Anaesthetists' Non-Technical Skills Research Articles

Impact of in situ simulation training on quality of postnatal stabilization and resuscitation—a before-and-after, non-controlled quality improvement study

This study aimed to evaluate the impact of in situ simulation-based training on quality indicators of patient care at a level IV neonatal intensive care unit. A before-and-after, non-controlled quality improvement study was performed at the Division of Neonatology, Medical University of Graz. The educational intervention comprised a period of 4 months, with structured in situ simulation training delivered regularly for neonatal providers and nurses in interprofessional teams. The primary study outcome was the quality of non-technical skills and team interaction during actual postnatal stabilization and resuscitation. This was assessed using video recording during two 2-month observational phases before (pre-training) and after the educational intervention (post-training). Delivery room video recordings were assessed by two external, blinded neonatologists using the Anaesthetists’ Non-Technical Skills (ANTS) score. Furthermore, we collected clinical patient data from video-recorded neonates during the pre- and post-training periods, and training participants’ individual knowledge of neonatal resuscitation guidelines was assessed using a before- and after-questionnaire. A total of 48 healthcare professionals participated in 41 in situ simulation trainings. The level of non-technical skills and team interaction was already high in the pre-training period, and it did not further improve afterwards. Nonetheless, we observed a significant increase in the teamwork event “evaluation of plans” (0.5 [IQR 0.0–1.0] versus 1.0 [1.0–2.0], p = 0.049). Following the educational intervention, training participants’ knowledge of neonatal resuscitation guidelines significantly improved, although there were no differences in secondary clinical outcome parameters.Conclusion: We have successfully implemented a neonatal in situ simulation training programme. The observed improvement in one teamwork event category in the post-training period demonstrates the effectiveness of the training curriculum, while also showing the potential of in situ simulation training for improving postnatal care and, ultimately, patient outcome. What is Known:• In situ simulation-based training is conducted in the real healthcare environment, thus promoting experiential learning which is closely aligned with providers’ actual work.• In situ simulation-based training may offer an additional benefit for patient outcomes in comparison to other instructional methodologies.What is New:• This observational study investigated translational patient outcomes in preterm neonates before and after delivery of high-frequency in situ simulation-based training at a level IV neonatal intensive care unit.• There was a significant increase in the frequency of one major teamwork event following the delivery of in situ simulation-based training, indicating a notable improvement in the non-technical skills domain, which is closely linked to actual team performance.

Development and applications of the Anaesthetists’ Non-Technical Skills behavioural marker system: a systematic review

ObjectivesTo comprehensively synthesise evidence regarding the validity and reliability of the Anaesthetists’ Non-Technical Skills (ANTS) behavioural marker system and its application as a tool for the training and assessment of...

Assessment of Anaesthesia Teams' Non-Technical Skills in Clinical Practice before and after Simulation-Based Team Training: A Quasiexperimental Study.

In situ simulation-based team training of non-technical skills is considered an important initiative for preventing adverse events caused by poor teamwork among healthcare personnel. This study aimed to assess the non-technical skills of anaesthesia personnel before and after in situ simulation-based team training in a clinical setting. The study was conducted from October 2020 to June 2021 using a quasiexperimental before and after design based on video-recorded observations and ratings of anaesthesia teams' non-technical skills during anaesthesia induction in the operating room before and shortly after in situ simulation-based team training. Anaesthesia personnel were divided into 20 teams and video recorded during anaesthesia induction. The Anaesthetists' Non-technical Skills (ANTS) system was used to score the teams' non-technical skills. A paired-sample t-test was used to assess the impact of the intervention on the anaesthesia teams' scores on the various ANTS categories. Interrater agreement between the two ANTS raters was assessed using weighted kappa. At the category level, the overall scores had a statistically significant increase in performance after simulation-based team training (3.48 vs. 3.71; p < 0.001). Furthermore, scores of five of the 15 elements were significantly different. Interrater agreement revealed moderate agreement between the two raters (weighted kappa = 0.51, p value <0.001). The anaesthesia teams' increased non-technical skills after simulation-based team training may indicate the transfer of knowledge from training to clinical practice. The moderate agreement between the raters could be attributed to the subjective nature of the evaluation procedure. The ANTS was originally used as an individual assessment tool; however, this study has demonstrated its potential as a team assessment tool.

