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Brogaard L, Rosvig L, Hjorth-Hansen KR, Hvidman L, Hinshaw K, Kierkegaard O, Uldbjerg N, Manser T. Team performance during vacuum-assisted vaginal delivery: video review of obstetric multidisciplinary teams. Front Med (Lausanne) 2024; 11:1330457. [PMID: 38572162 PMCID: PMC10987771 DOI: 10.3389/fmed.2024.1330457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/12/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Vacuum extraction is generally considered an operator-dependent task, with most attention directed toward the obstetrician's technical abilities (1-3). Little is known about the effect of the team and non-technical skills on clinical outcomes in vacuum-assisted delivery. This study aimed to investigate whether the non-technical skills of obstetricians were correlated with their level of clinical performance via the analysis of video recordings of teams conducting actual vacuum extractions. Methods We installed between two or three video cameras in each delivery room at Aarhus University Hospital and Horsens Regional Hospital and obtained 60 videos of teams managing vacuum extraction. Appropriate consent was obtained. Two raters carefully reviewed the videos and assessed the teams' non-technical skills using the Assessment of Obstetric Team Performance (AOTP) checklist, rating all items on a Likert scale score from 1 to 5 (1 = poor; 3 = average; and 5 = excellent). This resulted in a total score ranging from 18 to 90. Two different raters independently assessed the teams' clinical performance (adherence to clinical guidelines) using the TeamOBS-Vacuum-Assisted Delivery (VAD) checklist, rating each item (0 = not done, 1 = done incorrectly; and 2 = done correctly). This resulted in a total score with the following ranges (low clinical performance: 0-59; average: 60-84; and high: 85-100). Interrater agreement was analyzed using intraclass correlation (ICC), and the risk of high or low clinical performance was analyzed on a logit scale to meet the assumption of normality. Results Teams that received excellent non-technical scores had an 81% probability of achieving high clinical performance, whereas this probability was only 12% among teams with average non-technical scores (p < 0.001). Teams with a high clinical performance often had excellent behavior in the non-technical items of "team interaction," "anticipation," "avoidance fixation," and "focused communication." Teams with a low or average clinical performance often neglected to consider analgesia, had delayed abandonment of the attempted vaginal delivery and insufficient use of appropriate fetal monitoring. Interrater reliability was high for both rater-teams, with an ICC for the non-technical skills of 0.83 (95% confidence interval [CI]: 0.71-0.88) and 0.84 for the clinical performance (95% CI: 0.74-0.90). Conclusion Although assisted vaginal delivery by vacuum extraction is generally considered to be an operator-dependent task, our findings suggest that teamwork and effective team interaction play crucial roles in achieving high clinical performance. Teamwork helped the consultant anticipate the next step, avoid fixation, ensure adequate analgesia, and maintain thorough fetal monitoring during delivery.
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Affiliation(s)
- L. Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L. Rosvig
- Department of Obstetrics and Gynecology, Randers Hospital, Randers, Denmark
| | | | - L. Hvidman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K. Hinshaw
- Department of Obstetrics and Gynecology, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - O. Kierkegaard
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - N. Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - T. Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Idrees S, Sabaretnam M, Chand G, Mishra A, Rastogi A, Agarwal G. Noise level and surgeon stress during thyroidectomy in an endocrine surgery operating room. Head Neck 2024; 46:37-45. [PMID: 37860889 DOI: 10.1002/hed.27552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/03/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Noise in the operating room is an ongoing problem that impacts the outcome of any surgery. Noise as a stressor can produce a startling reaction and activate the fight or flight response of the autonomic and endocrine systems. The psychobiology of stress as assessed by salivary cortisol level is a sensitive measure of allostatic load. This study aims to correlate, both subjectively and objectively, the salivary cortisol levels of the surgeon with noise level measurement in an endocrine surgery operating room (OR). MATERIALS AND METHODS A prospective observational study was conducted in the Endocrine surgery OR of a tertiary care center. We recorded the noise from the shifting in of patients in the OR to shifting out using a digital sound level meter. The operating surgeon (S) provided two salivary cortisol samples (normal salivary cortisol <5 nmol/L), one baseline and another after the procedure. The questionnaire for the assessment of distraction during thyroidectomy was filled in by the S at the end of the procedure. Salivary cortisol levels were analyzed using SLV-4635 (formerly SLV-2930) DRG Instruments GmbH German using the ELISA technique. Statistical analysis was performed using SPSS 22.0. RESULTS A total of 37 procedures with 74 salivary cortisol samples and 259 questionnaire responses from S were analyzed. All patients with only benign FNAC were operated upon (64.9% colloid). Mean TSH levels were 3.5 ± 6.7 mIU/L. The majority had a solitary thyroid nodule (STN) (25/37, 67.6%). Nineteen patients (51.3%) underwent open hemithyroidectomy, 10 patients total thyroidectomy, and eight patients endoscopic hemithyroidectomy. The mean noise level in the OR was 70 db. The maximum and minimum noise level in the OR was 90.06 and 51.81 dB, respectively. A total of 74 salivary cortisol samples from the S were collected (baseline and post-noise exposure) and mean cortisol levels were recorded. The surgeon was more significantly affected by surrounding noise, especially during critical phases 3 of surgery, mainly, RLN dissection and parathyroid dissection as recorded by their responses in the questionnaire (p = 0.003). The maximum value of post-operative salivary cortisol of surgeon was recorded as 23. 48 ng/mL and the minimum value recorded was 0.49 ng/mL. The difference in baseline cortisol and post-noise exposure cortisol levels of surgeon was found to be significant (p < 0.001). Maximum and mean noise levels were significantly associated with post-noise exposure salivary cortisol elevation in the surgeon (p = 0.032 and 0.014, respectively). The noise levels during RLN dissection were borderline significant with the post-noise exposure salivary cortisol of the surgeon (p = 0.055). CONCLUSION Our research is the first such study which has been done to assess noise levels and their effect on thyroidectomy using objective salivary cortisol measurement. It challenges the misconstrued notion that visceral surgeries requiring lesser instruments are not associated with noise-related stress. Noise is a major distraction and the effect of long-term effect on the entire surgical team needs to be studied.
