Surgical Adaptation of the Situation Awareness Rating Technique (S-SART): Assessing Situational Awareness Among Medical Students

Jie Jane Chen; Annika Gompers; Amy Evenson; Benjamin C James; Celeste Royce

doi:10.1016/j.jsurg.2022.09.015

Surgical Adaptation of the Situation Awareness Rating Technique (S-SART): Assessing Situational Awareness Among Medical Students

J Surg Educ. 2023 Feb;80(2):216-227. doi: 10.1016/j.jsurg.2022.09.015. Epub 2022 Oct 19.

Authors

Jie Jane Chen¹, Annika Gompers², Amy Evenson³, Benjamin C James³, Celeste Royce⁴

Affiliations

¹ Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, University of California, San Francisco, California. Electronic address: JieJane.Chen@ucsf.edu.
² Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
³ Harvard Medical School, Boston, Massachusetts; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
⁴ Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

PMID: 36270915
DOI: 10.1016/j.jsurg.2022.09.015

Abstract

Objective: Situational awareness (SA) impacts team dynamics and patient care. However, few formal curricula and tools exist to teach and assess longitudinal SA in surgical environments. We sought to evaluate medical students' SA in the operating room (OR) during surgical clerkships over time.

Design: We prospectively administered pre- and post-rotation surveys using a surgical adaptation of the previously validated Situation Awareness Rating Technique (SART). Surgical SART (S-SART) scores were calculated as: Situational Awareness = Understanding - (Attentional Demand - Attentional Supply) + 14. Each of 10 questions was scored from 1 to 7, with a maximum possible score of 60. Two-tailed two-sample and paired t-tests were conducted to determine differences in S-SART scores.

Participants/setting: Sixty-nine of 75 second- and third-year medical students rotating in Surgery and Obstetrics/Gynecology clerkships at a tertiary academic medical center from September 2018 to September 2019 completed the surveys for a response rate of 92.0%.

Results: The mean baseline pre-rotation baseline S-SART score was 29.5 (SD=8.3), which increased by 20.9% to 35.9 (SD=6.9) post-rotation (p<0.001). Significant predictors of higher baseline S-SART scores included age ≥25 (p=0.02), surgical career interest (p=0.01), completion of prior surgical rotations (p<0.001), confidence about pre-procedural OR steps (p<0.001), and knowledge of OR item locations (p<0.001). There were increases in each of the subdomains of Understanding-including OR familiarity (3.2 to 4.3, p<0.001), knowledge of the medical student OR role (3.5 to 5.7, p<0.001), and knowledge of others' OR roles (4.1 to 5.9, p<0.001)-along with increases in alertness within Attentional Supply (5.1 to 5.5, p=0.001).

Conclusions: SA is a learnable skill with increases in S-SART scores from pre- to post-rotation, with the greatest gains in the domain of Understanding. More advanced aspects of SA such as Attentional Demand may require further surgical training or curricular innovations to address these needs.

Keywords: Situational awareness; assessment; cognitive load; curricula; operating room; surgical.

MeSH terms

Awareness
Curriculum
Gynecology* / education
Humans
Obstetrics* / education
Students, Medical*