Elsevier

Surgery

Volume 145, Issue 2, February 2009, Pages 138-146
Surgery

Original Communication
High-fidelity, simulation-based, interdisciplinary operating room team training at the point of care

https://doi.org/10.1016/j.surg.2008.09.010Get rights and content

Background

The operating room (OR) is a dynamic, high risk setting requiring effective teamwork for the safe delivery of care. Teamwork in the modern OR, however, is less than ideal. High fidelity simulation is an attractive approach to training key teamwork competencies. We have developed a portable simulation platform, the mobile mock OR (MMOR) that permits bringing team training over long distances to the point of care. We examined the effectiveness of this innovative, simulation-based interdisciplinary operating room (OR) team training model on its participants.

Methods

All general surgical OR team members at an academic affiliated medical center underwent scenario-based training using a mobile mock OR. Pre- and post-session mean scores were calculated and analyzed for 15 Likert-type items measuring self-efficacy in teamwork competencies using t test.

Results

The mean gain in pre-post item scores for 38 participants averaged 0.4 units on a 6-point Likert scale. The significance was demonstrated in 4 of the items: role clarity (Δ = 0.6 units, P = .02), anticipatory response (Δ = 0.6 units, P = .01), cross monitoring (Δ = 0.6 units, P < .01), and team cohesion and interaction (Δ = 0.7 units, P < .01).

Conclusion

High-fidelity, simulation-based OR team training at the point of care positively impacts self-efficacy for effective teamwork performance in everyday practice.

Section snippets

Training setting

A detailed description of the conceptual framework, format, and fidelity of the MMOR has been published.16 Training occurred within the actual OR of a 157-bed academic affiliated medical center located approximately 80 miles from the School of Medicine and its simulation center. All surgical equipment, including a minimally invasive surgical tower with monitor, light source, and insufflator was provided by the hospital.

Simulation equipment included a portable computer-operated mannequin

Results

Thirty-eight OR personnel representing all OR team disciplines participated in 11 training sessions implemented in March 2007. Table I shows the breakdown of participants by OR team discipline. Ten individuals (5 residents, 1 nurse anesthetist, 3 surgical technologists, and 1 circulating nurse) participated in the training session more than once to ensure complete OR teams in each instance. All participants completed pre- and post-session surveys. The average pre- to post-session gain based on

Discussion

Our STEPS program incorporates high fidelity simulation at the point of care to train interdisciplinary OR teams. In the current study, it resulted in a 0.4 unit mean gain on a 6-point Likert scale in pre- to post-session scores for the 38 participants who were involved. Such an increase is noteworthy because of the relatively large proportional increase (40% of the maximum possible 1.0 unit increase) from the overall mean pre-session score (5.0 units) to the overall mean post-session score

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    This project was supported by grant number 1 U18 HS016680 from the Agency for Healthcare Research and Quality, Department of Health and Human Services.

    Dr Kozmenko and Dr Hilton report applying for a patent for the software interface with the computerized mannequin simulator. Drs Paige, Yang, Cohn, Paragi Gururaja, and Chauvin report no biomedical financial interests or other potential conflicts of interest.

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