Commentary on Use of high fidelity operating room simulation to assess and teach communication, teamwork, and laparoscopic skills: Initial experience. Gettman MT, Pereira CW, Lipsky K, Wilson T, Arnold JJ, Leibovich BC, Karnes RJ, Dong Y, Departments of Urology and Nursing, and the Multidisciplinary Simulation Center, Mayo Clinic, Rochester, MN

Structured opportunities for learning communication, teamwork, and laparoscopic principles are limited for urology residents. We evaluated and taught teamwork, communication, and laparoscopic skills to urology residents in a simulated operating room. Scenarios related to laparoscopy (insufflator failure, carbon dioxide embolism) were developed using mannequins, urology residents, and nurses. These scenarios were developed based on Accreditation Council for Graduate Medical Education core competencies and performed in a simulation center. Between the pre-test scenario (insufflation failure) and the post-test scenario (carbon dioxide embolism) instruction was given on teamwork, communication, and laparoscopic skills. A total of 19 urology residents participated in the training that involved participation in at least 2 scenarios. Performance was evaluated using validated teamwork instruments, questionnaires, and videotape analysis. Significant improvement was noted on validated teamwork instruments between scenarios based on resident (pre-test 24, post-test 27, P = 0.01) and expert (pre-test 16, post-test 25, P = 0.008) evaluation. Increased teamwork and team performance were also noted between scenarios on videotape analysis with significant improvement for adherence to best practice (P = 0.01) and maintenance of positive rapport among team members (P = 0.02). Significant improvement in the setup of the laparoscopic procedure was observed (P = 0.01). Favorable face and content validity was noted for both scenarios. Teamwork, intraoperative communication, and laparoscopic skills of urology residents improved during the high fidelity simulation course. Face and content validity of the individual sessions was favorable. In this study, high fidelity simulation was effective for assessing and teaching Accreditation Council for Graduate Medical Education core competencies related to intraoperative communication, teamwork, and laparoscopic skills.