Safer Surgery part 40. 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. | 364 Safer Surgery Table Non-technical skills in the first simulation series Mean NOTECHS subscale rating standard deviation Communication Vigilance Teamworking Leadership Decisionmaking Trainer Trainee ratings were not significantly different from trainee surgeons self-ratings t 37 p thus indicating agreement in the assessment of skill. In the second series of simulations decision-making was rated significantly lower than all other skills all ps . Moreover there was a significant pre-post training improvement in the ratings of decision-making for the surgical trainees M F 1 15 p . Taken together these studies suggest that simulation-based team training is feasible and has great potential as a training tool. From the decision-making perspective simulations offer a unique environment in which the skill can be observed and assessed in action - in other words in a dynamic fluid potentially stressful but safe training environment. v Concluding Remarks Surgical decision-making is an important but under-researched field. The aim of the present chapter was to discuss the characteristics of surgical decision-making highlight how some behavioural and naturalistic decision research approaches can be applied to surgery and finally present empirical work that has been carried out by our research team to date to assess decision-making processes and decisionmaking as a skill in surgery. We presented empirical applications of three different approaches to surgical decision-making - namely knowledge elicitation from experts experimentation and modelling using Judgement Analysis JA and finally simulation-based assessment of and training in decision-making among other non-technical skills . All approaches yielded promising findings. Knowledge elicitation resulted in the representation of the care pathway for patients presenting with .
