evidence of validity plus or minus usability. 11,101 articles were identified. After limits were applied, 576 were retrieved for evaluation and 118 articles included in this review.ResultsOne hundred and eighteen studies describing 76 tools for assessment of NTS in healthcare met the eligibility criteria. There was substantial variation in the method of design of the tools and the extent of validity, and usability testing. There was considerable overlap in the skills assessed, and the contexts of use of the tools.ConclusionThis study suggests a need for rationalisation and standardisation of the way we assess NTS in healthcare and greater consistency in how tools are developed and deployed.
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Ragonese M, Di GIanfrancesco L, Bassi P, Sacco E. Psychological aptitude for surgery: The importance of non-technical skills. Urologia 2019; 86:45-51. [PMID: 30983535 DOI: 10.1177/0391560319840523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Psychological aptitude for surgery includes all the non-technical abilities that are necessary for the surgeons. However, differently from the other careers, these skills are not considered in the selection process and their role is definitively underestimated in the field of surgery. We perform a literature review of non-technical skills for surgery to identify their role and to understand how to train and evaluate these abilities among the surgeons. RESULTS Different methods have been presented for the evaluation and training of non-technical skills for surgeons; based on the model of aviation and anesthesia a wide range of simulated scenarios have been proposed to practice these aptitudes and abilities. Different behavioral markers systems have been developed for correct identification and definition of these skills, these can be used in the real surgical room and even learned and trained in the simulated operating theatre. CONCLUSION This article shows the importance of non-practical abilities in the surgical performance and in defining the aptitude for surgery. Learning these skills and introducing them in surgical education can be useful to improve the surgical performance.
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Affiliation(s)
- Mauro Ragonese
- Urology Clinic, Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic, Rome, Italy
| | - Luca Di GIanfrancesco
- Urology Clinic, Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic, Rome, Italy
| | - PierFrancesco Bassi
- Urology Clinic, Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic, Rome, Italy
| | - Emilio Sacco
- Urology Clinic, Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic, Rome, Italy
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Yang YY, Yang LY, Lee FY, Hwang SJ. DAA-based IIT simulation model enhances the interprofessional collaboration and team efficiency competency of health professionals. J Chin Med Assoc 2019; 82:169-171. [PMID: 30908410 DOI: 10.1097/jcma.0000000000000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
One of the ten recommendations of the commission on education of health professionals for the twenty-first century is the "promotion of interprofessional education that breaks down professional silos while enhancing collaborative relationships in effective teams." Continuously, the increasing prevalence of patients with complex chronic health issues challenges the staff's training strategy of healthcare institution. To ensure patient safety, the collaborative involvement of a team of health professional is necessary to delivery care to patients with complex health conditions and social disadvantage. Integrated interprofessional collaboration and team efficiency (IIT) is a competency that can optimize the multiple professional skills to provide well-coordinated, high-quality, and patient-centered care. IIT-based training is a way to improve team-based care through positive shared learning activities in a nonthreatening environment to respond to patient's needs. The describe, analysis, application (DAA) diamond is a debriefing method that provides different health professionals with valuable learning experiences through communication. Using advocacy-inquiry approach, DAA-based IIT simulation offers an effective platform for training IIT. Including all disciplines in the DAA-based IIT simulation process reinforces the unique role/contribution of each team member and provides a mechanism for the team to talk together for system improvements. Actually, good clinical care requires practitioner's ability to effectively resolve stress and conflict, improve job satisfaction/wellbeing, and enhance quality and safety of patient care. In our institution, regular DAA-based IIT simulation courses were held at various divisions and had been proved to improve the safety and quality of healthcare.
