International Journal of Healthcare Simulation

Background:

The non-technical skills of surgeons play a significant role in patient confidence, experience and safety ^[1]. Courses, such as NOTSS, have been successful in advancing senior surgeons’ abilities in situational awareness, decision-making, communication and teamwork, and leadership. These courses focus on non-technical skills intraoperatively ^[1]; however, the work of a surgeon is far from limited to the operating theatre. Often, critical events take place in A&E or the ward environment involving junior surgical practitioners potentially unsupervised. Still, there remains no required human factors training at the junior stage or surrounding surgical care outside of the operating theatre at any stage of practice. We are establishing a course for junior surgical practitioners encompassing two areas where non-technical skills are frequently tested outside of the theatre environment; DNACPR and consent.

Aims:

The aim of the study was to improve non-technical skills and confidence of junior surgical practitioners regarding DNACPR conversations and obtaining operative consent.

Method:

We have developed a speciality-specific course to address the educational deficit surrounding non-technical skills outside of the operating theatre, focussing on DNACPR and consent, for junior surgical practitioners. It was piloted at Aintree University Hospital with their Orthopaedic Department. We combined lectures and workshops delivered by subject matter specialists with simulated scenarios. The simulated scenarios were debriefed by human factors specialists using the gold standard validated NOTSS tool ^[2]. Anonymized candidate data were collected using electronic forms.

Implementation outline:

The pilot course in June was a resounding success; candidate confidence scores increased significantly across both skills and knowledge surrounding capacity, consent and DNACPR. All attending candidates have recommended the course to their peers and suggested integration into the Foundation training curriculum. However, identifying and implementing courses appropriate for all foundation doctors with such a specialized course would be challenging. Most foundation doctors have at least one placement in a surgical specialty. Therefore, it is more realistic to adjust the course to become less specialized, encompassing all the surgical specialities, to target all foundation doctors initially instead of juniors in each speciality. Following the capture of foundation doctors, the second phase of implementation will return to speciality-specific courses to address the learning needs of non-medical practitioners, such as Physician Associates and Advanced Nurse Practitioners, working in surgical departments.