Safer Surgery part 18. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 144 Safer Surgery coordination. Verbal communication and feedback has been shown to improve team performance in image guided surgical teams Shiliang Chang et al. 2008 . Bearing the recent evolution in medical simulation in mind it is now prime time to take one step further looking at the whole perioperative team the OR team and not only the patient s pathophysiology and the surgeon. The A-TEAM scale which rates all team members enables this step towards increased team coordination. As shown in Table it assesses behaviours. It is important to keep in mind the impact of patient outcome variables clinical performance and team members subjective experiences of the process of teamworking. Consequently such additional assessments also have to be addressed by other scales in order to yield a more finegrained analysis. True mastery of intra-operative skills transcends from teamwork in harmony with manual dexterity. It stems from mastery of oneself being fully aware and in tune with the rest of the team despite leadership or followership and irrespective of the current context. The traditional focus being mainly on the leader deserves challenge and a new hypothesis needs to be outlined the equal importance of followership for successful surgery. This evolution can be considered as sluggish within the field of perioperative care. According to empirical evidence one reason could be the inherent promotion of vertical climbing of the pyramid of hierarchy within surgery rather than a horizontal process-oriented approach. Intimidation and harassment have been described as functional educational tools in surgical education Musselman et al. 2005 . The authors found that intimidation was sustained in the surgical education by encapsulation and rationalizing the behaviour to good or beneficial intimidation. These fundamental values in the surgical community towards education have no doubt served as conservers of the old system. This mastery of teamwork can be developed and .
