Eva Kassab

Observational Teamwork Assessment for Surgery: Content Validation and Tool Refinement

BACKGROUND Effective teamwork is crucial for safe surgery. Failures in nontechnical and teamwork skills are frequently implicated in adverse events. The Observational Teamwork Assessment for Surgery (OTAS) tool assesses teamwork of the entire team in the operating room. Empirical testing of OTAS has yet to explore the content validity of the tool. STUDY DESIGN This was a cross-sectional observational study. Data were collected in 30 procedures by 2 trained researchers. Five teamwork behaviors were scored (ie, communication, leadership, cooperation, coordination, and monitoring) and behavior exemplar completion was recorded (phase 1). Expert operating room personnel (5 surgeons, 5 anesthesiologists, and 5 scrub nurses) assessed the content validity of the OTAS exemplar behaviors. Finally, a panel of operating room patient-safety experts refined the exemplars (phase 2). RESULTS In total, the observability (presence/absence) of 130 exemplars was assessed by 2 blinded observers in 30 general surgical cases. Observer agreement was high (Cohens κ ≥ 0.41) for 83.85% (109 of 130) of exemplar behaviors; 60.77% (79 of 130) of exemplar behaviors were observed frequently with high observer agreement. The majority of the exemplars were rated by expert operating room practitioners and an expert panel as substantial contributors to teamwork and patient safety. Based on expert consensus, 21 behavior exemplars were removed from OTAS and an additional 23 were modified. CONCLUSIONS The exemplars of OTAS demonstrated very good content validity. Taken together with recent evidence on the construct validity of the tool, these findings demonstrate that OTAS is psychometrically robust for capturing teamwork in the operating room.

Distributed simulation--accessible immersive training.

Distributed simulation (DS) is the concept of high-fidelity immersive simulation on-demand, made widely available wherever and whenever it is required. DS provides an easily transportable, self-contained ‘set’ for creating simulated environments within an inflatable enclosure, at a small fraction of the cost of dedicated, static simulation facilities. High-fidelity simulation is currently confined to a relatively small number of specialised centres. This is largely because full-immersion simulation is perceived to require static, dedicated and sophisticated equipment, supported by expert faculty. Alternatives are needed for healthcare professionals who cannot access such centres. We propose that elements of immersive simulations can be provided within a lightweight, low-cost and self-contained setting which is portable and can therefore be accessed by a wide range of clinicians. We will argue that mobile simulated environments can be taken to where they are needed, making simulation more widely available. We develop the notion that a simulation environment need not be a fixed, static resource, but rather a ‘container’ for a range of activities and performances, designed around the needs of individual users. We critically examine the potential of DS to widen access to an otherwise limited resource, putting flexible, ‘just in time’ training within reach of all clinicians. Finally, we frame DS as a ‘disruptive innovation’ with potential to radically alter the landscape of simulation-based training.

A novel approach to contextualized surgical simulation training.

Introduction Decontextualized benchtop simulators play a key role in surgical training. Educational theory highlights the importance of context for effective learning, yet existing full-immersion simulation facilities are prohibitively expensive. This study explored the concept of contextualized training of a key surgical procedure in a novel, low-cost, high-fidelity simulation environment [distributed simulation (DS)] and compared it with decontextualized training in a traditional benchtop simulation. Methods Eleven novice surgeons performed a small bowel anastomosis in a benchtop simulation and in DS. Likert-type questionnaires and semistructured interviews captured surgeons’ responses. Results Surgeons perceived the contextualized DS training as realistic, giving surgeons the opportunity to increase their confidence, motivation, and integration of technical and nontechnical skills. Distributed simulation would be of value after benchtop training and before surgery in a real operating room. Conclusions Contextualized simulation training allows junior surgeons to gain the necessary confidence before operating in a real operating room. This article presents DS as a solution to widen access to contextualized surgical training.

Actor training for surgical team simulations

Background: Immersive simulations can enable surgeons to learn complex sets of skills required for safe surgical practice without risk to patients. However, recruiting healthcare professionals to support surgeons training as members of an operating theatre (OT) team is challenging and resource intensive. Aim: We developed a training programme for actors to take on the role of an OT team to support validation studies in a simulated environment. This article describes the evaluation of the programme. Methods: The programme comprised of written materials, video discussion and experiential activities. Evaluation methods consisted of post-simulation interviews and questionnaires with actors and surgeons. Participants were recruited by convenience sampling. Quantitative data were analysed using descriptive statistics and interviews were analysed using thematic extraction. Results: Three actors participated in the programme. Twelve surgeons completed simulations. All data suggest that the training was successful. Actors were perceived as realistic. Suggestions were made to improve training. Conclusion: After a brief training, actors can realistically portray members of an OT team in simulations designed to support surgeon training. This article highlights factors that contributed to success and suggests improvements. Although there are limitations with the study, its findings have relevance to training and assessment that focuses on individual clinicians functioning as a member of an OT team.

Distributed Simulation in surgical training: an off-site feasibility study.

Background: Simulation offers recognised training benefits, but the cost of high-fidelity contextualised simulation is prohibitive and its accessibility limited to specialised Distributed Simulation centres. Distributed simulation (DS) is an innovative concept of low-cost, portable and high-fidelity contextualised simulation. However, it has previously only been trialled at a central London teaching hospital. Aims: (1) To explore the off-site feasibility of DS. (2) To determine the response of end-users to DS. Methods: A DS naive researcher recreated a standardised porcine laparoscopic cholecystectomy scenario at a District General Hospital using DS. A research diary detailed the logistical feasibility of the project, whilst mixed methods were used to determine the response of the 10 surgeons who completed the full-team simulation. Results: DS is feasible off-site with end-users comparing it favourably to their previous simulation experiences. Surgeons perceived DS as being most useful for building the operative confidence of juniors between learning the basics on a bench top model and before entering the operating theatre. Conclusions: DS has the potential to provide high-fidelity contextualised simulation as an adjunct to, and not a replacement for, surgical training. Unlike other modalities, it is low cost and portable, thereby addressing concerns over affordability and accessibility.

Increasing the Realism of a Laparoscopic Box Trainer: A Simple, Inexpensive Method

BACKGROUND AND PURPOSE Simulation-based training in medical education is increasing. Realism is an integral element of creating an engaging, effective training environment. Although physical trainers offer a low-cost alternative to expensive virtual reality (VR) simulators, many lack in realism. The aim of this research was to enhance the realism of a laparoscopic box trainer by using a simple, inexpensive method. MATERIALS AND METHODS Digital images of the abdominal cavity were captured from a VR simulator. The images were printed onto a laminated card that lined the bottom and sides of the box-trainer cavity. The standard black neoprene material that encloses the abdominal cavity was replaced with a skin-colored silicon model. RESULTS AND CONCLUSIONS The realism of the modified box trainer was assessed by surgeons, using quantitative and qualitative methodologies. Results suggest that the modified box trainer was more realistic than a standard box trainer alone. Incorporating this technique in the training of laparoscopic skills is an inexpensive means of emulating surgical reality that may enhance the engagement of the learner in simulation.