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The Spine Blog

Saturday, November 30, 2019

Using surgical simulation to assess technical and non-technical skills

The assessment of surgeon technical skills is difficult, though some tools such as the Objective Structured Assessment of Technical Skills (OSATS) have been developed to do this. Even less well understood is the assessment of non-technical skills in the operating room such as leadership, teamwork, and communication. Very little has been published on these topics in spine surgery. In order to better understand spine surgeons' technical skills, non-technical skills, and the relationship between the two, Michael Pfandler and colleagues from Germany developed a surgical simulation for vertebroplasty including a simulated OR with fluoroscopy, a mannequin with a 3D printed spine model, and a mock surgical team including an anesthesiologist, scrub tech, and circulating nurse. Eleven surgeons, including orthopaedic and trauma surgeons, were recruited for the simulation. Surgeons were rated on an OSATS developed for vertebroplasty, an objective evaluation of the surgical outcome, and a non-technical score based on communication, coordination, cooperation, leadership, and situational awareness. They found moderate to strong correlations between technical and non-technical skills as well as moderate to strong correlations between technical and non-technical skills and experience (both years in practice and number of vertebroplasties performed). Controlling for experience substantially reduced the correlation between technical and non-technical skills.

The authors have done a nice job adding a study to the limited literature looking at the objective assessment of spine surgery skills. This may also be the first study looking at non-technical skills in spine surgery. Their primary conclusion that technical and non-technical skills correlated with each other and experience is not surprising. Some of the surgeons in their sample had zero years of experience as an attending surgeon and had never performed vertebroplasty. Surgeons in this situation likely struggled with the technical aspects of the surgery and probably did not have sufficient cognitive reserve to even be aware of the non-technical aspects of the procedure. Likewise, highly experienced surgeons who had performed many vertebroplasties likely found the technical demands easy and were cognizant of the non-technical aspects of the procedure such as communication and teamwork. This study was limited by the relatively low number of participants and the fact that some had no experience with the procedure. While this cohort allowed for them to demonstrate that their outcome measures could detect different skill levels, it would have been more interesting to see if they could detect more subtle skill differences among experienced surgeons. Objective assessment of technical skills is likely helpful to assess surgical trainees' progress and possibly to determine basic proficiency. Its role in assessing experienced spine surgeons is less clear. This paper raises the important issue of surgeons' non-technical skills such as leadership and communication in the operating room. These are important skills that likely have a direct effect on patient outcomes, not to mention the efficiency and morale of the operating room team. We look forward to more research in this field, which will hopefully include evaluation of actual performance in real operating rooms.

Please read this paper in the December 1 issue. Do you believe objective evaluation of surgeons' technical and non-technical skills in the operating room is a worthwhile pursuit? Let us know by leaving a comment on The Spine Blog.

Adam Pearson, MD, MS

Associate Web Editor