Basic Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2016; 7(8): 475-480
Published online Aug 18, 2016. doi: 10.5312/wjo.v7.i8.475
Using simulation to train orthopaedic trainees in non-technical skills: A pilot study
Samuel R Heaton, Zoe Little, Kash Akhtar, Manoj Ramachandran, Joshua Lee
Samuel R Heaton, Zoe Little, Kash Akhtar, Manoj Ramachandran, Joshua Lee, Centre for Orthopaedics, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, United Kingdom
Author contributions: Heaton SR and Akhtar K drafted the manuscript; Little Z collated the statistics; Ramachandran M and Lee J designed the course.
Institutional review board statement: All participant questionnaires were obtained with the informed consent from the candidates with express permission for this paper. All responses are anonymised. There was no requirement for ethical approval as this was purely a questionnaire of doctors experiences of a course.
Informed consent statement: All involved persons gave their verbal informed consent prior to study inclusion. All study responses were anonymised.
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest exists.
Data sharing statement: Dataset and course specifics are available from the corresponding author. Participant consent was obtained to share the data but all feedback data is anonymous.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Samuel R Heaton, FRCS, Centre for Orthopaedics, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, United Kingdom.
Telephone: +44-20-73777000
Received: February 15, 2016
Peer-review started: February 16, 2016
First decision: March 24, 2016
Revised: April 5, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: August 18, 2016

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.

Keywords: Teaching, Learning, Simulation, Non-technical, Surgery

Core tip: We have developed what we believe to be the first non-technical skills course specifically catering to the unique issues affecting orthopaedic surgeons in everyday practice. Participants demonstrated an improved understanding of the importance of non-technical performance, recognised its relevance to improving patient safety and expressed a desire for it to become an integral part of training. Non-technical skills training may also provide a means of identifying and supporting trainees in difficulty.