ORLANDO, Fla.—Medical error has been cited as the third-leading cause of death in the United States, and failures in teamwork are one of the root causes of medical error. Could more successful teamwork lie in interprofessional training?

At Minimally Invasive Surgery Week 2024, Mireille Truong, MD, the director of minimally invasive gynecologic surgery at MedStar Washington Hospital Center–Georgetown, in Washington, D.C., made the case for interprofessional training and provided an example of one effective and arguably entertaining approach to it.

Interprofessional training—when two or more professions learn about, from and with each other—can be a bit of a departure from what surgeons are used to, she noted.

“For example, in robotics we train as surgeons, and the nurses follow their own training pathway, kind of training in parallel, which is important because we know the effectiveness of a team is based on the competency of each team member; everyone needs to know their job,” Dr. Truong said.

But team training is also important. “Studies show that interprofessional training can improve a lot of nontechnical skills,” she said (J Interprof Care 2021;35[4]:612-621).

These nontechnical skills include understanding the roles and responsibilities of other professions, developing collaborative behaviors, learning skills related to interprofessional collaboration, building comfort in working with people from other professions, and increasing satisfaction. Teams with strong nontechnical skills also tend to have more efficient workflow and fewer errors.

Escaping the Norm

There hasn’t been much research conducted on this type of training in surgery, but a group in Switzerland trained together, developed a protocol for robotic surgery and reported their findings over four years. The team training of these trainees, surgeons, nurses and techs included theoretical training together, hands-on simulation including emergency simulation situations, and communication training.

“They found they had decreased docking time, decreased operative time and reduced overall cost,” Dr. Truong said (J Robot Surg 2022; 16[1]:89-96).

Given the paucity of data on interprofessional training in medicine, Dr. Truong and her former team at Cedars-Sinai in Los Angeles—an interprofessional team that included a surgeon, a nurse educator and a human factors specialist—developed an interprofessional robotic team training simulation.

“Our goal was to develop something time-efficient, interactive and fun, but educational, and that covered both nontechnical and technical skills of robotic surgery,” she said.

What they came up with was an escape room: a one-hour exercise that gives participants 45 minutes to figure their way out by using clues and solving riddles and puzzles in a sequence as a team. The remaining 15 minutes are used to debrief.

“Apart from this one, escape rooms haven’t been used in surgery, but they have been used in other medical fields and [have been] found to increase satisfaction, the learning experience and learner motivation as well as improve teamwork, collaboration and communication,” Dr. Truong said.

Indeed, those results are what participants in the pilot project of three groups reported. “Everyone agreed it improved technical skills, teamwork and communication, and they all felt the skills they learned were applicable to practice and necessary for their job,” Dr. Truong said.

Implementing Teamwork

In addition to showing that interprofessional robotic training is feasible, the project helped identify key factors for implementing interprofessional training in general: The session should be short, no more than an hour; it involves team members in the planning and buy-in; it helps to have access to a robotic system; it should be both educational and interactive and meet learning objectives for both technical and nontechnical skills.

“We are now trying to implement continuous training of this escape room and establishing it as a little competition—because everyone loves competition—such as having leaderboards,” Dr. Truong said. They are also working on a training toolkit that other hospitals and programs can use, and have reached out to some virtual reality companies to see if it can be integrated into VR, thus eliminating the need for access to a robotic system.

“Long term, we really want to see if this reduces operative time, improves team dynamics, increases OR safety, and reduces cost to patients and hospitals over time,” Dr. Truong said.

Paul G. Toomey, MD, a general surgeon with Florida Surgical Specialists, in Bradenton, also advocated for team building in the OR. “In surgery, we’re so accustomed doing classroom learning that breaking into smaller groups and engaging in hands-on sessions is essential, especially when it comes to building a team in the OR.”

One message he has promoted over the years is telling people why things are done the way they’re done. “We can train our staffs to perform specific roles, but people work much better in a group when they understand why they’re doing something rather than being told, ‘This is the way it’s done,’” Dr. Toomey added.

He hasn’t had the opportunity to develop or participate in something like Dr. Truong’s escape room, but finds other ways to incorporate a team-building mentality into everyday practice. “A lot of it is team building in real time.”

An attitude of inclusion is part of it, sharing anecdotes about his life outside the OR and encouraging interpersonal conversation. “If you treat people like they’re just coworkers, you’re unlikely to get very far in building a strong team.”

Using closed-loop communication—asking for feedback in the moment—and teaching through procedures are other tactics he uses in team building.

“If you’re teaching while undertaking a task, it will be much more engrained the next time—not just what we’re doing but why we’re doing it,” Dr. Toomey noted.

Dr. Toomey reported no relevant financial disclosures. Dr. Truong reported a consultantship to Intuitive.