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Affiliation(s)
- Sarrah Idrees
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mayilvaganan Sabaretnam
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gyan Chand
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anjali Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amit Rastogi
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gaurav Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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3
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Soenens G, Marchand B, Doyen B, Grantcharov T, Van Herzeele I, Vlerick P. Surgeons' Leadership Style and Team Behavior in the Hybrid Operating Room: Prospective Cohort Study. Ann Surg 2023; 278:e5-e12. [PMID: 35904023 DOI: 10.1097/sla.0000000000005645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the relationship between surgeons' leadership style and team behavior in the hybrid operating room through video coding. Secondly, possible fluctuations possible fluctuations in leadership styles and team behavior during operative phases were studied. BACKGROUND Leadership is recognized as a key component to successful team functioning in high-risk industries. The 'full range of leadership' theory is commonly used to evaluate leadership, marking transformational, transactional, and passive. Few studies have examined the effects of these leadership styles on team behavior in surgery and/or their fluctuations during surgery. METHODS A single-center study included patients planned for routine endovascular procedures. A medical data capture system was used to allow post hoc video coding through Behavior Anchored Rating Scales. Multilevel statistical analysis was performed to assess possible correlations between leadership style and 3 team behavior indicators (speaking up, knowledge sharing, and collaboration) on an operative phase level. RESULTS Twenty-two cases were analyzed (47 hours recording). Transformational leadership is positively related to the extent to which team members work together (γ=0.20, P <0.001), share knowledge (γ=0.45, P <0.001), and speak up (γ=0.64, P <0.001). Passive leadership is significantly positively correlated with speaking up (γ=0.29, P =0.004). Leadership style and team behavior clearly fluctuate during a procedure, with similar patterns across different types of endovascular procedures. CONCLUSIONS Consistent with other professional fields, surgeons' transformational leadership enhances team behavior, especially during the most complex operative phases. This suggests that encouraging surgeons to learn and actively implement a transformational leadership style is meaningful to enhance patient safety and team performance.
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Affiliation(s)
- Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Benoit Marchand
- Department of Work, Organization and Society, Ghent University, Ghent, Belgium
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Teodor Grantcharov
- Department of Surgery, Stanford University, Clinical Excellence Research Center, Stanford, CA
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Peter Vlerick
- Department of Work, Organization and Society, Ghent University, Ghent, Belgium
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Raveendran L, McGuire CS, Gazmin S, Beiko D, Martin LJ. The who, what, and how of teamwork research in medical operating rooms: A scoping review. J Interprof Care 2022; 37:504-514. [PMID: 35543316 DOI: 10.1080/13561820.2022.2058917] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the importance of teamwork in the operating room (OR), teamwork can often be conflated with teamwork components (e.g., communication, cooperation). We reviewed the existing literature pertaining to OR teamwork to understand which teamwork components have been assessed. Following PRISMA guidelines for scoping reviews, 4,233 peer-reviewed studies were identified using MEDLINE and Embase. Eighty-seven studies were included for synthesis and analysis. Using the episodic model of teamwork as an organizing framework, studies were grouped into the following teamwork categories: (a) transition processes (e.g., goal specification), (b) action processes (e.g., coordination), (c) interpersonal processes (e.g., conflict management), (d) emergent states (e.g., psychological safety), or (e) omnibus topics (a combination of higher-order teamwork processes). Results demonstrated that action processes were most frequently explored, followed by transition processes, omnibus topics, emergent states, and interpersonal processes. Although all studies were framed as investigations of teamwork, it is important to highlight that most explored only one or a few constructs under the overarching umbrella of teamwork. We advocate for enhanced specificity with descriptions of OR teamwork, reporting practices pertaining to interprofessional demographics and outcomes, and increased diversity in study design and surgery type to advance understanding of teamwork and its implications.
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Affiliation(s)
| | - Cailie S McGuire
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Stefanie Gazmin
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Darren Beiko
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Luc J Martin
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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5
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Minehart RD, Foldy EG, Long JA, Weller JM. Challenging gender stereotypes and advancing inclusive leadership in the operating theatre. Br J Anaesth 2020; 124:e148-e154. [DOI: 10.1016/j.bja.2019.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/20/2022] Open
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Rydenfält C, Borell J, Erlingsdottir G. What do doctors mean when they talk about teamwork? Possible implications for interprofessional care. J Interprof Care 2018; 33:714-723. [PMID: 30362854 DOI: 10.1080/13561820.2018.1538943] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The concept of teamwork has been associated with improved patient safety, more effective care and a better work environment. However, the academic literature on teamwork is pluralistic, and there are reports on discrepancies between theory and practice. Furthermore, healthcare professionals' direct conceptualizations of teamwork are sometimes missing in the research. In this study, we examine doctors' conceptualizations of teamwork. We also investigate what doctors think is important in order to achieve good teamwork, and how the empirical findings relate to theory. Finally, we discuss the methodological implications for future studies. The research design was explorative. The main data consisted of semi-structured interviews with twenty clinically active doctors, analyzed with conventional content analysis. Additional data sources included field observations and interviews with management staff. There was large variation in the doctors' conceptualizations of teamwork. The only characteristic they shared in common was that team members should have specific roles. This could have consequences for practice, because the rationale behind different behaviors depends on how teamwork is conceptualized. Several of the teamwork-enabling factors identified concerned non-technical skills. Future studies should put more emphasis on the practitioners' perspective in the research design, to create a more grounded foundation for both research and practice.
