Curriculum Using the In-Situ Operating Room Setting.

Area of Science:

• Medical Education
• Surgical Simulation
• Team-Based Learning

Background:

• The American College of Surgeons/Association of Program Directors in Surgery curriculum includes a team-based skills phase (Phase 3) that has seen limited implementation.
• Simulation-based training is crucial for developing surgical competencies, but implementing advanced phases can be challenging.
• In-situ simulation offers a potential solution to logistical hurdles in training.

Purpose of the Study:

• To assess the feasibility of implementing the Phase 3 team-based skills curriculum in an in-situ operating room (OR) setting.
• To evaluate the effectiveness of in-situ simulation on surgical team performance.
• To gather participant feedback on the training experience.

Main Methods:

• Conducted 8 in-situ simulation sessions in an OR at a tertiary care university hospital.
• Included 8 surgery residents, 16 anesthesia residents, 16 nurses, and 13 ancillary staff.
• Utilized 14 diverse scenarios (e.g., laparoscopic crisis, postoperative complications) and assessed team performance using the NOTECHs II scale, with audiovisual recording and inter-rater reliability analysis.

Main Results:

• Significant improvement in total team NOTECHs II scores from the first to the second simulation (69.4 to 77.3, p=0.007).
• All subteams (surgery, anesthesia, nursing) showed improved NOTECHs II scores.
• Participant feedback was predominantly favorable, though inter-rater reliability for the NOTECHs II scale was modest.

Conclusions:

• The in-situ OR environment is a viable and effective setting for team-based surgical training, overcoming logistical challenges.
• Administrative and departmental buy-in, along with protected faculty time, are essential for successful in-situ training.
• The NOTECHs II scale is a valid tool for evaluating teams in this setting, but further refinement of inter-rater reliability is needed.