Team Oriented Medical Simulation (TOMS) in Switzerland

Dr. Dieter Betzenderfer

I read the fall 1995 APSF Newsletter with interest, noting the article about simulators. I thought you would be interested in information about our simulator at the Kantonsspital, University of Basel.

In November 1994, the University of Basel Simulation Centre opened under the direction of the late Dr. Hans-Gerhard Schaefer. Working with Professor Robert L. Helmreich of the Department of Psychology of the University of Texas at Austin, Dr. Schaefer pioneered the concept of full operating room simulation, that is, participation of the entire operating room team (anaesthetist, surgeon, residents, nurses and orderlies) in the simulation of a complete operation.

The simulator operating room contains the usual anaesthetic equipment, linked to a Pentium computer. In addition, the mannequin (“Wilhelm Tell”) has a special abdominal segment which allows the surgeon to perform laparoscopic surgery on pig organs (kidney, omentum, liver). The organs are perfused by a pump (connected to the monitors) with a driving pressure inversely proportional to the heart rate.

The objective of each simulator session is not simply to reinforce adherence to recognised protocols by the anaesthetists, surgeons, or nurses by presenting them with multiple problems. Rather, the goal is to improve the overall performance of the operating room team by providing training in human factors, in particular, establishment of an effective team, maintenance of situational awareness, appropriate decision-making, and successful conflict resolution. Each session starts with briefing and then the anaesthetic and operation proceed, with videotaping of team behavior in real-time. Then the team debriefs, with the videotapes used to highlight and illuminate key points of the team-led discussion. Participant ratings of the value of the training, its potential for increasing safety, and its realism are very positive. Simulator sessions are now being held for operating room teams from outside hospitals, as well as Kantonsspital staff, and validation to evaluate the TOMS programme is ongoing.

Dr. Dieter Betzenderfer, Director of TOMS, Kantonsspital, University of Basel, Switzerland