In March of 1977, one of the world’s deadliest aviation accidents occurred when two 747 jumbo jets collided on the runway in Tenerife. Whilst a number of factors contributed (including severe fog and an unusually busy airport), one of the key factors was human error. Poor radio communications and imperfect cockpit procedures were in large part to blame and resulted in the airline industry developing ‘crew resource management’ (CRM). CRM is all about interpersonal communication, leadership, and decision-making. It was pioneered by a Royal Air Force pilot and has become a core component of pilot training, undoubtedly making air travel safer.
Team-working, leadership, situational awareness, decision-making, and communication are keys aspects of CRM – and all are similarly fundamental to providing a high quality surgical service.
At eoSurgical, our focus is on enabling improvements in technical skills in accessible simulated surgical environments. These skills are crucial but we are also mindful of the need to develop non-technical skills, an area that has probably been neglected by surgeons. Fortunately, we now have the Non-Technical Skills for Surgeons (NOTSS) framework.
NOTSS was developed in Scotland by teams of surgeons, psychologists, and anaesthetists and has clear parallels with its counterpart in the aviation world. It provides a way for surgeons to better understand how their cognitive and interpersonal skills impact performance. It has been shown that failures in these domains, rather than technical skills, are often what is responsible when things go wrong.
All of these skills intertwine. For example, a surgeon who is working hard to acquire a new technical skill will have less ‘bandwidth’ to deal with, for instance, aberrant patient anatomy or interruptions. As a result, they may make a mistake. If that technical skill has already been honed, they are more ready to detect and respond to changes appropriately.
We are planning to incorporate additions to our SurgTrac software and curriculum which will promote the development of relevant non-technical skills. In this way, we hope that our simulators can help you become a safer surgeon. If you want to get involved, please get in touch.
Clinical Lecturer in Neurosurgery, University of Edinburgh