The usefulness of simulator training in combination with psychological training sessions for the improvement of non-technical skills

Abstract

SANTANDER-02-01 Good management of medical crises requires non-technical skills like communication, team co-operation, planning, etc. In current medical training these competencies are not systematically being trained. Simulator trainings of crisis management use psychological knowledge for the improvement of non-technical skills. Objective: To evaluate the usefulness of simulator training in combination with psychological training modules for the improvement of soft skills. The first module is 'communication and team co-operation'. Here, first results of the evaluation are given. 'Mental models' is the next module to follow. Methods: 34 anaesthetists (1 to 4 yr experience in anaesthesia) took part in either a 2 h training session on team co-operation and co-ordination (treatment, n = 20) or heard a talk on human factors in the operating room (OR) (control, n = 14). All subjects then performed one out of three simulator scenarios with specific requirements of team co-ordination and communication. Having obtained informed consent, the simulator sessions were video-taped. Subjects answered an evaluation questionnaire immediately after the course and were interviewed 4 weeks later about behavioural changes in the OR and memory of the course. The video tapes were analysed on three levels: behavioural markers for the quality of communication and team co-ordination, a protocol system for action regulation and problem solving, and two medical experts' assessment of the medical management. Results: The relevance of communication and team coordination in the OR is highlighted by the correlation between medical management scores and behavioural markers (r = 0.56). The need for recurrent training in these domains is emphasized by most participants in the follow-up interviews. The simulator course is evaluated by both groups as interesting, relevant, and challenging. Significant differences between the groups: The treatment group (communication training) remembers more of the training than the control group. Relevance and practicability of the course are rated higher. For the treatment group the scenario was more stressful, due to the attention they gave to communication and team processes. Participants of the training group report 4-8 weeks later more changes in their team behaviour and in self-reflection than those of the control group. They draw more personal conclusions and give more specific 'lessons learned'. Analysis of behavioural data show significant differences between training and control group: the training group addresses the surgeon more often. They also have more conflicts with the surgeon, but the reaction to conflicts is more often problem-orientated or de-escalating or ignoring than in the control group. In the training group, more utterances refer to the process of problem-solving, and hypotheses play a stronger role. Conclusions: The training of crisis management with simulator scenarios is evaluated as useful and practicable. Psychological training sessions are seen as important and valuable. The combination leads to significant changes in behaviour. Results indicate that time and opportunity for practising new behaviour is needed. We conclude that soft skills should not only be trained in crisis scenarios but also in the real OR and perhaps in special training sessions outside the simulator.