Identifying the Unspoken: Development of an Evidence-Based Observational Tool to Explore Trace-Based Communication in Surgical Settings

Abstract

Trace-based communication refers to non-verbal actions that leave behind clues or signals, such as tool placement, markings, or environmental changes, that influence how surgical teams work together. This thesis presents a research study examining trace-based communication in the operating room. The purpose of this research study was to define and explore trace-based communication in the surgical operating room, as it is a relatively new phenomenon in medical education, despite being widely studied in the context of sociobiology. There was a clear need to derive a context-specific definition of trace-based communication. This study systematically developed and provided validity evidence for an observational tool to identify trace-based communication in surgical settings. Following a tailored approach of the seven-step design framework described in AMEE Guide No. 87, the tool was iteratively refined using qualitative analysis of three literature reviews, ten expert interviews, expert panel validation, three cognitive interviews, and five pilot-testing sessions. The research study was granted with an IRB exemption from the Office of Regulatory Affairs & Research Compliance at Harvard Medical School. The research findings indicate that the tool is clear and usable, with concerns about feasibility challenges when it comes to real-world surgical settings. Further research studies are needed to improve the modality and adaptability of the evidence-based tool in real-setting surgical operating room procedures, across different surgical domains, to identify and explore trace-based communication in medical education and healthcare.