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"TECHNICAL SKILLS"
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Surgical Coaching for Operative Performance Enhancement (SCOPE): skill ratings and impact on surgeons’ practice
BackgroundEvidence for surgical coaching has yet to demonstrate an impact on surgeons’ practice. We evaluated a surgical coaching program by analyzing quantitative and qualitative data on surgeons’ intraoperative performance.MethodsIn the 2018–2019 Surgical Coaching for Operative Performance Enhancement (SCOPE) program, 46 practicing surgeons in multiple specialties at four academic medical centers were recruited to complete three peer coaching sessions, each comprising preoperative goal-setting, intraoperative observation, and postoperative debriefing. Coach and coachee rated the coachee’s performance using modified Objective Structured Assessment of Technical Skills (OSATS, range 1–5) and Non-Technical Skills for Surgeons (NOTSS, range 4–16). We used generalized estimating equations to evaluate trends in skill ratings over time, adjusting for case difficulty, clinical experience, and coaching role. Upon program completion, we analyzed semi-structured interviews with individual participants regarding the perceived impact of coaching on their practice.ResultsEleven of 23 coachees (48%) completed three coaching sessions, three (13%) completed two sessions, and six (26%) completed one session. Adjusted mean OSATS ratings did not vary over three coaching sessions (4.39 vs 4.52 vs 4.44, respectively; P = 0.655). Adjusted mean total NOTSS ratings also did not vary over three coaching sessions (15.05 vs 15.50 vs 15.08, respectively; P = 0.529). Regarding patient care, participants self-reported improved teamwork skills, communication skills, and awareness in and outside the operating room. Participants acknowledged the potential for coaching to improve burnout due to reduced intraoperative stress and enhanced peer support but also the potential to worsen burnout by adding to chronic work overload.ConclusionsSurgeons reported high perceived impact of peer coaching on patient care and surgeon well-being, although changes in coachees’ technical and non-technical skills were not detected over three coaching sessions. While quantitative skill measurement warrants further study, longitudinal peer surgical coaching should be considered a meaningful strategy for surgeons’ professional development.
Journal Article
Prospects for the use of objective assessment indicators of surgical skills in medical education: a twenty-year scoping review
Automatic and objective evaluation indicators can address the limitations of subjective assessments of surgical skills that are easily influenced by individual subjectivity and provide a more collected and accurate evaluation method. The aim of this study is to investigate, synthesize, and discuss various objective assessment indicators for surgical skills as reported in current literature.
A systematic search was conducted in the PubMed medical database following the PRISMA-ScR reporting guidelines. Inclusion criteria encompassed studies involving participants from the healthcare industry and scenarios involving surgical simulations or real surgical procedures. The research involved objective assessment indicators in two aspects: technical skills (TS) and non-technical skills (NTS).
After searching 3366 articles, 70 articles met the inclusion criteria. According to the objective assessment methods used in the included literature, some of which involve multiple methods (n = 3), the current real-time objective assessment indicators of surgical skills can be divided into physical indicators (n = 29), physiological indicators related to brain function (n = 30), and physiological indicators related to non-brain function (n = 14). The surgery types encompassed open surgical procedures, minimally invasive surgical procedures, and basic operations, while the surgical settings involved simulation-based surgery and surgery on real patients.
Currently, research on automatic and objective assessment indicators for surgical skills is in its preliminary stages, and it can indicate the difference between novices and experts, but it lacks the ability of universal, accurate, and detailed differentiation. It is necessary to develop multi-dimensional and multi-scenario combined evaluation methods.
•Reviewed past 20 years of PubMed studies on surgical skills assessment: study types, methods, indicators and populations.•Assess relationships between indicators and skill level, and differences and links among types of objective evaluation indicators.•This analysis is beneficial to the development of authoritative surgical skills evaluation criteria in the future.
Journal Article
The effects of stress on surgical performance: a systematic review
Introduction
Acute stress, the psychological response to short-term challenging stimuli, is frequently encountered in the high-pressure environment of the operating theatre. Surgeon stress is associated with deterioration in surgical performance, surgical team working and compromised patient safety. Given these concerns, the aim of this review was to understand the impact of acute stress on surgical performance in technical and non-technical domains as well as patient outcomes.
Methods
A systematic review was conducted following PRISMA guidelines. Electronic databases were searched for studies examining acute stress in medical professionals during real or simulated surgical procedures that reported performance outcomes in technical and non-technical skills. Risk of bias assessment was conducted using appropriate tools for each study design.
