Non-technical Skills Performance Research Articles

Resident performance of nontechnical skills in level 1 traumas

Resident performance of nontechnical skills in level 1 traumas

Teaching Professionalism during and Posta Pandemic to Surgical Trainees: A Survey of the Impact of a Workshop on Trainers and Trainees.

Focussed professionalism training improves surgical trainees' communication, information gathering, and counselling skills. This study reviews the impact of a professionalism workshop for surgical trainees within a large trust in the United Kingdom developed during the pandemic to support the trainees and help them develop resilience and appropriate behaviours during the time of increased pressure. A workshop involving case-based discussions and reflections on professionalism was developed from the themes and methods of training noted to be effective on a literature search of Medline, EMBASE, and PsycINFO databases carried out in May 2020. The impact of Covid on surgical trainees and educator's professionalism training and the techniques of training preferred by trainees was evaluated by a survey of trainees and trainers after the intervention to evolve future training initiatives. During the workshop, a behavioural marker checklist was used to improve feedback on the observed behaviours. 83 trainers and trainees were surveyed following a professional behaviour workshop training 63 surgeons at various stages of training. Surgical list availability had reduced by at least 5-10 a month for all the trainees within the trust during the pandemic. Most trainees surveyed (49 (60%)) felt that this had reduced the opportunities to train technical skills and develop professional non-technical skills like teamwork and communication skills, adversely impacting the trainee's clinical performance. The increased support offered by the workshop helped 50 trainees (80%) to improve non-technical skill performance objectively by referencing to behavioural markers and this was felt to have become embedded in practice when surveyed 4 weeks later in 38 trainees (60%). The majority of those surveyed (47 (75%)) felt trainers and trainees had acted professionally during the pandemic and subsequently. The workshop discussions also helped (56 (67%)) trainers and trainees to consider how best to engage professionally with new ways of working as work, and training switched to virtual or telemedicine platforms during the pandemic. Professionalism-based education facilitates surgical trainee development, making them stronger team members and helping to restore team working skills and embrace new working practices.

Using Simulation for Anesthesia Crisis Management in The Undergraduate Curriculum: Systematic Literature Review

This literature review aims to shed light on the present status of simulation-based training for anesthesia crisis management in undergraduate medical education and suggest prospective areas for further study and improvement. This research study will implement a PICO formula to facilitate the search strategy's organized documentation. The study selection was performed using the EBSCOhost, and ScienceDirect to find studies that investigated the use of simulation in anesthesiology. The search strategy involved combining the keywords using the Boolean operator "AND" to refine the search and ensure the retrieval of relevant articles. After the inclusion and exclusion criteria, 15 studies were included. In this systematic review. The search was limited from 2018 to 2023 in both databases. Finally, Using simulation for anesthesia crisis management in undergraduate curricula effectively improves the performance of non-technical skills, such as situational awareness, decision-making, communication, and teamwork. The long-term effects of simulation-based training on clinical results and patient safety also need further investigation.

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.

Bilingual resuscitation training does not affect adherence to resuscitation guidelines but reduces leadership skills and overall team performance. An observational study with cross-border German-Polish training

Aim of studyThis study aims to investigate feasibility and quality of a bilingual cardiopulmonary resuscitation training with interprofessional emergency teams from Germany and Poland. MethodsAs part of a cross-border European Territorial Cooperation (Interreg-VA) funded project a combined communication and simulation training was organised. Teams of German and Polish emergency medicine personnel jointly practised resuscitation. The course was held in both languages with consecutive translation.Quality of chest compression was assessed using a simulator with feedback application. Learning objectives (quality of cardiopulmonary resuscitation, adherence to guidelines, closed loop communication), and team performance were assessed by an external observer. Coopeŕs Team Emergency Assessment Measure questionnaire was used. ResultsTwenty-one scenarios with 17 participants were analysed. In all scenarios, defibrillation and medication were delivered with correct dosage and at the right time. Mean fraction of correct hand position was 85.7% ± 25.7 [95%-CI 74.0; 97.4], mean fraction of compression depth 75.1% ± 21.0 [95%-CI 65.6; 84.7], compression rate 117.7 min−1 ± 7.1 [95%-CI 114.4; 120.9], and chest compression fraction 83.3% ± 3.8 [95%-CI 81.6; 85.0].Quality of cardiopulmonary resuscitation was rated as “fair” to “good”, adherence to guidelines as “good”, and closed loop communication as “fair”. Bilingual teams demonstrated good situational awareness, but lack of leadership and suboptimal overall team performance. ConclusionBilingual and interprofessional cross-border resuscitation training in German and Polish tandem teams is feasible. It does not affect quality of technical skills such as high-quality chest compression but does affect performance of non-technical skills (e.g. closed loop communication and leadership).

