Pears, Matthew (2021) Can Expert-level Cognition be Rapidly Acquired? The Effect of a Human Factors-based Virtual Reality Trainer on Non-Technical Skills in the Operating Theatre. Doctoral thesis, University of Huddersfield.


Restrictions to real-life experiences in surgical training can hinder skill acquisition. Factors such as large student-to-teacher ratios, equipment limitations, or pandemics can reduce access to expert cognition and pedagogical guidance that is required by novices. Additionally, high quality pedagogy from workshops, lectures, and boot camps are not accessible enough and cannot be attended during pandemic restrictions. Therefore, Non-Technical Skills (NTS) of Operating Theatre (OT) teams need more training content that can provide simulations for training purposes. Patient safety and undesired event prevention can be improved by a scenario-driven approach that is built upon practice and feedback to scaffold cognitive skills for OT trainees. An NTS virtual reality training tool was created and compared to existing theory-based content.


Eighty-two undergraduate surgical students were asked different scenarios and showed decision-making is not distinct as a factor of course year, to generally concur with previous findings. A Task Analysis of a surgical procedure and the OT environment was formed, and 3 experts in surgery were interviewed with thematic analysis of data. The design and creation of the virtual reality instrument then occurred with 360-degrees OT videos. Then, a two groups comparison of a one-hour session with before, during, and after intervention measures compared 14 3rdyear operating theatre practitioners. Verbal Protocol Analysis (VPA) of the trainees’ sessions were paired with Situation Awareness Global Assessment Technique (SAGAT) scores and rankings for a written decision-making scenario. Post-session reflections were analysed using Interpretative Phenomenological Analysis(IPA)to understand how they experienced the materials and common occurrences between participants.


Thematic analysis of expert interviews revealed rich mental models, tacit knowledge, and purposeful augmentation of NTS as a countermeasure when teaching. This allowed insight into what non-technical elements were feasible when incorporated into a headset. The main VPA findings from the 14 OT trainees suggested significant increase of verbalization around Teamwork and Communication(p=0.028). Within this NTS category, significantly more verbalizations for shared mental models for the experimental condition occurred (p=0.018).Additionally, a significant increase in transformation of cue meaning to improve understanding of the environment occurred, compared to control condition (p=0.02).However, SAGAT scores showed no significant differences in 23 questions for both conditions, this may be a limit in both conditions’ presentation delivery as items in the videos are difficult to identify.


Significant results in specific and not all are as highlight complexities in NTS training but is a step towards improved support for OT staff to improve awareness and safety during surgery. Although supposed homogenous technical skills, large variations in participants’ decision-making strategies and perceptions of cues may have confounded the intervention effects. During intervention, the control condition used past experiences to contextually interpret theory to strengthen their schemata in more concrete rather than abstract forms. Real-life scenarios in the experimental condition reduced this need therefore applied their feedback to actual events shown, which may increase transfer of skill to real-life. More sessions over a longer period could observe stronger improvements in the same directions in the current results. Overall, the intervention was equal to or greater than the control condition promoting further research on a greater timeframe and audience.

FINAL THESIS - Pears.pdf - Accepted Version
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