Learning Outside the Box: Why Surgical Safety Begins with Human Factors

Jo Williams Cody EdDs, M.Ed, BSST, CST, FAST, AAS, Surgical Technology Program Director, Pima Medical Institute

An experienced surgical education leader at Pima Medical Institute, Jo Williams Cody drives program excellence through rigorous curriculum design, clinical integration, and student-centered leadership. She champions teamwork, innovation, and high certification outcomes while strengthening industry partnerships and academic standards.

Moving beyond technical skills to build stronger OR teams through experiential education

The operating room is a crucible. Its where high stakes, time pressure, and human variability collide. We spend countless hours perfecting technical skills” the precision of a suture, the sterility of a field, the mastery of a new device. And while that technical prowess is non-negotiable, research consistently points to a different truth: the most significant contributors to errors in the OR aren't technical failures. They are human factors.

If our goal is safer surgeries and stronger, more resilient teams, we must fundamentally rethink how we educate perioperative professionals. We need to move beyond the textbook and the checklist. We need to start learning outside the box.

The Invisible Drivers of Performance

When we talk about human factors, we are talking about the invisible drivers of every action in the room: communication (or the lack of it), situational awareness, fatigue, cognitive load, stress, and the unspoken weight of hierarchy.

Surgical Technologists don’t just pass instruments; they operate at the very center of these dynamics. They anticipate a surgeons next move, maintain a sterile field, and coordinate with nurses” all while managing their own human limitations. You can’t teach someone to navigate a communication breakdown under pressure with a PowerPoint slide.

Learning outside the box means creating experiences where learners feel the consequences of a missed assumption, the chaos of disrupted communication, or the hesitation caused by a hierarchical barrier. These aren’t lessons to be memorized for a test; they are visceral takeaways that change future behavior.

Teamwork Is a Deliberate Practice

We often treat teamwork as a personality trait” something you either have or you don’t. In healthcare, this is a dangerous assumption. Effective teamwork in the OR is a learned skill that requires deliberate, intentional practice.

Out-of-the-box learning challenges the idea that teamwork will magically appear once a student enters the clinical setting. Instead, we use simulated procedures, time-pressured drills, and unexpected complications to force collaboration. When a team must employ closed-loop communication during a simulated crisis or when a role-reversal exercise builds empathy between disciplines, they aren't just working in parallel. They are learning to function as a single, cohesive unit.

For the Surgical Technologist, this type of training validates their role as more than just a technician. It reinforces their position as an active communicator, a safety advocate, and an anticipatory thinker who is an equal contributor to the patients outcome.

Breaking the Hierarchy Through Experience

Perhaps the most complex human factor in the OR is hierarchy. A clear chain of command is necessary, but a rigid hierarchy can become a wall that silences the very voices that might prevent an error.

Experiential learning is the key to breaking down these walls. By creating a psychologically safe environment in a simulation lab, we give students and professionals permission to practice speaking up. They learn how to question a decision, advocate for the patient, or voice a concern without fear. When they rehearse these behaviors in a simulated environment, that confidence carries over. They walk into the real OR, not with diminished respect for authority, but with the tools to enhance the entire teams performance.

From the Ideal to the Real

Traditional education often prepares students for the ideal version of surgery” the one where everything goes according to plan. Learning outside the box prepares them for reality.

By integrating human factors and teamwork into every aspect of experiential learning, we are building a workforce that can:

• Adapt when the plan changes in an instant.

• Recognize the early warning signs of error before they escalate.

• Support one another when the pressure mounts.

• Prioritize patient safety above ego or routine.

This approach transforms education from a simple transfer of knowledge into a true professional formation. It acknowledges that excellence in the OR isn't just about what you know, but about how you think, how you communicate, and how you work together.

We design complex simulations and high-fidelity labs to prepare the hands for surgery. Now, its time to be just as intentional about preparing the humans behind them. That is where true learning” and true surgical safety” begins.

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