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The added value of prehospital emergency medicine is usually assessed by measuring patient-centered outcomes. Prehospital rotations might however also help senior residents acquire specific skills and knowledge. To assess the perceived added value of the prehospital rotation in comparison with other rotations, we analyzed web-based questionnaires sent between September 2011 and August 2020 to senior residents who had just completed a prehospital rotation. The primary outcome was the perceived benefit of the prehospital rotation in comparison with other rotations regarding technical and non-technical skills. Secondary outcomes included resident satisfaction regarding the prehospital rotation and regarding supervision. A pre-specified subgroup analysis was performed to search for differences according to the participants&rsquo, service of origin (anesthesiology, emergency medicine, or internal medicine). The completion rate was of 71.5% (113/158), and 91 surveys were analyzed. Most senior residents found the prehospital rotation either more beneficial or much more beneficial than other rotations regarding the acquisition of technical and non-technical skills. Anesthesiology residents reported less benefits than other residents regarding pharmacological knowledge acquisition and confidence as to their ability to manage emergency situations. Simulation studies should now be carried out to confirm these findings.

The care process is a complex event involving the collaboration of several specialized professionals in a high-tech environment. In this context, the teaching and acquisition of increasingly specialized technical skills has long been the main driving force behind the selection of health professionals. However, improving the quality and safety of care can only be based on the development of a genuine safety culture allowing the implementation of a risk management strategy. Several approaches will make it possible to structure this risk management: secure the learning of potentially dangerous invasive procedures for patients, acquire and assess organizational skills, promote communication and appropriate cooperation between the various healthcare professionals, adopt rationalization tools and standardization of practices.The development of new educational tools such as Simulation makes it possible to improve the quality of patient care by integrating non-technical and organizational skills into the training of health professionals through a reflective and experiential approach. Simulation-based teaching thus aims to teach, evaluate and improve technical procedure, diagnostic or therapeutic processes, more or less complex clinical situations or decision-making. It makes it possible to identify and recognize risky situations through a systemic analysis of the error. Soft skills can be organized into four broad categories: task management (planning and prioritizing, providing and maintaining standards and identifying available resources), teamworking (coordinating activities, exchanging information, leadership), situational awareness and decision making. Along with this classification of non-technical skills, we looked at the impact of simulation-based pedagogy according to the Kirkpatrick classification (reactions, learning, behavior, results), the final target being to improve quality and safety in patient care.We first built and validated simulation-based models for teaching and assessing technical and non-technical skills in healthcare. The “Tricked cart” model was developed for the purpose of teaching and evaluating task management by improving the recognition of sources of medication errors. The OTPA (Obstetric Team Performance Assessment) grid has been developed to provide a tool for assessing skills in critical situations.We then focused on measuring the impact of a larger-scale, inter-professional and multi-disciplinary educational program enabling the implementation of teamworking and in particular communication.Finally, we have developed a tool for measuring and analyzing situational awareness and decision making by combining a standardized simulated scenario with the use of an eye-tracking device. We analyzed the signals from an oculometric recording in order to identify the factors involved in situational awareness and decision making.More than a teaching technique, simulation is a methodological tool that allows teaching and evaluating technical and non-technical skills in healthcare and thus contribute to improving the quality and safety of care in a risk analysis and management process., Le processus de soins est un événement complexe impliquant la collaboration de plusieurs professionnels spécialisés dans un environnement à haute technicité. Dans ce contexte, l’enseignement et l’acquisition de compétences techniques de plus en plus pointues a longtemps été le principal moteur de sélection des professionnels de santé. Pourtant, l’amélioration de la qualité et de la sécurité des soins ne peut reposer que sur le développement d’une véritable culture sécurité permettant de mettre en place une stratégie de gestion du risque. Plusieurs démarches vont permettre de structurer cette gestion du risque : sécuriser l’apprentissage des gestes invasifs potentiellement dangereux pour les patients, acquérir et évaluer des compétences organisationnelles, favoriser une communication et une coopération adaptée entre les différents professionnels de santé, adopter des outils de rationalisation et de standardisation des pratiques.Le développement de nouveaux outils pédagogiques tels que la Simulation permet d’améliorer la qualité de la prise en charge des patients en intégrant à la formation des professionnels de santé des compétences non techniques et organisationnelles à travers une démarche réflexive et expérientielle. La pédagogie par simulation vise ainsi à enseigner, évaluer et améliorer des gestes techniques, des processus diagnostiques ou thérapeutiques, des situations cliniques plus ou moins complexes ou des prises de décisions. Elle permet d’identifier et de reconnaître les situations à risque à travers une analyse systémique de l’erreur. Les compétences non techniques peuvent être organisées en quatre grandes catégories : la gestion des tâches (planification et priorisation, mise en place de référentiels et identification des ressources disponibles), le travail en équipe (coordination, communication, leadership), la conscience situationnelle et la prise de décision. Parallèlement à cette classification des compétences non techniques, nous nous sommes intéressés à l’impact de la pédagogie par simulation selon la classification de Kirkpatrick (réactions, apprentissages, comportements, résultats), l’objectif final étant d’améliorer la qualité et la sécurité des soins aux patients.Nous avons dans un premier temps construit et validé des modèles d’enseignement et d’évaluation des compétences techniques et non techniques basés sur la simulation en santé Le modèle du « Chariot Piégé » a été développé dans un objectif d’enseignement et d’évaluation de la gestion des tâches à travers l’amélioration de la reconnaissance des sources d’erreurs médicamenteuses. La grille OTPA (Obstetric Team Performance Assessment) a été élaborée afin de fournir un outil d’évaluation des compétences en situation critique.Nous nous sommes ensuite intéressés à la mesure de l’impact d’un programme pédagogique à plus grande échelle, interprofessionnel et multidisiplinaire permettant d’implémenter le travail en équipe et notamment la communication.Enfin, nous avons développé un outil de mesure et d’analyse de la conscience situationnelle et de la prise de décision en combinant un scénario simulé standardisé à l’utilisation d’un dispositif de suivi oculaire (eye-tracking). Nous avons ainsi analysé les signaux issus d’un enregistrement oculométrique dans le but d’identifier les facteurs impliqués dans la conscience situationnelle et la prise de décision.Plus qu’une technique pédagogique, la simulation est un outil méthodologique qui permet d’enseigner et d’évaluer les compétences techniques et non techniques en santé et de contribuer ainsi à l’amélioration de la qualité et de la sécurité des soins dans une démarche d’analyse et de gestion du risque en santé.

