title: Hybrid simulation: bringing motivation to the art of teamwork training in the operating room.
abstract: OBJECTIVE
  Crew resource management-based operating room team training will be an evident part of future surgical training. Hybrid simulation in the operating room enables the opportunity for trainees to perform higher fidelity training of technical and non-technical skills in a realistic context. We focus on situational motivation and self-efficacy, two important factors for optimal learning in light of a prototype course for teams of residents in surgery and anesthesiology and nurses.
  
  
  METHODS
  Authentic operating room teams consisting of residents in anesthesia (n = 2), anesthesia nurses (n = 3), residents in surgery (n = 2), and scrub nurses (n = 6) were, during a one-day course, exposed to four different scenarios. Their situational motivation was self-assessed (ranging from 1 = does not correspond at all to 7 = corresponds exactly) immediately after training, and their self-efficacy (graded from 1 to 7) before and after training. Training was performed in a mock-up operating theater equipped with a hybrid patient simulator (SimMan 3G; Laerdal) and a laparoscopic simulator (Lap Mentor Express; Simbionix). The functionality of the systematic hybrid procedure simulation scenario was evaluated by an exit questionnaire (graded from 1 = disagree entirely to 5 = agree completely).
  
  
  CONCLUSIONS
  The trainees were mostly intrinsically motivated, engaged for their own sake, and had a rather great degree of self-determination toward the training situation. Self-efficacy among the team members improved significantly from 4 to 6 (median). Overall evaluation showed very good result with a median grading of 5. We conclude that hybrid simulation is feasible and has the possibility to train an authentic operating team in order to improve individual motivation and confidence.
authors.affiliation: Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden ann.kjellin@ki.se.
authors.forename: A
authors.initials: A
authors.lastname: Kjellin
authors.affiliation: Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden Department of Psychology, Umeå University, Umeå, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Hedman
authors.affiliation: Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Escher
authors.affiliation: Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Felländer-Tsai
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum; D013502:General Surgery / Q000193:education*; D006801:Humans; D009042:Motivation; D009873:Operating Rooms; D010348:Patient Care Team / Q000592:standards*; D016544:Patient Simulation
keywords: Simulation; education; surgical training