Association of a Surgical Task During Training With Team Skill Acquisition Among Surgical Residents: The Missing Piece in Multidisciplinary Team Training.
JAMA Surg
; 152(9): 818-825, 2017 Sep 01.
Article
em En
| MEDLINE
| ID: mdl-28538983
ABSTRACT
IMPORTANCE The human patient simulators that are currently used in multidisciplinary operating room team training scenarios cannot simulate surgical tasks because they lack a realistic surgical anatomy. Thus, they eliminate the surgeon's primary task in the operating room. The surgical trainee is presented with a significant barrier when he or she attempts to suspend disbelief and engage in the scenario. OBJECTIVE:
To develop and test a simulation-based operating room team training strategy that challenges the communication abilities and teamwork competencies of surgeons while they are engaged in realistic operative maneuvers. DESIGN, SETTING, ANDPARTICIPANTS:
This pre-post educational intervention pilot study compared the gains in teamwork skills for midlevel surgical residents at Wake Forest Baptist Medical Center after they participated in a standardized multidisciplinary team training scenario with 3 possible levels of surgical realism (1) SimMan (Laerdal) (control group, no surgical anatomy); (2) "synthetic anatomy for surgical tasks" mannequin (medium-fidelity anatomy), and (3) a patient simulated by a deceased donor (high-fidelity anatomy).INTERVENTIONS:
Participation in the simulation scenario and the subsequent debriefing. MAIN OUTCOMES ANDMEASURES:
Teamwork competency was assessed using several instruments with extensive validity evidence, including the Nontechnical Skills assessment, the Trauma Management Skills scoring system, the Crisis Resource Management checklist, and a self-efficacy survey instrument. Participant satisfaction was assessed with a Likert-scale questionnaire.RESULTS:
Scenario participants included midlevel surgical residents, anesthesia providers, scrub nurses, and circulating nurses. Statistical models showed that surgical residents exposed to medium-fidelity simulation (synthetic anatomy for surgical tasks) team training scenarios demonstrated greater gains in teamwork skills compared with control groups (SimMan) (Nontechnical Skills video score 95% CI, 1.06-16.41; Trauma Management Skills video score 95% CI, 0.61-2.90) and equivalent gains in teamwork skills compared with high-fidelity simulations (deceased donor) (Nontechnical Skills video score 95% CI, -8.51 to 6.71; Trauma Management Skills video score 95% CI, -1.70 to 0.49). CONCLUSIONS AND RELEVANCE Including a surgical task in operating room team training significantly enhanced the acquisition of teamwork skills among midlevel surgical residents. Incorporating relatively inexpensive, medium-fidelity synthetic anatomy in human patient simulators was as effective as using high-fidelity anatomies from deceased donors for promoting teamwork skills in this learning group.
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Base de dados:
MEDLINE
Assunto principal:
Equipe de Assistência ao Paciente
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Cirurgia Geral
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Análise e Desempenho de Tarefas
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Simulação de Paciente
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Competência Clínica
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Educação de Pós-Graduação em Medicina
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Manequins
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article