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

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Background: While bedside assistants play a critical role in many robotic operations, substantial heterogeneity remains in bedside assistant training pathways. As such, this study aimed to develop consensus guidelines for bedside assistant skills required for team members in robotic operations. Methods: We designed a study using the Delphi process to develop consensus guidelines around bedside assistant skills. We generated an initial list of bedside assistant skills from the literature, training materials, and expert input. We selected experts for the Delphi process based on prior scholarship in the area of robotic bedside assistant education and experience facilitating robotic bedside assistant training. For each item, respondents specified which robotic team members should have the skill from a list of "basic" bedside assistants, "advanced" bedside assistants, surgeons, surgical technologists, and circulating nurses. We conducted two rounds of the Delphi process and defined 80% agreement as sufficient for consensus. Results: Fourteen experts participated in two rounds of the Delphi process. By the end of the second round, the group had reached consensus on 253 of 305 items (83%). The group determined that "basic" bedside assistants should have 52 skills and that "advanced" bedside assistants should have 60 skills. The group also determined that surgeons should have 54 skills, surgical technologists should have 25 skills, and circulating nurses should have 17 skills. Experts agreed that all participants should have certain communication skills and basic knowledge of aspects of the robotic system. Conclusions: We developed consensus guidelines on the skills required during robotic surgery by bedside assistants and other team members using the Delphi process. These findings can be used to design training around bedside assistant skills and assess team members to ensure that each team member has the appropriate skills. Hospitals can also use these guidelines to standardize expectations for robotic team members. [ABSTRACT FROM AUTHOR]

Coronavirus disease (COVID)-19 had an impact on medical graduation, causing weaknesses arising from social isolation and remote emergency teaching, with an emphasis on deficits in the development of non-technical skills (soft skills). In this context, the interaction between a group of medical students and adolescents who develop activities at the Center for Learning and Mobilization for Citizenship in Campinas/SP, Brazil, was evaluated about the development of soft skills during the COVID-19 pandemic. The observational study was carried out using an electronic questionnaire based on a Likert scale on the feelings of undergraduate medical students regarding participation in project activities in the context of the development of social skills. The study demonstrated an important positive impact of student participation in a socio-educational project for the development of soft skills, emphasizing the ability to deal with adverse situations, decision-making, and the ability to deal with the fear of not corresponding. However, the existence of limitations and difficulties in the development of non-technical skills by students was revealed, further reinforced by the challenges brought by the COVID-19 pandemic. In this aspect, the study demonstrated participation in a voluntary social project as an important strategy to improve the teaching of these skills. [ABSTRACT FROM AUTHOR]

Purpose: European training pathways for surgeons dedicated to treating severely injured and critically ill surgical patients lack a standardized approach and are significantly influenced by diverse organizational and cultural backgrounds. This variation extends into the realm of mentorship, a vital component for the holistic development of surgeons beyond mere technical proficiency. Currently, a comprehensive understanding of the mentorship landscape within the European trauma care (visceral or skeletal) and emergency general surgery (EGS) communities is lacking. This study aims to identify within the current mentorship environment prevalent practices, discern existing gaps, and propose structured interventions to enhance mentorship quality and accessibility led by the European Society for Trauma and Emergency Surgery (ESTES). Methods: Utilizing a structured survey conceived and promoted by the Young section of the European Society of Trauma and Emergency Surgery (yESTES), we collected and analyzed responses from 123 ESTES members (both surgeons in practice and in training) across 20 European countries. The survey focused on mentorship experiences, challenges faced by early-career and female surgeons, the integration of non-technical skills (NTS) in mentorship, and the perceived role of surgical societies in facilitating mentorship. Results: Findings highlighted a substantial mentorship experience gap, with 74% of respondents engaging in mostly informal mentorship, predominantly centered on surgical training. Notably, mentorship among early-career surgeons and trainees was less reported, uncovering a significant early-career gap. Female surgeons, representing a minority within respondents, reported a disproportionately poorer access to mentorship. Moreover, while respondents recognized the importance of NTS, these were inadequately addressed in current mentorship practices. The current mentorship input of surgical societies, like ESTES, is viewed as insufficient, with a call for structured programs and initiatives such as traveling fellowships and remote mentoring. Conclusions: Our survey underscores critical gaps in the current mentorship landscape for trauma and EGS in Europe, particularly for early-career and female surgeons. A clear need exists for more formalized, inclusive mentorship programs that adequately cover both technical and non-technical skills. ESTES could play a pivotal role in addressing these gaps through structured interventions, fostering a more supportive, inclusive, and well-rounded surgical community. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Effective teamwork is crucial to providing safe and high-quality patient care, especially in acute care. Crew Resource Management (CRM) principles are often used for training teamwork in these situations, with escape rooms forming a promising new tool. However, little is known about escape room design characteristics and their effect on learning outcomes. We investigated the current status of design characteristics and their effect on learning outcomes for escape room-based CRM/teamwork training for acute care professionals. We also aimed to identify gaps in literature to guide further research. Methods: Multiple databases were searched for studies describing the design and effect of escape rooms aimed training CRM/teamwork in acute care professionals and in situations that share characteristics. A standardized process was used for screening and selection. An evidence table that included study characteristics, design characteristics and effect of the escape room on learning outcomes was used to extract data. Learning outcomes were graded according to IPE expanded typology of Kirkpatrick's levels of learning outcome and Medical Education Research Study Quality Instrument (MERSQI) scores were calculated to assess methodology. Results: Fourteen studies were included. Common design characteristics were a team size of 4–6 participants, a 40-minute time limit, linear puzzle organization and use of briefing and structured debriefing. Information on alignment was only available in five studies and reporting on several other educational and escape room design characteristics was low. Twelve studies evaluated the effect of the escape room on teamwork: nine evaluated reaction (Kirkpatrick level 1; n = 9), two evaluated learning (Kirkpatrick level 2) and one evaluated both. Overall effect on teamwork was overtly positive, with little difference between studies. Together with a mean MERSQI score of 7.0, this precluded connecting specific design characteristics to the effect on learning outcomes. Conclusions: There is insufficient evidence if and how design characteristics affect learning outcomes in escape rooms aimed at training CRM/teamwork in acute care professionals. Alignment of teamwork with learning goals is insufficiently reported. More complete reporting of escape rooms aimed at training CRM/teamwork in acute care professionals is needed, with a research focus on maximizing learning potential through design. [ABSTRACT FROM AUTHOR]

