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Human Factors in the Surgical Arena
Human Factors in the surgical arena is a programme of personal skills for
surgical practice which has been developed by The Royal College of Surgeons in
Ireland specifically for surgical and anaesthetic trainees. It aims to give
trainees the personal skills and attitudes necessary for successful surgical
practice as part of a multidisciplinary team.
It is clearly important for all surgeons to have a sound knowledge and
understanding of the theory of surgical practice. It is likewise important for
surgeons to be technically adept at the craft of surgery. On their own,
however, knowledge and skills are not enough. There are surgeons who know
virtually everything there is to know in the surgical literature but are less
than adequate in the operating room. Likewise, there are surgeons who are
technically very expert in the operating theater but consistently fail to get
the results that would be expected from such expertise. Sometimes, surgeons
with less knowledge and less technical expertise get better outcomes for their
patients because they operate on the right patients at the right time, they
continue to perform well under stress or in times of crisis, and they manage
to successfully harness the support of a multidisciplinary team to get the
best results for their patients. This is the “human factor” in surgery. It has
been estimated that only 25% of the important events which occur during a
surgical procedure are related to manual or technical skills and that 75%
relate to human factors such as decision making (especially during crises or
emergencies), communication, team work and leadership. Other human factors
which are important in surgical practice include self awareness (i.e.
insight), conflict resolution and error management.
It has always been considered that personal skills such as those listed
above are innate aspects of ones personality and that they can neither be
taught nor acquired. Whilst some individuals seem to be born with these
skills, many others can have these skills improved by formal education and
training. Although it is unlikely that one’s innate personality can be changed
it is undoubtedly possible to alter aspects of behavior which impact
negatively on colleagues and on the team in the work place. With appropriate
training, individuals can improve their personal skills and thus function more
effectively as part of the multidisciplinary team in which all surgeons work
in the 21st century.
The Royal College of Surgeons in Ireland has developed a programme in
human factors training to equip surgical and anaesthetic trainees with the
personal skills and attitudes required for modern surgical practice. The
programme is based on a clearly defined syllabus. This syllabus includes ten
modules, each of which contains four tutorials. The syllabus is arranged so
that the modules can be taken in any order and a system of credits will be
used to signify satisfactory completion of individual modules. Each module is
designed to be delivered over a two day period and it is intended that each
trainee will take one module every six months (i.e. will complete two modules
per year).
The programme will be delivered by acknowledged experts in the
individual subject areas of each module. Each module will have precise
learning objectives. The training will be delivered by a combination of
didactic teaching and practical work which will involve roll playing and small
group discussions. There will be a heavy emphasis on audio visual support.
Trainees will be encouraged to find solutions to human factor problems for
themselves and they will be given assignments on which to work between
modules. There will be heavy emphasis on practical application in the work
place and the assignments will reflect the importance of work place
application. Participation in the programme will form part of the competence
assessment and performance appraisal (CAPA) process for all trainees.
Above all the Human Factors Programme is intended to be an enjoyable
experience for trainees rather than a chore. The skills learned in the Human
Factors Programme are essentially “life skills” and are not unique to surgical
practice. Trainees will undoubtedly realize the value of the programme as part
of their personal development as well as part of their surgical training.
Please contact surgicaltraining@rcsi.ie with any queries.
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