Geraghty A, Tang B, Tait I, Maran N, Monepenny M
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Transcript of Geraghty A, Tang B, Tait I, Maran N, Monepenny M
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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
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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
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Threats
• Physical problems– Bleeding– Leaks – bowel/bile/urine/CSF– Unusual anatomy
• Human factors problems– Communication– Teamwork– Leadership– Situation awareness– Decision making
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Effective Management
• Physical problems– Technical training
• Human factors problems– Non technical skills for surgeons– Graded assertiveness– Shared mental models– SBAR– Closed loop communication
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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
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Role of Human Factors in Crisis Development
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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
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Simulated Crisis Scenarios
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Debriefing
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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%)
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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”
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Managing Surgical Crisis: non-technical skills for new surgeons3rd JuneCuschieri Skills Centre, Dundee
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