Purpose: Mastering non-technical skills (NTS) is a fundamental part of the training of new physicians to perform effectively and safely in the medical practice environment. Ideally, they learn these skills during medical school. Decentralized medical education is being implemented increasingly worldwide. Two of the three training sites studied, Bodø (a regional hospital) and Finnmark (a rural local hospital), implemented decentralized medical education. The third training site was the main campus in Tromsø, located at an urban university hospital. The training in Finnmark emphasised training in non-technical skills using simulation to a larger extent than the two other university campuses. This study aimed to compare the NTS performance of medical students in their last year of education at three different training sites of the same university. Methods: This blinded cohort study included students from the three training sites who participated in identical multi-professional simulations over a six-year period. Eight raters evaluated the video recordings of eight students from each training site using the Norwegian Medical Students Non-Technical Skills (NorMS-NTS) tool. The NorMS-NTS tool, which comprises four categories and 13 elements, assesses the NTS of Norwegian medical students and assigns an overall global score. Pairwise significant differences in the NTS performance levels between the training sites studied were assessed using Tukey's test. Results: The overall NTS performance levels of the medical students from Finnmark (mean 4.5) were significantly higher than those of the students from Tromsø (mean 3.8) and Bodø (mean 3.5). Similarly, the NTS performance levels at category-level of the students in Finnmark were significantly higher than those of the students from Bodø and Tromsø. Except for one category, no significant differences were observed between the students from Bodø and Tromsø in terms of the overall or category-level NTS performance. Conclusion: The NTS performance levels of the medical students from Finnmark, which implements rural, decentralized medical education, were significantly higher than those of the students from Tromsø and Bodø. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of a hysteroscopic myoma resection (HMR) two-day training course on non-technical (cognitive) surgical skills among gynecologists. Materials and methods: A 2-day educational course was held in which 95 consultant gynecologic surgeons and beginner infertility fellowship residents took part. Among all 80 participants (84.2%) had ever performed diagnostic hysteroscopy and 30 (31.3%) had performed non-resectoscopic operative hysteroscopy. The training program included instructive speeches, simulated surgical presentations, and a live hands-on myomectomy workshop. Non-technical skills were assessed two times, once before and the other after the course through two written tests with 10 multiple-choice questions for each. Results: Concerning the 95 participants, 43 (47.3%) took the pre-course test and all of them (100%) took the post-course one. The mean score improved significantly from 3 (interquartile range [IQR], 0-4.0) to 7 (IQR, 5.0-8.0) [bootstrap p<0.0001] for each of the randomly chosen pairings. The majority of candidates showed significantly improved cognitive skills after the HMR course despite their poor cognitive skills before the course. According to further analysis, there were significant enhancements in grades for all topics, especially regarding the basic principles of the procedure and management of complications (bootstrap p<0.0001). The odds ratio for the pre- versus post-course mean test results was 5.23. Due to the confidentiality stipulation, the pre- and post-course scores were not matched. Conclusion: A two-day continuing medical educational course could be efficient in improving the nontechnical (cognitive) skills for HMR. [ABSTRACT FROM AUTHOR]

Background: Surgical skills acquisition is under continuous development due to the emergence of new technologies, and there is a need for assessment tools to develop along with these. A range of neuroimaging modalities has been used to map the functional activation of brain networks while surgeons acquire novel surgical skills. These have been proposed as a method to provide a deeper understanding of surgical expertise and offer new possibilities for the personalized training of future surgeons. With studies differing in modalities, outcomes, and surgical skills there is a need for a systematic review of the evidence. This systematic review aims to summarize the current knowledge on the topic and evaluate the potential use of neuroimaging in surgical education. Methods: We conducted a systematic review of neuroimaging studies that mapped functional brain activation while surgeons with different levels of expertise learned and performed technical and non-technical surgical tasks. We included all studies published before July 1st, 2023, in MEDLINE, EMBASE and WEB OF SCIENCE. Results: 38 task-based brain mapping studies were identified, consisting of randomized controlled trials, case–control studies, and observational cohort or cross-sectional studies. The studies employed a wide range of brain mapping modalities, including electroencephalography, functional magnetic resonance imaging, positron emission tomography, and functional near-infrared spectroscopy, activating brain areas involved in the execution and sensorimotor or cognitive control of surgical skills, especially the prefrontal cortex, supplementary motor area, and primary motor area, showing significant changes between novices and experts. Conclusion: Functional neuroimaging can reveal how task-related brain activity reflects technical and non-technical surgical skills. The existing body of work highlights the potential of neuroimaging to link task-related brain activity patterns with the individual level of competency or improvement in performance after training surgical skills. More research is needed to establish its validity and usefulness as an assessment tool. [ABSTRACT FROM AUTHOR]

Aim: When making anastomotic decisions in rectal cancer surgery, surgeons must consider the risk of anastomotic leakage, which bears implications for the patient's quality of life, cancer recurrence and, potentially, death. The aim of this study was to investigate the views of colorectal surgeons on how their individual attributes (e.g. experience, personality traits) may influence their decision‐making and experience of complications. Method: This qualitative study used individual interviews for data collection. Purposive sampling was used to invite certified UK‐based colorectal surgeons to participate. Participants were recruited until ongoing data review indicated no new codes were generated, suggesting data sufficiency. Data were analysed thematically following Braun and Clarke's six‐step framework. Results: Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes with relevant subthemes were identified: (1) personal attributes influencing variation in decision‐making (e.g. demographics, personality) and (2) the influence of complications on decision‐making. Surgeons described variation in the management of complications based upon their personal attributes, which included factors such as gender, experience and subspeciality interests. Surgeons described the detrimental impact of anastomotic leakage on their mental and physical health. Experience of anastomotic leakage influences future decision‐making and is associated with changes in practice even when a technical error is not identified. Conclusion: Colorectal surgeons consider anastomotic leaks to be personal 'failures', which has a negative impact on surgeon welfare. Better understanding of how surgeons make difficult decisions, and how surgeons respond to and learn from complications, is necessary to identify 'personalized' methods of supporting surgeons at all career stages, which may improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background Resuscitation is a team effort, and it is increasingly acknowledged that team cooperation requires training. Staff shortages in many healthcare systems worldwide, as well as recent pandemic restrictions, limit opportunities for collaborative team training. To address this challenge, a learner-centred approach known as flipped learning has been successfully implemented. This model comprises self-directed, asynchronous pre-course learning, followed by knowledge application and skill training during in-class sessions. The existing evidence supports the effectiveness of this approach for the acquisition of cognitive skills, but it is uncertain whether the flipped classroom model is suitable for the acquisition of team skills. The objective of this study was to determine if a flipped classroom approach, with an online workshop prior to an instructor-led course could improve team performance and key resuscitation variables during classroom training. Methods A single-centre, cluster-randomised, rater-blinded study was conducted on 114 final year medical students at a University Hospital in Germany. The study randomly assigned students to either the intervention or control group using a computer script. Each team, regardless of group, performed two advanced life support (ALS) scenarios on a simulator. The two groups differed in the order in which they completed the flipped e-learning curriculum. The intervention group started with the e-learning component, and the control group started with an ALS scenario. Simulators were used for recording and analysing resuscitation performance indicators, while professionals assessed team performance as a primary outcome. Results The analysis was conducted on the data of 96 participants in 21 teams, comprising of 11 intervention groups and 10 control groups. The intervention teams achieved higher team performance ratings during the first scenario compared to the control teams (Estimated marginal mean of global rating: 7.5 vs 5.6, p < 0.01; performance score: 4.4 vs 3.8, p < 0.05; global score: 4.4 vs 3.7, p < 0.001). However, these differences were not observed in the second scenario, where both study groups had used the e-learning tool. Conclusion Flipped classroom approaches using learner-paced e-learning prior to hands-on training can improve team performance. [ABSTRACT FROM AUTHOR]

