Categories Of Non-technical Skills Research Articles

A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues.

Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.

A Delphi study identifying operating room nurses' non-technical skills.

To identify the non-technical skills of operating room nurses. This is the first empirical study that includes scrub and circulating operating room nurses. A three-round modified online Delphi technique was used for this study. Eligible participants (n=106) with a minimum of 2years of operating room nursing experience were selected for the expert panel by self-recruitment from a population (N=1640) of operating room nurses. Data were collected through online surveys, based on crew recourse management theory, between April and September 2020. Descriptive statistics analysis was used for the quantitative data, and deductive thematic analysis for the qualitative data. Consensus was determined using stability between the survey rounds. A consensus was obtained to maintain the non-technical skills categories of situation awareness, leadership, decision-making, communication and teamwork. The qualitative data revealed several novel non-technical skills, including independent decision-making and leadership skills. The non-technical skills of operating room nurses are more extensive than previously identified. This study has contributed to a verbalization of the tacit knowledge and skills of the operating room nurses. In addition, a list of non-technical skills that should be included in the education of operating room nurses to ensure patient safety in the operating room has been prepared. This study addresses the lack of research on the non-technical skills of operating room nurses. When exploring the non-technical skills of scrub and circulating nurses, a diversity of novel non-technical skills was uncovered. This research will provide input for the development of a new training, supervision and assessment tool for accelerated development of the non-technical skills of operating room nurses. This contribution to the verbalization of the formerly tacit non-technical skills may facilitate clinical and formal teaching of such skills and may subsequently impact surgery-related patient safety.

Comprehensive Literature Search to Identify Assessment Tools for Operating Room Nontechnical Skills to Determine Common Critical Components.

Effective use of nontechnical skills (NTS) contributes to the provision of safe, quality care in the fast-paced, dynamic setting of the operating room (OR). Inter-professional education of NTS to OR team members can improve performance. Such training requires the accurate measurement of NTS in order to identify gaps in their utilization by OR teams. Although several instruments for measuring OR NTS exist in the literature, each tool tends to define specific NTS differently. We aimed to determine commonalities in defined measurements among existing OR NTS tools. We undertook a comprehensive literature review of assessment tools for OR NTS to determine the critical components common to these instruments. A PubMed search of the literature from May 2009 to May 2019 combined various combinations of keywords and Medical Subject Headings (MeSH) related to the following subjects: teamwork, teams, assessment, debriefing, surgery, operating room, nontechnical, communication. From this start, articles were selected describing specific instruments. Three reviewers then identified the common components measured among these assessment tools. Reviewers collated kin constructs within each instrument using frequency counts of similarly termed and conceptualized components. The initial PubMed search produced 119 articles of which 24 articles satisfied the inclusion criteria. Within these articles, 10 assessment tools evaluated OR NTS. Kin constructs were grouped into six NTS categories in the following decreasing frequency order: communication, situation awareness, teamwork, leadership, decision making, andtask management/decision making (equal). NTS OR assessment tools in the literature have a variety of kin constructs related to the specific measured components within the instruments. Such kin constructs contain thematic cohesion across six primary NTS groupings with some variation in scale and scope. Future plans include using this information to develop an easy-to-use assessment tool to assist with debriefing in the clinical environment.

Assessing Medical Students' Nontechnical Skills Using Immersive Simulation: What Are the Essential Components?

