Introduction:There is ongoing interest in the development of technical and nontechnical skills in healthcare to improve safety and efficiency; however, barriers to developing and delivering related training programs make them difficult to implement. Unique approaches to training such as "serious games" may offer ways to motivate teams, reinforce skill acquisition, and promote teamwork. Given increased challenges to teamwork in robotic-assisted surgery (RAS), researchers aimed to develop the "RAS Olympics," a game-based educational competition to improve skills needed to successfully perform RAS.Methods: This pilot study was conducted at an academic medical center in Southern California. Robotic-assisted surgery staff were invited to participate in the "RAS Olympics" to develop their skills and identify opportunities to improve processes. Impact of the activity was assessed using surveys and debriefs.Results: Sixteen operating room team members participated and reacted favorably toward the RAS-Olympics (average score, 4.5/5). They enjoyed the activity, would recommend all staff participate, felt that it was relevant to their work, and believed that they practiced and learned new techniques that would improve their practice. Confidence in skills remained unchanged. Participants preferred the RAS Olympics to traditional training because it provided an interactive learning environment. Conclusions:The successful implementation of the RAS Olympics provided insight into new opportunities to engage surgical staff members while also training technical and nontechnical skills. Furthermore, this shared experience allowed surgical staff members to gain a greater appreciation for their teammates and an understanding of the current challenges and methods to improve teamwork and communication while promoting safety and efficiency in RAS.

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Abstract This mixed model study first implemented a quantitative approach to investigate the structural coherence of the narratives that 3- to 6-year old children construct with and without their mothers. We then employed qualitative analysis to identify and categorize strategies that mothers used to scaffold their children’s developing sequencing skill during narrative conversations. Analysis of 233 co-constructed and 209 independent past-event narratives from 65 mother-child dyads revealed that the children produced narratives with a range of structural coherence both independently and with maternal assistance. Chronological narratives were the most common structure produced with and without assistance, but leapfrog narratives persisted in the dyadic context. Five distinct patterns of maternal strategies that provided chronological structure to their children’s leapfrogs emerged. We discuss the ways in which the maternal strategies identified promote early literacy skills through scaffolding and modeling school-like literacy practices in everyday conversations.

Purpose Bariatric surgery is an effective and durable treatment for weight loss for patients with extreme obesity. Although traditionally approached laparoscopically, robotic bariatric surgery (RBS) has unique benefits for both surgeons and patients. Nonetheless, the technological complexity of robotic surgery presents new challenges for OR teams and the wider clinical system. Further assessment of the role of RBS in delivering quality care for patients with obesity is necessary and can be done through a human factors approach. This observational study sought to investigate the impact of RBS on the surgical work system via the study of flow disruptions (FDs), or deviations from the natural workflow progression. Materials and Methods RBS procedures were observed between October 2019 and March 2022. FDs were recorded in real time and subsequently classified into one of nine work system categories. Coordination FDs were further classified into additional sub-categories. Results Twenty-nine RBS procedures were observed at three sites. An average FD rate of 25.05 (CI =  ± 2.77) was observed overall. FDs were highest between insufflation and robot docking ( M = 29.37, CI =  ± 4.01) and between patient closing and wheels out ( M = 30.00, CI =  ± 6.03). FD rates due to coordination issues were highest overall, occurring once every 4 min during docking ( M = 14.28, CI =  ± 3.11). Conclusion FDs occur roughly once every 2.4 min and happen most frequently during the final patient transfer and robot docking phases of RBS. Coordination challenges associated with waiting for staff/instruments not readily available and readjusting equipment contributed most to these disruptions. Graphical abstract