Article Text

0114 Using Simulation To Train Orthopaedic Registrars In Non-technical Skills
  1. Sam Heaton,
  2. Manoj Ramachandran,
  3. Kash Akhtar,
  4. Zoe Little,
  5. Josh Lee
  1. Royal London Hospital, London, UK


Background Non-technical skills include situational awareness, decision-making, communication, teamwork and leadership.1,2 The role of simulation-based training is gradually developing within the orthopaedic community but the focus is predominantly centred on technical skills such as dexterity and hand-eye coordination with little emphasis on human factors. Our aims were to produce a course tailored to teach non-technical skills to orthopaedic registrars and to analyse participants’ perceptions and feedback.

Methodology A Delphi technique was used to develop a course in human factors specific to orthopaedic residents with challenging real-life situations in order to assess non-technical skills. These used high-fidelity mannequins and simulated patients in environments incorporating a simulated operating suite, a clinic room and a ward setting. A multidisciplinary healthcare team trained in Crisis Resource Management then used these videos as the basis for structured feedback and review. Participants completed a 5-point Likert scale questionnaire before and after the course.

Results 27 orthopaedic residents took part. Pre-course questionnaires demonstrated a lack of foundation in non-technical skills. There was a significantly greater appreciation after the course and the perceived importance of these skills was reported as good or very good in 100%. Participants also felt that patient care, patient safety and team working would all improve with further human factors training (4.4–4.6). The course was reported to be enjoyable and provided an unthreatening learning environment (96%).

Conclusions We have developed and piloted what we believe to be the first non-technical skills course that specifically caters to some of the unique needs and issues that affect orthopaedic surgeons. Participants demonstrated an improved understanding of the importance of non-technical performance, recognised its relevance to improving patient safety and expressed a desire for it to become an integral in training. Non-technical skills training may also go on to provide a means of identifying and supporting trainees in difficulty.


  1. Yule S, Flin R, Maran N, et al. Surgeons’ non-technical skills in the operating room: Reliability testing of the NOTSS behaviour rating system. World J Surg 2008;32, 548–556

  2. Gawande AA, Zinner MJ, Studdert DM, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery 2003;133:614–21

  • Category: Course or curriculum evaluation/innovation/integration

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.