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Original Investigation
August 2016

Feasibility of Human Factors Immersive Simulation Training in OphthalmologyThe London Pilot

Author Affiliations
  • 1National Institute for Health Research Biomedical Research Centre at University College London Institute of Ophthalmology, Moorfields Eye Hospital, London, England
  • 2Moorfields Eye Hospital, London, England
  • 3Department of Computing, University of Surrey, Surrey, England
  • 4Simulation and Clinical Skills Centre, University College London Hospital, London, England
JAMA Ophthalmol. 2016;134(8):905-911. doi:10.1001/jamaophthalmol.2016.1769

Importance  Human factors training can enhance teamworking and reduce error. It is used regularly in certain medical disciplines, but its use has not been established for ophthalmology to our knowledge.

Objective  To explore the feasibility of providing immersive simulation human factors training for ophthalmic surgical teams.

Design, Setting, and Participants  Prospective scenario-based simulation and concept description at University College London Hospital and Moorfields Eye Hospital, London, England, from December 12, 2013, to March 13, 2014. At both sites, fully immersive simulated operating theater environments were used, comprising live interactive communication with patients and theater staff, full anesthetic and operating facilities, replicated patient notes, active vital signs, and the ability to contact surgical or anesthetic teams outside of the theater via telephone. Participants were consultant (attending) and trainee ophthalmic surgeons and anesthetists, operating department assistants and practitioners, and ophthalmic nursing staff.

Main Outcomes and Measures  The following 4 previously validated rating tools for nontechnical skills were applied to a replicated series of scenarios based on actual patient safety incidents at Moorfields Eye Hospital and in the literature: Observational Teamwork Assessment for Surgery (OTAS), Non-Technical Skills Scale (NOTECHS), Anesthetists’ Non-Technical Skills (ANTS), and Non-Technical Skills for Surgeons (NOTSS). The Pearson product moment correlation coefficient was calculated for each pair of scoring tools. Intertool and interassessor reliability was established. Interassessor consistency was compared by calculating a normalized standard deviation of scores for each tool across all assessors.

Results  Twenty simulation scenarios, including wrong intraocular lens implantation, wrong eye operation, wrong drug administration, and wrong patient, were provided. The intertool correlations were 0.732 (95% CI, 0.271-0.919; P = .01) for NOTECHS vs ANTS, 0.922 (95% CI, 0.814-0.968; P < .001) for NOTSS vs ANTS, 0.850 (95% CI, 0.475-0.964; P < .001) for OTAS vs ANTS, 0.812 (95% CI, 0.153-0.971; P = .03) for OTAS vs NOTECHS, 0.716 (95% CI, −0.079 to 0.955; P = .07) for OTAS vs NOTSS, and 0.516 (95% CI, −0.020 to 0.822; P = .06) for NOTECHS vs NOTSS. The normalized standard deviations of scores obtained using each tool across all assessors were 0.024 (95% CI, 0.014-0.091) for NOTSS, 0.060 (95% CI, 0.034-0.225) for OTAS, 0.068 (95% CI, 0.041-0.194) for ANTS, and 0.072 (95% CI, 0.043-0.206) for NOTECHS.

Conclusions and Relevance  This study describes the feasibility of a high-fidelity immersive simulation course specifically for ophthalmic surgical teams. The ANTS and NOTSS had the highest intertool and interrater consistency, respectively. Human factors simulation in ophthalmology offers a new method of teaching team members, with the potential to reduce serious ophthalmic patient safety events. Further work will define its usefulness and practical applications.