Utilizing Eye Tracking to Assess Medical Student Non-Technical Performance During Scenario-Based Simulation: Results of a Pilot Study.

Non-technical skills (NTS) are essential for safe surgical patient management. However, assessing NTS involves observer-based ratings, which can introduce bias. Eye tracking (ET) has been proposed as an effective method to capture NTS. The purpose of the current study was to determine if ET metrics are associated with NTS performance. Participants wore a mobile ET system and participated in two patient care simulations, where they managed a deteriorating patient. The scenarios featured several challenges to leadership, which were evaluated using a 4-point Likert scale. NTS were evaluated by trained raters using the Non-Technical Skills for Surgeons (NOTSS) scale. ET metrics included percentage of fixations and visits on areas of interest. Ten medical students participated. Average visit duration on the patient was negatively correlated with participants' communication and leadership. Average visit duration on the patient's intravenous access was negatively correlated with participants' decision making and situation awareness. Our preliminary data suggests that visual attention on the patient was negatively associated with NTS and may indicate poor comprehension of the patient's status due to heightened cognitive load. In future work, researchers and educators should consider using ET to objectively evaluate and provide feedback on their NTS.

Simulation in healthcare during COVID-19: An experience with residents in Anaesthesiology.

The restrictions to stop COVID-19 pandemic have had a negative impact in simulation, however, it is imperative to develop new strategies that facilitate healthcare education. To describe a simulation in healthcare based on the learning of Non-Technical Skills (NTS) and performed under the restrictions of COVID-19 Pandemic. Quasi-experimental study of an educational activity performed through simulation with anaesthesiology residents in November 2020. Twelve residents participated in two consecutive days. A questionnaire was filled related to the performance of NTS that encompasses leadership, teamwork and decision making. The complexity of the scenarios and the NTS results obtained between the two days were analysed. Advantages and challenges were documented when a clinical simulation is performed under COVID-19 restrictions. The global performance of the teams improved when comparing first and second day (79.5% vs 88.6%, p<0.01). Leadership was the worst section rated, however, was the one that showed the best improvement (70% vs 87.5%, p<0.01). The complexity of the simulation cases had no relation with the group performance in leadership and teamwork but affected task management results. General satisfaction was over 75%. The main challenges to develop the activity were the technology required to adapt virtuality to simulation and the time spent for the preparation of it. No cases of COVID-19 were reported within the first month after the activity. Clinical simulation can be done in the context of COVID-19 Pandemic, obtaining satisfactory learning results but requiring the adaptation of institutions to the new challenges it implies.

Can Different Admissions to Medical School Predict Performance of Non-Technical Skill Performance in Simulated Clinical Settings?

Non-technical skills (NTS) in medical care are essential to ensure patient safety. Focussing on applicants' NTS during medical school admission could be a promising approach to ensure that future physicians master NTS at a high level. Next to pre-university educational attainment, many selection tests have been developed worldwide to facilitate and standardise the selection process of medical students. The predictive validity of these tests regarding NTS performance in clinical settings has not been investigated (yet). Therefore, we explored the predictive validities and prognosis of the Hamburg MMI (HAM-Int), HAM-Nat, PEA, and waiting as well as other quota (as example) designated by the Federal Armed Forces) for NTS performance in clinical emergency medicine training of medical students. During 2017 and 2020, N = 729 second, third, and fourth year students were enrolled within the study. The mean age of participants was 26.68 years (SD 3.96) and 49% were female students. NTS of these students were assessed during simulation scenarios of emergency training with a validated rating tool. Students admitted via waiting quota and designated by the Armed Forces performed significantly better than students admitted by excellent PEA (p = 0.026). Non-EU students performed significantly inferior (p = 0.003). Our findings provide further insight to explain how and if admission to medical school could predict NTS performance of further physicians.

Effects of simulation-based education for neonatal resuscitation on medical students' technical and non-technical skills.

