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“Managing Surgical Crisis: non-technical skills for new surgeons” A Human Factors course for core surgical trainees. Geraghty A, Tang B, Tait I, Maran N, Monepenny M. Threat Error Management. Highly effective safety training - train to overcome threats identified in error literature. - PowerPoint PPT Presentation
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“Managing Surgical Crisis: non-technical skills for new surgeons”
A Human Factors course for core surgical trainees
Geraghty A, Tang B, Tait I, Maran N, Monepenny M
Threat Error Management
• Highly effective safety training - train to overcome threats identified in error literature
• Cognitively more effective way to avoid error is to train to overcome it
Threats
• Physical problems– Bleeding– Leaks – bowel/bile/urine/CSF– Unusual anatomy
• Human factors problems– Communication– Teamwork– Leadership– Situation awareness– Decision making
Effective Management
• Physical problems– Technical training
• Human factors problems– Non technical skills for surgeons– Graded assertiveness– Shared mental models– SBAR– Closed loop communication
Core Surgical Trainees
• Developing independent operative skills
• Naïve situation awareness/judgement pathways
• High technical demand can compromise non-technical skills
• Same threats are present in ALL surgical contexts
Role of Human Factors in Crisis Development
Crisis Management Algorithm
Team
Environment
Assess/Analyse/Anticipate
Manage Resources
Graded assertiveness
SBARClosed loop communication
Shared mental models
Situation Awareness
Sterile cockpit
Analytical decision making
Simulated Crisis Scenarios
Debriefing
Skills All the
timeRegularly Sometimes Rarely Never
Graded assertiveness Pre 1 (20%) 3 (60%) 1 (20%) Post 3 (43%) 4 (57%)
Open questions Pre 1 (20%) 1 (20%) 3 (60%) Post 2 (29%) 4 (57%) 1 (14%)
Closed loop communication
Pre 3 (60%) 2 (40%) Post 2 (29%) 4 (57%) 1 (14%)
SBAR Pre 1 (20%) 2 (40%) 1 (20%) 1 (20%)Post 2 (29%) 4 (57%) 1 (14%)
Sterile cockpit Pre 3 (60%) 1 (20%) 1 (20%)Post 1 (14%) 5 (72%) 1 (14%)
Sharing mental models Pre 1 (20%) 2 (40%) 2 (40%)Post 1 (14%) 3 (43%) 2 (29%) 1 (14%)
Checking your interpretation of situation with others
Pre 1 (20%) 3 (60%) 1 (20%) Post 2 (29%) 3 (43%) 2 (29%)
Analytical decision making
Pre 1 (20%) 1 (20%) 3 (60%) Post 2 (29%) 4 (57%) 1 (14%)
Attitudes
“It has made me think about what I can do to prepare before situations so more information is in the automatic portion of my brain so that I have maximum space for active thought processes in emergency and elective situations”
“I am more aware and ready to take action before a crisis hits.”
Empowered me in my role as a surgical trainee to take responsibility in theatre
“It has given me a structured approach to managing crisis…. helpful in thinking about the big picture and definitive solution”
Managing Surgical Crisis: non-technical skills for new surgeons3rd JuneCuschieri Skills Centre, Dundee
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