Skip to main content
NCBI home page
Quality & Safety in Health Care logoLink to Quality & Safety in Health Care
. 2004 Oct;13(Suppl 1):i27–i32. doi: 10.1136/qshc.2004.010009

The simulated operating theatre: comprehensive training for surgical teams

R Aggarwal, S Undre, K Moorthy, C Vincent, A Darzi
PMCID: PMC1765789  PMID: 15465952

Abstract

Surgical excellence is traditionally defined in terms of technical performance, with little regard for the importance of interpersonal communication and leadership skills. Studies in the aviation industry have stressed the role of human factors in causing error and, in an attempt to reduce the occurrence of adverse events, led to the organisation of simulation based training scenarios. Similar strategies have recently been employed for the surgical team with the development of a simulated operating theatre project. This enables technical and non-technical performance of the surgeon and circulating staff to be assessed by experts situated in an adjacent control room, and provides an opportunity for constructive feedback. The scenarios have good face validity and junior surgeons can benefit from the process of learning new technical skills in a realistic environment. The effect of external influences such as distractions, new technology, or a crisis scenario can also be defined, with the ultimate aim of reducing the number of adverse events arising in the real operating room.

Full Text

The Full Text of this article is available as a PDF (185.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bevan P. G. Craft workshops in surgery. Br J Surg. 1986 Jan;73(1):1–2. doi: 10.1002/bjs.1800730102. [DOI] [PubMed] [Google Scholar]
  2. Carthey J., de Leval M. R., Reason J. T. The human factor in cardiac surgery: errors and near misses in a high technology medical domain. Ann Thorac Surg. 2001 Jul;72(1):300–305. doi: 10.1016/s0003-4975(00)02592-3. [DOI] [PubMed] [Google Scholar]
  3. Chopra V., Bovill J. G., Spierdijk J., Koornneef F. Reported significant observations during anaesthesia: a prospective analysis over an 18-month period. Br J Anaesth. 1992 Jan;68(1):13–17. doi: 10.1093/bja/68.1.13. [DOI] [PubMed] [Google Scholar]
  4. Copeland G. P., Jones D., Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991 Mar;78(3):355–360. doi: 10.1002/bjs.1800780327. [DOI] [PubMed] [Google Scholar]
  5. Datta V., Mackay S., Mandalia M., Darzi A. The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg. 2001 Nov;193(5):479–485. doi: 10.1016/s1072-7515(01)01041-9. [DOI] [PubMed] [Google Scholar]
  6. Dean Bryony, Schachter Mike, Vincent Charles, Barber Nick. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet. 2002 Apr 20;359(9315):1373–1378. doi: 10.1016/S0140-6736(02)08350-2. [DOI] [PubMed] [Google Scholar]
  7. Eubanks T. R., Clements R. H., Pohl D., Williams N., Schaad D. C., Horgan S., Pellegrini C. An objective scoring system for laparoscopic cholecystectomy. J Am Coll Surg. 1999 Dec;189(6):566–574. doi: 10.1016/s1072-7515(99)00218-5. [DOI] [PubMed] [Google Scholar]
  8. Gilliam A. D., Speake W. J., Lobo D. N., Beckingham I. J. Current practice of emergency vagotomy and Helicobacter pylori eradication for complicated peptic ulcer in the United Kingdom. Br J Surg. 2003 Jan;90(1):88–90. doi: 10.1002/bjs.4003. [DOI] [PubMed] [Google Scholar]
  9. Grantcharov T. P., Kristiansen V. B., Bendix J., Bardram L., Rosenberg J., Funch-Jensen P. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg. 2004 Feb;91(2):146–150. doi: 10.1002/bjs.4407. [DOI] [PubMed] [Google Scholar]
  10. Haluck R. S., Krummel T. M. Computers and virtual reality for surgical education in the 21st century. Arch Surg. 2000 Jul;135(7):786–792. doi: 10.1001/archsurg.135.7.786. [DOI] [PubMed] [Google Scholar]