Simulation is a learner-centered practice that helps develop and maintain knowledge, skills, and competencies. This study evaluated the effect of neonatal resuscitation simulation-based education for medical students in the fifth year (part of the regular clinical clerkship program) on the perceived performance of their technical and non-technical skills. In addition, we analyzed the difference between instructor's and learners' evaluations of technical skills after the simulation. A one-group pretest-posttest design was adopted. The simulation-based education of the neonatal resuscitation program (NRP) was conducted for 40 medical students from July to November 2020 at a medical school in South Korea. The simulation-based education comprised 5 minutes of pre-briefing, 10 minutes of running the simulation, and 30 minutes of debriefing (using a recorded video). The perceived performance of students' technical and non-technical skills before and after the simulation was compared by collecting and analyzing the pre- and post-questionnaires. The perceived performance of technical (p = .001) and non-technical skills (p < .001) was found to have significantly increased after the simulation. Particularly, the performance of technical skills, such as diagnostic (p = .007) and therapeutic actions (p < .001) and non-technical skills, such as leadership (p < .001), teamwork (p = .001), and task management (p = .020) improved significantly. There was no significant difference in the evaluations of the technical performance of the instructor and learners after the simulation (p = .953). Simulation-based education can improve technical skills, such as diagnostic and therapeutic actions for neonatal resuscitation. It is also effective in enhancing non-technical skills, such as leadership, teamwork, and task management. Further, after the simulation-based education, students can fully self-evaluate through objective reflection and improve their clinical competency.

High-Fidelity Simulation to Assess Task Load Index and Performance: A Prospective Observational Study.

Objective:The NASA Task Load Index is a questionnaire widely used in aviation. This index might help for attesting the quality of a scenario in high-fidelity simulation in healthcare. The main purpose of this study was to observe whether NASA Task Load Index for critical care-simulated scenarios, designed for residents, was consistent with the literature. The second purpose was to describe relationships between NASA Task Load Index, performance and generated stress during high-fidelity simulation.Methods:All residents in anaesthesia and intensive care undergoing high-fidelity simulation were included. The primary endpoint was the task load generated by each scenario assessed by NASA Task Load Index. Based on the literature, the NASA Task Load Index scores between 39 and 61 were considered an acceptable level. Stress level (Visual Analogue Scale) and specific technical and non-technical skills performances (Team Emergency Assessment Measure) were also assessed.Results:Totally 53 residents actively participated in 1 of 10 different scenarios, between June and December 2017. The median NASA Task Load Index score of scenarios was 61 [48-65]. Five scenarios generated acceptable task load levels. There was no association between the NASA Task Load Index score and technical or non-technical skills performance scores, but an association between NASA Task Load Index and the stress level (rho = 4.7, P  = .001) was observed.Conclusion:Simulation scenarios generate different task loads for residents; the task load was deemed acceptable for half of the scenarios. The NASA Task Load Index could be considered as a tool to assess the pedagogic adequacy of scenarios. Scenario and generated stress level, but not task load, can modify residents’ performance during simulation. This should be considered when planning normative simulation.

High-fidelity hybrid simulation not only optimizes skills acquisition but improves nontechnical skills

ObjectiveKnee arthrocentesis is frequently performed as a diagnostic or therapeutic procedure. Although considered a key competency for medical doctors, most students never execute the procedure during their training. We aimed to assess technical and nontechnical skills for knee arthrocentesis through high-fidelity hybrid simulation.DesignTrainees received educational documentation prior to training. Trainees took a medical history and obtained informed consent from a patient-actor, then encountered a simulated knee to execute the procedure. We adapted a direct observation scale to assess technical and nontechnical skill performance. Personalized feedback was received after each session. Performance among trainees (learning curves) and between trainees and experts was compared using a mixed-effects model.SettingPontifical Catholic University of Chile Simulation Center.ParticipantsMedical students and general physicians were recruited for training; orthopedic surgeons were recruited as experts.ResultsTrainees significantly improved from the first session to the second and third. The third session was the learning curve plateau. Performance obtained in the third and fourth sessions were similar to expert performance. The assessment tool evaluated technical and nontechnical skills with high internal consistency and showed high interobserver reliability.DiscussionLearning curve analysis showed that high-fidelity simulation allowed trainees to become proficient in technical and nontechnical skills required to perform a safe knee arthrocentesis.Level of evidenceLevel II (prospective cohort study).

Objective Nontechnical Skills Measurement Using Sensor-based Behavior Metrics in Surgical Teams.

