title: Multidisciplinary crisis simulations: the way forward for training surgical teams.
abstract: 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.
authors.affiliation: 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.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Undre
authors.affiliation: 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.
authors.forename: Maria
authors.initials: M
authors.lastname: Koutantji
authors.affiliation: 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.
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.affiliation: 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.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gautama
authors.affiliation: 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.
authors.forename: Nowlan
authors.initials: N
authors.lastname: Selvapatt
authors.affiliation: 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.
authors.forename: Samantha
authors.initials: S
authors.lastname: Williams
authors.affiliation: 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.
authors.forename: Parvinderpal
authors.initials: P
authors.lastname: Sains
authors.affiliation: 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.
authors.forename: Peter
authors.initials: P
authors.lastname: McCulloch
authors.affiliation: 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.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: 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.
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
mesh_terms: 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*