Aim The aim of this study was to explore how operating room nurses (ORNs) experience operating room (OR) team communication concerning non‐technical skills. Design Based on the Scrub Practitioners List of Intraoperative Non‐Technical Skill (SPLINTS), qualitative individual in‐depth semi‐structured interviews were conducted with 11 ORNs in a Norwegian university hospital. Braun and Clarke's six analytic phases for thematic data analysis were used. Results Surgeons being unprepared or demanding different instruments than the preoperative information indicates, cause stress and frustration. So does noise and brusquely or poor communication. Ensuring good information flow within the entire team is important. When silence is required, the ORNs communicate with gestures, looks and nods. Creating a positive and secure team culture facilitates discussions, questions and information sharing. Conclusion Inappropriate dynamics, inaccurate and/or disrespectful communication and noise may reduce patient safety. Interdisciplinary team training may bring attention to the value of communication as a non‐technical skill.

There is an increasing focus in medical education on trainee evaluation. Often, reliability and other psychometric properties of evaluations fall below expected standards. Rater training, a process whereby raters undergo instruction on how to consistently evaluate trainees and produce reliable and accurate scores, has been suggested to improve rater performance within behavioral sciences. A scoping literature review was undertaken to examine the effect of rater training in medical education and address the question: “Does rater training improve performance attending physician evaluations of medical trainees?” Two independent reviewers searched PubMed®, MEDLINE®, EMBASE™, the Cochrane Library, CINAHL®, ERIC™, and PsycInfo® databases and identified all prospective studies examining the effect of rater training on physician evaluations of medical trainees. Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklists were used to assess quality. Fourteen prospective studies met the inclusion criteria. All had heterogeneity in design, type of rater training, and measured outcomes. Pooled analysis was not performed. Four studies examined rater training used to assess technical skills; none identified a positive effect. Ten studies assessed its use to evaluate non-technical skills: six demonstrated no effect, while four showed a positive effect. The overall quality of studies was poor to moderate. Rater training in medical education literature is heterogeneous, limited, and describes minimal improvement on the psychometric properties of trainee evaluations when implemented. Further research is required to assess rater training’s efficacy in medical education.

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).