The purpose of this study was to identify objective measures that predict surgeon nontechnical skills (NTS) during surgery. NTS are cognitive and social skills that impact operative performance and patient outcomes. Current methods for NTS assessment in surgery rely on observation-based tools to rate intraoperative behavior. These tools are resource intensive (e.g., time for observation or manual labeling) to perform; therefore, more efficient approaches are needed. Thirty-four robotic-assisted surgeries were observed. Proximity sensors were placed on the surgical team and voice recorders were placed on the surgeon. Surgeon NTS was assessed by trained observers using the NonTechnical Skills for Surgeons (NOTSS) tool. NTS behavior metrics from the sensors included communication, speech, and proximity features. The metrics were used to develop mixed effect models to predict NOTSS score and in machine learning classifiers to distinguish between exemplar NTS scores (highest NOTSS score) and non-exemplar scores. NTS metrics were collected from 16 nurses, 12 assistants, 11 anesthesiologists, and four surgeons. Nineteen behavior features and overall NOTSS score were significantly correlated (12 communication features, two speech features, five proximity features). The random forest classifier achieved the highest accuracy of 70% (80% F1 score) to predict exemplar NTS score. Sensor-based measures of communication, speech, and proximity can potentially predict NOTSS scores of surgeons during robotic-assisted surgery. These sensing-based approaches can be utilized for further reducing resource costs of NTS and team performance assessment in surgical environments. Sensor-based assessment of operative teams' behaviors can lead to objective, real-time NTS measurement.

Non-technical skills in pre-hospital care in the Czech Republic: a prospective multicentric observational study (NTS study)

BackgroundNon-technical skills (NTS) are important for the proper functioning of emergency medical ambulance crews but have hardly been researched in the conditions of clinical pre-hospital care.The primary objective of this study, therefore, is to describe the use of NTS in practice. The secondary objective is to compare if the performance of NTS varies according to the type of case.MethodsIn this multicentric observational study the modified Team Emergency Assessment Measure (TEAM) score was used to assess the performed NTS of two or more crews on site. The evaluation consisted of leadership, teamwork and task management, rated by a field supervisor.The study observations took place in real clinical pre-hospital emergency medical cases when two or more crews were dispatched between October 2019 and August 2020. The sample size was determined by researchers prior to the study to at least 100 evaluated events per each of the three participating emergency medical services.The results are presented as median and interquartile range. The internal reliability, consistency and validity of test items and results were evaluated. The Kruskal–Wallis test and the post hoc Mann-Whitney U test with Bonferroni correction were used for multiple comparisons of three groups.ResultsA total of 359 events were evaluated. Surprisingly, the median value for all eight items was as high as 3.0 with a similar interquartile range of 1.0. There were no differences observed by case type (CPR vs. TRAUMA vs. MEDICAL) except from item 1. A post hoc analysis revealed that this difference is in favour of a higher rated performance of non-technical skills in CPR.ConclusionsThe overall result of the performance of non-technical skills can be regarded as very good and can serve for further evaluations. The crews achieved better parameters of NTS in leadership in resuscitation situations in comparison with general medical events.Trial RegistrationThe study is registered at Clinical Trials under the ID: NCT04503369.

Simulación sanitaria durante la COVID-19: una experiencia con los residentes de Anestesiología

BackgroundThe restrictions to stop COVID-19 pandemic have had a negative impact in simulation. However, it is imperative to develop new strategies that facilitate healthcare education. ObjectiveTo describe a simulation in healthcare based on the learning of non-technical skills and performed under the restrictions of COVID-19 pandemic. MethodsQuasi-experimental study of an educational activity performed through simulation with Anaesthesiology residents in November 2020. Twelve residents participated in 2 consecutive days. A questionnaire was filled related to the performance of non-technical skills that encompasses leadership, teamwork and decision making. The complexity of the scenarios and the non-technical skills results obtained between the 2 days were analysed. Advantages and challenges were documented when a clinical simulation is performed under COVID-19 restrictions. ResultsThe global performance of the teams improved when comparing first and second day (79.5 vs. 88.6%, P<.01). Leadership was the worst section rated, however, was the one that showed the best improvement (70 vs. 87.5%, P<.01). The complexity of the simulation cases had no relation with the group performance in leadership and teamwork but affected task management results. General satisfaction was over 75%. The main challenges to develop the activity were the technology required to adapt virtuality to simulation and the time spent for the preparation of it. No cases of COVID-19 were reported within the first month after the activity. ConclusionClinical simulation can be done in the context of COVID-19 pandemic, obtaining satisfactory learning results but requiring the adaptation of institutions to the new challenges it implies.

Effect of Korean Advanced Life Support Education on Non-Technical and Technical Skills of Nursing Students: A Pilot Study.

