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Exploring the use of high and low demand simulation for human performance assessment during multiorgan retrieval with the joint scrub practitioner
  1. Gala Morozova1,
  2. Amanda Martindale1,
  3. Hugh Richards1,
  4. John Stirling2,
  5. Ian Currie3,4
  1. 1Institute of Sport, P.E., & Health Sciences, Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
  2. 2NORS Workforce Transformation Programme Lead, NHS Blood and Transplant, Watford, UK
  3. 3NRS Clinician, Consultant Transplant Surgeon, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
  4. 4Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
  1. Correspondence to Gala Morozova, Institute of Sport, P.E., & Health Sciences, Moray House School of Education and Sport, The University of Edinburgh, Edinburgh EH8 9YL, UK; gala.morozova{at}ed.ac.uk

Abstract

Introduction The National Organ Retrieval Service (NORS) 2015 review recommended a Joint Scrub Practitioner for abdominal and cardiac teams during combined organ retrieval. To evaluate the feasibility of this role, and to understand the functional implications, this study explores the use of simulation and provides a novel and comprehensive approach to assess individual and team performance in simulated multiorgan retrievals.

Methods Two high-fidelity simulations were conducted in an operating theatre with porcine organs, en bloc, placed in a mannequin. For donation after brainstem death (DBD) simulation, an anaesthetic machine provided simulated physiological output. Retrievals following donation after circulatory death (DCD) began with rapid arrival in theatre of the mannequin. Cardiothoracic (lead surgeon) and abdominal (lead and assistant surgeons; joint scrub practitioner, n=9) teams combined for the retrievals. Data collected before, during and after simulations used self-report and expert observers to assess: attitudinal expectations, mental readiness, mental effort, non-technical skills, teamwork, task workload and social validation perceptions.

Results Attitudinal changes regarding feasibility of a joint scrub practitioner for DBD and DCD are displayed in the main body. There were no significant differences in mental readiness prior to simulations nor in mental effort indicated afterwards; however, variance was noted between simulations for individual team members. Non-technical skills were slightly lower in DCD than in DBD. Global ratings of teamwork were significantly (p<0.05) lower in DCD than in DBD. Measures of attitude indicated less support for the proposed joint scrub practitioner role for DCD than for DBD.

Discussion The paper posits that the joint scrub practitioner role in DCD multiorgan retrieval may bring serious and unanticipated challenges. Further work to determine the feasibility of the NORS recommendation is required. Measures of team performance and individual psychological response can inform organ retrieval feasibility considerations nationally and internationally.

  • psychology, org. Studies
  • surgical simulation
  • transplantation
  • non technical skills
  • managing performance
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Footnotes

  • Twitter @GalaMRZVa

  • Contributors GM: contributed to study design and measures selection, carried out data collection and data analysis, prepared first draft of study report, contributed to preparation and revision of the manuscript for publication, finalised and submitted the manuscript. AM: co-PI, cocreated study proposal, contributed to study design and measures selection, carried out data collection, supervised data analysis and write up by GM, prepared the manuscript for publication. HR: co-PI, cocreated study proposal, contributed to study design, carried out data collection, supervised data analysis and write up by GM, contributed to preparation and revision of the manuscript for publication. JS: initiated and contributed to study proposal, coorganised the simulation event, facilitated data collection, and reviewed the manuscript for publication. IC: initiated and contributed to study proposal, coorganised the simulation event, created simulation scenarios, facilitated data collection, critically reviewed and edited the manuscript for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests IC has received Honoraria from Sandoz and Chiesi for giving lectures in the field of transplantation. IC is now UK Lead for Organ Retrieval, NHSBT. This work was completed prior to taking up this appointment, whilst he was NORS Team Lead for the Edinburgh Abdominal Retrieval Team. JS was the Perioperative Clinical Lead for the Edinburgh Abdominal Retrieval Team at the time this research was conducted.

  • Ethics approval Ethical approval for the study was granted by the relevant institutional ethics committee of the University of Edinburgh.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Study protocols and deidentified participant data are available on request from the corresponding author https://orcid.org/0000-0003-2470-9316.

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