Are Technical Skills Assessed Using Medical Knowledge Associated with Non-technical Skill Knowledge in Anaesthesia Resident Training?

Objective: We examined the association between midterm examinations and anaesthetists’ non-technical skills (ANTS) knowledge using multiple choice questions (MCQs) for anaesthesia training.&#x0D; Materials and Methods: A prospective cross-sectional study was implemented based on two cohort studies conducted in November 2017 and November 2019 at the university hospital in southern Thailand. Each cohort consisted of MCQs, short answer questions (SAQs), objective structured clinical examinations (OSCEs), and MCQs after ANTS simulation workshops during the midterm examinations. The main exposure variable was the midterm examination (MCQs/ SAQs/ OSCEs) whereas the ANTS MCQs were the outcome. The potential predictors were the residents’ role, sex, PGY (1-3), and competency. Associations between midterm examinations and ANTS MCQ scores were analysed using Pearson’s correlation coefficients (r) and multivariate linear regression analysis, and presented as beta coefficient (β) and 95% confidence limit (CL).&#x0D; Results: Forty-eight anaesthesia residents were recruited for the study. After adjusting for PGY, knowledge score, and attitude evaluated by the staff, OSCE was found to be significantly associated with the pretest ANTS scores (β [95% CL]= 1.02 (0.06, 1.98)) and MCQ scores were significantly associated with the posttest ANTS scores (β [95% CL]= 0.14 (0.04, 0.24)). SAQ scores had negative associations with the pretest (β [95% CL]=-0.11 (-0.21, -0.01)) and posttest (β [95% CL]=-0.16 (-0.27, -0.05)) ANTS scores. It was found that there was a significant relationship between midterm examinations and posttest ANTS scores (r=0.52).&#x0D; Conclusion: Technical skills using OSCE and midterm MCQ examination scores were associated with non-technical skill knowledge in anaesthesia training.

Development and applications of the anaesthetists’ non-technical skills behavioural marker system: protocol for a systematic review

IntroductionThe high incidence of unsafe anaesthetic care leads to adverse events and increases the burden on patient safety. An important reason for unsafe anaesthesia care is the lack of non-technical...

Virtual Immersion into a Poorly-Managed Medical Crisis Worsens Subsequent Performance: A Randomized, Controlled Trial

BackgroundThis study aimed to determine effects of a 360-head mounted display (360-HMD) simulation demonstrating poor behaviors on non-technical skills (NTS) in nurses. MethodsA prospective comparative study was conducted. The intervention group viewed a 360-HMD video displaying poor NTS and were introduced to Anaesthetists’ NTS (ANTS) and behaviorally anchored rating scales (BARS). The control group was only introduced to scales. Both groups then completed in-person simulations. ResultsNTS simulation performance in the 360-HMD group was lower than the control, (ANTS: -2.80, p = 0.0004; BARS: -5.80, p = 0.0005). ConclusionHMD modeling of poor behaviors predicted worse in-person performance in a simulated context.

Scenario-based simulation and debriefing sessions can potentially improve non-technical skills in nurse anesthetist students of Iran; A quasi-experimental study