Background Non-Technical Skills (NTS) are cognitive, social, and personal resource skills that are crucial in complex and high-risk environments. The aims of our research are to determine the prevalence and content of NTS in the surgical rotation teaching guides of the Medicine Degree programs in Spanish Universities, to identify the most prevalent types and subtypes of NTS, and to analyze factors associated with the prevalence of surgical NTS in Medical Schools in Spain. Methods Descriptive observational cross-sectional study involving the identification and collection of competencies outlined in the surgical rotation teaching guides of Spanish Medical Schools. Information regarding university performance was obtained from the Foundation for Knowledge and Development Ranking webpage. The “NonTechnical Skills for Surgeons” (NOTSS) system was used to classify each competency in the teaching guides as NTS (categories and elements) and technical skills. Disagreements were resolved through group consensus. Results A total of 1,846 competencies were analyzed in surgical rotations of the Medicine Degree programs across 40 Spanish Universities, with 99 competencies identified as surgical NTS, accounting for 5% of the total. The most frequently identified surgical NTS were “Decision Making” (46%), “Communication & Teamwork” (25%), and “Leadership” (19%). Additionally, several NOTSS were not identified in any institution. Public universities and those including a greater number of competencies had a higher rate of surgical NTS competencies, and we did not find a correlation between surgical NTS competencies and quality indices of University Centers. Conclusions There is a limited presence of surgical NTS in the educational plans of Spanish Universities. [ABSTRACT FROM AUTHOR]

Background: There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes add value for disaster responders. Some studies suggest that disaster responders need not only technical skills but also non-technical skills. Consensus of which non-technical skills are needed and how training for these can be provided is lacking, and little is known about how to apply knowledge of non-technical skills in the recruitment of disaster responders. Therefore, this scoping review aimed to identify the non-technical skills required for the disaster medicine response. Method: A scooping review using the Arksey & O´Malley framework was performed. Structured searches in the databases PuBMed, CINAHL Full Plus, Web of Science, PsycInfo and Scopus was conducted. Thereafter, data were structured and analyzed. Results: From an initial search result of 6447 articles, 34 articles were included in the study. These covered both quantitative and qualitative studies and different contexts, including real events and training. The most often studied real event were responses following earthquakes. Four non-technical skills stood out as most frequently mentioned: communication skills; situational awareness; knowledge of human resources and organization and coordination skills; decision-making, critical-thinking and problem-solving skills. The review also showed a significant lack of uniform use of terms like skills or competence in the reviewed articles. Conclusion: Non-technical skills are skills that disaster responders need. Which non-technical skills are most needed, how to train and measure non-technical skills, and how to implement non-technical skills in disaster medicine need further studies. [ABSTRACT FROM AUTHOR]

Background: Undeniably, robotic-assisted surgery (RAS) has become very popular in recent decades, but it has introduced challenges to the workflow of the surgical team. Non-technical skills (NTS) have received less emphasis than technical skills in training and assessment. The systematic review aimed to update the evidence on the role of NTS in robotic surgery, specifically focusing on evaluating assessment tools and their utilisation in training and surgical education in robotic surgery. Methods: A systematic literature search of PubMed, PsycINFO, MEDLINE, and EMBASE was conducted to identify primary articles on NTS in RAS. Messick's validity framework and the Modified Medical Education Research Study Quality Instrument were utilised to evaluate the quality of the validity evidence of the abstracted articles. Results: Seventeen studies were eligible for the final analysis. Communication, environmental factors, anticipation and teamwork were key NTS for RAS. Team-related factors such as ambient noise and chatter, inconveniences due to repeated requests during the procedure and constraints due to poor design of the operating room may harm patient safety during RAS. Three novel rater-based scoring systems and one sensor-based method for assessing NTS in RAS were identified. Anticipation by the team to predict and execute the next move before an explicit verbal command improved the surgeon's situational awareness. Conclusion: This systematic review highlighted the paucity of reporting on non-technical skills in robotic surgery with only three bespoke objective assessment tools being identified. Communication, environmental factors, anticipation, and teamwork are the key non-technical skills reported in robotic surgery, and further research is required to investigate their benefits to improve patient safety during robotic surgery. [ABSTRACT FROM AUTHOR]