This study aimed to investigate the effect of the Korean Advanced Life Support (KALS) education program on the non-technical skills and technical skills of nursing students. This one-group pretest–posttest experimental study included 46 participants who were fourth year nursing students at Shinsung University located in Dangjin-si, Chungcheongnam-do Province, Republic of Korea. Data were collected in April 2021 and analyzed via SPSS/WIN 25.0, using a paired samples t-test. The current study results report a significant improvement in the non-technical skills from 30.58 to 47.16 points (t = −5.892, p < 0.001). Furthermore, KALS training improved communication confidence from 23.45 to 35.77 points (t = −6.563, p < 0.001), critical thinking tendency from 96.71 to 107.16 points (t = −3.352, p = 0.002), and self-efficacy in performing cardiopulmonary resuscitation from 33.56 to 49.81 points (t = −13.242, p < 0.001). Lastly, technical skills also improved from 18.35 to 27.94 points (t = −28.439, p < 0.001). Therefore, the findings indicate that KALS education was effective in improving the non-technical and technical skills of these nursing students. However, this study did not analyze the effect of the stress level experienced by the study participants in emergency situations on their non-technical and technical skill performance. Thus, future studies should verify the effect of external stressors, caused by unpredictable emergencies, on non-technical and technical skill performance.

Flipped learning enhances non-technical skill performance in simulation-based education: a randomised controlled trial

BackgroundMany efforts of the past years aimed to build a safer health care system and hereby, non-technical skills (NTS) have been recognised to be responsible for over 70 % of preventable medical mishaps. In order to counteract those mishaps, several simulation-based trainings have been implemented in health care education to convey NTS. Still, the best and effective way to foster NTS in simulation-based training is not known. Due to the importance of NTS, this gap in knowledge needs to be filled. A possible approach to convey NTS effectively during simulation-based medical education (SBME), might be the use of the flipped learning approach. The benefits of flipped learning regarding the improvement of human factors (NTS), have not been investigated yet. Therefore, the authors introduced flipped learning as an experimental intervention into their SBME emergency trainings and aimed to analyse, whether flipped learning improved students´ NTS performance compared to lecture-based learning (LBL).MethodsIn a randomized controlled trial, 3rd year medical students participated in a SBME training and then received either a further SBME training with integrated flipped learning on NTS (intervention), or a further SBME training and an accompanying lecture on NTS (control). NTS performance was assessed on three skill dimensions with a validated behavioural marker system.ResultsThe authors analysed NTS performance of 102 students, prior and after their allocation to each teaching method. The baseline NTS performance of both groups did not differ, whereas the intervention group enhanced significantly on all three skill dimensions (t (44) = 5.63, p < .001; t (44) = 4.47, p < .001; t (44) = 4.94, p < .001).ConclusionThe integration of flipped learning into SBME yields a significant improvement of NTS performance and therefore medical educators should consider the application of flipped learning to convey complex human factors and skills.

Stress and resident interdisciplinary team performance: Results of a pilot trauma simulation program

BackgroundExcessive stress negatively impacts surgical residents’ technical performance. The effect of stress on trainee nontechnical skills, however, is less well studied. Given that nontechnical skills are known to impact clinical performance, the purpose of this study was to assess the relationship between residents’ perceived stress and nontechnical skills during multidisciplinary trauma simulations. MethodsFirst-year surgery and emergency medicine residents voluntarily participated in this study. Residents participated in 3 trauma simulations across 2 training sessions in randomly assigned teams. Each team’s nontechnical skills were evaluated by faculty using the Trauma Nontechnical Skills scale. The Trauma Nontechnical Skills scale consists of 5 items: leadership, cooperation, communication, assessment, and situation awareness/coping with stress. After each scenario, residents completed the 6-item version of the State-Trait Anxiety Inventory and the Surgery Task Load Index to detail their perceived stress and workload during scenarios. Linear regressions were run to assess relationships between stress, workload, and nontechnical skills. ResultsTwenty-five residents participated in the first simulation day, and 24 residents participated in the second simulation day. Results from regressions revealed that heightened stress and workload predicted significantly lower nontechnical skills performance during trauma scenarios. In regard to specific aspects of nontechnical skills, residents’ heightened stress and workload predicted statistically significant lower situation awareness and decision-making during trauma scenarios. ConclusionResidents’ perceived stress and workload significantly impaired their nontechnical skills during trauma simulations. This finding highlights the need to offer stress management and performance-optimizing mental skills training to trainees to lower their stress and optimize nontechnical skills performance during challenging situations.