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Affiliation(s)
- Ying-Ying Yang
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yu Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Irfan W, Sheahan C, Mitchell EL, Sheahan MG. The pathway to a national vascular skills examination and the role of simulation-based training in an increasingly complex specialty. Semin Vasc Surg 2019; 32:48-67. [DOI: 10.1053/j.semvascsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Simulation in Vascular Surgery. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ounounou E, Aydin A, Brunckhorst O, Khan MS, Dasgupta P, Ahmed K. Nontechnical Skills in Surgery: A Systematic Review of Current Training Modalities. JOURNAL OF SURGICAL EDUCATION 2019; 76:14-24. [PMID: 30122636 DOI: 10.1016/j.jsurg.2018.05.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/16/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The complexity of the operating room requires a surgeon to have both technical ability and an array of nontechnical skills. The emphasis on technical skills during surgical training is well established, however it is deficiencies in nontechnical skills that have been identified as the main cause of errors in the operating room. OBJECTIVE This systematic review aims to identify current methods used to teach nontechnical skills and how these methods are assessed to determine their validity, evidence, and role in training. METHODS MEDLINE and Embase databases were searched for English language articles between 2000 and 2017 for nontechnical surgical skills training. Original research articles were included if they described non-technical surgical skills training modalities and their assessment. Results were assessed for the level of evidence and each modality was awarded a level of recommendation, using a modified educational Oxford Centre for Evidence-Based Medicine classification, as adapted by the European Association of Endoscopic Surgery. RESULTS A total of 19 studies were identified pertaining to high fidelity simulation (n = 8), low fidelity simulation (n = 6), didactic teaching (n = 2) and crisis resource management (n = 3). Of the included studies 1 was classified Level 1b, 1 level 2b, 7 level 2b, 2 level 2c, and 8 level 3. CONCLUSION With the importance of nontechnical skills being increasingly recognized, it is essential for surgeons to receive adequate training in nontechnical skills. Therefore the most valuable teaching modalities such as high and low fidelity simulation needs to be implemented into surgical training curricula.
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Affiliation(s)
- Esther Ounounou
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom.
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
| | - M Shamim Khan
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust King's Health Partners, London, United Kingdom
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Complex Decision Making in the Pediatric Catheterization Laboratory: Catheterizer, Know Thyself and the Data. Pediatr Cardiol 2018; 39:1281-1289. [PMID: 30105465 DOI: 10.1007/s00246-018-1949-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/03/2018] [Indexed: 12/24/2022]
Abstract
Optimal outcomes are as much influenced by critical decision making pathways as by the technical skill of the operator. The complexity and potential cognitive traps underlying critical decision making has long been recognized in the aviation and business communities, however, remains a largely subconscious, unexamined discipline amongst congenital cardiac interventionalists. Challenges to making good decisions in the catheterization laboratory include heuristics, biases, and cognitive traps. In this paper we discuss some of the more common decision making challenges encountered and we address potential solutions to such decision making with particular focus towards standardization.
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Sullivan S, Campbell K, Ross JC, Thompson R, Underwood A, LeGare A, Osman I, Agarwal SK, Jung HS. Identifying Nontechnical Skill Deficits in Trainees Through Interdisciplinary Trauma Simulation. JOURNAL OF SURGICAL EDUCATION 2018; 75:978-983. [PMID: 29100919 PMCID: PMC5955804 DOI: 10.1016/j.jsurg.2017.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/08/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The goal of this study was to investigate nontechnical skills in a simulated trauma setting both before and after a debriefing session in order to better understand areas to target for the development of educational interventions. DESIGN Wilcoxon signed rank tests were used to compare scores on the 5 domains of the T-NOTECHS pre- and postdebriefings. A qualitative analysis using the PEARLS debriefing framework was performed to provide a rich description of the strategies used by the debriefing facilitators. SETTING The Joint Trauma Simulation Program is an interdisciplinary project designed to improve the quality of trauma care through simulation exercises emphasizing nontechnical skills development. PARTICIPANTS Thirteen teams of 5 trauma trainees participated in trauma resuscitation simulations: a surgical chief resident, a surgical junior resident, an emergency medicine resident, and 2 emergency medicine nurses. RESULTS Teams significantly improved on communication and interaction skills in the simulation scenarios from pre- to postdebriefing. The debrief facilitators spent most of their time engaged in Directive Performance Feedback (56.13%). CONCLUSIONS Interprofessional team simulation in trauma resuscitation scenarios followed by debriefing differently affected individual nontechnical skills domains. Additional facilitation strategies, such as focused facilitation and encouraging learner self-assessment, may target other nontechnical skills in different ways.