Background: Nurse anesthesia is acknowledged as advanced practice nursing, and requires independency in patient monitoring and clinical decision-making. In Norway, 2022, a prerequisite to nurse anesthesia education programs of at least two years of clinical nursing experience prior to entry, was removed. The consequences of removing the prerequisite of clinical nursing experience prior to entering the nurse anesthetist education program on academic progression or on students' qualifications after completion of the program remain unexplored. Hence, the purpose of the current study was to explore nurse anesthetist students' experiences of the impact their previous clinical nursing experience had on their academic progression. Methods: A qualitative design with semi-structured individual interviews was used. The sample consisted of 12 nurse anesthetist students at the end of the education program. The data were analyzed using thematic analysis in-line with recommendations from Braun & Clarke. Results: Two main themes with in total six subthemes were identified, namely 1) Experience develops non-technical skills, with subthemes (a) feeling secure in task management, (b) recognizing different situations, (c) understanding my role in teamwork, and 2) Integration of non-technical and technical skills, with subthemes (a) possessing procedural competence, (b) taking responsibility in medication administration, and (c) including a patient-centred approach. Previous clinical experience as a nurse prior to entry to a NA education program had provided a basis of non-technical and technical competencies, that supported further learning and development of advanced level competencies that are needed for NAs. Conclusion: Non-technical and technical nursing competence represented a solid base for achievement of anesthesia competence within the same areas, also ensuring patient-centred practice. Hence, the change in prerequisites to the NA education program must be followed by evaluations of consequences on students' academic progress and competence at the end of the program, as well as a possible increased need for supervision throughout. [ABSTRACT FROM AUTHOR]

Robot-assisted surgery (RAS) in gynaecology has undergone exponential growth in recent decades, with utility in treating both benign and malignant gynaecological conditions. The technological complexities and amended theatre dynamics that RAS demands mean that effective non-technical skills (NTS) are vitally important to overcome these unique challenges. However, NTS have been neglected in RAS-training programmes with focus placed instead on the exclusive acquisition of technical skills (TS). NTS include teamwork, communication, leadership, situational awareness, decision-making and stress management. Communication is the most frequently cited NTS impacted during RAS, as the physical limitations imposed by the robotic hardware make communication exchange difficult. The full immersion that RAS enables can contribute to situational awareness deficits. However, RAS can complement communication and teamwork when multidisciplinary (MDT) surgeries (such as complex endometriosis excisions) are undertaken; dual-console capabilities facilitate the involvement of specialties such as general surgery and urology. The development of NTS in RAS cannot be achieved with in-situ experience alone, and current training is poorly standardised. RAS-training programmes and curricula for gynaecology do exist, however the integration of NTS remain limited. Simulation is a viable tool to facilitate enhanced-NTS integration, yet cost implications form a barrier to its wider implementation. However, given that RAS will continue to occupy a greater proportion of the gynaecological caseload, integration of NTS within gynaecological RAS training curricula is necessary. Patients undergoing gynaecological RAS would benefit from the improved safety standards and enhanced surgical outcomes that would result. [ABSTRACT FROM AUTHOR]

Background: In an era where team communication and patient safety are paramount, standardized tools have been deemed critical to safe, efficient practice. In some cases—perhaps most notably in the surgical safety checklist (SSC)—these tools have been elevated as the key to safe patient care. However, effects of the SSC on patient safety in practice remain mixed. We explore the role and impact of the surgeon leader in the use of structured communication tools to understand how surgeon engagement impacts intraoperative teamwork. Methods: Using a constructivist grounded theory approach, OR staff members (surgeons, anesthetists, nurses and perfusionists) were recruited to participate in a one-on-one semi-structured interview. The interview explored participant experiences working in the OR, focusing on the role and impact of the surgeon as leader. Results: Engaged use of the surgical safety checklist by the attending surgeon had the potential to improve teamwork in the operating room. Surgeons who used the checklist to engage with their team and facilitate group discussion were able to avoid tensions later in the operation typically arising from lack of situation awareness and familiarity with team member experience levels. Surgeons who engaged with the SSC as more than a memory aid were able to foster a better team environment. Conclusions: Surgeons can harness their role as leader in the operating room by engaging with structured communication tools such as the SSC to foster improved teamwork. [ABSTRACT FROM AUTHOR]

Paramedicine is a rapidly evolving profession and teaching strategies need to be creative and forward thinking to meet the ever-changing demands of the role. Educational escape rooms incorporate a variety of learning environments in which students participate in a range of simulation-based activities based on solving puzzles and retrieving codes, which result in finding a prize. A mixed methods action research study was undertaken to ascertain whether an escape room approach can increase engagement and attainment in year-one paramedic science degree students at a UK university. The results showed that 100% (n=52) stated they would recommend this activity, 100% (n=52) agreed it helped them to review their teamwork skills and 98% (n=51) said that it improved their communication techniques. Non-technical skills enable the development of technical skills and knowledge within the workplace and are an overarching factor in providing good practice and reducing errors. An escape room approach is arguably an effective teaching method when the activities are based on learning outcomes. [ABSTRACT FROM AUTHOR]

Simulation refers to the replication of various elements of a real-world situation to achieve pre-specified objectives by enabling experiential learning. As the global burden of preventable medical errors remains high, simulation-based teaching may be used to standardise medical training and improve patient safety. With the same intent, the National Medical Commission has adopted simulation as part of the Competency Based Medical Education approach. Simulation-based training creates immersive and experiential learning, which keeps the new generation of learners actively involved in the learning process. Simulation is widely used to impart technical and non-technical skills for postgraduate trainees in anaesthesiology, but it is still not integrated as a structured part of the curriculum. This article aims to identify technical and non-technical skills that can be taught using simulation and suggests opportunities for using the existing infrastructure and resources to integrate simulation as part of the anaesthesiology training curriculum. [ABSTRACT FROM AUTHOR]

The Industrial Revolution 4.0 (IR 4.0) is a significant period of industrial progress marked by advanced technologies like the Internet of Things (IoT) and Cyber-Physical Systems (CPS). The current change presents significant challenges and opportunities for various sectors, including the Heating, Ventilation, and Air Conditioning (HVAC) industry. Addressing the readiness of HVAC students for IR 4.0, this study investigates the gap in skills and competencies required in this new era. This study primarily assesses the readiness of final-year bachelor's degree students in HVAC, focusing on balancing technical and non-technical skills. Employing a qualitative descriptive research design, the study involved 100 final-year HVAC students from Universiti Tun Hussein Onn Malaysia (UTHM) and Universiti Teknikal Malaysia Melaka (UTeM). A structured questionnaire, developed based on a thorough literature review and validated through expert reviews and a pilot study, was used to collect data. The questionnaire assessed students' self-evaluation of their readiness, understanding of technical skills, and developing non-technical skills relevant to IR 4.0. The analysis revealed that students possess a high level of perceived readiness for IR 4.0, with non-technical skills emerging as significant contributors to their readiness. These skills accounted for 44% of the variance in students' readiness. The findings underscore the importance of integrating non-technical skills into the HVAC curriculum, highlighting their role in equipping students to navigate the evolving technological landscape of IR 4.0. In conclusion, the study provides comprehensive insights into the skillsets necessary for HVAC students to thrive in the IR 4.0 era. It emphasises the need for educational institutions to adapt their curricula and pedagogical strategies to include a balanced focus on technical and non-technical skills, thereby enhancing student employability and readiness for the challenges of the modern industrial world. [ABSTRACT FROM AUTHOR]

