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Original Investigation
September 2017

Association of a Surgical Task During Training With Team Skill Acquisition Among Surgical ResidentsThe Missing Piece in Multidisciplinary Team Training

Author Affiliations
  • 1Miami University, Oxford, Ohio
  • 2Wake Forest Baptist Health, Winston Salem, North Carolina
JAMA Surg. 2017;152(9):818-825. doi:10.1001/jamasurg.2017.1085
Key Points

Question  Does the presence/absence of a simulated surgical task affect the acquisition of teamwork skills among midlevel surgical residents?

Findings  In this study, surgical residents who were exposed to medium-fidelity simulation team training scenarios demonstrated greater gains in teamwork skills compared with the control group and equal gains in teamwork skills compared with high-fidelity simulation groups.

Meaning  Incorporating the use of relatively inexpensive, medium-fidelity synthetic anatomy in human patient simulators was as effective as using high-fidelity anatomy from deceased donors for promoting teamwork skills among this learning group.

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, and Participants  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 and Measures  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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