Results
Out of 1445 identified studies, 19 met the inclusion criteria. In simulated environments, acute stress consistently led to impairment in both technical and non-technical skills during surgical procedures. Technical skill deterioration included higher procedural error rates, longer task completion times and diminished instrument handling. Non-technical skills, such as teamwork and communication, also were impaired under stress conditions. Real-world studies echoed these findings, demonstrating acute stress resulting in higher error rates and impaired non-technical skills. No studies identified surgeon stress as having a causal relationship with patient outcomes.
Conclusion
Acute stress significantly impacts both technical and non-technical skills during surgical procedures, impairing performance in simulated and real-world surgical environments. Despite the growing understanding of the detrimental effects of stress, gaps remain in comprehensively assessing its impact on patient outcomes. Further research is warranted to develop reliable stress measurement methods applicable in surgical settings and explore effective stress management strategies.
Journal Article
Consensus guidelines on the bedside assistant skills required in robotic surgery
BackgroundWhile bedside assistants play a critical role in many robotic operations, substantial heterogeneity remains in bedside assistant training pathways. As such, this study aimed to develop consensus guidelines for bedside assistant skills required for team members in robotic operations.MethodsWe designed a study using the Delphi process to develop consensus guidelines around bedside assistant skills. We generated an initial list of bedside assistant skills from the literature, training materials, and expert input. We selected experts for the Delphi process based on prior scholarship in the area of robotic bedside assistant education and experience facilitating robotic bedside assistant training. For each item, respondents specified which robotic team members should have the skill from a list of “basic” bedside assistants, “advanced” bedside assistants, surgeons, surgical technologists, and circulating nurses. We conducted two rounds of the Delphi process and defined 80% agreement as sufficient for consensus.ResultsFourteen experts participated in two rounds of the Delphi process. By the end of the second round, the group had reached consensus on 253 of 305 items (83%). The group determined that “basic” bedside assistants should have 52 skills and that “advanced” bedside assistants should have 60 skills. The group also determined that surgeons should have 54 skills, surgical technologists should have 25 skills, and circulating nurses should have 17 skills. Experts agreed that all participants should have certain communication skills and basic knowledge of aspects of the robotic system.ConclusionsWe developed consensus guidelines on the skills required during robotic surgery by bedside assistants and other team members using the Delphi process. These findings can be used to design training around bedside assistant skills and assess team members to ensure that each team member has the appropriate skills. Hospitals can also use these guidelines to standardize expectations for robotic team members.
Journal Article
Using neuroimaging to assess brain activity and areas associated with surgical skills: a systematic review
BackgroundSurgical skills acquisition is under continuous development due to the emergence of new technologies, and there is a need for assessment tools to develop along with these. A range of neuroimaging modalities has been used to map the functional activation of brain networks while surgeons acquire novel surgical skills. These have been proposed as a method to provide a deeper understanding of surgical expertise and offer new possibilities for the personalized training of future surgeons. With studies differing in modalities, outcomes, and surgical skills there is a need for a systematic review of the evidence. This systematic review aims to summarize the current knowledge on the topic and evaluate the potential use of neuroimaging in surgical education.MethodsWe conducted a systematic review of neuroimaging studies that mapped functional brain activation while surgeons with different levels of expertise learned and performed technical and non-technical surgical tasks. We included all studies published before July 1st, 2023, in MEDLINE, EMBASE and WEB OF SCIENCE.Results38 task-based brain mapping studies were identified, consisting of randomized controlled trials, case–control studies, and observational cohort or cross-sectional studies. The studies employed a wide range of brain mapping modalities, including electroencephalography, functional magnetic resonance imaging, positron emission tomography, and functional near-infrared spectroscopy, activating brain areas involved in the execution and sensorimotor or cognitive control of surgical skills, especially the prefrontal cortex, supplementary motor area, and primary motor area, showing significant changes between novices and experts.ConclusionFunctional neuroimaging can reveal how task-related brain activity reflects technical and non-technical surgical skills. The existing body of work highlights the potential of neuroimaging to link task-related brain activity patterns with the individual level of competency or improvement in performance after training surgical skills. More research is needed to establish its validity and usefulness as an assessment tool.
Journal Article
Analysing human factors and non-technical skills in offshore drilling operations using FRAM (functional resonance analysis method)
Workplaces in the oil and gas (O&G) industry have evolved to become part of the modern complex sociotechnical system that characterises onshore and offshore facilities today. The intense interactions between workers, systems, equipment and processes have made companies in this sector more productive. However, significant and complex risks have also emerged. Managing them requires a methodology capable of understanding and recognising how this entire sociotechnical system works. This research uses the FRAM to model the activities performed by drillers, from the perspective of their workplace, inside the drilling unit of an offshore oil rig—a complex sociotechnical system. The interviews, on-board observations and data gathering performed as part of this study provided information that was used to build a FRAM model capable of representing the real work done by drillers inside the doghouses on offshore oil rigs. Through this model, the variability of human behaviour could be analysed in the context of the different situations that may happen, enabling researchers to understand the specific demands of the work and the correlation between WAI and WAD that naturally emerges. This FRAM-based analysis acknowledges that human factors and non-technical skills are responsible for the productive and safe execution of the work in both normal and critical operations situations, and identifies the impact of this variability—positive or negative—in the execution of daily tasks. It shows that workers’ varied responses can properly deal with complex system demands both in normal situations and in emergencies.