Nowadays, due to the rapidly changing business environment, non-technical skills have become critical factors in determining employment. Companies assert that fresh graduates often fall short of their expectations. Nevertheless, employers emphasize that non-technical skills are crucial for fresh graduates to remain competitive and secure employment in the current job market. Therefore, this research aims to study the importance of non-technical skills and their impact on graduates' employability. The study utilizes online questionnaire surveys for 120 graduates from different states, universities, occupations, and backgrounds to rank the importance of 15 non-technical skills. Meanwhile, Pearson correlations and multiple regression analysis are employed to study the relationship between three independent variables and graduates' employability. The statistical findings reveal a positive correlation between non-technical skills and graduates' employment. According to the study results, the top five skills deemed more important than others are adaptability, ethical behavior, leadership, critical and creative thinking, and tolerance of ambiguity. Therefore, it is essential for students to develop their non-technical skills during their studies to meet the expectations of future employers. [ABSTRACT FROM AUTHOR]

Background and importance: Use of video review in medicine is established in contexts such as surgery. Although not widely used in the emergency department (ED), some centres use it to evaluate non-technical skills (NTS) to support teaching and quality improvement. Objective: There is no consensus on assessment of NTS using video review in the ED and the purpose of this review was to identify tools used in this context. Design, setting and participants: Studies were identified using Embase, Medline, CINAHL and Google Scholar. Inclusion criterion for the review was NTS of resuscitation teams working within the ED were assessed using video review. A systematic search method was used, and results were synthesised after search criteria was checked by two independent reviewers. Authors settled on the same 9 studies eligible for inclusion. Outcome measures and analysis: Reliability and validity of tools identified for use in this context. Due to the heterogeneity of studies, no meta-analysis occurred. Main results: There are 9 studies included in the review. The review was registered with PROSPERO (Ref No: CRD42022306129). Four unique tools were identified – 6 studies used T-NOTECHS, 1 used TTCA-24, 1 used CALM and 1 used the Communication tool. T-NOTECHS is validated in the literature for use in this context. Conclusion: T-NOTECHS is the tool of choice for assessing ED teams in this context. [ABSTRACT FROM AUTHOR]

Gross anatomy education utilizing body donors and human specimens assists the acquisition of non‐traditional, discipline‐independent skills (NTDIS) such as teamwork, communication, and leadership. Alterations to anatomy curricula, such as those resulting from the COVID‐19 pandemic, likely impact NTDIS acquisition, yet how this manifests is unclear. This study, therefore, explored anatomy educator perspectives on NTDIS acquisition as a response to changes in teaching delivery. Gross anatomy educators across different countries were recruited and took part in one‐on‐one, semi‐structured interviews that were audio recorded and transcribed. Data were analyzed using the framework method. Basic statistical analyses were performed on demographic and categorical data. Fifteen educators from five continents were interviewed (average length 32.5 min, range 17–51 min). Educator experience ranged from 0–4 years (n = 3) to 20+ years (n = 7). Most taught using dissection (n = 14) with prosection use (n = 13) also common. Themes relating to NTDIS included expected content (respect for donors, teamwork, communication skills, humanistic values), assessable content, assessment challenges, and impact of curriculum changes; NTDIS unique to anatomy education included cultural, ethical, and social considerations around dead bodies, including boundaries, and social norms. Informed by curriculum alterations during the COVID‐19 pandemic, this first empirical study of anatomy educator perspectives on NTDIS highlights the potentially adverse educational impacts of decreased interaction with body donors and human specimens on NTDIS acquisition and difficulties with NTDIS assessment. Findings support gross anatomy education as unique in providing NTDIS that cannot easily be replicated elsewhere. Recommendations around NTDIS‐specific educator competencies and promoting NTDIS are provided. [ABSTRACT FROM AUTHOR]

Regional anaesthesia is an essential tool in the armamentarium for paediatric anaesthesia. While largely safe and effective, a range of serious yet preventable adverse events can occur. Incidence and risk factors have been described, but few detailed case series exist relating to paediatric regional anaesthesia. Across Australia and New Zealand, a web-based anaesthesia incident reporting system enables voluntary reporting of detailed anaesthesia-related events in adults and children. From this database, all reports involving paediatric regional anaesthesia (age less than 17 years) were retrieved. Perioperative events and their outcomes were reviewed and analysed. When offered, the reported contributing or alleviating factors relating to the case and its management were noted. This paper provides a summary of these reports alongside an evidence review to support safe practice. Of 8000 reported incidents, 26 related to paediatric regional anaesthesia were identified. There were no deaths or reports of permanent harm. Nine reports of local anaesthetic systemic toxicity were included, seven equipment and technical issues, six errors in which regional anaesthesia made an indirect contribution and four logistical and communication issues. Most incidents involved single-shot techniques or a neuraxial approach. Common themes included variable local anaesthetic dosing, cognitive overload, inadequate preparation and communication breakdown. Neonates, infants and medically complex children were disproportionately represented, highlighting their inherent risk profile. A range of preventable incidents are reported relating to patient, systems and human factors, demonstrating several areas for improvement. Risk stratification, application of existing dosing and administration guidelines, and effective teamwork and communication are encouraged to ensure safe regional anaesthesia in the paediatric population. [ABSTRACT FROM AUTHOR]

Non-technical skills (NTS) are important skills in emergency medicine and should be a necessity even at the stage of medical studies. The aim of this study was to assess how increasing the number of non-technical skills hours influenced the results of non-technical competences among medical students. In this investigation, 296 Polish medical students in the sixth year at Medical College in Krakow, Poland were included in the study. The students were divided into two research groups: I in 2018 and II in 2019. The groups differed in the number of total hours that focused on non-technical skills, in 2018: 60 hr, and 2019: 120 total hours. Non-technical competencies were assessed at the Crisis Resource Management station using sudden cardiac arrest scenarios. In 2018, the median was 20 points and the average of the points obtained in this group was 19.53 points (SD 5.39 points). In 2019, the median was 26 points and the average of points was 25.07 points (SD 5.23 points). Students who had more non-technical skills classes (120 hr) scored more points on the OSCE exam than group I (60 hr) (p <.001). The median of points in non-technical competences depended on the number of teaching hours in which the main emphasis was on the development of these skills. This investigation demonstrates that more teaching hours dedicated to improving the non-technical skills of students corresponded to better results on the cardiopulmonary resuscitation scenarios. [ABSTRACT FROM AUTHOR]