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Affiliation(s)
- Sarah Sullivan
- Department of Surgery, University of Wisconsin, Madison, Wisconsin.
| | | | - Joshua C Ross
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | - Ryan Thompson
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | - Alyson Underwood
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Anne LeGare
- Nursing, UWHC Emergency Services, Madison, Wisconsin
| | - Ingie Osman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Suresh K Agarwal
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Hee Soo Jung
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
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Yang LY, Yang YY, Huang CC, Liang JF, Lee FY, Cheng HM, Huang CC, Kao SY. Simulation-based inter-professional education to improve attitudes towards collaborative practice: a prospective comparative pilot study in a Chinese medical centre. BMJ Open 2017; 7:e015105. [PMID: 29122781 PMCID: PMC5695335 DOI: 10.1136/bmjopen-2016-015105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Inter-professional education (IPE) builds inter-professional collaboration (IPC) attitude/skills of health professionals. This interventional IPE programme evaluates whether benchmarking sharing can successfully cultivate seed instructors responsible for improving their team members' IPC attitudes. DESIGN Prospective, pre-post comparative cross-sectional pilot study. SETTING/PARTICIPANTS Thirty four physicians, 30 nurses and 24 pharmacists, who volunteered to be trained as seed instructors participated in 3.5-hour preparation and 3.5-hour simulation courses. Then, participants (n=88) drew lots to decide 44 presenters, half of each profession, who needed to prepare IPC benchmarking and formed Group 1. The remaining participants formed Group 2 (regular). Facilitators rated the Group 1 participants' degree of appropriate transfer and sustainable practice of the learnt IPC skills in the workplace according to successful IPC examples in their benchmarking sharing. RESULTS For the three professions, improvement in IPC attitude was identified by sequential increase in the post-course (second month, T2) and end-of-study (third month, T3) Interdisciplinary Education Perception Scale (IEPS) and Attitudes Towards Healthcare Teams Scale (ATHCTS) scores, compared with pre-course (first month, T1) scores. By IEPS and ATHCTS-based assessment, the degree of sequential improvements in IPC attitude was found to be higher among nurses and pharmacists than in physicians. In benchmarking sharing, the facilitators' agreement about the degree of participants'appropriate transfer and sustainable practice learnt 'communication and teamwork' skills in the workplace were significantly higher among pharmacists and nurses than among physicians. The post-intervention random sampling survey (sixth month, Tpost) found that the IPC attitude of the three professions improved after on-site IPC skill promotion by new programme-trained seed instructors within teams. CONCLUSIONS Addition of benchmark sharing to a diamond-based IPE simulation programme enhances participants' IPC attitudes, self-reflection, workplace transfer and practice of the learnt skills. Furthermore, IPC promotion within teams by newly trained seed instructors improved the IPC attitudes across all three professions.
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Affiliation(s)
- Ling-Yu Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Ying Yang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chang Huang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jen-Feng Liang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Chou Huang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Yen Kao
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Beyer-Berjot L, Pucher P, Patel V, Hashimoto D, Ziprin P, Berdah S, Darzi A, Aggarwal R. Colorectal surgery and enhanced recovery: Impact of a simulation-based care pathway training curriculum. J Visc Surg 2017. [DOI: 10.1016/j.jviscsurg.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
BACKGROUND Care of the trauma patient requires a well-coordinated intensive effort during the golden hour to optimize survival. PURPOSE We hypothesized that this program would improve knowledge, satisfaction, self-confidence, and simulated team performance. METHODS A pre-, post-test design with N = 7 BSN nurses, 21 years of age, less than 2 years of intensive care unit and nursing experience. SETTING Trauma intensive care unit, single-center academic Level 1 trauma center. RESULTS Improvement was shown in perception of team structure (paired t test 13.71-12.57; p = .0001) and communication (paired t test 14.85-12.14; p = .009). Improvement was shown in observed situation monitoring (paired t test 17.42-25.28; p = .000), mutual support (paired t test 12.57-18.57; p = .000), and communication (paired t test 15.42-25.00; p = .001). A decrease was shown in attitudes of mutual support (paired t test 25.85-19.71; p = .04) and communication (paired t test 26.14-23.00; p = .001). Mean satisfaction scores were 21.5 of a possible 25 points. Mean self-confidence scores were 38.83 out of a possible 40 points. DISCUSSION Simulation-based team training improved teamwork attitudes, perceptions, and performance. Team communication demonstrated significant improvement in 2 of the 3 instruments. Most participants agreed or strongly agreed that they were satisfied with simulation and had gained self-confidence.
