Non-technical Skills Training Research Articles

A Pilot Study Evaluating a Virtual Reality-Based Nontechnical Skills Training Application for Urology Trainees: Usability, Acceptability, and Impact

This study aimed to develop and evaluate a virtual reality (VR)-based nontechnical skills (NTS) training application for urology trainees and assess its effectiveness in improving their skills and confidence. A mixed-methods study was conducted to develop and evaluate a VR-based NTS training application for 32 urology trainees. The development process involved collaboration with 5 urology experts, 2 medical education specialists, and a human factors researcher. The study evaluated the application's usability, acceptability, and efficacy through 3 phases: scenario development with expert feedback integration, storyboarding and creation processes with facilitators and urology trainees, and a final evaluation by trainees. The data were collected during a 4-day urology boot camp in October 2022. Thirty-two urology trainees participated in the study and completed 2 VR scenarios designed to enhance their NTS skills RESULTS: The System Usability Scale (SUS) showed a moderate usability score of 66. The Training Evaluation Inventory (TEI) and additional feedback demonstrated positive effects on trainees' learning and confidence in their NTS abilities. Most participants found the application easy to use, and effective and they expressed interest in using similar VR applications for other aspects of surgical training. VR-based NTS training applications show potential for enhancing urology trainees' nontechnical skills. The integration of expert feedback and immersive technology offers a promising, accessible, and cost-effective solution to the challenges of delivering NTS training. Future research should explore the long-term impact of VR-based NTS training on trainees' performance and patient outcomes and consider incorporating advanced AI technologies for personalized and dynamic learning experiences.

Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate Students

Introduction: Non-technical skills (NTS) are essential to maintain best patient care and to enhance patient safety. Therefore, the early integration and implementation of non-technical skills (NTS) training during undergraduate medical education has not only been repeatedly emphasized but is crucial to ensure patient safety. However, there is a gap in knowledge on how to effectively convey and thereby enhance NTS in under- or postgraduate medical training. Although medical educators are eager to convey NTS, the best approach to do so is yet to be found. Next to didactic and teaching approaches, the design of the curriculum, in the sense of an integrated curricula, might have an influence in conveying NTS effectively. Therefore, we investigated if repetitive simulation-based training enhanced the NTS of medical undergraduates. Methods: 945 undergraduate students in their 1st, 2nd, 3rd and 4th year of medical studies who attended mandatory emergency simulation trainings at the medical faculty in Hamburg participated in this prospective observational study. The trainings are designed to align to a learning spiral (vertically integrated curriculum) and build upon each other, resulting in repetitive and advanced training. Each training has a preset training-specific standardized simulation scenarios. To determine progress in NTS performance, the NTS of the students were assessed during each training with the Anaesthesiology Students’ NTS (AS-NTS) taxonomy, which is composed of three dimensions. Differences in performance between the investigated cohorts of students were calculated with an analysis of variance (Welch’s ANOVA) and with a follow-up post hoc test (Games-Howell), and the significant differences were analysed. Results: The NTS of the undergraduate students improved with every ascending training and, hence, year of medical school. The overall NTS performance of the 4thyear undergraduate students differed significantly compared to the 1st, 2nd and 3rd year undergraduate students performances, F = 6.72 (4, 439.6), p ≤ 0.001. The greatest improvement was detected on dimension one of the AS-NTS (“Planning tasks, prioritising and problem-solving”) (F = 6.75 (4, 434.5), p ≤ 0.001), where 4th year undergraduates performed at a significantly higher skill level than the 1st, 2nd and 3rd year undergraduate students. On dimension two (“Teamwork and Leadership”) and three (“Team orientation”), significant differences were pronounced between the 4th year and 1st year undergraduate students (F = 3.56 (4, 442.9), p = 0.010; F = 4.50 (4, 441.0), p = 0.001). The lowest skill improvement was observed on dimension two. Conclusions: NTS are essential skills to complement technical skills and hereby ensure patient safety. The early longitudinal and vertical integration of NTS training in undergraduate medical curricula (learning spiral) is an effective approach to enhance and foster the NTS of future doctors.