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Affiliation(s)
- Christofer Rydenfält
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Jonas Borell
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
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Widmer LW, Keller S, Tschan F, Semmer NK, Holzer E, Candinas D, Beldi G. More Than Talking About the Weekend: Content of Case-Irrelevant Communication Within the OR Team. World J Surg 2018; 42:2011-2017. [PMID: 29318356 PMCID: PMC5990573 DOI: 10.1007/s00268-017-4442-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Case-irrelevant communication (CIC) is defined as "any conversation" irrelevant to the case. It includes small talk, but also communication related to other work issues besides the actual task. CIC during surgeries is generally seen as distracting, despite a lack of knowledge about the content of CIC and its regulation in terms of adjustments to the situation of CIC. Primary goal of the study was to evaluate CIC content; secondary goal was to evaluate whether surgical teams regulate CIC according to different concentration demands of surgical procedures. METHODS In 125 surgeries, 1396 CIC events were observed. CIC were content coded into work-related CIC (pertaining to other tasks or work in general) and social CIC (pertaining to acquaintance talk, gossip, or private conversation). The impact of different phases and the difficulty of the surgical procedure on CIC were assessed. RESULTS Work-related CIC were significantly more frequent (2.49 per hour, SD = 2.17) than social CIC (1.42 per hour, SD = 2.17). Across phases, frequency of work-related CIC was constant, whereas social CIC increased significantly across phases. In surgeries assessed as highly difficult by the surgeons, social CIC were observed at a lower frequency, and less work-related CIC were observed during the main phase compared to surgeries assessed as less difficult. CONCLUSION The high proportion of work-related CIC indicates that surgical teams deal with other tasks during surgeries. Surgical teams adapt CIC according to the demands of the procedure. Hospital policies should support these adaptations rather than attempt to suppress CIC entirely.
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Affiliation(s)
- Lukas W Widmer
- Department of Visceral Surgery and Medicine, University Hospital of Bern, 3010, Bern, Switzerland
| | - Sandra Keller
- University of Neuchâtel, Institute of Work and Organizational Psychology, Neuchâtel, Switzerland
| | - Franziska Tschan
- University of Neuchâtel, Institute of Work and Organizational Psychology, Neuchâtel, Switzerland
| | - Norbert K Semmer
- Department of Psychology, University of Berne, Bern, Switzerland
| | - Eliane Holzer
- University of Neuchâtel, Institute of Work and Organizational Psychology, Neuchâtel, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, University Hospital of Bern, 3010, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, University Hospital of Bern, 3010, Bern, Switzerland.
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8
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How to Teach Surgical Residents during Damage Control Surgery. CURRENT SURGERY REPORTS 2018. [DOI: 10.1007/s40137-018-0213-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Keller S, Tschan F, Semmer NK, Holzer E, Candinas D, Brink M, Beldi G. Noise in the Operating Room Distracts Members of the Surgical Team. An Observational Study. World J Surg 2018; 42:3880-3887. [DOI: 10.1007/s00268-018-4730-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Grozdanovic D, Grozdanovic M. Research on Key Indicators in Modern Surgical Practice Assessment: Ergonomic Approach. Surg Innov 2018; 25:323-332. [PMID: 29726307 DOI: 10.1177/1553350618772720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is undeniable that fundamental requirements in surgery refer to the adequate use of medical knowledge (eg, clinical knowledge and technical skills). However, this knowledge and skills of surgeons should be supplemented with synergetic research of capabilities of surgeons, operating rooms (ORs), and nontechnical skills. In this article, by using expert research, we presented 15 key indicators in surgical practice assessment. Communication efficiency in the OR has been ranked as the first and most important among indicators using the fuzzy analytic hierarchy process method. Within the analysis of this indicator, we have shown a new method that provided us with the results describing the extent of communication, the correlation in the communication system, surgeon workload uniformity, and isolation of individual surgeons in the OR. The goal of this research is aimed at the increase of operator efficiency in the OR. It is necessary that results of this kind of research find their practical use and become an obligatory element in the construction of new ORs as well as reconstruction of old ORs.
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11
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Yule J, Hill K, Yule S. Development and evaluation of a patient-centred measurement tool for surgeons' non-technical skills. Br J Surg 2018; 105:876-884. [DOI: 10.1002/bjs.10800] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/19/2017] [Accepted: 11/04/2017] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Non-technical skills are essential for safe and effective surgery. Several tools to assess surgeons' non-technical skills from the clinician's perspective have been developed. However, a reliable measurement tool using a patient-centred approach does not currently exist. The aim of this study was to translate the existing Non-Technical Skills for Surgeons (NOTSS) tool into a patient-centred evaluation tool.
Methods
Data were gathered from four cohorts of patients using an iterative four-stage mixed-methods research design. Exploratory and confirmatory factor analyses were performed to establish the psychometric properties of the tool, focusing on validity, reliability, usability and parsimony.
Results
Some 534 patients were recruited to the study. A total of 24 patient-centred non-technical skill items were developed in stage 1, and reduced to nine items in stage 2 using exploratory factor analysis. In stage 3, confirmatory factor analysis demonstrated that these nine items each loaded on to one of three factors, with excellent internal consistency: decision-making, leadership, and communication and teamwork. In stage 4, validity testing established that the new tool was independent of physician empathy and predictive of surgical quality. Surgical leadership emerged as the most dominant skill that patients could recognize and evaluate.
Conclusion
A novel nine-item assessment tool has been developed. The Patients' Evaluation of Non-Technical Skills (PENTS) tool allows valid and reliable measurement of surgeons' non-technical skills from the patient perspective.
