Education
Why should we care about human factors in surgery? Chris Lewis, James Tomlinson and Hiro Tanaka “Too err is to be human” – Alexander Pope Why human factors is important
M Chris Lewis is an ST7 on the North Yorkshire Rotation. He is the current BOTA secretary and is a member of the Faculty of Surgical Trainers, RCSEd. He is the previous BOTA education rep and has undertaken a Clinical Leadership Fellowship focusing on teaching leadership skills, non-technical skills and human factors to higher surgical trainees..
ost of us take it for granted that flying is one of the safest forms of transport, in fact we are more likely to die from the car journey to the airport than in a plane crash. During the 1970s, the media were quick to blame pilots for aviation accidents. After several high profile events, aviation woke up to the importance of understanding, recognising and managing human factors involved in error. Healthcare has one of the most highly trained, motivated and well selected workforce of any industry and yet 1 in 20 hospital admissions in the UK has some form of error. A recent meta-analysis of 70 studies involving 330,000 patients found that when there was an error, this can be severe or lead to death in 12% of cases1. Some of the most important human factors issues affecting surgeons and the surgical team include tiredness, emotional state, communication, interpersonal behaviour, being able to challenge authority and situational awareness. It is well known that humans make errors. Surgeons are not exempt. In a complex system such as healthcare it is essential that we design systems to account of errors and train our trainees to recognise why, how and when errors occur.
James Tomlinson is a Consultant Spinal Surgeon at Sheffield Teaching Hospitals. He has an interest in surgical education and training, and is the Academic TPD for HEE Yorkshire and Humber, and Deputy Director of the Faculty of Surgical Trainers, RCSEd. He is a member of the NOTSS faculty has taught nationally and internationally on surgical nontechnical skills and human factors.
38 | JTO | Volume 09 | Issue 04 | December 2021 | boa.ac.uk
The benefits of bootcamp in early years training Transition points in training can be stressful, with trainees often feeling underprepared for their new role2. Reduced clinical working hours and an increased focus on patient safety have increased pressure on trainees. Bootcamps are one strategy to mitigate these challenges and are normally short, intense educational events designed to help trainees transition to a new phase of training3.
Bootcamps have traditionally focused on acquisition of technical skills training with mixed success. Such a model is potentially flawed. Motor learning theory has demonstrated that distributed practice is more effective than massed practice in learning new motor skills4. It is thus foolish to think we can materially change the operative learning curve over six years of training with a two or three-day technical intervention. Bootcamps with a primary focus on technical skills training are highly resource and cost intensive. Non-technical skills and human factors training have been shown to correlate with favourable patient outcomes5. Surgical trainees have identified a lack of exposure to these skills early in their training despite an appetite for such6. Trainees in other surgical specialties report their nontechnical and inter-professional skills are not sufficiently developed for consultant practice at completion of training. The new curriculum and introduction of Generic Professional Capabilities and Capabilities in Practice means a welcome increasing focus on the development and assessment of nontechnical skills. Ethnographical work on the Scottish Core Surgical Bootcamp has identified a clear role bootcamp can play in establishing behavioural norms and expectations, whilst also allowing relationships to develop with key members of the training team.
Yorkshire and Humber Bootcamp The Yorkshire and Humber region developed and piloted a novel ST3 bootcamp with primary focus on human factors, nontechnical skills and professionalism. Sessions were led and delivered by trainees wherever possible to reduce the perceived