Learning teamworking and non-technical skills: a pilot study of a postgraduate course at the University of Florence

AbstractBackground: Non-technical skills (NTS) are the cognitive and social skills that integrate the technical skills of a worker. In healthcare systems, NTS exert positive effects on patients’ safety and healthcare professionals’ efficiency.Aim: This study aims to assess the degree of NTS knowledge, before and after a workshop administered to a group of 17 nursing students attending a critical care nursing postgraduate course at the University of Florence.Methods: A cross-over design study was conducted. The workshop was composed of short lectures on “fundamentals of teamworking” and “team building and communication”, followed by team activities and gaming. At the end of the day a medical “escape room” about a shock scenario, was developed and run by the students. A questionnaire investigating participants’ entertainment and self-evaluation of NTS use, was administered at the end of the simulation sessions.Results: A sample of 17 nurses was enrolled. Pre-posttests were completed by 16 participants. Seventy-five % (n=12) of the respondents found the team working activities exciting. Most of the participants (62.5%, n=10) considered the “escape shock room game” enjoyable and stimulating and would recommend the learning activities to other healthcare professionals (75%, n=12). Compared to pre-test scores, statistically, significant improvements in NTS understanding were found on the topics of “team building” (p<0.001; r= -0.60), “teamworking” (p= 0.001; r= -0.56), “membership” (p= 0.001; r= -0.56), “hard skills” (p= 0.001; r= -0.57), “soft skills” (p=0.001; r= -0.56) and “situational awareness” (p< 0.001; r= -0.61) items.Conclusions: The process of NTS training is well accepted by critical care nursing students and can improve their competencies. Therefore, simulation based NTS training programs and gaming activities should be periodically implemented as part of Critical Care Nursing Postgraduate Courses.

No size fits all - a qualitative study of factors that enable adaptive capacity in diverse hospital teams.

Resilient healthcare research studies how healthcare systems and stakeholders adapt and cope with challenges and changes to enable high quality care. By examining how performance emerges in everyday work in different healthcare settings, the research seeks to receive knowledge of the enablers for adaptive capacity. Hospitals are defined as complex organizations with a large number of actors collaborating on increasingly complexity tasks. Consequently, most of today's work in hospitals is team based. The study aims to explore and describe what kind of team factors enable adaptive capacity in hospital teams. The article reports from a multiple embedded case study in two Norwegian hospitals. A case was defined as one hospital containing four different types of teams in a hospital setting. Data collection used triangulation of observation (115 h) and interviews (30), followed by a combined deductive and inductive analysis of the material. The study identified four main themes of team related factors for enabling adaptive capacity; (1) technology and tools, (2) roles, procedures, and organization of work, (3) competence, experience, knowledge, and learning, (4) team culture and relations. Investigating adaptive capacity in four different types of teams allowed for consideration of a range of team types within healthcare and how the team factors vary within and across these teams. All of the four identified team factors are of importance in enabling adaptive capacity, the various attributes of the respective team types prompt differences in the significance of the different factors and indicates that different types of teams could need diverse types of training, structural and relational emphasis in team composition, leadership, and non-technical skills in order to optimize everyday functionality and adaptive capacity.

Resuscitation team training in Rwanda: A mixed method study exploring the combination of the VAST course with Advanced Cardiac Life Support training

