Communicating from a distance: medical student perspectives from a robotic bedside assist simulation

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Anya L. Greenberg1, Shareef Syed1, Adnan Alseidi1, Patricia O’Sullivan2, Hueylan Chern1
1Department of Surgery, University of California, San Francisco, USA
2Department of Medicine, University of California, San Francisco, USA

Tóm tắt

Abstract Background To safely engage medical students in robotic operations as bedside assists would require new curricula. We aimed to understand student perspectives on communication with a console surgeon during a bedside assist simulation as a step in the process of designing an effective bedside assist curriculum. Methods Senior medical students were offered an introductory robotic surgery course. An Intuitive Surgical trainer reviewed robotic features, functionalities, and roles. Then, students participated in a simulation where they introduced an instrument through a laparoscopic port and advanced it into the field of view navigating around obstacles. A non-surgeon researcher conducted post-course focus groups (FGs) to explore participants’ perceptions about communication with the console surgeon during the simulation. Using FG transcriptions, two researchers conducted an inductive thematic analysis. Results Thirteen students (46% female) participated in three FGs. The first theme, tension between hierarchy and patient safety, reflected students’ pressure to follow instructions quickly and obediently from their superior and trepidation about revealing knowledge gaps as barriers to communication. Students also recognized that patient safety as at risk with rote following of instructions in the face of their uncertainty. The second theme identified opportunities to enhance communication including shared vocabulary, effective team dynamics, and explicit expectations. Conclusion Barriers to effective communication between students and surgical faculty exist. Establishing a bedside assist curriculum that teaches relevant terminology, communicating specific expectations, and promoting a team culture that fosters open communication without judgment may safely expand the role for students in robotic cases.

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Tài liệu tham khảo

Irani JL, Greenberg JA, Blanco MA, Greenberg CC, Ashley S, Lipsitz SR, et al. Educational value of the operating room experience during a core surgical clerkship. Am J Surg. 2010;200:167–72. https://doi.org/10.1016/j.amjsurg.2009.06.023.

Sheetz KH, Claflin J, Dimick JB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open. 2020;3: e1918911. https://doi.org/10.1001/jamanetworkopen.2019.18911.

Higgins RM, O’Sullivan P. The robotic surgery learning experience through the eyes of the medical student: what do they see? J Surg Educ. 2020;77:549–56. https://doi.org/10.1016/j.jsurg.2019.12.011.

Bittner-Fagan H, Davis J, Savoy M. Improving patient safety: improving communication. FP Essent. 2017;463:27–33.

Leape LL. Now the hard part: creating a culture of safety. Cham: Springer; 2021. p. 401–38. https://doi.org/10.1007/978-3-030-71123-8_23.

Torralba KD, Jose D, Byrne J. Psychological safety, the hidden curriculum, and ambiguity in medicine. Clin Rheumatol. 2020;39:667–71. https://doi.org/10.1007/s10067-019-04889-4.

Reeves SA, Denault D, Huntington JT, Ogrinc G, Southard DR, Vebell R. Learning to overcome hierarchical pressures to achieve safer patient care: an interprofessional simulation for nursing, medical, and physician assistant students. Nurse Educ. 2017;42:S27-31. https://doi.org/10.1097/NNE.0000000000000427.

Peadon R, Hurley J, Hutchinson M. Hierarchy and medical error: Speaking up when witnessing an error. Saf Sci. 2020;125:104648. https://doi.org/10.1016/j.ssci.2020.104648.

Lingard L. Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care. 2004;13:330–4. https://doi.org/10.1136/qshc.2003.008425.

Halverson AL, Casey JT, Andersson J, Anderson K, Park C, Rademaker AW, et al. Communication failure in the operating room. Surgery. 2011;149:305–10. https://doi.org/10.1016/j.surg.2010.07.051.

Kurmann A, Tschan F, Semmer NK, Seelandt J, Candinas D, Beldi G. Human factors in the operating room—the surgeon’s view. Trends Anaesth Crit Care. 2012;2:224–7. https://doi.org/10.1016/j.tacc.2012.07.007.

Christian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, et al. A prospective study of patient safety in the operating room. Surgery. 2006;139:159–73. https://doi.org/10.1016/j.surg.2005.07.037.

Mcleod R, Myint-Wilks L, Davies S, Elhassan H. The impact of noise in the operating theatre: a review of the evidence. Ann R Coll Surg Engl. 2021;103:83–7. https://doi.org/10.1308/rcsann.2020.7001.

Schiff L, Tsafrir Z, Aoun J, Taylor A, Theoharis E, Eisenstein D. Quality of communication in robotic surgery and surgical outcomes. JSLS. 2016;20:e2016.00026. https://doi.org/10.4293/JSLS.2016.00026.

Nezhat C, Lakhi N. Learning experiences in robotic-assisted laparoscopic surgery. Best Pract Res Clin Obstet Gynaecol. 2016;35:20–9. https://doi.org/10.1016/j.bpobgyn.2015.11.009.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. https://doi.org/10.1191/1478088706qp063oa.

Dedoose 7.0.23, web application for managing, analyzing, and presenting qualitative and mized method research data 2018, Los Angeles, CA: Sociocultural Research Consultatnats, LLC, www.dedoose.comn.d.

Belyansky I, Martin TR, Prabhu AS, Tsirline VB, Howley LD, Phillips R, et al. Poor resident-attending intraoperative communication may compromise patient safety. J Surg Res. 2011;171:386–94. https://doi.org/10.1016/j.jss.2011.04.011.

Makary MA, Sexton JB, Freischlag JA, Holzmueller CG, Millman EA, Rowen L, et al. Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg. 2006;202:746–52. https://doi.org/10.1016/j.jamcollsurg.2006.01.017.

Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79:186–94. https://doi.org/10.1097/00001888-200402000-00019.

Walton MM. Hierarchies: the Berlin Wall of patient safety. Qual Saf Health Care. 2006;15:229–30. https://doi.org/10.1136/qshc.2006.019240.

Greenberg CC, Regenbogen SE, Studdert DM, Lipsitz SR, Rogers SO, Zinner MJ, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204:533–40. https://doi.org/10.1016/j.jamcollsurg.2007.01.010.

Coats RD, Burd RS. Intraoperative communication of residents with faculty: perception versus reality. J Surg Res. 2002;104:40–5. https://doi.org/10.1006/jsre.2002.6402.

Henry SG, Holmboe ES, Frankel RM. Evidence-based competencies for improving communication skills in graduate medical education: a review with suggestions for implementation. Med Teach. 2013;35:395–403. https://doi.org/10.3109/0142159X.2013.769677.

Berkhof M, van Rijssen HJ, Schellart AJM, Anema JR, van der Beek AJ. Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. Patient Educ Couns. 2011;84:152–62. https://doi.org/10.1016/j.pec.2010.06.010.

Kieran K, Jensen NM, Rosenbaum M. See, do, teach? a review of contemporary literature and call to action for communication skills teaching in urology. Urology. 2018;114:33–40. https://doi.org/10.1016/j.urology.2017.10.058.

Nakagawa S, Fischkoff K, Berlin A, Arnell TD, Blinderman CD. Communication skills training for general surgery residents. J Surg Educ. 2019;76:1223–30. https://doi.org/10.1016/j.jsurg.2019.04.001.

Blackmore A, Kasfiki EV, Purva M. Simulation-based education to improve communication skills: a systematic review and identification of current best practice. BMJ Simul Technol Enhanc Learn. 2018;4:159–64. https://doi.org/10.1136/bmjstel-2017-000220.

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