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Comparison of simulation-based assessments and faculty ratings for general surgery resident milestone evaluation: Are they telling the same story? Am J Surg 2017; 214:547-553. [DOI: 10.1016/j.amjsurg.2016.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022]
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Implementation Science: A Neglected Opportunity to Accelerate Improvements in the Safety and Quality of Surgical Care. Ann Surg 2017; 265:1104-1112. [PMID: 27735828 DOI: 10.1097/sla.0000000000002013] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this review was to emphasize the importance of implementation science in understanding why efforts to integrate evidence-based interventions into surgical practice frequently fail to replicate the improvements reported in early research studies. SUMMARY OF BACKGROUND DATA Over the past 2 decades, numerous patient safety initiatives have been developed to improve the quality and safety of surgical care. The surgical community is now faced with translating "promising" initiatives from the research environment into clinical practice-the World Health Organization (WHO) has described this task as one of the greatest challenges facing the global health community and has identified the importance of implementation science in scaling up evidence-based interventions. METHODS Using the WHO surgical safety checklist, a prominent example of a rapidly and widely implemented surgical safety intervention of the past decade, a review of literature, spanning surgery, and implementation science, was conducted to identify and describe a broad range of factors affecting implementation success, including contextual factors, implementation strategies, and implementation outcomes. RESULTS Our current approach to conceptualizing and measuring the "effectiveness" of interventions has resulted in factors critical to implementing surgical safety interventions successfully being neglected. CONCLUSION Improvements in the safety and quality of surgical care can be accelerated by drawing more heavily upon implementation science and that until this rapidly evolving field becomes more firmly embedded into surgical research and implementation efforts, our understanding of why interventions such as the checklist "work" in some settings and appear "not to work" in other settings will be limited.
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Wood TC, Raison N, Haldar S, Brunckhorst O, McIlhenny C, Dasgupta P, Ahmed K. Training Tools for Nontechnical Skills for Surgeons-A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:548-578. [PMID: 28011262 DOI: 10.1016/j.jsurg.2016.11.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/11/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Development of nontechnical skills for surgeons has been recognized as an important factor in surgical care. Training tools for this specific domain are being created and validated to maximize the surgeon's nontechnical ability. This systematic review aims to outline, address, and recommend these training tools. DESIGN A full and comprehensive literature search, using a systematic format, was performed on ScienceDirect and PubMed, with data extraction occurring in line with specified inclusion criteria. SETTING Systematic review was performed fully at King's College London. RESULTS A total of 84 heterogeneous articles were used in this review. Further, 23 training tools including scoring systems, training programs, and mixtures of the two for a range of specialities were identified in the literature. Most can be applied to surgery overall, although some tools target specific specialities (such as neurosurgery). Interrater reliability, construct, content, and face validation statuses were variable according to the specific tool in question. CONCLUSIONS Study results pertaining to nontechnical skill training tools have thus far been universally positive, but further studies are required for those more recently developed and less extensively used tools. Recommendations can be made for individual training tools based on their level of validation and for their target audience. Based on the number of studies performed and their status of validity, NOTSS and Oxford NOTECHS II can be considered the gold standard for individual- and team-based nontechnical skills training, respectively, especially when used in conjunction with a training program.
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Affiliation(s)
- Thomas Charles Wood
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Nicholas Raison
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
| | - Shreya Haldar
- Department of Opthalmology, Stoke Mandeville Hospital, Aylesbury, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Craig McIlhenny
- Department of Urology, NHS Forth Valley, Larbert, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
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Srisarajivakul N, Lucero C, Wang XJ, Poles M, Gillespie C, Zabar S, Weinshel E, Malter L. Disruptive behavior in the workplace: Challenges for gastroenterology fellows. World J Gastroenterol 2017; 23:3315-3321. [PMID: 28566892 PMCID: PMC5434438 DOI: 10.3748/wjg.v23.i18.3315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/04/2017] [Accepted: 04/21/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).