In Obstetrics and Gynecologic operating room emergencies, the surgeon cannot both operate and lead a suddenly expanded and redirected team response. However, one of the most often used approaches to interprofessional continuing education designed to improve teams' ability to respond to unanticipated critical events still emphasizes surgeon leadership. We developed Explicit Anesthesia and Nurse Distributed (EXPAND) Leadership to imagine a workflow that might better distribute emergency leadership task responsibilities and practices. The purpose of this exploratory study was to investigate teams' responses to distributing leadership during an interprofessional continuing education simulated obstetrical emergency. We used interpretive descriptive design in a secondary analysis of teams' post-simulation reflective debriefings. One-hundred sixty providers participated, including OB-Gyn surgeons, anesthesiologists, CRNAs, scrub technicians, and nurses. Using reflective thematic analysis, we identified three core themes: 1) The surgeon is focused on the surgical field, 2) Explicit leadership initiates a nurse transition from follower to leader in a hierarchical environment, and 3) Explicit distributed leadership enhances teamwork and taskwork. Continuing education which uses distributed leadership to improve teams' ability to respond to an obstetric emergency is perceived to enhance team members' response to the critical event. The potential for nurses' career growth and professional transformation was an unexpected finding associated with this continuing education which used distributed leadership. Our findings suggest that healthcare educators should consider ways in which distributed leadership may improve teams' response to critical events in the operating room. [ABSTRACT FROM AUTHOR]

Background: Operating room nurses have specialised technical and non-technical skills and are essential members of the surgical team. The profession's dependency of tacit knowledge has made their non-technical skills difficult to access for researchers, thus, creating limitations in the identification of the non-technical skills of operating room nurses. Non-technical skills are categorised in the crew resource management framework, and previously, non-technical skills of operating room nurses have been identified within the scope of the framework. The purpose of this study is to explore operating room nurses' descriptions of their practices in search for non-technical skills not included in the crew resource management framework. Methods: This study has a qualitative design. An expert panel of experienced operating room nurses (N = 96) in Norway provided qualitative descriptions of their practice in a Delphi survey. The data were analysed in an inductive thematic analysis. This study was conducted and reported in line with Standards for Reporting Qualitative Research (SRQR). Results: The inductive thematic analysis developed two themes, 'Ethical competence' and 'Professional accountability', that encompass operating room nurses' novel descriptions of their non-technical skills. The participants take pride in having the patients' best interest as their main objective even if this may threaten their position in the team. Conclusions: This study has identified novel non-technical skills that are not described in the crew resource management framework. These findings will contribute to the development of a new behavioural marker system for the non-technical skills of operating room nurses. This system will facilitate verbalisation of tacit knowledge and contribute to an increased knowledge about the operating room nursing profession. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: Simulation-based training allows surgical skills to be learned safely. Most virtual reality-based surgical simulators address technical skills without considering non-technical skills, such as gaze use. In this study, we investigated surgeons' visual behavior during virtual reality-based surgical training where visual guidance is provided. Our hypothesis was that the gaze distribution in the environment is correlated with the simulator's technical skills assessment. Methods: We recorded 25 surgical training sessions on an arthroscopic simulator. Trainees were equipped with a head-mounted eye-tracking device. A U-net was trained on two sessions to segment three simulator-specific areas of interest (AoI) and the background, to quantify gaze distribution. We tested whether the percentage of gazes in those areas was correlated with the simulator's scores. Results: The neural network was able to segment all AoI with a mean Intersection over Union superior to 94% for each area. The gaze percentage in the AoI differed among trainees. Despite several sources of data loss, we found significant correlations between gaze position and the simulator scores. For instance, trainees obtained better procedural scores when their gaze focused on the virtual assistance (Spearman correlation test, N = 7, r = 0.800, p = 0.031). Conclusion: Our findings suggest that visual behavior should be quantified for assessing surgical expertise in simulation-based training environments, especially when visual guidance is provided. Ultimately visual behavior could be used to quantitatively assess surgeons' learning curve and expertise while training on VR simulators, in a way that complements existing metrics. [ABSTRACT FROM AUTHOR]

Introduction: Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. Materials and methods: We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. Results: We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. Conclusion: The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings. [ABSTRACT FROM AUTHOR]

Copyright of Die Gynäkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Globally, at least one adverse event occurs in 10% of patients using emergency, inpatient, outpatient, surgical and primary care services. Particularly in emergency health care, this problem is exacerbated by additional variables such as patient criticality, high-risk diagnostic and therapeutic interventions and varying levels of healthcare provider training. In relation to the last point, briefing and debriefing activities during an emergency reinforce staff training and support them in managing work resources, planning interventions and improving future performance. The aim of the scoping review is to explore the state of the art in human factors applied to emergency situations and to develop a new tool to support healthcare professionals in conducting evidence-based briefings and debriefings. This review was developed using a search strategy based on the Arksey and O'Malley's six-step framework for scoping reviews. The literature analysed and the data identified, which are heterogeneous due to different study methodologies, objectives and types of interventions, suggest that human factors applied to emergency situations are still under-researched. At the end of the data extraction, analysis process, authors' reviews, discussion rounds and comparison with the multidisciplinary team of healthcare providers, 42 behaviours, 33 elements and 8 domains were considered relevant and included in the Emergency Team Comptencies (ETC) briefing and debriefing tool, ranked in order of priority as follows: communication, decision-making, clinical skills, situational awareness, leadership, task management, collaboration and stress and fatigue management. Further research is needed to investigate human factors applied to emergency situations and to generate new evidence to improve clinical practice and reduce the risk of error. In the near future, further studies will be conducted by the authors to test the validity of the Emergency Team Competencies tool in objectively measuring the performance of professionals and multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Background: Non-technical skill (NTS) teaching is a recent development in medical education that should be applied in medical education, especially in medical specialties that involve critically ill patients, resuscitation, and management, to promote patient safety and improve quality of care. Our study aimed to compare the effects of mini-course training in NTS versus usual practice among emergency residents. Methods: In this prospective (non-randomized) experimental study, emergency residents in the 2021–2022 academic year at Ramathibodi Hospital, a tertiary care university hospital, were included as participants. They were categorized into groups depending on whether they underwent a two-hour mini-course training on NTS (intervention group) or usual practice (control group). Each participant was assigned a mean NTS score obtained by averaging their scores on communication and teamwork skills given by two independent staff. The outcome was the NTS score before and after intervention at 2 weeks and 16 weeks. Results: A total of 41 emergency residents were enrolled, with 31 participants in the intervention group and 10 in the control group. The primary outcome, mean total NTS score after 2 weeks and 16 weeks, was shown to be significantly better in intervention groups than control groups (25.85 ± 2.06 vs. 22.30 ± 2.23; P < 0.01, 28.29 ± 2.20 vs. 23.85 ± 2.33; P < 0.01) although the mean total NTS score did not differ between the groups in pre-intervention period. In addition, each week the NTS score of each group increased 0.15 points (95% CI: 0.01–0.28, P = 0.03), although the intervention group showed greater increases than the control (0.24 points) after adjustment for time (95% CI: 0.08–0.39, P < 0.01). Conclusion: Emergency residents who took an NTS mini-course showed improved mean NTS scores in communication and teamwork skills versus controls 2 weeks and 16 weeks after the training. Attention should be paid to implementing NTS in the curricula for training emergency residents. Trial registration: This trial was retrospectively registered in the Thai Clinical Trial Registry on 29/11/2022. The TCTR identification number is TCTR20221129006. [ABSTRACT FROM AUTHOR]