Nontechnical skills (NTS) have been acknowledged to be important for medical students and can be linked to improved clinical performance. However, existing tools to evaluate these within a simulated setting address only a limited number of NTS. The Medical Students' Nontechnical Skills (Medi-StuNTS) behavioral marker system (BMS) outlines 5 categories of NTS for medical students. This study aimed to seek evidence for completeness and content validity to refine the BMS and to ascertain which NTS are essential for medical students. We asked 128 workshop participants if they felt there were any missing or irrelevant items in Medi-StuNTS system. A subject matter expert panel (n = 10) rated how essential they considered each item in the BMS. An Item-Content Validity Index was calculated for each skill element and the Scale-Content Validity Index was calculated as a measure of content validity of the full system. Of the workshop participants, 78.9% felt that there were no missing items and 93% felt that there were no irrelevant items. Potentially missing items highlighted were as follows: "working in a hierarchy," "leadership," "awareness of the emotional state of other team members," and "nonverbal communication." Fourteen of 16 skill elements achieved the recommended level for content validity (Item-Content Validity Index ≥ 0.78), and the Scale-Content Validity Index was higher than the acceptable level (≥0.8). Evidence for completeness and content validity of Medi-StuNTS has been demonstrated. There is a far wider range of NTS that seem to be essential for medical students than those assessed by tools developed before Medi-StuNTS. Medi-StuNTS provides comprehensive cover of the essential NTS required by medical students, with specific reference to the skill categories "self-awareness" and "escalating care," which do not feature in other tools for assessing NTS in this group.

Exploring undergraduate nursing student interactions with virtual patients to develop \u2018non-technical skills\u2019 through case study methodology

BackgroundVirtual patients are a recent addition to the educational arsenal to develop non-technical skills in undergraduate health professionals. The Virtual Simulated Patient Resource (www.vspr.net.au) is a web-based resource that uses branching, narrative virtual patients to develop knowledge, attitude and practice of all categories of non-technical skills in undergraduate health professionals. However, there is limited literature exploring how the interaction with a virtual patient influences the development of knowledge, attitude and practice of non-technical skills in undergraduate nursing students.MethodsAn intrinsic case study method, using focus groups and individual interviews, enabled exploration of the experience of undergraduate nursing students when interacting with a virtual patient to develop non-technical skills. Purposive sampling identified participants to address the research question. Framework analysis supported by a codebook enabled deductive and inductive data analysis.ResultsForty-five first-year and 31 third-year students consented to participate. Findings indicated that the different years interacted differently with the virtual patients. Four themes were recognised in the data: how the virtual patients enabled learning non-technical skills, learning surrounding the virtual patient encounter, changing the way students perceive practice and potential limitations to learning.ConclusionsInteractions with virtual patients influence learning knowledge, attitudes and practice of non-technical skills in undergraduate nursing students via authenticity in the virtual patient interaction, socialisation to the professional role, vicarious learning and learning by making mistakes. Potential limitations to learning from virtual patient interactions include fear, overconfidence, groupthink and confusion. To manage limitations to learning, facilitation approaches, opportunities for reflection, constructive feedback and debriefing may be key. This study demonstrates learning non-technical skills via interactions with virtual patients can change the way students perceive practice, with learning transferable to the clinical setting to support safe and competent patient care.

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<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<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.

The Essence of Nursing

Learning nontechnical skills has been recognized to play an important role in enhancing patient safety. This study aimed to synthesize the available evidence regarding nontechnical skills training to enhance patient safety in undergraduate nursing education. We identified the following important categories of nontechnical skills: communication, situational awareness, teamwork, decision-making, and leadership. Future studies need to focus on more rigorous study designs and methodologies and on evaluation systems using high-level outcome measures.

What non-technical skills competencies are addressed by Australian standards documents for health professionals who work in secondary and tertiary clinical settings? A qualitative comparative analysis

ObjectivesAt minimum, safe patient outcomes are recognised as resulting from a combination of technical and non-technical skills. Flin and colleagues provide a practical framework of non-technical skills, cognitive, social and...

Nontechnical Skills Training and Patient Safety in Undergraduate Nursing Education: A Systematic Review

Learning nontechnical skills has been recognized to play an important role in enhancing patient safety. This study aimed to synthesize the available evidence regarding nontechnical skills training to enhance patient safety in undergraduate nursing education. We identified the following important categories of nontechnical skills: communication, situational awareness, teamwork, decision-making, and leadership. Future studies need to focus on more rigorous study designs and methodologies and on evaluation systems using high-level outcome measures.

