Massachusetts Chapter of the American College of Surgeons

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An Implementation Framework-Based Evaluation of a Virtual Simulation to Develop Non-Technical Skills in the Operating Room
Rashid, Gazi MD1, Roussin, Christopher MS, PhD2, Jung, James J. MD, PhD3, Healy, Michael G. Ed.D.4, Gee, Denise, MD4
1University of Massachusetts, Dept. of Surgery, Worcester, MA; 2Massachusetts General Hospital, Dept. of Anesthesia, Critical Care, and Pain Medicine, Boston, MA; 3University of Toronto, Dept. of Surgery, Toronto, ON Canada; 4Massachusetts General Hospital, Dept. of Surgery, Boston, MA

Background: Non-technical skills are critical to patient safety in the operating room. Though historically practiced through in-person simulations, the COVID-19 pandemic necessitated new learning paradigms. We implemented a virtual interprofessional simulation to improve non-technical skills and evaluated outcomes through the RE-AIM framework.
Methods: In 2020 and 2021, surgeons, anesthesiologists, and nurses at a large academic institution participated in a two-hour virtual simulation session and evaluated its relevance and impact through post-course surveys. Responses on Likert scale were quantitatively analyzed, and free text responses underwent content analyses. Other data included records of participation, personnel, and costs.
Results: In the two-year timeframe, participants included 136/156 invited surgeons (87%) from five departments, 27/30 invited anesthesiologists (90%), and 81 nurses. Twenty-six sessions were held, each with a median (IQR) of 2 (2-3) facilitators and 10 (9-10) participants. Besides the opportunity costs of faculty time, there were no additional costs of implementation. The survey was completed by 152/244 participants (62%), of whom 93% agreed/strongly agreed that the activity would impact their practice and 96% agreed/strongly agreed that the information increased patient safety skills. Content analyses found that understanding and navigating the workplace (31%) was the most common benefit perceived by participants toward addressing risks in their practice, while the most common expected change was improving communication (33%).
Conclusion: There is evidence that virtual interprofessional simulation is an accessible and feasible learning and organizational innovation and an impactful framework for improving non-technical skills. The RE-AIM framework can be useful for evaluating the impact of next iterations.


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