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Affiliation(s)
- J Yule
- D'Amore-McKim School of Business, Northeastern University, Boston, Massachusetts, USA
| | - K Hill
- Babson College, Wellesley, Massachusetts, USA
| | - S Yule
- Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Boston, Massachusetts, USA
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12
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Yule S, Gupta A, Gazarian D, Geraghty A, Smink DS, Beard J, Sundt T, Youngson G, McIlhenny C, Paterson-Brown S. Construct and criterion validity testing of the Non-Technical Skills for Surgeons (NOTSS) behaviour assessment tool using videos of simulated operations. Br J Surg 2018; 105:719-727. [DOI: 10.1002/bjs.10779] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/06/2017] [Accepted: 11/04/2017] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Surgeons' non-technical skills are an important part of surgical performance and surgical education. The most widely adopted assessment tool is the Non-Technical Skills for Surgeons (NOTSS) behaviour rating system. Psychometric analysis of this tool to date has focused on inter-rater reliability and feasibility rather than validation.
Methods
NOTSS assessments were collected from two groups of consultant/attending surgeons in the UK and USA, who rated behaviours of the lead surgeon during a video-based simulated crisis scenario after either online or classroom instruction. The process of validation consisted of assessing construct validity, scale reliability and concurrent criterion validity, and undertaking a sensitivity analysis. Central to this was confirmatory factor analysis to evaluate the structure of the NOTSS taxonomy.
Results
Some 255 consultant surgeons participated in the study. The four-category NOTSS model was found to have robust construct validity evidence, and a superior fit compared with alternative models. Logistic regression and sensitivity analysis revealed that, after adjusting for technical skills, for every 1-point increase in NOTSS score of the lead surgeon, the odds of having a higher versus lower patient safety score was 2·29 times. The same pattern of results was obtained for a broad mix of surgical specialties (UK) as well as a single discipline (cardiothoracic, USA).
Conclusion
The NOTSS tool can be applied in research and education settings to measure non-technical skills in a valid and efficient manner.
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Affiliation(s)
- S Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - A Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - D Gazarian
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A Geraghty
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
| | - D S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - J Beard
- Faculty of Medicine, University of Sheffield, Sheffield, UK
| | - T Sundt
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - G Youngson
- Department of Paediatric Surgery, Royal Aberdeen Children's Hospital, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - C McIlhenny
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
| | - S Paterson-Brown
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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13
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The impact of positive and negative intraoperative surgeons' leadership behaviors on surgical team performance. Am J Surg 2018; 215:14-18. [DOI: 10.1016/j.amjsurg.2017.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022]
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14
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Jones LK, Jennings BM, Goelz RM, Haythorn KW, Zivot JB, de Waal FBM. An Ethogram to Quantify Operating Room Behavior. Ann Behav Med 2017; 50:487-96. [PMID: 26813263 DOI: 10.1007/s12160-016-9773-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The operating room (OR) is a highly social and hierarchical setting where interprofessional team members must work interdependently under pressure. Due primarily to methodological challenges, the social and behavioral sciences have had trouble offering insight into OR dynamics. PURPOSE We adopted a method from the field of ethology for observing and quantifying the interpersonal interactions of OR team members. METHODS We created and refined an ethogram, a catalog of all our subjects' observable social behaviors. The ethogram was then assessed for its feasibility and interobserver reliability. RESULTS It was feasible to use an ethogram to gather data in the OR. The high interobserver reliability (Cohen's Kappa coefficients of 81 % and higher) indicates its utility for yielding largely objective, descriptive, quantitative data on OR behavior. CONCLUSIONS The method we propose has potential for social research conducted in healthcare settings as complex as the OR.
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Affiliation(s)
| | | | - Ryan M Goelz
- Emory Healthcare Surgical Services, Atlanta, GA, USA.,South University Anesthesiologist Assistant Program, Savannah, GA, USA
| | - Kent W Haythorn
- Emory Healthcare Surgical Services, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Joel B Zivot
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Frans B M de Waal
- Living Links, Yerkes National Primate Research Center and Professor at Emory University, Atlanta, GA, USA
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15
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Stone JL, Aveling EL, Frean M, Shields MC, Wright C, Gino F, Sundt TM, Singer SJ. Effective Leadership of Surgical Teams: A Mixed Methods Study of Surgeon Behaviors and Functions. Ann Thorac Surg 2017; 104:530-537. [PMID: 28395873 PMCID: PMC5527126 DOI: 10.1016/j.athoracsur.2017.01.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The importance of effective team leadership for achieving surgical excellence is widely accepted, but we understand less about the behaviors that achieve this goal. We studied cardiac surgical teams to identify leadership behaviors that best support surgical teamwork. METHODS We observed, surveyed, and interviewed cardiac surgical teams, including 7 surgeons and 116 team members, from September 2013 to April 2015. We documented 1,926 surgeon/team member interactions during 22 cases, coded them by behavior type and valence (ie, positive/negative/neutral), and characterized them by leadership function (conductor, elucidator, delegator, engagement facilitator, tone setter, being human, and safe space maker) to create a novel framework of surgical leadership derived from direct observation. We surveyed nonsurgeon team members about their perceptions of individual surgeon's leadership effectiveness on a 7-point Likert scale and correlated survey measures with individual surgeon profiles created by calculating percentage of behavior types, leader functions, and valence. RESULTS Surgeon leadership was rated by nonsurgeons from 4.2 to 6.2 (mean, 5.4). Among the 33 types of behaviors observed, most interactions constituted elucidating (24%) and tone setting (20%). Overall, 66% of interactions (range, 43%-84%) were positive and 11% (range, 1%-45%) were negative. The percentage of positive and negative behaviors correlated strongly (r = 0.85 for positive and r = 0.75 for negative, p < 0.05) with nonsurgeon evaluations of leadership. Facilitating engagement related most positively (r = 0.80; p = 0.03), and negative forms of elucidating, ie, criticism, related most negatively (r = -0.81; p = 0.03). CONCLUSIONS We identified 7 surgeon leadership functions and related behaviors that impact perceptions of leadership. These observations suggest actionable opportunities to improve team leadership behavior.
