“Managing Surgical Crisis: non-technical skills for new surgeons”

A Human Factors course for core surgical trainees

Geraghty A, Tang B, Tait I, Maran N, Monepenny M

Threat Error Management

• Highly effective safety training - train to overcome threats identified in error literature

• Cognitively more effective way to avoid error is to train to overcome it

Threats

• Physical problems– Bleeding– Leaks – bowel/bile/urine/CSF– Unusual anatomy

• Human factors problems– Communication– Teamwork– Leadership– Situation awareness– Decision making

Effective Management

• Physical problems– Technical training

• Human factors problems– Non technical skills for surgeons– Graded assertiveness– Shared mental models– SBAR– Closed loop communication

Core Surgical Trainees

• Developing independent operative skills

• Naïve situation awareness/judgement pathways

• High technical demand can compromise non-technical skills

• Same threats are present in ALL surgical contexts

Role of Human Factors in Crisis Development

Crisis Management Algorithm

Team

Environment

Assess/Analyse/Anticipate

Manage Resources

Graded assertiveness

SBARClosed loop communication

Shared mental models

Situation Awareness

Sterile cockpit

Analytical decision making

Simulated Crisis Scenarios

Debriefing

Skills All the

timeRegularly Sometimes Rarely Never

Graded assertiveness Pre 1 (20%) 3 (60%) 1 (20%) Post 3 (43%) 4 (57%)

Open questions Pre 1 (20%) 1 (20%) 3 (60%) Post 2 (29%) 4 (57%) 1 (14%)

Closed loop communication

Pre 3 (60%) 2 (40%) Post 2 (29%) 4 (57%) 1 (14%)

SBAR Pre 1 (20%) 2 (40%) 1 (20%) 1 (20%)Post 2 (29%) 4 (57%) 1 (14%)

Sterile cockpit Pre 3 (60%) 1 (20%) 1 (20%)Post 1 (14%) 5 (72%) 1 (14%)

Sharing mental models Pre 1 (20%) 2 (40%) 2 (40%)Post 1 (14%) 3 (43%) 2 (29%) 1 (14%)

Checking your interpretation of situation with others

Pre 1 (20%) 3 (60%) 1 (20%) Post 2 (29%) 3 (43%) 2 (29%)

Analytical decision making

Pre 1 (20%) 1 (20%) 3 (60%) Post 2 (29%) 4 (57%) 1 (14%)

Attitudes

“It has made me think about what I can do to prepare before situations so more information is in the automatic portion of my brain so that I have maximum space for active thought processes in emergency and elective situations”

“I am more aware and ready to take action before a crisis hits.”

Empowered me in my role as a surgical trainee to take responsibility in theatre

“It has given me a structured approach to managing crisis…. helpful in thinking about the big picture and definitive solution”

Managing Surgical Crisis: non-technical skills for new surgeons3rd JuneCuschieri Skills Centre, Dundee

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