Background: Technical skills refer to all practical abilities necessary for surgery or anesthesia. Non-technical skills (Task management, Team-working, Situation-awareness, and Decision-making) are abilities accelerate the individuals' adaptability in critical anesthetic situations. Simulation (a type of unreal simulated education similar to the real situation in which the learner can achieve clinical experiences using human models) and debriefing sessions (a method of education in which the learners have a discussion about what they have learned during simulation) are educational protocols for non-technical skills improvement. Thus, in the current quasi-experimental study, we aimed to investigate the effects of scenario-based simulation and debriefing sessions on the development of non-technical skills among nurse anesthetist students (Hamadan, Iran). Methods: Nurse anesthetist students (n = 60) were categorized into control (n = 30) and test (n = 30) groups. Anesthesia induction was simulated by an anesthesiologist for students in a practice hall. Immediately, debriefing sessions were held to improve non-technical skills. A week later, the Anaesthetists' Non-Technical Skills (ANTS) checklist was hired, and non-technical skills were scored. Collected data were analyzed (SPSS v.16.0) and represented as Mean ± SD. P-value < 0.05 was also considered a significant level. Results: Significantly (p < 0.05), following simulation and debriefing interventions, non-technical skills were improved, including Task management (mean ANTS score: 11.13 ± 2.87 and 14.53 ± 2.20 in control and test, respectively), Team-working (mean ANTS score: 10.42 ± 3.20 and 14.93 ± 2.19 in control and test, respectively), and Situation-awareness (mean ANTS score: 9.62 ± 4.30 and 13.20 ± 2.86 in control and test, respectively) skills. Besides, Decision-making skills represented no significant (p = 0.299) alteration after the intervention (mean ANTS score: 5.81 ± 2.75 and 4.73 ± 2.55 in control and test, respectively). Conclusions: Scenario-based simulation training and debriefing sessions, as the proposed educational curriculum, can promote non-technical skills during anesthesia induction in nurse anesthetist students leading to improvement of patient safety and prevention of medical profession errors.

Validity of scoring systems for the assessment of technical and non-technical skills in ophthalmic surgery-a systematic review.

Evaluation and recommendation of the scoring systems for technical skills (TS) and non-technical skills (NTS) assessments in ophthalmic surgery. A literature search was performed between December 2019 and May 2020. Studies describing the development or validation of TS or NTS scoring systems in ophthalmic surgery were included. Only scoring systems for completion by hand were included. The primary outcome was the validity and reliability status for each scoring system. The secondary outcome was recommendation based on modified Oxford Centre for Evidence-Based Medicine guidelines. Nineteen and five scoring systems were identified for TS and NTS respectively. TS scoring systems exist for cataract surgery (including the steps of phacoemulsification and paediatric cataract surgery) ptosis, strabismus, lateral tarsal strip, vitrectomy, and intraocular surgery in general. NTS scoring systems apply to cataract surgery or ophthalmic surgery in general. No single scoring system satisfied all validity and reliability measures. The recommended TS scoring systems are 'International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubrics' (ICO-OSCAR) for phacoemulsification, strabismus and paediatric cataract surgery, and 'Objective Structured Assessment of Cataract Surgical Skill' (OSACSS). Non-Technical Skills for Surgeons (NOTSS), Observational Teamwork Assessment for Surgery (OTAS) and Anaesthetists Non-Technical Skills (ANTS) are recommended for NTS. There is a paucity of NTS scoring systems. Further research is required to validate all scoring systems to consistent standards. Limitations of the assessment tools included infrequent quantification of face and content validity, and inconsistency in terminology and statistical methods between studies.

Anaesthetic nurse training in South Africa and the role of the anaesthetist

One night during a polytrauma theatre case, I asked the anaesthetic nurse to run a blood gas analysis in a nearby intensive care unit. He returned with saline, glucose and insulin, announcing from the door that “we need to crank up the respiratory rate a bit and shift the potassium”. To me, that was the embodiment of the anaesthetic nurse. He referred to “we” because he saw himself as part of the team. In that one moment, he displayed not only his knowledge of physiology and pharmacology but every category of non-technical skill defined in the anaesthetists’ non-technical skills (ANTS) framework – teamwork, situational awareness, task management and decision-making. Of course it was not his first day on the job. He drew on years of experience, training and inquisitive self-learning.

Nontechnical Skills (NTS) in the Undergraduate Surgical and Anesthesiology Curricula: Are We Adequately Preparing Medical Students?

