Communication through simulation: Developing a curriculum to teach interpersonal skills.

BACKGROUND

Nontechnical issues are linked to up to 60% of adverse events in surgery and have become one of the core competencies of surgical education. Simulation-based training allows development of these skills. We hypothesized that we could both assess and improve the communication skills of interdisciplinary teams through a simulated crisis situation.

METHODS

We designed a simulated crisis involving the intraoperative development of a tension pneumothorax. Audiovisual analysis was used to evaluate team interaction, and a combination of proctored assessment and self-assessment was used to evaluate individual learners. Time to communication and event intervention was measured. Data were analyzed using paired t-tests and 1-way analysis of variance in SPSS.

RESULTS

Time from development of hypotension to communication of deterioration was 57 ± 60 seconds; time to intervention was 93 ± 30 seconds. Nontechnical skills in surgery II scores were greatest for surgery senior residents and least for surgery junior residents. Insight was least in surgery junior residents. Correctability was not different between groups but tended to be greater in surgery junior residents.

CONCLUSIONS

Poor communication delayed timing of intervention, indicating a need for enhanced communication in the operating room. Junior surgery residents scored lowest both on nontechnical skills and insight and should be taught nontechnical skills through simulation. Our curriculum is a suitable and reproducible model to educate surgery residents in communication skills.