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Affiliation(s)
- Juliana L Stone
- Department of Health Research and Policy, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Emma-Louise Aveling
- Department of Health Research and Policy, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, United Kingdom
| | - Molly Frean
- Department of Health Research and Policy, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Health Care Management Department, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Morgan C Shields
- Department of Health Research and Policy, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Cameron Wright
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Francesca Gino
- Negotiation, Organizations & Markets, Harvard Business School, Boston, Massachusetts
| | - Thoralf M Sundt
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sara J Singer
- Department of Health Research and Policy, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Wood TC, Raison N, Haldar S, Brunckhorst O, McIlhenny C, Dasgupta P, Ahmed K. Training Tools for Nontechnical Skills for Surgeons-A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:548-578. [PMID: 28011262 DOI: 10.1016/j.jsurg.2016.11.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/11/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Development of nontechnical skills for surgeons has been recognized as an important factor in surgical care. Training tools for this specific domain are being created and validated to maximize the surgeon's nontechnical ability. This systematic review aims to outline, address, and recommend these training tools. DESIGN A full and comprehensive literature search, using a systematic format, was performed on ScienceDirect and PubMed, with data extraction occurring in line with specified inclusion criteria. SETTING Systematic review was performed fully at King's College London. RESULTS A total of 84 heterogeneous articles were used in this review. Further, 23 training tools including scoring systems, training programs, and mixtures of the two for a range of specialities were identified in the literature. Most can be applied to surgery overall, although some tools target specific specialities (such as neurosurgery). Interrater reliability, construct, content, and face validation statuses were variable according to the specific tool in question. CONCLUSIONS Study results pertaining to nontechnical skill training tools have thus far been universally positive, but further studies are required for those more recently developed and less extensively used tools. Recommendations can be made for individual training tools based on their level of validation and for their target audience. Based on the number of studies performed and their status of validity, NOTSS and Oxford NOTECHS II can be considered the gold standard for individual- and team-based nontechnical skills training, respectively, especially when used in conjunction with a training program.
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Affiliation(s)
- Thomas Charles Wood
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Nicholas Raison
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
| | - Shreya Haldar
- Department of Opthalmology, Stoke Mandeville Hospital, Aylesbury, United Kingdom
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Craig McIlhenny
- Department of Urology, NHS Forth Valley, Larbert, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
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17
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Nontechnical skill training and the use of scenarios in modern surgical education. Curr Opin Urol 2017; 27:330-336. [DOI: 10.1097/mou.0000000000000402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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18
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Seamans DP, Louka BF, Fortuin FD, Patel BM, Sweeney JP, Lanza LA, DeValeria PA, Ezrre KM, Ramakrishna H. The utility of live video capture to enhance debriefing following transcatheter aortic valve replacement. Ann Card Anaesth 2017; 19:S6-S11. [PMID: 27762242 PMCID: PMC5100244 DOI: 10.4103/0971-9784.192576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The surgical and procedural specialties are continually evolving their methods to include more complex and technically difficult cases. These cases can be longer and incorporate multiple teams in a different model of operating room synergy. Patients are frequently older, with comorbidities adding to the complexity of these cases. Recording of this environment has become more feasible recently with advancement in video and audio capture systems often used in the simulation realm. Aims: We began using live capture to record a new procedure shortly after starting these cases in our institution. This has provided continued assessment and evaluation of live procedures. The goal of this was to improve human factors and situational challenges by review and debriefing. Setting and Design: B-Line Medical's LiveCapture video system was used to record successive transcatheter aortic valve replacement (TAVR) procedures in our cardiac catheterization/laboratory. An illustrative case is used to discuss analysis and debriefing of the case using this system. Results and Conclusions: An illustrative case is presented that resulted in long-term changes to our approach of these cases. The video capture documented rare events during one of our TAVR procedures. Analysis and debriefing led to definitive changes in our practice. While there are hurdles to the use of this technology in every institution, the role for the ongoing use of video capture, analysis, and debriefing may play an important role in the future of patient safety and human factors analysis in the operating environment.
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Affiliation(s)
- David P Seamans
- Department of Anesthesiology, Mayo Clinic Arizona, AZ 85054, USA
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - F David Fortuin
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - Bhavesh M Patel
- Department of Critical Care, Mayo Clinic Arizona, AZ 85054, USA
| | - John P Sweeney
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - Louis A Lanza
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, AZ 85054, USA
| | - Patrick A DeValeria
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, AZ 85054, USA
| | - Kim M Ezrre
- Department of Catheterization Laboratory, Mayo Clinic Arizona, AZ 85054, USA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Arizona, AZ 85054, USA
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Gostlow H, Marlow N, Thomas MJW, Hewett PJ, Kiermeier A, Babidge W, Altree M, Pena G, Maddern G. Non-technical skills of surgical trainees and experienced surgeons. Br J Surg 2017; 104:777-785. [DOI: 10.1002/bjs.10493] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/09/2016] [Accepted: 12/18/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
In addition to technical expertise, surgical competence requires effective non-technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non-technical skills considered essential for a competent surgeon. This study sought to compare the non-technical skills of experienced surgeons who completed their training before the introduction of SET with the non-technical skills of more recent trainees.
Methods
Surgical trainees and experienced surgeons undertook a simulated scenario designed to challenge their non-technical skills. Scenarios were video recorded and participants were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring system. Participants were divided into subgroups according to years of experience and their NOTSS scores were compared.
