Dual surgeon operating to improve patient safety.

The COVID-19 pandemic resulted in an unprecedented reduction in the delivery of surgical services worldwide, especially in non-urgent, non-cancer procedures. A prolonged period without operating (or 'layoff period') can result in surgeons experiencing skill fade (both technical and non-technical) and a loss of confidence. While senior surgeons in the UK may be General Medical Council (GMC) validated and capable of performing a procedure, a loss of 'currency' may increase the risk of error and intraoperative patient harm, particularly if unexpected or adverse events are encountered. Dual surgeon operating may mitigate risks to patient safety as surgeons regain currency while returning to non-urgent operating and may also be beneficial after the greatly reduced activity observed during the COVID-19 pandemic for low-volume complex operations. In addition, it could be a useful tool for annual appraisal, sharing updated surgical techniques and helping team cohesion. This paper explores lessons from aviation, a leading industry in human factors principles, for regaining surgical skills currency. We discuss real and perceived barriers to dual surgeon operating including finance, training, substantial patient waiting lists, and intraoperative power dynamics.

Cutting edge selection: learning from high reliability organisations for virtual recruitment in surgery during the COVID-19 pandemic.

INTRODUCTION: National selection for higher surgical training (ST3+) recruitment in the UK is competitive. The process must prioritise patient safety while being credible, impartial and fair. During the COVID-19 pandemic, all face-to-face interviews were cancelled. Selection was based on a controversial isolated self-assessment score with no evidence checking taking place. From 2021, selection will take place entirely online. Although this has cost and time advantages, new challenges emerge. METHODS: We review surgical selection as it transitions to an online format and suggest validated methods that could be adapted from High Reliability Organisations (HRO). FINDINGS: Virtual selection methods include video interviewing, online examinations and aptitude testing. These tools have been used in business for many years, but their predictive value in surgery is largely unknown. In healthcare, the established online Multi-Specialty Recruitment Assessment (MSRA) examines generic professional capabilities. Its scope, however, is too limited to be used in isolation. Candidates and interviewers alike may have concerns about the technical aspects of virtual recruitment. The significance of human factors must not be overlooked in the online environment. Surgery can learn from HROs, such as aviation. Pilot and air traffic control selection is integral to ensuring safety. These organisations have already established digital selection methods for psychological aptitude, professional capabilities and manual dexterity. CONCLUSION: National selection for higher surgical training (ST3+) can learn from HROs, using validated methods to prioritise patient safety while being acceptable to candidates, trainers and health service recruiters.

You Have Control: aviation communication application for safety-critical times in surgery.

High-risk organisations (HRO), including aviation, undergo formal communication training, with emphasis on safety-critical moments. Such training is not widespread or mandatory in healthcare, and while there are many differences both share the 'human element' with circumstances leading to an increased risk of harm. A typical operating theatre consists of an operating surgeon, and an assisting surgeon, roles that may change throughout the course of a procedure. Similarly, a training aircraft or multi-crew cockpit (flight deck) has a pilot in control, or 'pilot flying', and a 'pilot not flying'. Both interact with wider teams, for example the scrub team and air traffic controllers, respectively. Surgical error is the second most prevalent cause of preventable harm to patients after drug errors. Every year in the UK National Health Service (NHS), there are typically 500 never events, 21,000 serious incidents, and many more episodes of physical or psychological harm. Ineffective communication (46%) is the most common behavioural factor leading to a never event. In this review, we examine the concept of 'sterile cockpit', use of unambiguous terminology, callsigns, important information readback, sharing of mental models, and the mini-brief, and how these may be used to reduce patient harm during safety-critical moments.

Are you surgically current? Lessons from aviation for returning to non-urgent surgery following COVID-19.

The COVID-19 crisis has caused many issues across healthcare. In surgery, many operations have been cancelled with some surgeons losing their regular operating lists. During this time, technical expertise and decision making can deteriorate. In aviation after a prolonged period of absence from flying, this deficit in keeping skills and thinking up to date is known as being "out of currency" or "not current". Although aviation and healthcare cannot be compared, numerous human factors concepts are applicable to both. In this article, we explore the likely impact of potentially prolonged absences in operating on surgical skills and psyche, and introduce the concept of a Surgical Skills Currency Barometer. We also discuss a "task-o-meter" thought experiment, and suggest practices which could be adopted to help protect surgeon workload from exceeding surgical capability when returning to operating following a period of prolonged absence.