Ethics, errors and education in surgical operating room

Abstract

Patient safety errors in OR may originate from: <italic>surgeon</italic> on account of forgetfulness, inattention, poor motivation, carelessness, negligence and recklessness; <italic>Hospital</italic> system due to understaffing, inadequate equipment, fatigue, time pressure and inexperience. Quality surgical training is crucial for creation of surgical workforce for health care delivery. The surgical trainees during ‘Junior Residency’ need training in both ‘Surgical’ and ‘Communication’ OR skill. The surgical skill learnt in OR is: competence in ‘basic surgical techniques’; skill of ‘assistance and minor surgeries’: hernia repair, appendectomy, skin grafting and laparoscopic skills. During ‘Senior Residency’ independent surgical judgment and performance of advanced surgical procedures to gain extensive operating experience. The non-surgical skill that promotes patient safety in OR are ‘communication skill’ and ‘team skill’. The ’<italic>supervised progressive responsibility model of surgical training</italic>’ has elements embedded for patient safety. Surgical trainer promotes trainee’s skill and ensures patient safety as well the highest quality of surgery, through gradual decreasing levels of supervision in OR, namely <italic>Direct Supervision</italic> where the trainer is physically present; <italic>Indirect supervision</italic> where the trainer becomes available within few minutes; <italic>oversight</italic> where after the surgery review is provided with feedback and progress <italic>monitoring</italic> where progress is monitored and supervision is done only in complex surgeries. Supervised surgical training helps creation of skilled practicing surgeon and ensures patient safety.