Nontechnical skills (NTS) encompass interpersonal, cognitive, and personal resource skills that can mitigate surgical errors and improve patient outcomes. However, inconsistencies in medical student awareness around NTS suggest limited exposure to these skills. This study aimed to determine the prevalence and content of NTS in medical school surgery and anesthesiology education. Learning objectives from clerkship core surgery and anesthesiology rotations were collected from Canadian anglophone medical schools. Two raters independently classified each objective under one of the Non-Technical Skills for Surgeons (NOTSS) or Anaesthetists' Non-Technical Skills (ANTS) "Categories" and "Elements" of NTS, or as a non-NTS objective. Rater disagreements were resolved by group consensus. Group discussion was also held to identify examples of objectives that could help develop future curricula. Descriptive statistics were used to determine the number of NTS objectives from each school and within each NOTSS and ANTS Categories and Elements. Learning objectives were obtained from 12 out of 14 Canadian medical schools. A total of 2116 surgery objectives and 571 anesthesiology objectives were reviewed. Of these, 16 (0.76%) and 26 (4.55%) were identified as NTS objectives in surgery and anesthesiology, respectively. Of the NOTSS and ANTS Categories, "Situation Awareness" and "Decision Making" were represented by only one objective each in both specialties. Approximately half of the NOTSS and ANTS Elements were not represented by a single objective. Group discussion yielded examples of NTS objectives that were excellent, could use improvement, or were too vague to be classified as NTS. A paucity of objectives in the clerkship perioperative curricula involve NTS. These findings suggest that NTS are unlikely being adequately introduced as critical skillsets of surgeons and anesthesiologists in undergraduate perioperative education. Future curriculum development should involve greater medical student exposure to NTS as key components of their surgery and anesthesiology education.

Effect of Computer Debriefing on Acquisition and Retention of Learning After Screen-Based Simulation of Neonatal Resuscitation: Randomized Controlled Trial.

BackgroundDebriefing is key in a simulation learning process.ObjectiveThis study focuses on the impact of computer debriefing on learning acquisition and retention after a screen-based simulation training on neonatal resuscitation designed for midwifery students.MethodsMidwifery students participated in 2 screen-based simulation sessions, separated by 2 months, session 1 and session 2. They were randomized in 2 groups. Participants of the debriefing group underwent a computer debriefing focusing on technical skills and nontechnical skills at the end of each scenario, while the control group received no debriefing. In session 1, students participated in 2 scenarios of screen-based simulation on neonatal resuscitation. During session 2, the students participated in a third scenario. The 3 scenarios had an increasing level of difficulty, with the first representing the baseline level. Assessments included a knowledge questionnaire on neonatal resuscitation, a self-efficacy rating, and expert evaluation of technical skills as per the Neonatal Resuscitation Performance Evaluation (NRPE) score and of nontechnical skills as per the Anaesthetists’ Non-Technical Skills (ANTS) system. We compared the results of the groups using the Mann-Whitney U test.ResultsA total of 28 midwifery students participated in the study. The participants from the debriefing group reached higher ANTS scores than those from the control group during session 1 (13.25 vs 9; U=47.5; P=.02). Their scores remained higher, without statistical difference during session 2 (10 vs 7.75; P=.08). The debriefing group had higher self-efficacy ratings at session 2 (3 vs 2; U=52; P=.02). When comparing the knowledge questionnaires, the significant baseline difference (13 for debriefing group vs 14.5 for control group, P=.05) disappeared at the end of session 1 and in session 2. No difference was found for the assessment of technical skills between the groups or between sessions.ConclusionsComputer debriefing seems to improve nontechnical skills, self-efficacy, and knowledge when compared to the absence of debriefing during a screen-based simulation. This study confirms the importance of debriefing after screen-based simulation.Trial RegistrationClinicalTrials.gov NCT03844009; https://clinicaltrials.gov/ct2/show/NCT03844009

Promoting anaesthesia providers' non-technical skills through the Vital Anaesthesia Simulation Training (VAST) course in a low-resource setting

