The Science and Training of Expert Operating Room Teams

Abstract

It is widely accepted that teamwork skills are critical to optimizing safety in the operating team. Failures in teamwork, rather than technical skills, are frequently identified as contributing factors in adverse events in the operating room. The fact that a team of experts do not simply merge to form an expert team, coupled with the fact the teamwork skills do not necessarily develop and perfect over time, has led to the development of many team training programs. The use of simulation to train teamwork skills has increased dramatically over the past decade. Drawing on the team science and surgical simulation literature, this chapter begins with a comprehensive overview of theoretical and conceptual underpinnings of effective teamwork (i.e., what distinguishes a high-performing team from a low-performing team). Next, methodologies to enhance team development and effectiveness are described and reviewed, followed by a summary of teamwork assessment tools that have been developed to measure the quality of OR teamwork. We discuss in detail a range of measurement issues including lack of standardization, psychometric quality, and rater trainer and provide “tips” on measuring and evaluating teamwork skills. A brief summary of the evidence regarding the effectiveness of team training in healthcare, surgery, and specifically multidisciplinary OR team training is presented. Finally, we highlight the challenges to widespread adoption, implementation, and sustainability of operating room simulation-based team training and identify a number of knowledge gaps that warrant future attention and exploration.