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Surgical Crisis Management Skills Training and Assessment: A Stimulation-Based Approach to Enhancing Operating Room Performance

Moorthy, Krishna MD, FRCS; Munz, Yaron MD; Forrest, Damien PhD; Pandey, Vikas BSc, MBBS, FRCS; Undre, Shabnam FRCS; Vincent, Charles PhD; Darzi, Ara MD, FRCS, FACS

doi: 10.1097/01.sla.0000217618.30744.61
Original Articles

Background: Intraoperative surgical crisis management is learned in an unstructured manner. In aviation, simulation training allows aircrews to coordinate and standardize recovery strategies. Our aim was to develop a surgical crisis simulation and evaluate its feasibility, realism, and validity of the measures used to assess performance.

Methods: Surgical trainees were exposed to a bleeding crisis in a simulated operating theater. Assessment of performance consisted of a trainee’s technical ability to control the bleeding and of their team/human factors skills. This assessment was performed in a blinded manner by 2 surgeons and one human factors expert. Other measures consisted of time measures such as time to diagnose the bleeding (TD), inform team members (TT), achieve control (TC), and close the laceration (TL). Blood loss was used as a surrogate outcome measures.

Results: There were considerable variations within both senior (n = 10) and junior (n = 10) trainees for technical and team skills. However, while the senior trainees scored higher than the juniors for technical skills (P = 0.001), there were no differences in human factors skills. There were also significant differences between the 2 groups for TD (P = 0.01), TC (P = 0.001), and TL (0.001). The blood loss was higher in the junior group.

Conclusions: We have described the development of a novel simulated setting for the training of crisis management skills and the variability in performance both in between and within the 2 groups.

This study describes the development of a surgical crisis simulation for the training and assessment of the surgical crisis management within a simulated operating theater. It establishes the face and construct validity of the measures used to assess the performance of surgical trainees and the perceived relevance of the environment among the trainees.

From the Department of Surgical Oncology and Technology, Imperial College, London.

Supported in part by the BUPA Foundation.

Members of the Imperial College-St. Mary’s Hospital Simulation Group are as follows: Shirley Martin, Lorraine Poore, Lee Edwards, John Abbot, Janet Henry, Benny Lo, and Prof. G. Z. Yang.

Reprints: Krishna Moorthy, MD, 28 Carless Avenue, Birmingham, B17 9EQ, UK. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.