Prophylactic cannula cricothyroidotomy is a recognised technique for actual or potential difficult airway management, where it confers a number of technical and non-technical benefits. Oxygenation with this technique is traditionally achieved by way of pressure-regulated, high flow jet ventilation and requires specialised equipment and considerable expertise for safe use, neither of which are always readily available. As an alternative, we describe the management of two patients with progressive upper airway obstruction in whom prophylactic cannula cricothyroidotomy and oxygen insufflation were performed using equipment which we consider is safer, widely available and already familiar to most anaesthetists throughout Australia. [ABSTRACT FROM AUTHOR]

It is on the sharp end of the O&G operations where the real work happens, but also where the highest risks and system demands are placed. Understanding the skills—technical and non-technical—necessary to perform efficiently and safely is not only needed to maintain the business and assets, but also to ensure the safety of lives and the environment. Accidents such as Piper Alpha (1988), P-36 (2001) and Deepwater Horizon (2010) highlight the importance of understanding the real role of the human element in these events, from the highest hierarchical levels to the sharp end, where the work as done takes place. This article presents a non-technical skills analysis focused on the sharp end of O&G operations, specifically in the facilities/utilities operations, onshore (refineries) and offshore (production platforms). The findings show the importance and presence of certain non-technical skills, as well as the need for improvement of others in the daily routine and in emergencies. [ABSTRACT FROM AUTHOR]

Copyright of Trakya University, Economics & Administrative Sciences Faculty E-Journal / Trakya Üniversitesi İktisadi ve İdari Bilimler Fakültesi E-dergi is the property of T.C. Trakya Universitesi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

New physicians need to master non-technical skills (NTS), as high levels of NTS have been shown to increase patient safety. It has also been shown that NTS can be improved through training. This study aimed to establish the necessary NTS for Norwegian medical students to create a tool for formative and summative assessments. Focus group interviews were conducted with colleagues and patients of newly graduated physicians. Interviews were then analyzed using card sort methods, and the identified NTS were used to establish a framework. Focus groups commented on a prototype of an NTS assessment tool. Finally, we conducted a search of existing tools and literature. The final tool was developed based on the combined inputs. We created Norwegian medical students' non-technical skills (NorMS-NTS) assessment tool containing four main categories; together comprising 13 elements and a rating scale for the NTS of the person observed. The NorMS-NTS represents a purpose-made tool for assessing newly graduated physicians' NTS. It is similar to existing assessment tools but based on domain-specific user perspectives obtained through focus group interviews and feedback, integrated with results from a literature search, and with consideration of existing NTS tools. [ABSTRACT FROM AUTHOR]

Background: The 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. Methods: We 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. Results: Of 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. Conclusion: The 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. [ABSTRACT FROM AUTHOR]

Background: Anaesthesia 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. Methods: Follow-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. Results: Anaesthesia 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. Conclusions: Participants 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. [ABSTRACT FROM AUTHOR]

Background: Situation awareness (SA) is a key factor in accountability and ensuring patient safety in health care. SA is an essential element to research on human factors in healthcare. It is essential to identify valid instruments for measuring this concept and assessing how it is affected by interventions and educational methods. Methods: This systematic review aimed to assess the measurement properties of situation awareness instruments in health care providers' (HCPS) using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Four databases (Medline (through PubMed), Embase, Scopus, and Web of Science) were systematically searched. A manual search was also conducted on Google Scholar and the reference list of the included primary studies to supplement the electronic search. Studies aiming to determine the measurement properties of SA instruments or non-technical skills in HCPS were included. The overall results for each measurement property were reported as sufficient, insufficient, inconsistent, or indeterminate, and the quality of evidence was reported as high, moderate, low, or very low. Results: A total of 25 studies and 15 instruments were included in the study. More than one measurement property was reported in some of the studies, and none of the studies presented all measurement properties. The most common measurement properties were content validity (12/25) and internal consistency (12/25). Cross‐cultural validity and responsiveness were not investigated in any study. Evidence quality for the measurement properties was not high in any of the 15 instruments. Conclusions: None of the instruments can be recommended as the most suitable instrument, and all instruments were classified as promising instruments in need of further psychometric assessment. This systematic review proves the dire need for the development and psychometric evaluation of instruments to measure SA in HCPs in clinical settings. Systematic review registration: PROSPERO CRD42020147349. [ABSTRACT FROM AUTHOR]

Keywords: anaesthesia; education and training; ergonomics; human factors; non-technical skills; patient safety; simulation; theatre team EN anaesthesia education and training ergonomics human factors non-technical skills patient safety simulation theatre team 407 410 4 03/15/23 20230401 NES 230401 The term "human factors" in medicine has been used flexibly to have a multitude of meanings. Anaesthesia, education and training, ergonomics, human factors, non-technical skills, patient safety, simulation, theatre team Perhaps more often in health and anaesthesia, "human factors" has been synonymous with the skills required for effective teamwork, also termed, "non-technical skills", "soft skills" or "teamwork competencies" [[2]]. [Extracted from the article]