METHODS Two OSCEs (“distracted care team” and “frazzled intern”) were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows’ ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows’ performances. The fellows completed a self-assessment survey.
RESULTS Twelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the “distracted care team” case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the “frazzled intern” case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored “well done” in a domain that focused on allowing the intern to think through the case with the fellow’s guidance.
CONCLUSION Fellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.
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Le S, Xi W, Li W, Xiao J, Wang Z. Entry-Level Forward Surgical Team Training in 5th Grade Students of Second Military Medical University of the Chinese People's Liberation Army. World J Surg 2017; 41:2435-2443. [PMID: 28477158 PMCID: PMC5596042 DOI: 10.1007/s00268-017-4035-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Forward surgical team (FST) is a highly mobile team for surgical missions in battlefield. FST training has been well held in many western countries. However, such training in Chinese army is far from satisfaction. Methods and Results Relying on Second Military Medical University and its affiliated hospitals, we are launching an entry-level training program for 5th grade students, in order to improve their understandings on basic concepts of FST, as well as their abilities to complete surgical missions on battlefield. Conclusions In this article, we are going to introduce our training facilities as well as our training methods in our training program.
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Affiliation(s)
- Shiguan Le
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, 31st Floor, 415#, Rd Fengyang, Shanghai, 200003, China
| | - Wang Xi
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, 31st Floor, 415#, Rd Fengyang, Shanghai, 200003, China
| | - Wei Li
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, 31st Floor, 415#, Rd Fengyang, Shanghai, 200003, China.,Department of Cardiothoracic Surgery, 161 Hospital of Chinese People's Liberation Army, Wuhan, 430012, China
| | - Jian Xiao
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, 31st Floor, 415#, Rd Fengyang, Shanghai, 200003, China.
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, 31st Floor, 415#, Rd Fengyang, Shanghai, 200003, China.
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Robertson JM, Dias RD, Yule S, Smink DS. Operating Room Team Training with Simulation: A Systematic Review. J Laparoendosc Adv Surg Tech A 2017; 27:475-480. [DOI: 10.1089/lap.2017.0043] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jamie M. Robertson
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Roger D. Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Douglas S. Smink
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
Situation awareness (SA) refers to the conscious awareness of the current situation in relation to one’s environment. In nursing, loss or failure to achieve high levels of SA is linked with adverse patient outcomes. The purpose of this integrative review is to examine various instruments and techniques used to measure SA among nurses across academic and clinical settings. Computerized database and ancestry search strategies resulted in 40 empirical research reports. Of the reports included in the review, 24 measured SA among teams that included nurses and 16 measured SA solely in nurses. Methods used to evaluate SA included direct and indirect methods. Direct methods included the Situation Awareness Global Assessment Technique and questionnaires. Indirect methods included observer rating instruments and performance outcome measures. To have a better understanding of how nurses’ make decisions in complex work environments, reliable and valid measures of SA is crucial.
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Affiliation(s)
- Sabrina B. Orique
- University of Missouri, Columbia, MO, USA
- Kaweah Delta Health Care District, Visalia, CA, USA
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Harris KR, Eccles DW, Shatzer JH. Team deliberate practice in medicine and related domains: a consideration of the issues. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:209-220. [PMID: 27307071 DOI: 10.1007/s10459-016-9696-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/10/2016] [Indexed: 06/06/2023]
Abstract
A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing individual expert performance in medicine and other domains. Highlighting these issues will inform the development of training for medical teams. The authors first describe team coordination and its critical role in medical teams. Presented next are the cognitive mechanisms that allow expert performers to accurately interpret the current situation via the creation of an accurate mental "model" of the current situation, known as a situation model. Following this, the authors propose that effective team performance depends at least in part on team members having similar models of the situation, known as a shared situation model. The authors then propose guiding principles for implementing team deliberate practice in medicine and describe how team deliberate practice can be used in an attempt to reduce barriers inherent in medical teams to the development of shared situation models. The paper concludes with considerations of limitations, and future research directions, concerning the implementation of team deliberate practice within medicine.