  11. Helmreich R. L., Merritt A. C., Wilhelm J. A. The evolution of Crew Resource Management training in commercial aviation. Int J Aviat Psychol. 1999;9(1):19–32. doi: 10.1207/s15327108ijap0901_2. [DOI] [PubMed] [Google Scholar]
  12. Helmreich R. L., Wilhelm J. A., Gregorich S. E., Chidester T. R. Preliminary results from the evaluation of cockpit resource management training: performance ratings of flightcrews. Aviat Space Environ Med. 1990 Jun;61(6):576–579. [PubMed] [Google Scholar]
  13. Helmreich R. L., Wilhelm J. A. Outcomes of crew resource management training. Int J Aviat Psychol. 1991;1(4):287–300. doi: 10.1207/s15327108ijap0104_3. [DOI] [PubMed] [Google Scholar]
  14. Holzman R. S., Cooper J. B., Gaba D. M., Philip J. H., Small S. D., Feinstein D. Anesthesia crisis resource management: real-life simulation training in operating room crises. J Clin Anesth. 1995 Dec;7(8):675–687. doi: 10.1016/0952-8180(95)00146-8. [DOI] [PubMed] [Google Scholar]
  15. Kneebone R. L., Nestel D., Moorthy K., Taylor P., Bann S., Munz Y., Darzi A. Learning the skills of flexible sigmoidoscopy - the wider perspective. Med Educ. 2003 Nov;37 (Suppl 1):50–58. doi: 10.1046/j.1365-2923.37.s1.2.x. [DOI] [PubMed] [Google Scholar]
  16. Krummel T. M. Surgical simulation and virtual reality: the coming revolution. Ann Surg. 1998 Nov;228(5):635–637. doi: 10.1097/00000658-199811000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Martin J. A., Regehr G., Reznick R., MacRae H., Murnaghan J., Hutchison C., Brown M. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg. 1997 Feb;84(2):273–278. doi: 10.1046/j.1365-2168.1997.02502.x. [DOI] [PubMed] [Google Scholar]
  18. Moorthy Krishna, Munz Yaron, Sarker Sudip K., Darzi Ara. Objective assessment of technical skills in surgery. BMJ. 2003 Nov 1;327(7422):1032–1037. doi: 10.1136/bmj.327.7422.1032. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Ponsky J. L. Complications of laparoscopic cholecystectomy. Am J Surg. 1991 Mar;161(3):393–395. doi: 10.1016/0002-9610(91)90605-d. [DOI] [PubMed] [Google Scholar]
  20. Reason J. Human error: models and management. BMJ. 2000 Mar 18;320(7237):768–770. doi: 10.1136/bmj.320.7237.768. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Schaefer H. G., Helmreich R. L., Scheidegger D. Human factors and safety in emergency medicine. Resuscitation. 1994 Dec;28(3):221–225. doi: 10.1016/0300-9572(94)90067-1. [DOI] [PubMed] [Google Scholar]
  22. Scott D. J., Bergen P. C., Rege R. V., Laycock R., Tesfay S. T., Valentine R. J., Euhus D. M., Jeyarajah D. R., Thompson W. M., Jones D. B. Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg. 2000 Sep;191(3):272–283. doi: 10.1016/s1072-7515(00)00339-2. [DOI] [PubMed] [Google Scholar]
  23. Sexton J. B., Thomas E. J., Helmreich R. L. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000 Mar 18;320(7237):745–749. doi: 10.1136/bmj.320.7237.745. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Seymour Neal E., Gallagher Anthony G., Roman Sanziana A., O'Brien Michael K., Bansal Vipin K., Andersen Dana K., Satava Richard M. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002 Oct;236(4):458–464. doi: 10.1097/00000658-200210000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Vincent Charles, Moorthy Krishna, Sarker Sudip K., Chang Avril, Darzi Ara W. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg. 2004 Apr;239(4):475–482. doi: 10.1097/01.sla.0000118753.22830.41. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Quality & safety in health care are provided here courtesy of BMJ Publishing Group

RESOURCES