Results
For most NOTSS elements, mean scores increased initially, peaking around the time of Fellowship, before decreasing roughly linearly over time. There was a significant downward trend in score with increasing years since being awarded Fellowship for six of the 12 NOTSS elements: considering options (score −0·015 units per year), implementing and reviewing decisions (−0·020 per year), establishing a shared understanding (−0·014 per year), setting and maintaining standards (−0·024 per year), supporting others (−0·031 per year) and coping with pressure (−0·015 per year).
Conclusion
The drop in NOTSS score was unexpected and highlights that even experienced surgeons are not immune to deficiencies in non-technical skills. Consideration should be given to continuing professional development programmes focusing on non-technical skills, regardless of the level of professional experience.
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Affiliation(s)
- H Gostlow
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - N Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - M J W Thomas
- Westwood-Thomas Associates, Norton Summit, South Australia, Australia
| | - P J Hewett
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
| | - A Kiermeier
- Statistical Process Improvement Consulting and Training, Gumeracha, South Australia, Australia
| | - W Babidge
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - M Altree
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - G Pena
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - G Maddern
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
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Gillespie BM, Harbeck E, Kang E, Steel C, Fairweather N, Chaboyer W. Correlates of non-technical skills in surgery: a prospective study. BMJ Open 2017; 7:e014480. [PMID: 28137931 PMCID: PMC5293872 DOI: 10.1136/bmjopen-2016-014480] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams' non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. METHODS We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams' NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. RESULTS We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams' NTS were observed. CONCLUSIONS Miscommunications and interruptions impact on team NTS performance.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- National Centre for Research Excellence in Nursing (NCREN), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia
| | - Emma Harbeck
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Evelyn Kang
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Catherine Steel
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Nicole Fairweather
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Wendy Chaboyer
- National Centre for Research Excellence in Nursing (NCREN), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia
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Keller S, Tschan F, Beldi G, Kurmann A, Candinas D, Semmer NK. Noise peaks influence communication in the operating room. An observational study. ERGONOMICS 2016; 59:1541-1552. [PMID: 27054273 DOI: 10.1080/00140139.2016.1159736] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/22/2016] [Indexed: 06/05/2023]
Abstract
Noise peaks are powerful distractors. This study focuses on the impact of noise peaks on surgical teams' communication during 109 long abdominal surgeries. We related measured noise peaks during 5-min intervals to the amount of observed communication during the same interval. Results show that noise peaks are associated with less case-relevant communication; this effect is moderated by the level of surgical experience; case-relevant communications decrease under high noise peak conditions among junior, but not among senior surgeons. However, case-irrelevant communication did not decrease under high noise level conditions, rather there was a trend to more case-irrelevant communication under high noise peaks. The results support the hypothesis that noise peaks impair communication because they draw on attentional resources rather than impairing understanding of communication. As case-relevant communication is important for surgical performance, exposure to high noise peaks in the OR should be minimised especially for less experienced surgeons. Practitioner Summary: This study investigated whether noise during surgeries influenced the communication within surgical teams. During abdominal surgeries, noise levels were measured and communication was observed. Results showed that high noise peaks reduced the frequency of patient-related communication, but did not reduce patient-irrelevant communication. Noise may negatively affect team coordination in surgeries.
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Affiliation(s)
- Sandra Keller
- a Institute for Work and Organizational Psychology , University of Neuchâtel , Neuchâtel , Switzerland
| | - Franziska Tschan
- a Institute for Work and Organizational Psychology , University of Neuchâtel , Neuchâtel , Switzerland
| | - Guido Beldi
- b Department of Visceral Surgery and Medicine, Inselspital , University Hospital of Bern, University of Bern , Bern , Switzerland
| | - Anita Kurmann
- b Department of Visceral Surgery and Medicine, Inselspital , University Hospital of Bern, University of Bern , Bern , Switzerland
| | - Daniel Candinas
- b Department of Visceral Surgery and Medicine, Inselspital , University Hospital of Bern, University of Bern , Bern , Switzerland
| | - Norbert K Semmer
- c Department of Psychology , University of Bern , Bern , Switzerland
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Heidenreich MJ, Musonza T, Pawlina W, Lachman N. Can a teaching assistant experience in a surgical anatomy course influence the learning curve for nontechnical skill development for surgical residents? ANATOMICAL SCIENCES EDUCATION 2016; 9:97-100. [PMID: 26126886 DOI: 10.1002/ase.1558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/05/2015] [Accepted: 06/11/2015] [Indexed: 06/04/2023]
Abstract
The foundation upon which surgical residents are trained to work comprises more than just critical cognitive, clinical, and technical skill. In an environment where the synchronous application of expertise is vital to patient outcomes, the expectation for optimal functioning within a multidisciplinary team is extremely high. Studies have shown that for most residents, one of the most difficult milestones in the path to achieving professional expertise in a surgical career is overcoming the learning curve. This view point commentary provides a reflection from the two senior medical students who have participated in the Student-as-Teacher program developed by the Department of Anatomy at Mayo Clinic, designed to prepare students for their teaching assistant (TA) role in anatomy courses. Both students participated as TAs in a six week surgical anatomy course for surgical first assistant students offered by the School of Health Sciences at Mayo Clinic. Development of teaching skills, nontechnical leadership, communication, and assessment skills, are discussed in relation to their benefits in preparing senior medical students for surgical residency.