Medical Students’ Non-Technical Skills (Medi-StuNTS): preliminary work developing a behavioural marker system for the non-technical skills of medical students in acute care

IntroductionGood non-technical skills (NTS) are critical to the delivery of high-quality patient care. It is increasingly recognised that training in such skills should be incorporated into primary medical training curricula. This study aimed to develop an NTS behavioural marker system (BMS), specifically applicable to medical students, for use within simulated acute care scenarios.MethodsThe methodology used to develop other BMS was adopted and modified. Following ethical approval, 16 final year medical students participated in acute care simulated scenarios. Semistructured interviews were performed to gauge the understanding of NTS. A panel meeting of subject matter experts was convened to translate key NTS into skill elements and observable behaviours. A second expert panel was consulted to refine aspects of the BMS. Further refinement and initial face validity was undertaken by a third panel of experts using the prototype BMS to observe prerecorded simulation scenarios.ResultsFive categories of NTS were identified: situation awareness, teamwork and communication, decision-making and prioritisation, self-awareness, and escalating care. Observable behaviours in each category describe good and poor performance. Escalating care was identified as a unique component that incorporated behaviours related to each of the other four skill categories. A 5-point rating scale was developed to enable both peer-to-peer and tutor-to–student feedback.ConclusionThe Medi-StuNTS (Medical Students’ Non-Technical Skills) system is the first BMS for the NTS of medical students. It reinforces the importance of escalating care effectively. It provides an exciting opportunity to provide feedback to medical students and may ultimately aid their preparedness for professional practice.

Aiming for excellence - A simulation-based study on adapting and testing an instrument for developing non-technical skills in Norwegian student nurse anaesthetists.

There is increasing focus on building safety into anaesthesia practice, with excellence in anaesthesia as an aspirational goal. Non-technical skills are an important factor in excellence and improved patient safety, though there have been few systematic attempts at integrating them into anaesthesia nursing education. This study aimed to test the reliability of NANTS-no, a specially adapted behavioural marker system for nurse anaesthetists in Norway, and explore the development of non-technical skills in student nurse anaesthetists. The pre-test post-test design incorporated a 10-week simulation-based programme, where non-technical skills in 14 student nurse anaesthetists were rated on three different occasions during high-fidelity simulation, before and after taking part in a training course. NANTS-no demonstrated high overall inter-rater reliability (ICC=0.91), high test-retest reliability (ICC=0.94) and good internal consistency (Cronbach's α of 0.85-0.92). A significant improvement was demonstrated across all categories of non-technical skills, with greatest improvements between the first and third and second and third sessions. There was also a significant improvement in two categories between the first and second sessions. NANTS-no is therefore suitable for assessing non-technical skills during simulation training in anaesthesia nursing education. More research is needed to validate its use in clinical practice.

A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation.

The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. A pre-post design was used. The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

Non-technical skills and health care provision in low- and middle-income countries: a systematic review.

Health care workers must possess high levels of medical knowledge, technical skills and also non-technical skills (NTS) in order to provide safe, effective and patient-centred care. Although there has been a recent proliferation of NTS assessment and training tools developed in high-income countries, little is known about NTS in low- and middle-income countries (LMICs), which face a variety of provider-level and system-level challenges. The aim of this study was to identify the NTS used by providers in LMICs that have been studied, describe how they are assessed and taught, and explain the contextual factors in LMICs that affect their use. We conducted a systematic literature review in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines for primary research publications from January 1994 to December 2013 on evaluation or teaching of NTS used by health care workers in LMICs using MEDLINE, Embase, CIHHAL and Web of Science. Bibliographies of relevant manuscripts were also hand-searched to identify all potentially eligible manuscripts. We identified 21 manuscripts from 17 LMICs involving eight types of health care providers and trainees. These studies covered five NTS categories: decision making, communication, teamwork, leadership and stress management. The most commonly used methods were questionnaires, interviews and observations, and 43% (n=9) scored >10 points using the Medical Education Research Study Quality Instrument. Although many studies highlighted the ways in which overburdened health care systems, lack of provider empowerment and deficiencies in provider training had an impact on providers' use of these NTS, no context-specific assessment or educational tools were identified. There is growing worldwide interest in understanding and teaching critical non-technical skills to health care providers. This review highlights several studies describing a variety of important non-technical skills. However, these skills must be further characterised in order to develop context-specific tools for assessing and teaching NTS that are sensitive to the local challenges that are common across a variety of LMIC contexts.

