Exploring Shared Mental Models of surgical teams in Video-Assisted Thoracoscopic Surgery lobectomy

BACKGROUND: Non-technical skills are important for safe and efficient surgery. Teams performing Video-Assisted Thoracoscopic Surgery (VATS) lobectomy express that it is of utmost importance to have a Shared Mental Model (SMM) of the patient, current situation, and team resources. However, these SMMs have never been explored in a clinical setting. The aim of this observational study was to measure the similarity of SMMs within teams performing VATS lobectomy.

METHODS: In this national, multi-center study, SMMs of teams performing VATS lobectomy (n=64) were measured by pre- and postoperative questionnaires that were completed by all team members (n=172). Participants' responses were compared within each team to explore SMMs of risk assessment, familiarity, technical skills, non-technical skills, and problems.

RESULTS: Analysis showed poor agreement between team members with respect to risk assessment, but higher levels of agreement were found for assessments of familiarity, technical and non-technical skills within the team (Cronbach's alpha=0.90), most notably for surgical subteams (=surgeon+assistant surgeon+surgical nurses). During the surgical procedure, the most frequent problems were related to anesthesia, and these were most often recognized by the surgeons. The operating room nurses were the least aware of each other's and the surgeons' problems.

CONCLUSIONS: Significant variation exists in the SMMs among VATS team members, with poor agreement regarding the patient and current situation, but better agreement with respect to team resources. Focus on pre-operative and peri-operative team reflexivity, in addition to explicit communication within unfamiliar teams, may provide opportunities to enhance SMMs, with possible downstream effects on team performance.