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Affiliation(s)
- Mark J Heidenreich
- Mayo Medical School, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tashinga Musonza
- Mayo Medical School, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Wojciech Pawlina
- Department of Anatomy, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nirusha Lachman
- Department of Anatomy, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
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Sadideen H, Weldon SM, Saadeddin M, Loon M, Kneebone R. A Video Analysis of Intra- and Interprofessional Leadership Behaviors Within "The Burns Suite": Identifying Key Leadership Models. JOURNAL OF SURGICAL EDUCATION 2016; 73:31-39. [PMID: 26699279 DOI: 10.1016/j.jsurg.2015.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 09/12/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of "The Burns Suite" (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS. METHODS A total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen's κ coefficient was used to measure inter-rater agreement and calculated as κ = 0.7 (substantial agreement). Each video was watched 4 times, focusing on 1 of the 4 team members per viewing (senior surgeon, senior nurse, trainee surgeon, and trainee nurse). The frequency and types of leadership behavior of each of the 4 team members were recorded. Statistical significance to assess any differences was assessed using analysis of variance, whereby a p < 0.05 was taken to be significant. Leadership behaviors were triangulated with verbal cues and actions from the videos. RESULTS All 3 scenarios were successfully completed. The mean scenario length was 22 minutes. A total of 362 leadership behaviors were recorded from the 12 participants. The most evident leadership behaviors of all team members were adhering to guidelines (which effectively equates to following Advanced Trauma and Life Support/Emergency Management of Severe Burns resuscitation guidelines and hence "maintaining standards"), followed by making decisions. Although in terms of total frequency the senior surgeon engaged in more leadership behaviors compared with the entire team, statistically there was no significant difference between all 4 members within the 8 leadership categories. This analysis highlights that "distributed leadership" was predominant, whereby leadership was "distributed" or "shared" among team members. The leadership behaviors within TBS also seemed to fall in line with the "direction, alignment, and commitment" ontology. CONCLUSIONS Effective leadership is essential for successful functioning of work teams and accomplishment of task goals. As the resuscitation of a patient with major burns is a dynamic event, team leaders require flexibility in their leadership behaviors to effectively adapt to changing situations. Understanding leadership behaviors of different team members within an authentic simulation can identify important behaviors required to optimize nontechnical skills in a major resuscitation. Furthermore, attempting to map these behaviors on to leadership models can help further our understanding of leadership theory. Collectively this can aid the development of refined simulation scenarios for team members, and can be extrapolated into other areas of simulation-based team training and interprofessional education.
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Affiliation(s)
- Hazim Sadideen
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Sharon-Marie Weldon
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Munir Saadeddin
- Department of Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mark Loon
- Worcester Business School, University of Worcester, Worcester, United Kingdom
| | - Roger Kneebone
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Kissane-Lee NA, Yule S, Pozner CN, Smink DS. Attending Surgeons' Leadership Style in the Operating Room: Comparing Junior Residents' Experiences and Preferences. JOURNAL OF SURGICAL EDUCATION 2016; 73:40-44. [PMID: 26422000 DOI: 10.1016/j.jsurg.2015.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 07/18/2015] [Accepted: 08/21/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Recent studies have focused on surgeons' nontechnical skills in the operating room (OR), especially leadership. In an attempt to identify trainee preferences, we explored junior residents' opinions about the OR leadership style of teaching faculty. METHODS Overall, 20 interns and 20 mid-level residents completed a previously validated survey on the style of leadership they encountered, the style they preferred to receive, and the style they personally employed in the OR. In all, 4 styles were explored; authoritative: leader makes decisions and communicates them firmly; explanatory: leader makes decisions promptly, but explains them fully; consultative: leader consults with trainees when important decisions are made, and delegative: leader puts the problem before the group and makes decisions by majority opinion. Comparisons were completed using chi-square analysis. RESULTS Junior resident preference for leadership style of attending surgeons in the OR differed from what they encountered. Overall, 62% of residents encountered an authoritative leadership style; however, only 9% preferred this (p < 0.001). Instead, residents preferred explanatory (53%) or consultative styles (41%). Preferences differed by postgraduate year. Although 40% of interns preferred a consultative style, 50% of mid-level residents preferred explanatory leadership. CONCLUSIONS Junior resident preference of leadership style in the OR differs from what they actually encounter. This has the potential to create unwanted tension and may erode team performance. Awareness of this difference provides an opportunity for an educational intervention directed at both attendings and trainees.
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Affiliation(s)
- Nicole A Kissane-Lee
- Neil and Elise Wallace STRATUS Center for Medical Simulation, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
| | - Steven Yule
- Neil and Elise Wallace STRATUS Center for Medical Simulation, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Charles N Pozner
- Neil and Elise Wallace STRATUS Center for Medical Simulation, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Douglas S Smink
- Neil and Elise Wallace STRATUS Center for Medical Simulation, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Agha RA, Fowler AJ, Sevdalis N. The role of non-technical skills in surgery. Ann Med Surg (Lond) 2015; 4:422-7. [PMID: 26904193 PMCID: PMC4720712 DOI: 10.1016/j.amsu.2015.10.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/14/2015] [Accepted: 10/05/2015] [Indexed: 11/30/2022] Open
Abstract
Non-technical skills are of increasing importance in surgery and surgical training. A traditional focus on technical skills acquisition and competence is no longer enough for the delivery of a modern, safe surgical practice. This review discusses the importance of non-technical skills and the values that underpin successful modern surgical practice. This narrative review used a number of sources including written and online, there was no specific search strategy of defined databases. Modern surgical practice requires; technical and non-technical skills, evidence-based practice, an emphasis on lifelong learning, monitoring of outcomes and a supportive institutional and health service framework. Finally these requirements need to be combined with a number of personal and professional values including integrity, professionalism and compassionate, patient-centred care.