Effect of a behavioral intervention on anxiety and perceived performance of non-technical skills during surgical simulations

BackgroundSurgical trainees experience intrinsic stress and anxiety during high-acuity clinical situations which can negatively impact performance. Emerging data suggests that education in mindfulness-based coping techniques may improve performance. We evaluated the effects of a stress recovery intervention on novice trainees’ perceived level of anxiety during an intentionally stressful simulation. MethodsParticipants were recruited from surgical intern classes over three consecutive years. All participants completed a simulation intentionally designed to evoke a stress response. Participants then completed a stress recovery intervention or received no additional training. All participants then completed a second novel simulation. ResultsIntervention participants had significantly higher self-reported ability to manage stress (intervention 2.4 to 3.6, p < 0.01; control 2.8 to 3.3, p = 0.06), and stop, think, and observe (intervention 2.5 to 3.7, p < 0.01; control 2.6 to 3.3, p = 0.08) during the second simulation. Both groups also had significantly lower levels of state anxiety during the second simulation as compared to the first (intervention 45.1 vs 59.3, p < 0.01; control 49.3 vs 57.4, p < 0.05). During the second simulation, trainees in both groups reported improvements in perceived abilities to: recognize stress (intervention 2.7 to 4.1, p < 0.01; control 2.9 to 3.6, p < 0.05), communicate with and lead their team (intervention 2.4 to 3.3, p < 0.05; control 2.3 to 3.3, p < 0.01), and to prioritize, plan, and prepare (intervention 2.1 to 3.1, p < 0.05; control 2.1 to 3.0, p < 0.01). ConclusionOur research shows that a brief intervention was associated with a significant increase in trainee ability to both recognize internal stress and engage in proactive coping mechanisms. This research also shows that while repeated stress-inducing simulations may themselves decrease perceived anxiety levels in novice surgical trainees, training in coping strategies may potentiate this effect.

Nurse Training in Gender-Based Violence Using Simulated Nursing Video Consultations during the COVID-19 Pandemic: A Qualitative Study.

Gender-based violence (GBV) is a serious global public health problem that becomes aggravated during public health emergencies that involve quarantine measures. It is important to train nursing students on GBV, especially in vulnerable situations, such as the current COVID-19 pandemic. The purpose of our study is to explore the perceptions of third-year nursing students about simulated nursing video consultations for providing assistance to potential cases of GBV victims using a high-fidelity clinical simulation methodology. After all of the simulated scenarios were completed, 48 scripted interviews were carried out following a guide composed of four open-ended questions to facilitate in-depth discussion. A descriptive qualitative study based on the interpretative paradigm was conducted. The nursing students indicated that they improved their knowledge on GBV victim management (mainly their awareness of the problem, recognition of the role of nursing professionals, and performance of non-technical skills), although they also mentioned the need for continuous training (particularly in socio-emotional skills, interview techniques, a holistic nursing care approach, and not presupposing). This innovative high-fidelity simulation methodology allows nursing students to improve their awareness of the GBV problem, acquire a realistic view about their role in addressing GBV, and build their non-technical skills (such as active listening, communication skills, empathy, and generating confidence) required to adequately care for victims of GBV.

Correlation of medical students' situational motivation and performance of non-technical skills during simulation-based emergency training

BackgroundNon-technical skills (NTS) are an indispensable element of emergency care and need to be prevalent alongside with good technical skills. Though, questions of how to teach (instructional design) and improve NTS effectively remain unresolved. One adjustment screw to enhance performance of NTS, which is detached from instructional designs and learning efforts might be motivation. Theoretical models and observational studies suggest that high levels of intrinsic (situational) motivation result in better performance and better learning. Therefore, this study analyzed the influence of motivation on performance of NTS, by exploring if high levels of intrinsic motivation lead to better performance of NTS in medical students.MethodsIn this prospective cross-sectional cohort study, the authors assessed the correlation of situational motivation and performance of NTS within a cohort of 449 undergraduates in their 1st to 4th year of medical studies, in a total of 101 emergency simulation trainings. Situational motivation was measured with the validated Situational Motivation Scale (SIMS), which was completed by every undergraduate directly before each simulation training. The NTS were evaluated with the Anesthesiology Students´ Non-Technical skills (AS-NTS) rating tool, a validated taxonomy, especially developed to rate NTS of undergraduates.ResultsStudent situational motivation was weakly correlated with their performance of NTS in simulation-based emergency trainings.ConclusionAlthough motivation has been emphasized as a determining factor, enhancing performance in different fields and in medicine in particular, in our study, student situational motivation was independent from their performance of NTS in simulation-based emergency trainings (SBET).