Multidisciplinary crisis simulations: the way forward for training surgical teams.
BACKGROUND
High-reliability organizations have stressed the importance of non-technical skills for safety and of regularly providing such training to their teams. Recently safety skills training has been applied in the practice of medicine. In this study, we developed and piloted a module using multidisciplinary crisis scenarios in a simulated operating theatre to train entire surgical teams.


METHODS
Twenty teams participated (n = 80); each consisted of a trainee surgeon, anesthetist, operating department practitioner (ODP), and scrub nurse. Crisis scenarios such as difficult intubation, hemorrhage, or cardiac arrest were simulated. Technical and non-technical skills (leadership, communication, team skills, decision making, and vigilance), were assessed by clinical experts and by two psychologists using relevant technical and human factors rating scales. Participants received technical and non-technical feedback, and the whole team received feedback on teamwork.


RESULTS
Trainees assessed the training favorably. For technical skills there were no differences between surgical trainees' assessment scores and the assessment scores of the trainers. However, nurses overrated their technical skill. Regarding non-technical skills, leadership and decision making were scored lower than the other three non-technical skills (communication, team skills, and vigilance). Surgeons scored lower than nurses on communication and teamwork skills. Surgeons and anesthetists scored lower than nurses on leadership.


CONCLUSIONS
Multidisciplinary simulation-based team training is feasible and well received by surgical teams. Non-technical skills can be assessed alongside technical skills, and differences in performance indicate where there is a need for further training. Future work should focus on developing team performance measures for training and on the development and evaluation of systematic training for technical and non-technical skills to enhance team performance and safety in surgery.
Undre
Shabnam
S
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom. s.undre@imperial.ac.uk.|Department of Anaesthesia, St. Mary's Hospital, London, W2 1NY, United Kingdom. s.undre@imperial.ac.uk.
Koutantji
Maria
M
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
Sevdalis
Nick
N
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
Gautama
Sanjay
S
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
Selvapatt
Nowlan
N
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
Williams
Samantha
S
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
Sains
Parvinderpal
P
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
McCulloch
Peter
P
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
Darzi
Ara
A
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
Vincent
Charles
C
Department of Bio-Surgery and Surgical Technology, Imperial College and St, Mary's Hospital, 10th floor QEQM building, Praed Street, London, W2 1NY, United Kingdom.
D001364:Awareness; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003198:Computer Simulation; D003479:Curriculum; D003657:Decision Making; D005240:Feasibility Studies; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D007857:Leadership; D008131:London; D009726:Nurses / Q000592:standards; D009873:Operating Rooms; D010348:Patient Care Team; D016544:Patient Simulation; D010820:Physicians / Q000592:standards; D010865:Pilot Projects; D011787:Quality of Health Care / Q000592:standards; D013043:Specialties, Surgical / Q000193:education*