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Affiliation(s)
- Kevin R Harris
- Department of Psychological Science and Counseling, Austin Peay State University, 4537, Clarksville, TN, 37044-4594, USA.
| | - David W Eccles
- School of Applied Social Sciences, Durham University, Durham, DH1 3HN, UK
| | - John H Shatzer
- Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
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Heaton SR, Little Z, Akhtar K, Ramachandran M, Lee J. Using simulation to train orthopaedic trainees in non-technical skills: A pilot study. World J Orthop 2016; 7:475-480. [PMID: 27622147 PMCID: PMC4990768 DOI: 10.5312/wjo.v7.i8.475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/05/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To enhance non-technical skills and to analyse participant’s experience of a course tailored for orthopaedic surgeons.
METHODS: A Delphi technique was used to develop a course in human factors specific to orthopaedic residents. Twenty-six residents (six per course) participated in total with seven course facilitators all trained in Crisis Resource Management providing structured feedback. Six scenarios recreated challenging real-life situations using high-fidelity mannequins and simulated patients. Environments included a simulated operating suite, clinic room and ward setting. All were undertaken in a purpose built simulation suite utilising actors, mock operating rooms, mock clinical rooms and a high fidelity adult patient simulator organised through a simulation control room. Participants completed a 5-point Likert scale questionnaire (strongly disagree to strongly agree) before and after the course. This assessed their understanding of non-technical skills, scenario validity, relevance to orthopaedic training and predicted impact of the course on future practice. A course evaluation questionnaire was also completed to assess participants’ feedback on the value and quality of the course itself.
RESULTS: Twenty-six orthopaedic residents participated (24 male, 2 female; post-graduation 5-10 years), mean year of residency program 2.6 out of 6 years required in the United Kingdom. Pre-course questionnaires showed that while the majority of candidates recognised the importance of non-technical (NT) skills in orthopaedic training they demonstrated poor understanding of non-technical skills and their role. This improved significantly after the course (Likert score 3.0-4.2) and the perceived importance of these skills was reported as good or very good in 100%. The course was reported as enjoyable and provided an unthreatening learning environment with the candidates placing particular value on the learning opportunity provided by reflecting on their performance. All agreed that the course achieved its intended aims with realistic simulation scenarios. Participants believed patient care, patient safety and team working would all improve with further human factors training (4.4-4.6). and felt that NT skills learnt through simulation-based training should become an integral component of their training program.
CONCLUSION: Participants demonstrated improved understanding of non-technical performance, recognised its relevance to patient safety and expressed a desire for its integration in training.
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Perrier L, Adhihetty C, Soobiah C. Examining semantics in interprofessional research: A bibliometric study. J Interprof Care 2016; 30:269-77. [DOI: 10.3109/13561820.2016.1142430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Saunders C, Rutkowski AF, Pluyter J, Spanjers R. Health information technologies: From hazardous to the dark side. J Assoc Inf Sci Technol 2016. [DOI: 10.1002/asi.23671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Carol Saunders
- W.A. Franke College of Business; Northern Arizona University; PO Box 5638 Flagstaff AZ 86011-5638
| | - Anne F. Rutkowski
- Department of Management; K1010,Tilburg University; Warandelaan 2, 5000 LE Tilburg The Netherlands
| | - Jon Pluyter
- Department of Management; K1010,Tilburg University; Warandelaan 2, 5000 LE Tilburg The Netherlands
| | - Ronald Spanjers
- Board member Comprehensive Cancer Organisation, The Netherlands Cancer Registry; PO Box 19079, 3501 DB Utrecht The Netherlands
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Conen D, Eberlein-Gonska M. [Not Available]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2016; 110-111:8-11. [PMID: 26875027 DOI: 10.1016/j.zefq.2015.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Johnston MJ, Paige JT, Aggarwal R, Stefanidis D, Tsuda S, Khajuria A, Arora S. An overview of research priorities in surgical simulation: what the literature shows has been achieved during the 21st century and what remains. Am J Surg 2016; 211:214-25. [DOI: 10.1016/j.amjsurg.2015.06.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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