IntroductionThe influence of non-technical skills training on resuscitation performance in low-resource settings is unknown. This study investigates combining the Vital Anaesthesia Simulation Training Course with Advanced Cardiac Life Support training on resuscitation performance in Rwanda. MethodsParticipants in this mixed method study are members of resuscitation teams in three district hospitals in Rwanda. The intervention was participation in a 2-day Advanced Cardiac Life Support course followed by the 3-day Vital Anaesthesia Simulation Training Course. Quantitative primary endpoints were time to initiation of cardiopulmonary resuscitation, time to epinephrine administration, and time to defibrillation. Qualitative data on workplace implementation were gathered during focus groups held 3-months post-intervention. ResultsForty-seven participants were recruited. Quantitative data showed a statistically significant decrease in time to cardiopulmonary resuscitation, epinephrine administration, and defibrillation from pre- to post-Advanced Cardiac Life Support, with times of [43.3 (49.7) seconds] versus [16.5 (20) sec], p = <0.001; [137.3 (108.9) sec] versus [51.3 (37.9)], p = <0.001; and [218.5 (105.8) sec] versus [110.8 (87.1) sec], p = <0.001; respectively. These improvements were maintained following the Vital Anaesthesia Simulation Training Course, and at 3-month retention testing. Qualitative analysis highlighted five key themes: ability to initiate cardiopulmonary resuscitation; team coordination for task allocation; empowerment; desire for training and mentorship; and advocacy for system improvement. ConclusionA modified 2-day Advanced Cardiac Life Support course improved resuscitation time indicators with retention 3-months later. Combining the Vital Anaesthesia Simulation Training Course and Advanced Cardiac Life Support led to better team coordination, empowerment to act, and advocacy for system improvement. This pairing of courses has promise for improving Advanced Cardiac Life Support skills amongst healthcare workers in low-resource settings.ClinicalTrials.gov Identifier: NCT05278884.

Beyond The Maritime Education Classrooms: Analysis Of Life Skills Gained From Maritime Trainings

Intensive maritime education and training cultivate the competence of students in their future career. As the industry evolves, it also requires professionals who can apply their skills in real-life scenarios. This investigation explored the life skills gained from maritime trainings by analyzing the experiences of maritime students (n=15). The participants in the one-on-one interview were purposively sampled based on several demographic characteristics i.e., a college student, have maritime units (&gt;50), have been in curriculum-specified trainings. Findings of the study indicated that maritime students gained life-essential skills, including career-based, health-related, and emergency skills, through undergoing rigorous training programs. These acquired skills empower students to effectively address practical challenges and contribute positively to their career progression, personal growth, and well-being. As maritime students undergo specialized training and gain proficiency in technical and non-technical skills, their self-confidence and self-efficacy in addressing challenges and excel in their careers could be enhanced. The students' recognition of the practical use of their acquired skills in real-world scenarios highlights their self-efficacy, influencing their motivation, critical thinking, and problem-solving capabilities. It is the responsibility of maritime education industry to raise awareness and provide comprehensive education to aspiring seafarers.

Nontechnical Skills for Surgeons as a Framework to Evaluate Cardiopulmonary Bypass Management Skills of Resident Trainees

Nontechnical skills are critical in cardiac surgery but currently there is no formal paradigm to teach these in residency training. We investigated the use of the Nontechnical skills for surgeons (NOTSS) system as a framework to assess and teach nontechnical skills related to cardiopulmonary bypass (CPB) management. Single-center retrospective analysis of Integrated and Independent pathway thoracic surgery residents who participated in dedicated nontechnical skills evaluation and training. Two CPB management simulation scenarios were utilized. All residents received a lecture on CPB fundamentals and then individually participated in the first simulation ("Pre-NOTSS"). Immediately following this, nontechnical skills were rated by self-assessment and by a NOTSS trainer. All residents then underwent group NOTSS training followed by the second individual simulation ("Post-NOTSS"). Nontechnical skills were rated as before. NOTSS categories assessed included Situation Awareness, Decision Making, Communication and Teamwork, and Leadership. Nine residents were divided into 2 groups: Junior (n = 4, PGY1-4) and Senior (n = 5, PGY5-8). Pre-NOTSS resident self-ratings were higher for Senior than Junior in the categories of Decision Making, Communication and Teamwork, and Leadership while trainer ratings were similar between the groups. Post-NOTSS, resident self-ratings were higher for Senior than Junior in Situation Awareness and Decision Making while trainer scores were higher for both groups in Communication and Teamwork and Leadership. The NOTSS framework in conjunction with simulation scenarios provides a practical framework to evaluate and teach nontechnical skills related to CPB management. NOTSS training can lead to improvements in both subjective and objective ratings of nontechnical skills for all PGY levels.

Crisis Scenarios for Simulation-Based Nontechnical Skills Training for Cardiac Surgery Teams: A National Survey Among Cardiac Anesthesiologists, Cardiac Surgeons, Clinical Perfusionists, and Cardiac Operating Room Nurses.

