Training Nontechnical Skills in Ward Rounds to Improve Team Performance

Abstract

To assess the utility of simulated ward rounds to train healthcare professionals in nontechnical skills using a qualitative analysis of participant feedback. We developed simulated scenarios to train members of the surgical healthcare team in nontechnical skills, derived from observations of real ward rounds. Participants performed the simulated ward rounds as a team, led by a Urology trainee. Scenarios were carried out using actors as patients, and a simulated "switchboard" for phone conversations. Throughout the scenarios, distractions were introduced and directed at different members of the participating team. Following each scenario, a whole group debrief took place to discuss and provide feedback on performances. All participants completed a 2-part feedback form comprising of questions answered on a Likert scale, as well as free-text responses. All simulations took place in a high-fidelity simulated ward bay. Observers were in a separate room, where the scenarios were projected on a screen in real-time. Thirty-five healthcare professionals in the department of Urology attended this session. There was no restriction on professional background or seniority for attendees. The qualitative thematic analysis revealed that participants commented positively on the type of scenarios, but would have preferred if more participants could partake in scenarios. The attendees also commended the use of debriefs between scenarios. Suggestions were also given regarding types of scenarios; and involved ensuring that participants are well briefed before each scenario. This simulated ward round exercise was positively received by participants. The approach to derive scenarios from real ward round observations permitted a variety of the main themes of nontechnical skills to be tested, and improved the fidelity of the simulation. The reflections expressed by participants demonstrate a need for this training, and drives our initiative to raise awareness and develop nontechnical skills in a controlled environment, supported with transparent discussion and feedback.