Surgeons’ skills go beyond the scalpel

While it’s a given that fine motor skills are important to learn when training to be a surgeon, there are other skills that are essential to a surgeon’s success: situational awareness, decision making, communication and teamwork, and leadership. Developed by the Royal College of Surgeons, the Non-Technical Skills for Surgeons is the topic of a monthly conference for Baylor College of Medicine medical students, surgery residents and surgery faculty who train and work at Ben Taub Hospital.

“There is increasing recognition of the role these non-technical skills play in surgical outcomes and preventable errors,” said Dr. Jeremy Ward, assistant professor in the Michael E. DeBakey Department of Surgery, who serves as a co-leader of the conference.

At the end of each month, the surgery trainees and faculty at Ben Taub come together and use real-world scenarios taken from clinical experiences during the prior month to address the non-technical skills required in each scenario.

Led by senior residents, the faculty and trainees are divided into groups, one for each non-technical skill. After the senior residents act out a real-life scenario from the operating room, each group is asked to discuss how their assigned skill is employed in the scenario and present opportunities to strengthen this skill.

For example, the group assigned to observe decision making skills pointed out how the residents in one scenario, after receiving a call that a patient was en route to the hospital, discussed what they needed to look for in the patient. They reviewed potential situations and how they would address each one once they assessed the condition of the patient. The group as a whole then talked about the importance of not being dismissive when someone offers a recommendation, because in the future they may not be as willing to offer recommendations. A simple “no, not yet” is better than saying “no.”

The situational awareness group discussed the importance of introducing and identifying everyone on the team while waiting for the patient. The leadership group discussed how the chief resident is the anchor at the foot of the patient’s bed who will assign tasks and who sets the tone by his or her behavior. Like the decision making group, they talked about not being dismissive of someone’s ideas in the operating room.

“Students should feel comfortable speaking up, that’s a part of the Baylor culture,” Ward said to the group.

During the leadership discussion, Ward reminded the group that everyone is a leader; there’s not just one leader in the operating room.

“You have to lead where you are – lead from where you sit or from where you stand,” Dr. James Suliburk, associate professor of surgery who co-leads the conference, said.

Senior resident Dr. Alicia Lay, who led the discussion that morning, compared the operating room to a jazz band.

“Each member of the band has a role to play, every individual has a different interpretation and everyone has a solo at some point,” she said.

Ward emphasized how each person participating in the conference benefits.

“For medical students and interns, this offers an introduction to a skill set that is increasingly recognized as intimately related to outcomes. For the more senior residents, they have had more exposure and this offers them an opportunity to further hone their ability to recognize and identify those skills and their implementation. For the faculty, I think this conference allows us to review our own facility with the non-technical skills and reinforce the ideal behaviors we hope to use for our patients’ benefit and role model for our trainees. Finally, for all involved, this is a unique opportunity to review a case with a good outcome. We find it very effective to focus the conference on ‘what went right.’”

-By Dipali Pathak