Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.
Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.
Ann Thorac Surg. 2019 Mar;107(3):954-961. doi: 10.1016/j.athoracsur.2018.08.010. Epub 2018 Oct 4.
Nontechnical skills are important for safe and efficient surgery. Teams performing video-assisted thoracoscopic surgery (VATS) lobectomy express that it is of utmost importance to have a shared mental model (SMM) of the patient, current situation, and team resources. However, these SMMs have never been explored in a clinical setting. The aim of this observational study was to measure the similarity of SMMs within teams performing VATS lobectomy.
In this national, multicenter study, SMMs of teams performing VATS lobectomy (n = 64) were measured by preoperative and postoperative questionnaires that were completed by all team members (n = 172). Participants' responses were compared within each team to explore SMMs of risk assessment, familiarity, technical skills, nontechnical skills, and problems.
Analysis showed poor agreement between team members with respect to risk assessment, but higher levels of agreement were found for assessments of familiarity, technical skills, and nontechnical skills within the team (Cronbach's alpha = 0.90), most notably for surgical subteams (ie, surgeon plus assistant surgeon plus surgical nurses). During the surgical procedure, the most frequent problems were related to anesthesia, and these were most often recognized by the surgeons. The operating room nurses were the least aware of each other's and the surgeons' problems.
Significant variation exists in the SMMs among VATS team members, with poor agreement regarding the patient and current situation, but better agreement with respect to team resources. Focus on preoperative and perioperative team reflexivity, in addition to explicit communication within unfamiliar teams, may provide opportunities to enhance SMMs, with possible downstream effects on team performance.
非技术技能对于安全高效的手术至关重要。进行电视辅助胸腔镜手术（VATS）肺叶切除术的团队表示，拥有患者、当前情况和团队资源的共享心理模型（SMM）是最重要的。然而，这些 SMM 在临床环境中从未被探索过。本观察性研究的目的是测量进行 VATS 肺叶切除术的团队内 SMM 的相似性。
在这项全国性、多中心研究中，通过术前和术后问卷调查测量进行 VATS 肺叶切除术的团队的 SMM（n=64），所有团队成员（n=172）都完成了问卷调查。在每个团队内比较参与者的回答，以探索风险评估、熟悉度、技术技能、非技术技能和问题的 SMM。
分析表明，团队成员在风险评估方面的一致性较差，但团队内对熟悉度、技术技能和非技术技能的评估一致性较高（Cronbach's alpha=0.90），尤其是对于手术子团队（即外科医生加助手外科医生加外科护士）。在手术过程中，最常见的问题与麻醉有关，这些问题大多由外科医生识别。手术室护士对彼此和外科医生的问题了解最少。
VATS 团队成员之间的 SMM 存在显著差异，对患者和当前情况的一致性较差，但对团队资源的一致性较好。除了在不熟悉的团队中进行明确沟通外，关注术前和围手术期团队反思可能为增强 SMM 提供机会，并可能对团队绩效产生潜在影响。