Nontechnical skills in cardiac surgery are vital in ensuring patient safety in the operating room (OR). To train these skills in a simulation-based scenario, a collection of commonly accepted crisis scenarios is needed to serve as a framework for a simulation-based training program. The objective of this study was to identify and reach consensus on a collection of relevant crisis scenarios in cardiac surgery suitable for simulation-based team training focusing on nontechnical skills. Using the Delphi method, a national assessment was performed among cardiac surgeons, cardiac anesthesiologists, clinical perfusionists, and cardiac OR nurses in the Netherlands. In the first Delphi round, potential crisis scenarios for simulation-based team training in cardiac surgery were identified. In the second round, the identified scenarios were rated using a 5-point Likert scale. Finally, based on consensus (two-thirds majority), scenarios were prioritized and explored for feasibility. One hundred fourteen experts participated in the study (26 cardiac anesthesiologists, 24 cardiac surgeons, 25 clinical perfusionists, and 39 OR nurses), representing all 16 cardiac surgical centers in the Netherlands. In the first round, 237 scenarios were identified. After eliminating duplicates and grouping similar scenarios, 44 scenarios were scored in round 2, which finally resulted in 13 relevant crisis scenarios with an expert consensus higher than 67%. Thirteen crisis scenarios relevant to simulation-based team training were identified by an expert panel consisting of all members of the cardiac surgical team. Further research is needed to evaluate the educational value of the respective scenarios.

The need for non-technical skills education in orthopedic surgery

BackgroundThe issue of surgical safety has increased significantly over the last few decades. Several studies have established that it is linked to non-technical performance, rather than clinical competencies. Non-technical skills can be blended with technical training in the surgical profession to improve surgeons’ abilities and enhance patient care and procedural skills. The main goal of this study was to determine orthopedic surgeons’ requirements of non-technical skills, and to identify the most pressing issues.MethodsWe conducted a self-administered online questionnaire survey in this cross-sectional study. The questionnaire was piloted, validated, pretested, and clearly stated the study’s purpose. After the pilot, minor wording and questions were clarified before starting the data collection. Orthopedic surgeons from the Middle East and Northern Africa were invited. The questionnaire was based on a five-point Likert scale, the data were analyzed categorically, and variables were summarized as descriptive statistics.ResultsOf the 1713 orthopedic surgeons invited, 60% completed the survey (1033 out of 1713). The majority demonstrated a high likelihood of participating in such activities in the future (80.5%). More than half (53%) of them preferred non-technical skills courses to be part of major orthopedic conferences, rather than independent courses. Most (65%) chose them to be face-to-face. Although 97.2% agreed on the importance of these courses, only 27% had attended similar courses in the last three years. Patient safety, infection prevention and control, and communication skills were ranked at the top as topics to be addressed. Moreover, participants indicated they would most likely attend courses on infection prevention and control, patient safety and teamwork, and team management.ConclusionThe results highlight the need for non-technical skills training in the region and the general preferences regarding modality and setting. These findings support the high demand from orthopedic surgeons’ perspective to develop an educational program on non-technical skills.

In situ simulation-based team training and its significance for transfer of learning to clinical practice—A qualitative focus group interview study of anaesthesia personnel

BackgroundAnaesthesia personnel are an integral part of an interprofessional operating room-team; hence, team-based training in non-technical skills (NTS) are important in preventing adverse events. Quite a few studies have been done on interprofessional in situ simulation-based team training (SBTT). However, research on anaesthesia personnel’s experiences and the significance for transfer of learning to clinical practice is limited. The aim of this study is to explore anaesthesia personnel’s experience from interprofessional in situ SBTT in NTS and its significance for transfer of learning to clinical practice.MethodsFollow-up focus group interviews with anaesthesia personnel, who had taken part in interprofessional in situ SBTT were conducted. A qualitative inductive content analysis was performed.ResultsAnaesthesia personnel experienced that interprofessional in situ SBTT motivated transfer of learning and provided the opportunity to be aware of own practice regarding NTS and teamwork. One main category, ‘interprofessional in situ SBTT as a contributor to enhance anaesthesia practice’ and three generic categories, ‘interprofessional in situ SBTT motivates learning and improves NTS’, ‘realism in SBTT is important for learning outcome’, and ‘SBTT increases the awareness of teamwork’ illustrated their experiences.ConclusionsParticipants in the interprofessional in situ SBTT gained experiences in coping with emotions and demanding situations, which could be significant for transfer of learning essential for clinical practice. Herein communication and decision-making were highlighted as important learning objectives. Furthermore, participants emphasized the importance of realism and fidelity and debriefing in the learning design.

