Charleston Reporter

Robots are being used more and more frequently in the operating room, not to replace surgeons but to improve both their precision and their vision of the surgical field.

With robotic surgery, cameras provide the surgeon, seated separately at a console across the room from the surgical team, a close-up view of the action as he or she carefully guides the robot’s movements. For all of its merits, however, this revolutionary technology puts the surgeon at some distance from the surgical team, making interactions between the two difficult. This separation can pose a challenge to effective teamwork.  

Training for surgeons on how to conduct robotic surgery is robust. However, little training has been available to members of the surgical team who need to adapt to this new environment.

“We train up surgeons very effectively and very rigorously to use the robots to perform the surgeries,” said Kenneth Catchpole, Ph.D., the S.C. SmartState Endowed Chair in Clinical Practice and Human Factors at MUSC and co-director of the Team Science program at the South Carolina Clinical and Translational Research Institute. “However, we don’t always train our staff as rigorously in all the things that they need to do to support the robotic surgery.”

“Being able to put the enjoyment back into learning is so important. If you’re not enjoying something, then you’re unlikely to learn.”

-- Dr. Kenneth Catchpole 

With funding from the Agency for Healthcare Research and Quality, Catchpole and Jennifer Anger, M.D., a urologic surgeon at Cedars Sinai Medical Center, co-led a study that showed that incorporating “serious games” into this type of training can be an effective and engaging way to teach teamwork and other skills to busy robotic surgery teams. Their findings are published in the Journal of Patient Safety. Tara Cohen, Ph.D., director of Surgical Safety and Human Factors Research in the Cedars Sinai Department of Surgery, is lead author of the publication.

“Being able to put the enjoyment back into learning is so important,” said Catchpole. “If you’re not enjoying something, then you’re unlikely to learn.”

Instead of asking teams to sit through didactic presentations, Catchpole and his collaborators engaged them in immersive scenarios. Raymund Avenido, robotics surgery specialist at Cedars Sinai, came up with the idea for a robot Olympics and collaborated with Catchpole and others at MUSC and Cedars Sinai to make it happen. Together, they created four escape rooms relevant to robotic surgery for teams to solve. In one, players had to identify safety hazards; in another, they had to troubleshoot the machinery. And in yet another, they had to retrieve instruments. The fourth room required them to navigate the workspace effectively, learning to maneuver around the robotic equipment and other obstacles.

Catchpole believes that games are more likely than traditional presentations to motivate teams to develop their teamwork skills and to ensure that those skills stick.

“It can be aspirational that you’re presenting team members with a challenge and letting them use and develop their own skills to address that, and then they’ll get feedback about how well they did,” said Catchpole.

“So, it’s interactive. That’s often how people learn best,” he continued. “And there’s a competitive element: You'll get a score at the end, and you can compare your scores, and those with the highest scores can get a prize.”

The recent publication reports data from the rollout of the four escape rooms at Cedars Sinai Medical Center. Sixteen surgical team members at Cedars Sinai participated in the four escape rooms and reported high satisfaction with the experience (4.5 on a 5-point scale). They also said that they found the experience relevant to their work, the interactive nature of the game engaging and enjoyable and the techniques they learned useful for improving their performances.  Team members’ confidence in their skills, already high, did not change.

"If we can package up some resources and tips for using serious games to train teams on these new [technology-rich] environments, their usefulness could extend well beyond robotic surgery.”

-- Dr. Kenneth Catchpole 

Conducted as a four-hour workshop on a weekend at Cedars Sinai, the escape rooms are now being adapted to the MUSC clinical environment, with the help of MUSC robotic surgery specialist Betts Bishop, R.N., and Jessica Waxman, a clinical practice nurse expert involved in training and quality improvement in operating rooms. At MUSC, the escape rooms will be worked into the established training/in-service schedule for surgical teams.

Having shown that teams find the escape rooms enjoyable, engaging and relevant, Catchpole and his collaborators are further collecting and analyzing data to determine whether teamwork improved due to the innovative training.

“We’ve done a lot of work looking at teamwork before and after participating in these escape rooms,” said Catchpole, and those findings will be the subject of a future article.

Catchpole and his collaborators are also developing a manual that other institutions could use to create their own escape rooms. They could be used for robotic surgery or other types of operating room teams.

“There’s more interest in this type of training as more technology comes into the operating rooms,” said Catchpole. “So, if we can package up some resources and tips for using serious games to train teams on these new environments, their usefulness could extend well beyond robotic surgery.”

Reference

Cohen, Tara N.; Anger, Jennifer T.; Kanji, Falisha F., et al. A novel approach for engagement in team training in high-technology surgery: The robotic-assisted surgery Olympics. Journal of Patient Safety 18(6):p 570-577, September 2022. | DOI: 10.1097/PTS.0000000000001056

Original source can be found here.