Using simulation to train orthopaedic trainees in non-technical skills: A pilot study.
OBJECTIVE
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.


CONCLUSIONS
Participants demonstrated improved understanding of non-technical performance, recognised its relevance to patient safety and expressed a desire for its integration in training.
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.
Samuel R
SR
Heaton
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.
Zoe
Z
Little
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.
Kash
K
Akhtar
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.
Manoj
M
Ramachandran
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.
Joshua
J
Lee
Learning; Non-technical; Simulation; Surgery; Teaching