Cardiopulmonary resuscitation in special circumstances

The standard process of basic and advanced life support can be complicated by a number of special circumstances. Over the last decade, the European Resuscitation Council developed an increasingly detailed guideline regarding the diagnosis and therapy of these situations. In our short review, we summarize the most important recommendations for the management of cardiopulmonary resuscitation in special circumstances. The proper training in non-technical skills and teamwork is crucial in the management of these situations. In addition, extracorporeal circulatory and respiratory support play an increasingly important role in some special circumstances with appropriate patient selection and timing. We also summarize the therapeutic options regarding the reversible causes of cardiac arrest as well as the steps of diagnostic and treatment methods in some special situations (cardiopulmonary resuscitation in the operating room, after cardiac surgery, in a catheterisation laboratory, after sudden cardiac arrest at dentistry or dialysis station) and among special patient populations (patient with asthma or COPD, neurologic disorders, obese patient, pregnant woman). Orv Hetil. 2023; 164(13): 488-498.

Advancing immersive virtual reality-based simulation practices: developing an evidence-based and theory-driven pedagogical framework for VR-based simulations of non-technical skills among healthcare professionals

ABSTRACT Virtual reality (VR) based simulation is emerging as an innovative tool for the training and education of healthcare professionals. However, pedagogical frameworks specific to this type of simulation are yet missing. This paper explores participants’ experiences with VR-based simulation training in non-technical skills (VR-SIMI) and integrates them with established pedagogical theory. Non-technical skills refer to cognitive, social, and personal resource skills such as effective communication, relational competence, and stress management. An observational study was conducted involving 11 healthcare professionals in children and adolescents’ mental healthwho attended four VR-SIMI sessions over one year. Data were collected through field notes during participant observation and informal conversations with the participants. Directed content analysis was conducted, informed by the established practice of VR-SIMI (including INACL standards of best practice simulation), Jeffries simulation theory, Kolb’s experiential learning theory, and adult learning theory. The findings indicate that the participants positively evaluated the use of VR-SIMI. However, they also reported that the implementation and learning outcomes should be further refined. Based on these findings, an evidence-based and theory-driven pedagogical framework is proposed to guide and enhance the quality of VR-based simulations of non-technical skills for various of healthcare professionals, as well as inform future research.

Improvement of Teamwork Nontechnical Skills Through Polytrauma Simulation Cases Using the Communication and Teamwork Skills (CATS) Assessment Tool

To assess acquisition of nontechnical skills (NTS) through clinical simulation cases by healthcare personnel who participated in a Crisis Resource Management (CRM) training program for the initial care of polytraumatisms. Pre-and postintervention study. Acute-care teaching hospital in Sabadell, Barcelona (Spain). Healthcare personnel that composed teamworks providing initial care to polytraumatized patients attended 12-hour simulation training using a SimMan 3G manikin and performed exercises corresponding to 3 clinical scenarios. All simulations lasted 15 to 25 min and were video recorded. The CATS Assessment tool was used for analysis of teamwork NTS, which included 21 behaviors clustered into the categories of coordination, situational awareness, cooperation, communication, and crisis situation. Three editions of the CRM training course were carried out with 12 trauma team groups composed by team leader, anesthesiologist, general surgeon, traumatologist, registered nurses, nursing assistant, and stretcher bearer. There were statistically significant (p <0.001) improvements in the speed of key times of total duration of case resolution, transfusion of hemoderivatives, Focused Assessment Sonography for Trauma, and chest and pelvic X-rays. The percentage of cases correctly resolved improved from 75% to 91.7% but differences were not statistically significant (p = 0.625). Precourse and postcourse results of CATS scores showed a statistically significant increase in the weighted total score as well as in all behavioral categories of coordination, situational awareness, cooperation, communication, and crisis situation. Simulation-based training of NTS was associated with significant improvements in teamwork behaviors in the setting of the initial care of patients with polytraumatisms.