Which non-technical skills do junior doctors require to prescribe safely? A systematic review.

Prescribing errors are a major source of avoidable morbidity and mortality. Junior doctors write most in-hospital prescriptions and are the least experienced members of the healthcare team. This puts them at high risk of error and makes them attractive targets for interventions to improve prescription safety. Error analysis has shown a background of complex environments with multiple contributory conditions. Similar conditions in other high risk industries, such as aviation, have led to an increased understanding of so-called human factors and the use of non-technical skills (NTS) training to try to reduce error. To date no research has examined the NTS required for safe prescribing. The aim of this review was to develop a prototype NTS taxonomy for safe prescribing, by junior doctors, in hospital settings. A systematic search identified 14 studies analyzing prescribing behaviours and errors by junior doctors. Framework analysis was used to extract data from the studies and identify behaviours related to categories of NTS that might be relevant to safe and effective prescribing performance by junior doctors. Categories were derived from existing literature and inductively from the data. A prototype taxonomy of relevant categories (situational awareness, decision making, communication and team working, and task management) and elements was constructed. This prototype will form the basis of future work to create a tool that can be used for training and assessment of medical students and junior doctors to reduce prescribing error in the future.

Developing non-technical ward-round skills.

Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform. There is evidence that newly qualified doctors are not adequately prepared by their undergraduate experiences for this task. The aim of this study was to analyse the challenges pertaining to non-technical skills that students would face during ward rounds, and to create a model that facilitates the transition from medical student to doctor. A total of 217 final-year medical students completed a simulated ward round. Free-text responses were analysed using template analysis applying an apriori template developed from the literature by the research team. This drew on the generic categories of non-technical skills suggested by Flin etal. Ninety-seven percent of students agreed or strongly agreed that the simulated ward round improved their insight into the challenges of ward rounds and their perceived ability to work efficiently as an active member of the ward round. The responding students (206) submitted written feedback describing the learning that they planned to use: 800 learning points were recorded, and all could be categorised into one of seven non-technical skills. Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform We believe that improved task efficiency and insight into the challenges of the ward round gained by medical students will lead to an enhancement in performance during clinical rounds, and will have a positive impact on patient safety. We would suggest that undergraduate medical schools consider this model in the preparation for the clinical practice element of the curriculum.

The Role of Nontechnical Skills in Simulated Trauma Resuscitation

Trauma team training provides instruction on crisis management through debriefing and discussion of teamwork and leadership skills during simulated trauma scenarios. The effects of team leader's nontechnical skills (NTSs) on technical performance have not been thoroughly studied. We hypothesized that team's and team leader's NTSs correlate with technical performance of clinical tasks. Retrospective cohort study. Brigham and Women's Hospital, STRATUS Center for Surgical Simulation A total of 20 teams composed of surgical residents, emergency medicine residents, emergency department nurses, and emergency services assistants underwent 2 separate, high-fidelity, simulated trauma scenarios. Each trauma scenario was recorded on video for analysis and divided into 4 consecutive sections. For each section, 2 raters used the Non-Technical Skills for Surgeons framework to assess NTSs of the team. To evaluate the entire team's NTS, 2 additional raters used the Modified Non-Technical Skills Scale for Trauma system. Clinical performance measures including adherence to guidelines and time to perform critical tasks were measured independently. NTSs performance by both teams and team leaders in all NTS categories decreased from the beginning to the end of the scenario (all p < 0.05). There was significant correlation between team's and team leader's cognitive skills and critical task performance, with correlation coefficients between 0.351 and 0.478 (p < 0.05). The NTS performance of the team leader highly correlated with that of the entire team, with correlation coefficients between 0.602 and 0.785 (p < 0.001). The NTSs of trauma teams and team leaders deteriorate as clinical scenarios progress, and the performance of team leaders and teams is highly correlated. Cognitive NTS scores correlate with critical task performance. Increased attention to NTSs during trauma team training may lead to sustained performance throughout trauma scenarios. Decision making and situation awareness skills are critical for both team leaders and teams and should be specifically addressed to improve performance.

