October 14, 2014By Lance Baily

Training Situational Awareness Through Simulation Valid to Reduce Surgical Errors in the Operating Room

Dr. Marlies Schijven, Past President of the Dutch Society for Simulation in Healthcare & Surgeon at Academic Medical Center Amsterdam just shared this great British Journal of Surgery Article entitled “Training situational awareness to reduce surgical errors in the operating room” M. Graafland, J. M. C. Schraagen, M. A. Boermeester, W. A. Bemelman and M. P. Schijven. The paper speaks to the need to train OR staff in the process of maintaining situational awareness, and found that medical simulation is a key methodology for accomplishing this training goal. Stress causes tunnel vision which leads to errors, but nonjudgemental communication practices and simulation training can open up our field of view for better patient outcomes. Recap of the study:


Surgical errors result from faulty decision-making, misperceptions and the application of suboptimal problem-solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim of this review was to assess the validity of methods for improving situational awareness in the surgical theatre.

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Nine articles were considered eligible. These evaluated surgical team crisis training in simulated environments for minimally invasive surgery (4) and open surgery (3), and training courses focused at training non-technical skills (2). Two studies showed that simulation-based surgical team crisis training has construct validity for assessing situational awareness in surgical trainees in minimally invasive surgery. None of the studies showed effectiveness of surgical crisis training on situational awareness in open surgery, whereas one showed face validity of a 2-day non-technical skills training course.


To improve safety in the operating theatre, more attention to situational awareness is needed in surgical training. Few structured curricula have been developed and validation research remains limited. Strategies to improve situational awareness can be adopted from other industries.

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What Needs to Happen?

Situational awareness is a key factor in Aviation Simulation training which is accomplished through CRM communication practices, where team members are taught to work together as a team to provide more comprehensive perspective during critical situations. The failure of healthcare communication is in the toxicity of work environments to be able to speak up without harsh criticism for doing so. Here’s an example of medical student having to go against his better judgement and speak up to save a patient’s life. For more of such reading check out Suzanne Gordon’s book “Beyond the Checklist: What Else Healthcare Can Learn from Aviation Teamwork & Safety“. Clearly, the research above continues to add to the enormous benefit of training opportunities simulation has to offer the healthcare community.

Read the full BJS Article on the Wiley website

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