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.

Review article: Use of the Team Emergency Assessment Measure in the rating of emergency teams' non-technical skills: A mapping review.

The present study aims to explore the utility of the Team Emergency Assessment Measure (TEAM) in relation to the enhancement of emergency team non-technical skills based on research conducted over the last decade. In this mapping review, a citation mining process identified 22 primary studies for inclusion, published between 2012 and 2022. It provides outcome data on emergency teams' non-technical skills following team training and/or real-life patient emergencies. Emergency team studies related to resuscitation teams (adult, paediatric, newborn and obstetric cases) and medical emergency team (MET) management of patient deterioration. Team performance ratings varied, ranging from approximately 90% for experienced clinical teams down to 38% for students. Statistically significant improvements in performance were notable following training and/or repeated practice. Validity evidence, across 11 studies that provided change data described positive learning outcomes and moderate intervention effects. However, according to Kirkpatrick's model of educational evaluation the studies were limited to professional development phases of learning and immediate post-training assessments rather than care quality improvement. The review highlights a lack of studies evidencing quality improvement or clinical impact such as change of patient care practice or health service performance. There is a need to conduct well-designed studies that explore both technical and non-technical skills of resuscitation teams and METs. Currently, non-technical skills training and repeated performance evaluations using the TEAM contribute immensely to the proficiency of emergency teams.

Virtual reality environments to train soft skills in medical and nursing education: a technical feasibility study between France and Japan.

To meet the urgent and massive training needs of healthcare professionals, the use of digital technologies is proving increasingly relevant, and the rise of digital training platforms shows their usefulness and possibilities. However, despite the impact of these platforms on the medical skills learning, cultural differences are rarely factored in the implementation of these training environments. By using the Scrub Nurse Non-Technical Skills Training System (SunSet), we developed a methodology enabling the adaptation of a virtual reality-based environment and scenarios from French to Japanese cultural and medical practices. We then conducted a technical feasibility study between France and Japan to assess virtual reality simulations acceptance among scrub nurses. Results in term of acceptance do not reveal major disparity between both populations, and the only emerging significant difference between both groups is on the Behavioral Intention, which is significantly higher for the French scrub nurses. In both cases, participants had a positive outlook. The findings suggest that the methodology we have implemented can be further used in the context of cultural adaptation of non-technical skills learning scenarios in virtual environments for the training and assessment of health care personnel.

Nontechnical skills training in intensive care units: Protocol for a systematic review and meta-analysis.

This study is aimed at describing a protocol for a systematic review and meta-analysis to assess the effect of nontechnical skills training on the acquisition of knowledge, skills or attitudes, and changes in behavior at the workplace, of healthcare professionals working in intensive care units (ICUs), as well as the effect on outcomes at an organizational level. We will search for original studies in the PubMed/Medline, Scopus, Web of Science, Science Direct, EMBASE and PsycINFO databases. Studies with a clinical trial or quasi-experimental design will be included. Two reviewers will independently screen and assess the included studies, with any disagreements being resolved by a third reviewer. We will summarize the findings using a narrative approach and, if possible, conduct a quantitative synthesis (meta-analysis). We will conduct the protocol following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. The review will summarize the current evidence on nontechnical skills training in ICUs, examining satisfaction with the training program, improvements in knowledge about nontechnical skills and the adoption of safety behaviors, as well as improvement in outcomes for the organization, such as mortality rates, length of stay and cost indicators. We expect that the systematic review could indicate effective strategies for training ICU professionals in nontechnical skills and also determine whether these strategies really improve the safety culture and professional knowledge and behaviors, as well as patient outcomes and safety.