BackgroundShort educational programmes are important in building global anaesthesia workforce capacity. The Vital Anaesthesia Simulation Training (VAST) course is a 3-day immersive simulation-based programme concentrating on core clinical challenges and non-technical skills required by anaesthesia providers in low-resource settings. MethodsThis mixed methods study prospectively evaluated the impact of VAST in Rwanda. Anaesthetists' Non-Technical Skills (ANTS) scores were quantitatively assessed for 30 course participants at three time points (pre-, post-, and 4 months after VAST). Qualitative data were gathered during focus groups (4 months after VAST) to learn of participants' experiences implementing new knowledge into clinical practice. ResultsThe ANTS total scores improved from pre- (11.0 [2.3]) (mean [standard deviation]) to post-test (14.0 [1.6]), and improvements were maintained at retention (14.2 [1.7]). A similar pattern was observed when data were analysed using the four ANTS categories (all P<0.001). The key theme that emerged during focus group discussions was that the use of cognitive aids and clinical algorithms, repeated and reinforced across simulated scenarios, encouraged a systematic approach to patient care. The participants attributed the systematic approach to improving their problem-solving skills and confidence, particularly during emergencies. They found value in well-functioning teams and shared decision-making. After VAST, the participants described empowerment to advocate for better patient care and system improvement. ConclusionsVAST offers a simulation-based training to anaesthesia providers working in low-resource settings. Skills retention and self-reported application of learning into the workplace reflect the scope of impact of this training.

Perioperative laryngospasm management in paediatrics: a high-fidelity simulation study

AimPaediatric anaesthesia is a very specialised domain lacking training during the traditional curriculum. The laryngospasm is a stressful and life-threatening event that requires immediate action. The main objective of this study was to assess the effect of knowledge of a simple algorithm on the management of laryngospasm by trainee anaesthetists and nurse anaesthetists during a high-fidelity simulation session.MethodResidents in paediatric anaesthesia and training nurse anaesthetists with similar curriculum were randomly allocated to undergo a simulation session of laryngospasm with the help of a simple algorithm administered to them 5 min before the simulation session (group A) or as taught in their curriculum (group C). The primary endpoint was the assessment score of laryngospasm management using 10 technical items (validated in experienced paediatric anaesthetists). Secondary endpoints were: the non-technical skills using the Anaesthetists' Non-Technical Skills (ANTS) score and timing of critical management steps. The correlation between the technical and non-technical scores was also studied. Data are expressed as median (range).Results72 participants (18 teams in each group) were included in this study. There was a statistically significant difference between group A and C on the primary endpoint: 8.5 (2–10) vs 5 (2–8), respectively (p&lt;0.0001). There was also a significant difference between the two groups for the ANTS score 12 (7–16) vs 8 (6–12), respectively (p&lt;0.0001). No difference in timing of management was observed. Finally, there was a strong correlation between the technical skills and all the non-technical skills categories in the A group.ConclusionA simple algorithm improved the technical and non-technical skills of students during the management of a simulated laryngospasm.

Human factors in preventing complications in anaesthesia: a systematic review.

Human factors in anaesthesia were first highlighted by the publication of the Anaesthetists Non-Technical Skills Framework, and since then an awareness of their importance has gradually resulted in changes in routine clinical practice. This review examines recent literature around human factors in anaesthesia, and highlights recent national reports and guidelines with a focus on team working, communication, situation awareness and human error. We highlight the importance of human factors in modern anaesthetic practice, using the example of complex trauma.

The use of a checklist improves anaesthesiologists’ technical and non-technical performance for simulated malignant hyperthermia management

BackgroundAnaesthesiologists may occasionally manage life-threatening operating room (OR) emergencies. Managing OR emergencies implies real-time analysis of often complicated situations, prompt medical knowledge retrieval, coordinated teamwork and effective decision making in stressful settings. Checklists are recommended to improve performance and reduce the risk of medical errors. This study aimed to assess the usefulness of the French Society of Anaesthesia and Intensive Care's (SFAR) “Malignant Hyperthermia” (MH) checklist on a simulated episode of MH crisis and management thereof by registered anesthesiologists. MethodsTwenty-four anaesthesiologists were allocated to 2 groups (checklist and control). Their technical performance in adherence with the SFAR guidelines was assessed by a 30-point score and their non-technical performance was assessed by the Anaesthetists’ Non-Technical Skills (ANTS) score. Every task completion was assessed independently. Data are shown as median (first-third quartiles). ResultsAnaesthesiologists in the checklist group had higher technical performance scores (24/30 (21.5–25) vs 18/30 (15.5–19.5), P=0.002) and ANTS scores (56.5/60 (47.5–58) vs 48.5/60 (41–50.5), P=0.024). They administered the complete initial dose of dantrolene (2mg/kg) more quickly (15.7 minutes [13.9–18.3] vs 22.4 minutes [18.6–25]) than the control group (P=0.017). However, anaesthesiologists deemed the usability of the checklist to be perfectible. ConclusionRegistered anaesthesiologists’ use of the MH checklist during a simulation session widely improved their adherence to guidelines and non-technical skills. This study strongly suggests the benefit of checklist tools for emergency management. Notwithstanding, better awareness and training for anaesthesiologists could further improve the use of this tool.

