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Simulation-Based Laparoscopic Surgery Crisis Resource Management Training-Predicting Technical and Nontechnical

Mitchell G Goldenberg¹, Kai H Fok¹, Michael Ordon²

¹Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Journal of Surgical Education

|December 24, 2017

Summary

Senior urology residents demonstrated superior technical and nontechnical skills in a simulated laparoscopic inferior vena cava (IVC) injury crisis. Resident experience, not personality traits, predicted performance in this surgical crisis simulation.

Keywords:

Patient Care Practice-Based Learning and Improvement crisis management laparoscopy nontechnical skills simulation-based assessment technical skills

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Area of Science:

Surgical Education
Medical Simulation
Urology

Background:

Assessing surgical skills is crucial for resident training.
Laparoscopic surgery presents unique challenges, especially during unexpected crises like inferior vena cava (IVC) injury.
Understanding factors influencing performance in surgical crises is essential for improving patient safety.

Purpose of the Study:

To create a simulation-based assessment for urology residents involving a laparoscopic IVC injury.
To evaluate both technical and nontechnical skills during this simulated surgical crisis.
To investigate the influence of personality traits on resident performance during surgical crises.

Main Methods:

Urology residents participated in a simulated laparoscopic nephrectomy with scripted IVC injury and vasovagal response.
Residents completed personality and demographic questionnaires.
Technical and nontechnical skills were assessed by expert surgeons using validated tools (checklist, GOALS, NOTSS).

Main Results:

Senior residents significantly outperformed junior residents in technical (checklist, GOALS) and nontechnical (NOTSS) skills.
Technical performance correlated with nontechnical skills (NOTSS) and overall pass/fail rating.
Only conscientiousness, a personality trait, showed a marginal correlation with technical score and pass/fail rating.

Conclusions:

Resident's level of training and laparoscopic experience are key predictors of performance in simulated IVC injury scenarios.
Nontechnical skills are closely linked to technical proficiency during surgical crises.
Personality traits, in this study, did not significantly predict technical skill in managing simulated surgical emergencies.