The human factor in agriculture: An interview study to identify farmers’ non-technical skills

BackgroundFarming represents a high risk occupation, responsible for several thousand worker injuries and fatalities worldwide per year. Research within other high risk industries, such as aviation, shipping and healthcare, has identified the importance of non-technical skills in maintaining effective performance and reducing the risk of an adverse event. The aim of the current study was to identify the categories of non-technical skills that are typically used by farmers. MethodA sample of 32 farmers, from within two geographical regions (Scotland and Northern Ireland), were interviewed using the critical incident technique. The interview transcripts were then coded using thematic analysis in order to identify reported non-technical skills. ResultsParticipants reported the daily use of a range of non-technical skills, these differed according to whether the farmer was working as part of a team or alone. Team non-technical skills were identified as: situation awareness, decision-making, leadership, teamwork and task management. Lone worker non-technical skills were identified as: situation awareness, decision-making and task management. ConclusionThe results indicate that non-technical skills are an important aspect of farmers’ work performance and safety; mirroring the findings reported within other high risk industries. Further research is required to validate the skill set suggested here, and to develop a behavioural marker system similar to that used in other industries.

Development of instruments for assessment of individuals’ and teams’ non-technical skills in healthcare: a critical review

Focus on patient safety has increased over the last decades; however, patient safety still relies on technology and the performance of healthcare professionals. Technology improves rapidly but despite numerous reports on how to improve the performance of healthcare professionals, this improvement has been more slow than expected. The performance of healthcare professionals is a product of each individual's medical knowledge, technical and non-technical skills as well as the settings in which these skills are used. Training and the assessment of non-technical skills for individuals or teams in healthcare have shown to improve a safe and efficient performance. However, the implementation has been slow. One reason for this might be the shortage of assessment instrument to assess individuals' and teams' non-technical skills. In this paper, we review the development process of 23 instruments for assessment of non-technical skills for individuals or teams within healthcare. The instruments are mainly for use in the operating room or for teams handling emergency situations. Several of the instruments are developed based on a thorough needs analysis by a team having the same professional background as the target group. Most of the instruments consist of almost the same categories of non-technical skills and many use behavioural markers. Overall, the instruments have been validated to some extent, but there is room for improvement. However, there seems to be a lack of training of the raters. The importance of providing feedback after the assessment is emphasised. The criteria on which the behavioural markers are developed should undergo continuous changes, representing the development of the patient safety culture in healthcare organisations.

Human-factors training for surgical trainees.

Shortcomings in non-technical skills have frequently been shown to play a role in adverse events during surgery. Human-factors training has an increasing role to play in enhancing patient safety and reducing medical errors. Programmes in non-technical skills are promoted by the surgical Royal Colleges in the UK and Ireland, and are currently aimed at consultants, senior trainees and theatre teams. Since 2009, the Severn Postgraduate Deanery School of Surgery in the UK has developed a 1-day human-factors training course specifically designed for junior surgical trainees. Analysis of post-course feedback on self-assessed confidence in the use of non-technical skills was undertaken for all junior surgical trainees undertaking the course in 2012/13. Thirty-three junior surgical trainees attended the 1-day human-factors training course. In all, 91 per cent of trainees reported that the course would change their practice. There was a statistically significant difference between the self-assessed confidence of trainees in the use of all four categories of non-technical skills (p ≤ 0.001) before and after the course. The Severn Deanery offers a compulsory human-factors training course for surgeons at the start of their career. Given the importance of reducing human error, maintaining patient safety and the introduction of competency-based training with an emphasis on simulation, human-factors training has a vital place in surgical training, and is highly recommended to others involved in training junior surgical trainees.

PL.18 Validation of a Skill List of Non-Technical Skills for Obstetricians when Performing an Operative Vaginal Delivery

Background Non-technical skills for obstetricians play a vital role in adequate patient care and combine social and cognitive elements that are separate from the practical skills involved in obstetric care....