Summary: Human factors is an evidence‐based scientific discipline used in safety critical industries to improve safety and worker well‐being. The implementation of human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high‐quality patient care. To encourage the adoption of human factors science in anaesthesia, the Difficult Airway Society and the Association of Anaesthetists established a Working Party, including anaesthetists and operating theatre team members with human factors expertise and/or interest, plus a human factors scientist, an industrial psychologist and an experimental psychologist/implementation scientist. A three‐stage Delphi process was used to formulate a set of 12 recommendations: these are described using a 'hierarchy of controls' model and classified into design, barriers, mitigations and education and training strategies. Although most anaesthetic knowledge of human factors concerns non‐technical skills, such as teamwork and communication, human factors is a broad‐based scientific discipline with many other additional aspects that are just as important. Indeed, the human factors strategies most likely to have the greatest impact are those related to the design of safe working environments, equipment and systems. While our recommendations are primarily provided for anaesthetists and the teams they work with, there are likely to be lessons for others working in healthcare beyond the speciality of anaesthesia. [ABSTRACT FROM AUTHOR]

Non-technical skills, the social and cognitive skills thought necessary for safe and effective working, have been studied within the farming context over the past six years. However, these skills are not yet taught as part of a safety curriculum for farmers, due, in part, to a lack of defined framework and assessment system. The current paper describes the development of the FLINTS behavioral marker system for discussion, observation, evaluation and feedback on non-technical skills for farmers. The development of the behavioral marker system proceeded through three key stages. First, the current research knowledge on non-technical skills was synthesized to compile a list of non-technical skill categories and elements. Second, a series of discussion groups with subject matter experts was conducted to develop behavioral markers for each element. Lastly, refinement and review of the system was undertaken by academics and experts. The prototype FLINTS taxonomy containing five non-technical skill categories and 16 elements was produced. The non-technical skill categories comprised situation awareness, teamwork & communication, leadership, task management and decision-making each with specific elements and behavioral markers. FLINTS represents the first behavioral marker system for farmer non-technical skills, constructed through expert knowledge and advice via discussion and review groups, combined with underpinning research findings. This represents the first step towards the development of non-technical training and assessment for farmers. The current version of the FLINTS system is freely available to all potential users (). [ABSTRACT FROM AUTHOR]

Health Education England has created seven endoscopy training academies across England. These will oversee the multidisciplinary training of all endoscopy staff on a regional basis to address the challenges of waiting times and recovery, which are often limited by human resources. This article outlines the North West vision for the future of endoscopy training and how it will impact on all staff, for the benefit of patients. [ABSTRACT FROM AUTHOR]

Safety training of migrant workers in construction has focused on technical skills with limited attention to non-technical skills, which support safety training transfer to the worksite, both immediately after training and in the long term. Using realist evaluation as our theoretical framework, this study explores the transfer of two key non-technical skills to construction sites: communication and decision-making. Trained workers completed questionnaires post-training and after six months. A moderated mediation model found an indirect link through training transfer between communication and decision-making skills immediately post-training and six months later. The results also revealed that high levels of safety self-efficacy moderated the relationship between communication, but not decision-making, safety skills post-training and the extent to which trained workers reported transferring these skills. The study has important practical implications, showing the significance of training transfer of non-technical skills, such as communication and decision-making, to the worksite. [ABSTRACT FROM AUTHOR]

This article explores the development of the most critical soft skills in midwifery through the use of a participatory method called the World Café in the context of continuing education at the Formation and Simulation Center (FORSim) in Settat, Morocco. Non-technical skills include a set of metacognitive abilities that complement technical skills to ensure the safe execution of technical activities and the parturient's satisfaction. In order to develop these midwifery skills through the World Café method, we invited nine midwives from two maternity units in the Casablanca-Settat region, with whom we elaborated our psychological, organizational, cognitive, and interactional (POCI) model. The study took place over a full day, structured into three distinct steps: a self-assessment of the level of mastery of the eight soft skills in the POCI model, four cycles of the World Café and, finally, a discussion of and feedback about the method. The use of the World Café method allowed for a dialogue on the possibilities of managing and addressing issues related to non-technical skills among midwives from various hospital settings. Based on the results, we found that the participants enjoyed the non-stressful atmosphere of the World Café and were very productive. The assessments and feedback from the midwives participating in this study suggest that managers can adopt the World Café approach to develop non-technical skills and enhance midwives' interactions and soft skills as part of their continuing education. [ABSTRACT FROM AUTHOR]

The International Federation of Accountants (IFAC) requires its member professional accounting organisations and their authorised educators to adopt the overarching guidelines that are provided in the International Education Standards (IES). Despite these requirements, which include that accounting students develop several non-technical skills (NTS), students fail to adequately develop such skills. Furthermore, several studies advise that accounting programmes must incorporate emotional intelligence (EI) development initiatives, but this requirement is excluded from the IES. Resultantly, educators may disregard EI development within accounting programmes, especially since these programmes are already considered overloaded. This study investigates whether it is possible to advance the NTS of accounting students while facilitating the development of their EI competencies by aiming to answer the following question: which EI capabilities can improve the NTS of accounting students? By following a qualitative research approach and performing a systematic literature review, the study found that the enhancement of multiple EI capabilities can lead to the improvement of several NTS of accounting students. Educators that want to renew their NTS development offering, or introduce EI development initiatives within their accounting programmes, can use these findings as a guide to determine which EI capabilities (or combination thereof) can advance the essential NTS of accounting students. [ABSTRACT FROM AUTHOR]

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Tactical decision games (TDGs) have been used in healthcare and other safety-critical industries to develop non-technical skills training (NTS). TDGs have been shown to be a realistic, feasible, and useful way of teaching NTS such as decision making, task prioritisation, situational awareness, and team working. Our 12-tips for using TDG to teach NTS are based on our experience of integrating them into an undergraduate medical and nursing programme. We cover how to design successful TDGs, how to facilitate and debrief them and how to integrate TDGs into curricula. We have found TDGs to be a cost-effective, low fidelity, and useful method of delivering NTS teaching, ideally as an adjunct to immersive simulation. Learners find them a useful way to be introduced to NTS in a safe and relaxed environment, with particular emphasis on critical decision making and prioritisation. [ABSTRACT FROM AUTHOR]