Abstract
Expertise in surgery is a complex context-specific construct encompassing knowledge, manual dexterity, and various complementary non-technical skills (NTS). The surgical community has experienced significant challenges following adoption of certain innovations, which suggested that NTS require better understanding in this context. This work sought to advance understanding relating to NTS during surgical innovation and to help identify strategies to optimise safe and effective innovation and adoption of novel surgical practices.The thesis employed mixed methods in three phases: an umbrella review of 81 reviews exploring NTS in surgery including content analysis of how surgical innovation was considered; thirty interviews with surgeons and psychologists with relevant roles and experiences; integration of findings from these two approaches within a “spiral” methodology.
Surgical innovation was felt to encompass a broad spectrum of novel practices. Although NTS were regarded as crucial due to their intricate relationship with manual skills, the term “non-technical” emerged as potentially unsuitable due to the “technical” nature of some NTS. Innovative procedures were perceived as more cognitively demanding and stressful. Optimal understanding underlies appropriate innovation. The data revealed the importance of education and research-related competencies (including critical appraisal, proactive investigation, and transparent reporting) for surgeons engaging with innovation. Team composition, competence and culture appear influential. Integrated findings facilitated generation of a model summarising “optimisation factors” during surgical innovation, categorised into “personal”, “academic” and “social” groups. These encompass skills, characteristics and processes which interact to influence overall surgical performance. Identified factors require recognition and consideration during four key phases which were used to outline a process tree for surgeons: i) enhancing understanding; ii) planning; iii) performance; and iv) evaluation and sharing.
This work has successfully advanced understanding in this field. The model and process tree will help inform future research and guidance for surgeons and teams undertaking and adopting innovations in surgery.
| Date of Award | 27 Sept 2022 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Nicola J Mills (Supervisor), Natalie S Blencowe (Supervisor) & Jane Blazeby (Supervisor) |