• Across surgical specialties, simulation training is becoming a

mandatory part of the curriculum as it offers experiential learning

opportunities. (1)

• In thoracic surgery programs, there are some high fidelity technical

skill-based simulations but there is a lack of “non-technical skill”

learning exercises which encompasses competent teamwork and

communication. Furthermore, most existing simulation programs

involve expensive mannequin, animal models and dedicated

facilities.

• Non-technical skills have been identified as relevant factors

promoting a successful and meaningful career through appropriate

decision making, communication and interprofessional skills. (2)

Background

Development of a Cost-Effective In-Situ Thoracic Surgery Simulation Model

Joel Bierer1, Eustatiu Memu1, Robert Leeper2, Dalilah Fortin1, Eric Fréchette1,Richard I. Inculet1 and Richard A. Malthaner1

Divisions of 1Thoracic Surgery, 2General Surgery, London Health Sciences Centre, Western University, London, Canada

.

Figure 1. NOTTS Scores: Consultant and Resident.

• Our goal was to develop a simulation training program with the

following qualities:

• Low cost

• Readily reproducible scenarios

• High fidelity scenarios

• In-situ (in functional operating rooms)

• Focused on non-technical skills

• Feature components which also require technical skills

Figure 3. MMMO Fidelity Scores.

Objective

Methods

Results Summary

• Three thoracic surgery experts and three thoracic surgery residents

were evaluated by four Thoracic Surgery Consultants through the

NOTTS and TeamSTEPPS2 criteria.

• All simulation participants completed MMMO questionnaire.

• A number of latent safety threats were identified within our

institution.

Figure 2. TeamSTEPPS2 Scores: Consultant and Resident.

• The simulation was trialed with thoracic surgery consultants and

residents with great effectiveness.

• NOTTS and TEAMSTEPPS2 scores proved the simulations validity

as it was able to differentiate trainee from consultant.

• There was a very positive response to this simulation training as

evident in the MMMO scores.

• In addition to trainee learning, this simulation program was able to

identify latent safety threats which can be addressed to improve

patient safety at our own institution.

• This is a unique simulation, in terms of learning objectives and in-

situ nature, and is a Canadian first.

• A novel and inexpensive Canadian in-situ Thoracic Surgery crisis

simulation model was developed and used to identify latent safety

threats and reinforce team training behaviors in a high risk clinical

setting.

Future Direction • This simulation model will be featured as part of the 2016 Canadian

Thoracic Surgery Boot Camp.

References (1) Envisioning simulation in the future of thoracic surgical education. J. Thorac. Cardiovas.

Surg. 135:477

(2) Yule 2., et al. 2009. Experience matters: comparing novice and expert ratings of non-

technical skills using the NOTSS system. Anz. J. Surg. 79:154

(3) TeamSTEPPS: Strategies and Tools to Enhance Performance and Patient Safety. 2015.

Agency for Healthcare Research and Quality. Available at:

www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/index.html.

(4) Tong B., et al. 2012. Validation of a thoracoscopic lobectomy simulator. Eur. J.

Cardiothorac. Surg. 42:364

Development Method

• This first scenario featured a post-pneumonectomy airway obstruction by

residual tumor.

• Thoracic surgery expert opinion design the simulation algorithm.

• The physical model featured a functioning operating room and a modified

Laerdal airway mannequin.

Simulation Model

• Laerdal Vital Sign SimulatorTM program was projected to OR screens to

drives the simulation as the patient’s vitals are changed in real time to

reflect the team’s progression through the crisis scenario.

• Each simulation features a thoracic surgeon, confederate anesthesiologist

and three surgical nurses.

• Laerdal airway mannequin was easily and reversibly modified to resemble

the patient by clamping the right bronchus and positioning a fixed tumor

replica to block the left airway.

• Real-time flexible bronchoscopy was available to visualize the obstruction.

• Rigid bronchoscopy kit was available upon request.

• Anesthesia cart and intubation equipment was present.

Simulation Training

• Non-technical skill curricula was previously sent out to participants to

identify learning objectives.

• All simulations were recorded and all participants were subsequently

evaluated through the NOTSS and TeamSTEPPS2 criteria. (2,3)

• Each participant had a 15 minute performance debrief to solidify learning.

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