A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre

Abstract

Background: High-risk organizations such as aviation rely on simulations for the training and assessment of technical and team performance. The aim of this study was to develop a simulated environment for surgical trainees using similar principles.

Methods: A total of 27 surgical trainees carried out a simulated procedure in a Simulated Operating Theatre with a standardized OR team. Observation of OR events was carried out by an unobtrusive data collection system: clinical data recorder. Assessment of performance consisted of blinded rating of technical skills, a checklist of technical events, an assessment of communication, and a global rating of team skills by a human factors expert and trained surgical research fellows. The participants underwent a debriefing session, and the face validity of the simulated environment was evaluated.

Results: While technical skills rating discriminated between surgeons according to experience (P = 0.002), there were no differences in terms of the checklist and team skills (P = 0.70). While all trainees were observed to gown/glove and handle sharps correctly, low scores were observed for some key features of communication with other team members. Low scores were obtained by the entire cohort for vigilance. Interobserver reliability was 0.90 and 0.89 for technical and team skills ratings.

Conclusions: The simulated operating theatre could serve as an environment for the development of surgical competence among surgical trainees. Objective, structured, and multimodal assessment of performance during simulated procedures could serve as a basis for focused feedback during training of technical and team skills.

FIGURE 1. Simulated Operating Theatre (SOT) with the anesthetic simulator (SimMan, Laerdl, UK). The SOT is separated from the control room, shown in the lower figure, by a one-way glass. The trainers/raters watch the simulation on monitors placed in the control room.

FIGURE 2. Generic global score and ICEPS score for the 3 groups.

FIGURE 3. Nontechnical skills: percentage score.

FIGURE 4. Average utterance frequency (UF) of the 3 groups of surgeons with other team members. S, surgeon; An, anesthetist; A, assistant; SN, scrub nurse.