SUBJECTIVE USABILITY VALIDATION OF A LEARNING MANAGEMENT SYSTEM FOR ONLINE TRAINING OF MINIMALLY INVASIVE SURGERY: COMPARISON BETWEEN EXPERTS AND STUDENTS

Abstract Introduction Remote learning has been increasingly required after the COVID-19 pandemic. In this regard, an integrative Learning Management System (LMS) that connects external assets for technical and nontechnical skills training in minimally invasive surgery has been implemented. Before its wider use as a training tool, a comparison of usability perception between experts and students has been performed. Methods The system usability scale (SUS) was used. Users rated the 10-item questionnaire on a 5-point Likert-scale (5-Strongly agree, 1-Strongly disagree), with odd questions referring to positive aspects and even questions to negative ones. Two profiles were considered: experts in surgical training and students and residents. They were requested to use the LMS and complete any of the implemented courses. Comparison between groups was done with a Mann-Whitney U-test. Results Seven experts and 110 students participated in the study. Overall, SUS score by experts reached a mean value of 67.14 points [Q1 = 68.05, Q3= 76.81; interquartile range (IQR) = 9.67], while the mean SUS score given by students was 73.09 [Q1 = 65.00, Q3= 84.38; IQR = 19.38]. When comparing both groups, significant differences were not found (p-value=0.639). Conclusions Since SUS scores are usually considered to be valid when the average is greater than 68, experts were slightly below, while students surpassed this threshold. Nevertheless, since there were no significant differences, it might be assumed that usability of the LMS is acceptable and it will not hinder the training process, although further studies to prove its pedagogical value are required.

CONTENT VALIDATION OF THREE MODULES FOR ONLINE TRAINING OF MINIMALLY INVASIVE SURGERY

Abstract Introduction Training tools should follow a thorough validation process that assure their value before their wider use. In this regard, three online modules for laparoscopic cholecystectomy, lumbar punction and knee arthroscopy have been created for an integrative Learning Management System (LMS) that connects external assets, therefore allowing training of technical and nontechnical skills. This work focuses on the content validation of the modules to determine the appropriateness of the material for learning purposes. Methods The contents for the three modules have been developed following a 3D pedagogical model designed for e-learning in minimally invasive surgery. Experts were requested to rate 10 items about the contents and the activities included within the modules. Rating was done on a 5-point Likert scale (5-Strongly agree, 1-Strongly disagree). Results Six experts took part in the study. Contents were well rated as unique (4.17), sufficient to cover the learning objectives (4.50), up to date (4.33), realistic and relevant (4.83), professional (4.67), with adequate assessment (4), useful forum (4.33), good quality multimedia contents (4) but not so innovative (3.83). Lastly, external assets provided added value to the courses (4.5). Conclusions In general, experts were satisfied with the structure and the quality of the education material and found them to be well prepared according to the best practice of each profession. Therefore, the modules will be incorporated in the LMS for training, which will be further validated to prove its utility as a training tool.

Team Stress and Its Impact on Interprofessional Teams: A Narrative Review

Phenomenon: Interprofessional healthcare team (IHT) collaboration can produce powerful clinical benefits for patients; however, these benefits are difficult to harness when IHTs work in stressful contexts. Research about stress in healthcare typically examines stress as an individual psychological phenomenon, but stress is not only a person-centered experience. Team stress also affects the team’s performance. Unfortunately, research into team stress is limited and scattered across many disciplines. We cannot prepare future healthcare professionals to work as part of IHTs in high-stress environments (e.g., emergency medicine, disaster response) unless we review how this dispersed literature is relevant to medical education. Approach: The authors conducted a narrative review of the literature on team stress experienced by interprofessional teams. The team searched five databases between 1 Jan 1990 and 16 August 2021 using the search terms: teams AND stress AND performance. Guided by four research questions, the authors reviewed and abstracted data from the 22 relevant manuscripts. Findings: Challenging problems, time pressure, life threats, environmental distractors, and communication issues are the stressors that the literature reports that teams faced. Teams reacted to team stress with engagement/cohesion and communication/coordination. Stressors impact team stress by either hindering or improving team performance. Critical thinking/decision-making, team behaviors, and time for task completion were the areas of performance affected by team stress. High-quality communication, non-technical skills training, and shared mental models were identified as performance safeguards for teams experiencing team stress. Insights: The review findings adjust current models explaining drivers of efficient and effective teams within the context of interprofessional teams. By understanding how team stress impacts teams, we can better prepare healthcare professionals to work in IHTs to meet the demands placed on them by the ever-increasing rate of high-stress medical situations.