Non-Technical Skills Training for Nigerian Surgical Teams: Which Way Forward?

Abstract

INTRODUCTION: The non-technical skills (NTS) of situational awareness, decision making, leadership, and communication and teamwork, are significant for enhancing surgical safety. Considered soft skills, they can be overlooked, particularly in low-income contexts. A survey was designed to explore exposure to NTS in north central Nigeria and identify felt needs for the design of a contextualized curriculum. METHODS: Six institutions with high surgical volumes, including private nonprofit and government-owned teaching hospitals, were purposively identified. Using snowball sampling through surgical team leads, a 19-item, web-based survey was distributed to 71 surgical providers, anesthetists and perioperative nurses between August and November 2021. Data were analyzed using proportions and Fisher’s exact test. RESULTS: The survey had a 95.7% completion rate. Respondents included 17 anesthetists, 21 perioperative nurses, and 29 surgeons. Over half were unaware of the concept of NTS, and 96% had never heard of a NTS framework for variable resource contexts. Only 8% had NTS training. Communication and teamwork was considered the most deficient personal skill (38, 57%), and most needed for team improvement (45, 67%). There was a high demand for training (64, 96%) motivated by expectations of improved patient safety and better team dynamics. Respondents preferred week-long, hybrid training courses with in-person and online components. Perceived barriers to attendance were time conflicts and costs. Facilitators included a desire for self-improvement and patient safety (Table). CONCLUSION: Surgical teams in north central Nigeria are strongly motivated for NTS training believing it can improve patient safety, team dynamics, and personal performance. Implementation should emphasize communication and teamwork. Table. - Barriers and Facilitators to Participating in Non-Technical Skill Training in Nigeria Themes Number Percentage Example phrases Barriers Hindrances from the perioperative and institutional work environment 40 59.7 Challenges with the “Release by my employer “; “Work stress”; Non-technical skills training may “Clash with normal duties” or be limited by “tight schedule of residency training programme”; “Scheduled time of training coinciding with work” Barriers Lack of funding to pay for non-technical skills courses 14 20.9 A barrier is “Cost”; “Financial constraints” Barriers Lack of access to non-technical skills courses, particularly if in-person 10 14.6 Limited access to courses due to the “Insecurity Nigeria is now experiencing”; “Poor Internet services in Nigeria”; “Distance if the program is not online” Facilitators The motivation of improved patient safety 34 50.7 “To improve patient outcomes”; “Quest for improvement in surgical outcome”; “Patient safety and satisfaction”; “achieving global excellence for the maximum patient benefit”; “Desire to improve surgical outcome for my patience”; “prevent errors during surgery” Facilitators A drive for self-improvement 18 26.9 Facilitated by a desire “To add value to myself”; “Skill acquisition “; “personal aim at achieving global excellence “; Desire to “To improve my skills and knowledge” Facilitators The motivation of experiencing an improved work environment 10 14.9 Motivated by “reduce toxicity in the Operating Room”; “Strengthening teamwork”; “To see the change in attitude of my colleagues and other workers”; “A better working relationship with other health professionals”; “Improving interpersonal relationships” Facilitators Funding and financial incentives for training 4 6.0 Non-technical skills training would be facilitated by “Sponsorship”; “Scholarship”; “Financial motivation” Facilitators Support from work hierarchy, and removal of workplace barriers 3 4.5 Facilitated by “Convenience”; “Permission from my work place” Facilitators The award of certificates of training or attendance 1 1.5 The award of a formal “certificate” of attendance or other certification in non-technical skills