Simulation Improves Nontechnical Skills Performance of Residents During the Perioperative and Intraoperative Phases of Surgery

J Surg Educ. 2015 Sep-Oct;72(5):957-63. doi: 10.1016/j.jsurg.2015.03.005. Epub 2015 Apr 21.


Objective: Failures in nontechnical skills (NTS) rather than technical expertise are frequently at the root of medical errors in the operating room (OR). NTS are the cognitive (decision making and situation awareness) and interpersonal (communication and teamwork) skills that are recognized but are not formally addressed in surgical training. The purpose of the study was to examine the effect of simulation-based training (SBT) on NTS performance of surgical residents during simulated laparoscopic cholecystectomy (LC).

Setting: The study was performed in a simulated OR at the Center for Medical Education and Innovation at Riverside Methodist Hospital, Columbus, OH. The simulated OR was arranged with standard equipment for LC, a high-fidelity patient simulator, and a real OR team.

Design: General surgical residents completed 2 identical SBT sessions. For each session, residents were briefed on the LC case, completed the case in the simulated OR, and debriefed their videotaped simulation performance with a content expert. The video recordings were reviewed and the residents' NTS were scored using a perioperative time-out checklist and an intraoperative checklist for LC by 4 raters who were blinded to both the residents' postgraduate year level and the order of the videotaped simulation sessions.

Results: Residents showed a significant improvement in completeness of the perioperative time-out checklist from session 1 (mean score = 1.27 ± 1.00) to session 2 (mean score = 5.00 ± 1.28), p < 0.001. Residents' scores on the intraoperative checklist also improved from session 1 to session 2, p < 0.05. Overall, residents felt that the simulation was a valuable teaching and training tool and recommend that it be incorporated into residency training.

Conclusion: SBT appears to be an effective technique for improving NTS of surgical residents during the perioperative and intraoperative phases of surgery. As surgical proficiency is 75% nontechnical and 25% technical, it could be reasonably argued that improved NTS of surgeons could improve surgical outcomes.

Keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; nontechnical skills; residency training; simulation; surgical education; time-out.

MeSH terms

  • Cholecystectomy, Laparoscopic / education*
  • Clinical Competence*
  • Education, Medical, Graduate / methods*
  • Humans
  • Internship and Residency
  • Intraoperative Period
  • Manikins*
  • Ohio
  • Perioperative Period
  • Videotape Recording