A modern operating room consists of many different medical devices. Therefore an adequate technological competence of surgeons is needed for the improvement of patient safety. A Cognitive Task Analysis (CTA) was performed to analyse the technological competence of spinal and ENT surgeons. In an international study 6 ENT and 4 spinal surgeons in Germany and Spain were interviewed. The results show the need and the relevance to develop specific trainings in technological competence for surgeons.
Introduction/Background: Spinal surgeries make high demands on appropriate training simulations and cannot be fully trained in simulation scenarios so far. The complex anatomical structures and haptic characteristics, as well as the lack of integration of X-ray control, which are important constituents in real surgeries, are the major limiting factors. So far, spinal surgeries are either gradually learned in real surgeries under the guidance and supervision directly on the patient or in wetlab courses on animal spinal preparations of swine and sheep or human cadavers. 1-3 Both Methods show disadvantages. Firstly, concerning the patient safety, as well as high costs, ethical and hygienic aspects and the limited availability. 4 Furthermore, X-ray controls are usually integrated for operations that have the objective of inserting metal implants (e.g. cage implantation). This is an essential part for establishing the operating area and the position control of the implant during and immediately after the surgery. In trainings, X-ray control is usually used only in limited form. Reasons are the high radiation exposure for participants, as well as the disproportionate high costs and technical requirements of real fluoroscopic equipment in training centers.
A safe application of modern surgical technology and computer-assisted surgery devices is based on an operation by adequately trained surgeons who are familiar with the benefits and limitations of the devices. We analyzed the in-depth interviews with seven Spanish and 10 German surgeons. Together with other studies, this analysis highlights the need for specific training in technological competence for surgeons. One way to train technological competence is to help surgeons understanding the basic principles of medical devices as well as explaining the basic concepts of risk analysis and risk management. Based on this premise, a stage model for risk assessment was developed and adapted for the training of surgeons. This was developed further into a train the trainer (TTT) concept, which was then evaluated for two example cases. During TTT-training, the trainers (expert surgeons) performed a risk analysis for several medical devices. Afterwards, the trainers organized a surgical workshop for surgical trainees (resident surgeons), in which high-fidelity simulators and the original medical devices were used. The results showed that the surgeons performed the risk analysis correctly with the stage model and afterwards were able to successfully apply the results in the workshop context.
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