Validity evidence of non-technical skills assessment instruments in simulated anaesthesia crisis management.

We sought to evaluate the validity of two non-technical skills evaluation instruments, the Anaesthetists' Non-Technical Skills (ANTS) behavioural marker system and the Ottawa Global Rating Scale (GRS), to apply them to anaesthesia training. The content validity, response process, internal structure, relations with other variables and consequences were described for validity evidence. Simulated crisis management sessions were initiated during which two trained raters evaluated the performance of postgraduate first-, second- and third-year (PGY-1, PGY-2 and PGY-3) anaesthesia residents. The study included 70 participants, composed of 24 PGY-1, 24 PGY-2 and 22 PGY-3 residents. Both instruments differentiated the non-technical skills of PGY-1 from PGY-3 residents (P <0.05). Inter-rater agreement was measured using the intraclass correlation coefficient (ICC). For the ANTS instrument, the intraclass correlation coefficients for task management, team-working, situation awareness and decision-making were 0.79, 0.34, 0.81 and 0.70, respectively. For the Ottawa GRS, the intraclass correlation coefficients for overall performance, leadership, problem-solving, situation awareness, resource utilisation and communication skills were 0.86, 0.83, 0.84, 0.87, 0.80 and 0.86, respectively. The Cronbach's alpha for internal consistency of the ANTS instrument was 0.93, and was 0.96 for the Ottawa GRS. There was a high correlation between the ANTS and Ottawa GRS. The raters reported the ease of use of the Ottawa GRS compared to the ANTS. We found sufficient evidence of validity in the ANTS instrument and the Ottawa GRS for the evaluation of non-technical skills in a simulated anaesthesia setting, but the Ottawa GRS was more practical and had higher reliability.

Impact of sleep deprivation on anaesthesia residents’ non-technical skills: a pilot simulation-based prospective randomized trial

BackgroundSleep deprivation is common in anaesthesia residents, but its impact on performance remains uncertain. Non-technical skills (team working, situation awareness, decision making, and task management) are key components of quality of care in anaesthesia, particularly in crisis situations occurring in the operating room. The impact of sleep deprivation on non-technical skills is unknown. We tested the hypothesis that in anaesthesia residents sleep deprivation is associated with impaired non-technical skills. MethodsTwenty anaesthesia residents were randomly allocated to undergo a simulation session after a night shift [sleep-deprived (SLD) group, n=10] or after a night of rest [rested (R) group, n=10] from January to March 2015. The simulated scenario was a situation of crisis management in the operating room. The primary end point was a composite score of anaesthetists’ non-technical skills (ANTS) assessed by two blinded evaluators. ResultsNon-technical skills were significantly impaired in the SLD group [ANTS score 12.2 (interquartile range 10.5–13)] compared with the R group [14.5 (14–15), P<0.02]. This difference was mainly accounted for by a difference in the team working item. On the day of simulation, the SLD group showed increased sleepiness and decreased confidence in anaesthesia skills. ConclusionsIn this randomized pilot trial, sleep deprivation was associated with impaired non-technical skills of anaesthesia residents in a simulated anaesthesia intraoperative crisis scenario. Trial registrationNCT02622217.

Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises.