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Affiliation(s)
- Riaz A. Agha
- Department of Plastic Surgery, Guys and St Thomas' NHS Foundation Trust, London
| | - Alexander J. Fowler
- Department of Medicine, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, UK
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Gordon LJ, Rees CE, Ker JS, Cleland J. Dimensions, discourses and differences: trainees conceptualising health care leadership and followership. MEDICAL EDUCATION 2015; 49:1248-1262. [PMID: 26611190 DOI: 10.1111/medu.12832] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/11/2015] [Accepted: 07/23/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT As doctors in all specialties are expected to undertake leadership within health care organisations, leadership development has become an inherent part of medical education. Whereas the leadership literature within medical education remains mostly focused on individual, hierarchical leadership, contemporary theory posits leadership as a group process, which should be distributed across all levels of health care organisation. This gap between theory and practice indicates that there is a need to understand what leadership and followership mean to medical trainees working in today's interprofessional health care workplace. METHODS Epistemologically grounded in social constructionism, this research involved 19 individual and 11 group interviews with 65 UK medical trainees across all stages of training and a range of specialties. Semi-structured interviewing techniques were employed to capture medical trainees' conceptualisations of leadership and followership. Interviews were audiotaped, transcribed verbatim and analysed using thematic framework analysis to identify leadership and followership dimensions which were subsequently mapped onto leadership discourses found in the literature. RESULTS Although diversity existed in terms of medical trainees' understandings of leadership and followership, unsophisticated conceptualisations focusing on individual behaviours, hierarchy and personality were commonplace in trainees' understandings. This indicated the dominance of an individualist discourse. Patterns in understandings across all stages of training and specialties, and whether definitions were solicited or unsolicited, illustrated that context heavily influenced trainees' conceptualisations of leadership and followership. CONCLUSIONS Our findings suggest that UK trainees typically hold traditional understandings of leadership and followership, which are clearly influenced by the organisational structures in which they work. Although education may change these understandings to some extent, changes in leadership practices to reflect contemporary theory are unlikely to be sustained if leadership experiences in the workplace continue to be based on individualist models.
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Affiliation(s)
- Lisi J Gordon
- Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK
| | - Charlotte E Rees
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Jean S Ker
- Medical Education Institute, School of Medicine, University of Dundee, Dundee, UK
| | - Jennifer Cleland
- Division of Medical and Dental Education, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
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Surgeons' Leadership Styles and Team Behavior in the Operating Room. J Am Coll Surg 2015; 222:41-51. [PMID: 26481409 DOI: 10.1016/j.jamcollsurg.2015.09.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards and transformational (team-oriented) leaders inspire performance beyond expectations. STUDY DESIGN We videorecorded 5 surgeons performing complex operations. Each surgeon was scored on the Multifactor Leadership Questionnaire, a validated method for scoring transformational and transactional leadership style, by an organizational psychologist and a surgeon researcher. Independent coders assessed surgeons' leadership behaviors according to the Surgical Leadership Inventory and team behaviors (information sharing, cooperative, and voice behaviors). All coders were blinded. Leadership style (Multifactor Leadership Questionnaire) was correlated with surgeon behavior (Surgical Leadership Inventory) and team behavior using Poisson regression, controlling for time and the total number of behaviors, respectively. RESULTS All surgeons scored similarly on transactional leadership (range 2.38 to 2.69), but varied more widely on transformational leadership (range 1.98 to 3.60). Each 1-point increase in transformational score corresponded to 3 times more information-sharing behaviors (p < 0.0001) and 5.4 times more voice behaviors (p = 0.0005) among the team. With each 1-point increase in transformational score, leaders displayed 10 times more supportive behaviors (p < 0.0001) and displayed poor behaviors 12.5 times less frequently (p < 0.0001). Excerpts of representative dialogue are included for illustration. CONCLUSIONS We provide a framework for evaluating surgeons' leadership and its impact on team performance in the operating room. As in other fields, our data suggest that transformational leadership is associated with improved team behavior. Surgeon leadership development, therefore, has the potential to improve the efficiency and safety of operative care.
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Spanager L, Konge L, Dieckmann P, Beier-Holgersen R, Rosenberg J, Oestergaard D. Assessing trainee surgeons' nontechnical skills: five cases are sufficient for reliable assessments. JOURNAL OF SURGICAL EDUCATION 2015; 72:16-22. [PMID: 25023468 DOI: 10.1016/j.jsurg.2014.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 05/27/2023]
Abstract
BACKGROUND Trainee surgeons would benefit from regular, formative assessments to ensure they learn the nontechnical aspects of surgical performance. Non-Technical Skills for Surgeons in Denmark (NOTSSdk) is a tool to assess surgeons' nontechnical skills (NTS) during an operation. The aims of this study were to explore which parts of NOTSSdk supervisors use to assess trainee surgeons' NTS, to determine the internal consistency reliability of NOTSSdk, and to estimate how many operations were needed to obtain reliable ratings of a trainee surgeon's NTS. METHODS A total of 12 supervisors from 2 hospitals assessed 13 trainees in 48 procedures including laparoscopic cholecystectomies, inguinal hernia repairs, and laparoscopic appendectomies. RESULTS NOTSSdk showed good internal consistency reliability (R(2) = 0.95). Supervisors used both categories and elements of the tool to provide assessments, although 2 elements of leadership ("supporting others" and "coping with pressure") were considered irrelevant in 27% to 31% of the cases. Assessments of 5 procedures were sufficient to gain reliable ratings (Generalizability coefficient > 0.80) of a trainee surgeon's NTS. CONCLUSION As supervisors used the full tool, the internal consistency reliability was high and assessment of 5 procedures could be achieved in clinical practice, we suggest that NOTSSdk could be implemented as a formative assessment tool to facilitate the training of surgeons' NTS.
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Affiliation(s)
- Lene Spanager
- Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark.
| | - Lars Konge
- Centre for Clinical Education, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Peter Dieckmann
- Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | | | - Jacob Rosenberg
- Department of Surgery, Herlev Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Doris Oestergaard
- Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
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Kothari SN. Surgical lessons from the lake. Am J Surg 2014; 208:886-92. [DOI: 10.1016/j.amjsurg.2014.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/25/2022]
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