The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility.

Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole-team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later. Medical management and teamwork were quantified via percentage adherence to key processes and the Team Emergency Assessment Measure, respectively. In the initial session, medical management was not improved by the presence of a checklist (56% without checklist vs. 62% with checklist; p = 0.50). In the retention session, teams performed significantly worse without the checklists (36% without checklist vs. 60% with checklist; p = 0.04). We did not observe a change in non-technical skills in the presence of a checklist in either the initial or retention sessions (68% without checklist vs. 69% with checklist (p = 0.94) and 69% without checklist vs. 65% with checklist (p = 0.36), respectively). Critical events checklists do not improve medical management or teamwork during simulated operating theatre crises in an ambulatory surgical daycare setting.

Simulation-based training in anaesthesiology: a systematic review and meta-analysis.

Simulation has long been integrated in anaesthesiology training, yet a comprehensive review of its effectiveness is presently lacking. Using meta-analysis and critical narrative analysis, we synthesized the evidence for the effectiveness of simulation-based anaesthesiology training. We searched MEDLINE, ERIC, and SCOPUS through May 2011 and included studies using simulation to train health professional learners. Data were abstracted independently and in duplicate. We included 77 studies (6066 participants). Compared with no intervention (52 studies), simulation was associated with moderate to large pooled effect sizes (ESs) for all outcomes (ES range 0.60-1.05) except for patient effects (ES -0.39). Compared with non-simulation instruction (11 studies), simulation was associated with moderate effects for satisfaction and skills (ES 0.39 and 0.42, respectively), large effect for behaviours (1.77), and small effects for time, knowledge, and patient effects (-0.18 to 0.23). In 17 studies comparing alternative simulation interventions, training in non-technical skills (e.g. communication) and medical management compared with training in medical management alone was associated with negligible effects for knowledge and skills (four studies, ES range 0.14-0.15). Debriefing using multiple vs single information sources was associated with negligible effects for time and skills (three studies, ES range -0.07 to 0.09). Our critical analysis showed inconsistency in measurement of non-technical skills and consistency in the (ineffective) design of debriefing. Simulation in anaesthesiology appears to be more effective than no intervention (except for patient outcomes) and non-inferior to non-simulation instruction. Few studies have clarified the key instructional designs for simulation-based anaesthesiology training.

Application of motor learning principles to complex surgical tasks: searching for the optimal practice schedule.

Practice of complex tasks can be scheduled in several ways: as whole-task practice or as practice of the individual skills composing the task in either a blocked or a random order. The authors used those 3 schedules to study 18 participants' learning of an orthopedic surgical task. They assessed learning by obtaining expert evaluation of performance and objective kinematic measures before, immediately after, and 1 week after practice (transfer test). During acquisition, the blocked group showed superior performance for simple skills but not for more complex skills. For the expert-based measures of performance, all groups improved from pretest to posttest and remained constant from posttest to transfer. Measures of the final product showed that the whole-practice group's outcomes were significantly better than those of the random group on transfer. All groups showed better efficiency of motions in the posttest than in the pretest. Those measures were also poorer on the transfer test than on the posttest. The present evidence does not support the contextual interference effect--hypothetically, because of the inherent cognitive effort effect associated with some of the component skills. The authors recommend that surgical tasks composed of several discrete skills be practiced as a whole. The results of this study demonstrate the importance of critically appraising basic theories in applied environments.

Quantification of process measures in laparoscopic suturing.

BACKGROUND: Process measures describing the generation of movement are useful for evaluation and performance feedback purposes. This study aimed to identify process measures that differ between novice and advanced laparoscopists while completing a suturing skill. METHODS: A group of junior and a group of senior residents and fellows in surgery (n = 6) placed 10 laparoscopic sutures in a synthetic model. Process measures were quantified using an opto-electric motion/force sensor assembly that recorded: instrument rotation, applied forces, time, and time delays between force application and instrument rotation. RESULTS: Advanced trainees showed increased instrument rotation, higher peak applied force, and faster performance compared to novices (alll p < .01). However, over trials, only novices showed adaptations for instrument rotation and total time (interactions at p < .01) with no adaptation for the force application. The difference between the moments of force application and instrument rotation was not sensitive to participant training. CONCLUSIONS: Movement process measures can enhance our understanding of early adaptation processes and how such factors might be used as feedback to facilitate skill acquisition.

Surface exploration using laparoscopic surgical instruments: the perception of surface roughness.

During laparoscopic surgery video images are used to guide the movements of the hand and instruments, and objects in the operating field often obscure these images. Thus, surgeons often rely heavily on tactile information (sense of touch) to help guide their movements. It is important to understand how tactile perception is affected when using laparoscopic instruments, since many surgical judgements are based on how a tissue 'feels' to the surgeon, particularly in situations where visual inputs are degraded. Twelve naïve participants used either their index finger or a laparoscopic instrument to explore sandpaper surfaces of various grits (60, 100, 150 and 220). These movements were generated with either vision or no vision. Participants were asked to estimate the roughness of the surfaces they explored. The normal and tangential forces of either the finger or instrument on the sandpaper surfaces were measured. Results showed that participants were able to judge the roughness of the sandpaper surfaces when using both the finger and the instrument. However, post hoc comparisons showed that perceptual judgements of surface texture were altered in the no vision condition compared to the vision condition. This was also the case when using the instrument, compared to the judgements provided when exploring with the finger. This highlights the importance of the completeness of the video images during laparoscopic surgery. More normal and tangential force was used when exploring the surfaces with the finger as opposed to the instrument. This was probably an attempt to increase the contact area of the fingertip to maximize tactile input. With the instrument, texture was probably sensed through vibrations of the instrument in the hand. Applications of the findings lie in the field of laparoscopic surgery simulation techniques and tactile perception.