Journal Article
Integrating technical and non-technical skills coaching in an acute trauma surgery team training: Is it too much?
Research on effective integration of technical and non-technical skills in surgery team training is sparse. In a previous study we found that surgical teachers predominantly coached on technical and hardly on non-technical skills during the Definitive Surgical and Anesthetic Trauma Care (DSATC) integrated acute trauma surgery team training. This study aims to investigate whether the priming of teachers could increase the amount of non-technical skills coaching during such a training.
Coaching activities of 12 surgical teachers were recorded on audio and video. Six teachers were primed on non-technical skills coaching prior to the training. Six others received no priming and served as controls. Blind observers reviewed the recordings of 2 training scenario's and scored whether the observed behaviors were directed on technical or non-technical skills. We compared the frequency of the non-technical skills coaching between the primed and the non-primed teachers and analyzed for differences according to the trainees' level of experience.
Surgical teachers coached trainees during the highly realistic DSATC integrated acute trauma surgery team training. Trainees performed damage control surgery in operating teams on anesthetized porcine models during 6 training scenario's.
Twelve experienced surgical teachers participated in this study.
Coaching on non-technical skills was limited to about 5%. The primed teachers did not coach more often on non-technical skills than the non-primed teachers. We found no differences in the frequency of non-technical skills coaching based on the trainees' level of experience.
Priming experienced surgical teachers does not increase the coaching on non-technical skills. The current DSATC acute trauma surgery team training seems too complex for integrating training on technical and non-technical skills.
Patient care, Practice based learning and improvement.
Journal Article
Communication as a non‐technical skill in the operating room: A qualitative study
Aim The aim of this study was to explore how operating room nurses (ORNs) experience operating room (OR) team communication concerning non‐technical skills. Design Based on the Scrub Practitioners List of Intraoperative Non‐Technical Skill (SPLINTS), qualitative individual in‐depth semi‐structured interviews were conducted with 11 ORNs in a Norwegian university hospital. Braun and Clarke's six analytic phases for thematic data analysis were used. Results Surgeons being unprepared or demanding different instruments than the preoperative information indicates, cause stress and frustration. So does noise and brusquely or poor communication. Ensuring good information flow within the entire team is important. When silence is required, the ORNs communicate with gestures, looks and nods. Creating a positive and secure team culture facilitates discussions, questions and information sharing. Conclusion Inappropriate dynamics, inaccurate and/or disrespectful communication and noise may reduce patient safety. Interdisciplinary team training may bring attention to the value of communication as a non‐technical skill.
Journal Article
Prerequisites for entry to advanced nurse practitioner studies- a qualitative study of Norwegian nurse anesthetist students’ experiences
Nurse anesthesia is acknowledged as advanced practice nursing, and requires independency in patient monitoring and clinical decision-making. In Norway, 2022, a prerequisite to nurse anesthesia education programs of at least two years of clinical nursing experience prior to entry, was removed. The consequences of removing the prerequisite of clinical nursing experience prior to entering the nurse anesthetist education program on academic progression or on students' qualifications after completion of the program remain unexplored. Hence, the purpose of the current study was to explore nurse anesthetist students' experiences of the impact their previous clinical nursing experience had on their academic progression.
A qualitative design with semi-structured individual interviews was used. The sample consisted of 12 nurse anesthetist students at the end of the education program. The data were analyzed using thematic analysis in-line with recommendations from Braun & Clarke.
Two main themes with in total six subthemes were identified, namely 1) Experience develops non-technical skills, with subthemes (a) feeling secure in task management, (b) recognizing different situations, (c) understanding my role in teamwork, and 2) Integration of non-technical and technical skills, with subthemes (a) possessing procedural competence, (b) taking responsibility in medication administration, and (c) including a patient-centred approach. Previous clinical experience as a nurse prior to entry to a NA education program had provided a basis of non-technical and technical competencies, that supported further learning and development of advanced level competencies that are needed for NAs.
Non-technical and technical nursing competence represented a solid base for achievement of anesthesia competence within the same areas, also ensuring patient-centred practice. Hence, the change in prerequisites to the NA education program must be followed by evaluations of consequences on students' academic progress and competence at the end of the program, as well as a possible increased need for supervision throughout.
Journal Article