Non-Technical Skills in Surgery

Project summary

Background

Surgery is a complex, inherently risky human activity. Everyday, surgeons perform potentially lifesaving procedures in the highly pressured environment of the operating room (OR). Surgeons do not work alone: they operate with anaesthetists, nurses, and potentially other specialists. Although the members of the OR team originate from different professional backgrounds (e.g., medicine & nursing), it is vital that they work together effectively to perform safe surgery. A substantial proportion of adverse events are attributed to poor teamworking and related skills – incl. situation awareness and coordination between team-members in the OR (Kohn et al., 1999).The past 10 years has witnessed a large growth in the number of researchers attempting to quantify, measure and improve teamwork in the OR. However the impact of non-technical performance on technical performance and clinical outcomes remains unclear due to a lack of empirical evidence which demonstrates the relationship between non-technical skills and technical performance.

The proposed research aims (i) to explore the current understanding of teamworking/non-technical skills in the OR and the relationship between teamworking/non-technical skills on technical performance (ii) to bridge the current gap in the evidence base between technical and non-technical skills.

Project aims:

Understand the relationship between surgical teamworking/non-technical skills and technical performance/clinical outcome.
Empirically assess the interdependency between technical and non-technical skills.
Explore how to deliver training in both technical and non-technical skills.

Project team

Louise Hull (key contact and Principal Investigator)
Nick Sevdalis
Sonal Arora
Rajesh Aggarwal
Charles Vincent

Key project outputs

Peer-reviewed papers

Russ S, Hull L, Rout S, Vincent C, Darzi A, Sevdalis N. Observational Teamwork Assessment for Surgery: Feasibility of Clinical and NonClinical Assessor Calibration With Short-Term Training. Ann Surg. 2012 Feb 24. [Epub ahead of print] Pubmed
Hull L, Arora S, Aggarwal R, Darzi A, Vincent C, Sevdalis N. The Impact of Non-Technical Skills on Technical Performance in Surgery: A Systematic Review. J Am Coll Surg. 2012 Feb;214(2):214-30. Pubmed
Arora S, Ahmed M, Paige J, Nestel D, Runnacles J, Hull L, Darzi A, Sevdalis N. Objective Structured Assessment of Debriefing (OSAD): Bringing science to the art of debriefing in surgery. Annals of Surgery 2011 (in press)
Arora S, Miskovic D, Hull L, Moorthy K, Aggarwal R, Johannsson H, Gautama S, Kneebone R, Sevdalis N. Self vs Expert Assessment of Technical and Non-Technical Skills in High Fidelity Simulation. Am J Surg (in press)
Hull L, Arora S, Kassab E, Kneebone R, Sevdalis N. Observational Teamwork Assessment for Surgery: Content Validation and Tool Refinement. J Am Coll Surg 2011. 212(2):234-243.e5. Pubmed
Hull L, Arora S, Kassab E, Kneebone R, Sevdalis N. Assessment of stress and teamwork in the operating room: an exploratory study. Am J Surg. 2011;201:24-30. Pubmed
Hull L; Kassab, Arora S; Kneebone R. Increasing the realism of a laparoscopic box trainer: a simple, inexpensive method. J Laparoendosc Adv Surg Tech A 2010. 20(6):559-62. Pubmed
Kassab ES; King D; Hull LM; Arora S; Sevdalis N; Kneebone RL; Nestel D. Actor training for surgical team simulations. Med Teach 2010. 32(3):256-8. Pubmed
Arora S; Hull L; Sevdalis N; Tierney T; Nestel D; Woloshynowych M, Darzi A, Kneebone R. Factors compromising safety in surgery: stressful events in the operating room. Am J Surg 2010. 199(1):60-5. Pubmed

Conference presentations

Hull L. Arora S, Symons N, Vincent C, Sevdalis N. Training Requirements for the Assessment of Non-Technical Skill in Surgery: UK Expert Consensus. 5th International Workshop on Behavioural Science Applied to Acute Care Teams (October 2011, Zurich)
Hull L, Arora S, Symons N, Vincent C, Sevdalis N. Training Requirements for the Assessment of Non-Technical Skills in Surgery: UK Expert Consensus. Graduate School of Life Sciences & Medicine Summer Research Symposium. (July 2011, Imperial College London)
Hull L, Arora S, Kassab E, Kneebone R, Sevdalis N. Assessment of Stress and Teamwork in the Operating Room: An exploratory study. 15th International Conference: European Association of Work and Organizational Psychology (May 25-28 2011, Maastricht, The Netherlands)
Hull L, Keijser W. Teamwork Training and Assessment. International Forum on Quality & Safety in Healthcare. (April 5-8th 2011, Amsterdam)
Hull L, Arora S, Kassab E, Kneebone R, Sevdalis N. Assessment of Stress and Teamwork in the Operating Room: An exploratory study. 4th International Workshop: Behavioural Science Applied to Surgery (Sep 13-14 2010, Amsterdam).
Arora S, Miskovic D, Hull L, Moorthy K, Aggarwal R, Johannsson H, Gautama S, Kneebone R, Sevdalis N. Self vs Expert Assessment of Technical and Non-Technical Skills in High Fidelity Simulation. 4th International Workshop: Behavioural Science Applied to Surgery. (Sep 13-14 2010, Amsterdam).
Hull L, Sevdalis N. Assessment of Non-Technical Skills of Surgical Teams in Simulation. International Meeting for Simulation in Healthcare, Phoenix, January 2010 (Workshop)
Hull L, Arora S, Kassab E, Kneebone R, Sevdalis N. Observational Teamwork Assessment for Surgery: Content Validation and Tool Refinement. 2nd North British Patient Safety Symposium, Aberdeen, November 2009 (poster presentation)
Arora S, Hull L, Sevdalis N, Tierney T, Nestel D, Woloshynowych M, Darzi A, Kneebone RL. Factors Compromising Safety in the Surgical Environment: Stressful Events in the Operating Room. 2nd North British Patient Safety Symposium, Aberdeen, November 2009 (oral presentation)