Deficiencies in non-technical skills (NTS) have been increasingly implicated in avoidable operating theatre errors. Accordingly, this study sought to characterize the impact of surgeon and anaesthetist non-technical skills on time to crisis resolution in a simulated operating theatre. Non-technical skills were assessed during 26 simulated crises (haemorrhage and airway emergency) performed by surgical teams. Teams consisted of surgeons, anaesthetists and nurses. Behaviour was assessed by four trained raters using the Non-Technical Skills for Surgeons (NOTSS) and Anaesthetists' Non-Technical Skills (ANTS) rating scales before and during the crisis phase of each scenario. The primary endpoint was time to crisis resolution; secondary endpoints included NTS scores before and during the crisis. A cross-classified linear mixed-effects model was used for the final analysis. Thirteen different surgical teams were assessed. Higher NTS ratings resulted in significantly faster crisis resolution. For anaesthetists, every 1-point increase in ANTS score was associated with a decrease of 53·50 (95 per cent c.i. 31·13 to 75·87) s in time to crisis resolution (P < 0·001). Similarly, for surgeons, every 1-point increase in NOTSS score was associated with a decrease of 64·81 (26·01 to 103·60) s in time to crisis resolution in the haemorrhage scenario (P = 0·001); however, this did not apply to the difficult airway scenario. Non-technical skills scores were lower during the crisis phase of the scenarios than those measured before the crisis for both surgeons and anaesthetists. A higher level of NTS of surgeons and anaesthetists led to quicker crisis resolution in a simulated operating theatre environment.

Evaluation of a Simpler Tool to Assess Nontechnical Skills During Simulated Critical Events.

Management of critical events requires teams to employ nontechnical skills (NTS), such as teamwork, communication, decision making, and vigilance. We sought to estimate the reliability and provide evidence for the validity of the ratings gathered using a new tool for assessing the NTS of anesthesia providers, the behaviorally anchored rating scale (BARS), and compare its scores with those of an established NTS tool, the Anaesthetists' Nontechnical Skills (ANTS) scale. Six previously trained raters (4 novices and 2 experts) reviewed and scored 18 recorded simulated pediatric crisis management scenarios using a modified ANTS and a BARS tool. Pearson correlation coefficients were calculated separately for the novice and expert raters, by scenario, and overall. The intrarater reliability of the ANTS total score was 0.73 (expert, 0.57; novice, 0.84); for the BARS tool, it was 0.80 (expert, 0.79; novice, 0.81). The average interrater reliability of BARS scores (0.58) was better than ANTS scores (0.37), and the interrater reliabilities of scores from novices (0.69 BARS and 0.52 ANTS) were better than those obtained from experts (0.47 BARS and 0.21 ANTS) for both scoring instruments. The Pearson correlation between the ANTS and BARS total scores was 0.74. Overall, reliability estimates were better for the BARS scores than the ANTS scores. For both measures, the intrarater and interrater reliability was better for novices compared with domain experts, suggesting that properly trained novices can reliably assess the NTS of anesthesia providers managing a simulated critical event. There was substantial correlation between the 2 scoring instruments, suggesting that the tools measured similar constructs. The BARS tool can be an alternative to the ANTS scale for the formative assessment of NTS of anesthesia providers.

Effect of expertise on diagnosis accuracy, non-technical skills and thought processes during simulated high-fidelity anaesthetist scenarios.

The expert performance approach can be used to examine expertise during representative field-based tasks, while collecting process-tracing measures such as think-aloud verbal reports. Collecting think-aloud verbal reports provides an insight into the cognitive mechanisms that support performance during tasks. We examined the thought processes and performance of anaesthetists during simulated environments. Verbal reports of thinking and the anaesthetists' non-technical skills (ANTS) were recorded to examine cognitive processes, non-technical behaviours and diagnosis accuracy during fully immersive, high-fidelity medical scenarios. Skilled (n=6) and less skilled (n=9) anaesthetists were instructed to respond to medical scenarios experienced in theatre. Skilled participants demonstrated higher diagnosis accuracy and ANTS scores compared to less skilled participants. Furthermore, skilled participants engaged in deeper thinking and verbalised more evaluation, prediction and deep planning statements. The ability to employ an effective cognitive processing strategy, more efficient non-technical behaviours and superior diagnosis is associated with superior performance in skilled participants.