The work in high-risk environments like an operating room is complex. The operating team consist of many professions with different tasks cooperating towards a common goal, the performance of safe surgery. The operating teams’ technical and non-technical skills may affect the surgical outcome. The aim of this thesis was to explore some of the factors that may influence safe surgery. Study I evaluated the operating team’s perceptions of an implemented intraoperative pause routine. The operating team felt positive about the implementation, many perceived that communication and teamwork was enhanced and some of the surgeons stated that a pause made them feel refreshed and sometimes contributed to changes of surgical strategy. Study II was an interventional study to evaluate teamwork and safety climate in the operating room after an intervention with education on safety climate and teamwork, and the introduction of a revised WHO Surgical Safety Checklist. We found deficiencies in communication and teamwork in the operating team. The intervention did not change teamwork or safety climate. Study III evaluated surgeons’ self-assessed satisfaction with the performance of prostatectomies in a large clinical trial. There was a strong correlation between surgeons’ satisfaction and intraoperative difficulties or complications, which became stronger with every additional difficulty or complication. Study IV was a randomized controlled trial to assess if surgeons’ stress levels were affected by an intraoperative pause during simulated operations. There were no significant differences in stress levels but the surgeons’ perception of the intraoperative pause was positive. In conclusion, to study non-technical skills in the operating team is complex as surgical outcome and patient safety are multi-factorial. Many among the operating team members believed that improved teamwork and communication could benefit patient safety. Thus, one way to enhance patient safety could be to introduce intraoperative pauses as they were perceived to be beneficial for teamwork and communication.

Background The non-technical skills for surgeons (NOTSS) system was developed as a tool to assess surgical skills for patient safety during surgery. This study aimed to develop a NOTSS-based training system for surgical trainees to acquire non-technical skills using a chest surgery scenario in a wet lab. Materials and methods Trainees were categorized into three subgroups according to the years of experience as follows: Level A: 6 years or more; Level B: 3–5 years; and Level C: 1–2 years. Three stages of surgical procedure were designed: 1. chest wall resection and right upper lobe lobectomy, 2. right middle lobe sleeve lobectomy, and 3. right lower lobe lobectomy. One instructor was assigned to each operation table, who evaluated each participant's NOTSS scores consisting of 16 elements. Results When comparing average NOTSS score of all the three procedures, significant differences were observed between Level A, B, and C trainees. As an example of varying elements by procedure, Level A trainees demonstrated differences in Situation Awareness, and a significant difference was observed in Level C trainees regarding the elements of Decision Making. On the contrary, no significant difference was observed among Level B trainees. In the comparison between first-time and experienced participants, a significant improvement was observed in some elements in Level B and C trainees. Conclusion This study highlights the usefulness and feasibility of the NOTSS scoring system for surgeons with different experiences and the effectiveness of providing feedback to trainees during intraoperative handoffs in a wet lab., Highlights • Team training was effective for trainees of different levels. • Surgeons need continuing education of a non-technical skills.

Master's thesis in Risk Management and Societal Safety Crew Resource Management (CRM) is a well-known training concept developed in the aviation industry in the 1970’s to reduce human error after several horrific accidents. It has since expanded to other high-risk industries. The goal of CRM is to increase human performance, increase team performance and utilize all available resources to achieve the highest level of safety possible. Research has shown that CRM is effective but results on the organizational level has not been established. CRM has traditionally only been implemented in the sharp end, while results are expected for the whole organization. This case study aims to explore the expansion of CRM in the non-operational parts of an organization by researching the project Team Resource Management (TRM) in CHC, an offshore helicopter operator. TRM is CRM for all employees, both operational and non-operational. The purpose is to shed a light on how it is done and what the possible benefits are as well as factors that can inhibit the success of CRM in the non-operational part of an organization. This study’s aim is answering: Why should CHC prioritize Team Resource Management? To answer this question interviews with employees in CHC, other CRM experts and document analysis has been conducted. To achieve the aim of this study, theories on safety and risk management in organizations and human factors has been used. The results show that the potential benefits from TRM could increase the organization’s reliability by creating a reliable flow of high-quality intelligence across departments, which increases the chance of achieving a shared situation awareness on an organizational level. The reliable flow of high-quality intelligence also enables the different actors within the system to see their part in the organization and how they affect each other. The factors that might inhibit the organization experiencing these benefits are weak safety leadership, blunt/sharp end difference in risk perception and potential for reaching a saturation point in terms of safety initiatives. The analysis not only found factors that might inhibit the project’s success, but also hurt the organization’s safety culture. The final conclusions recommend CHC to prioritize TRM, as it is shown to be a cost-effective safety measure that will provide a holistic approach to safety management and increase the organization’s reliability. Crew Resource Management (CRM) er et velkjent treningskonsept utviklet i luftfartsindustrien på 1970-tallet for å redusere menneskelig svikt etter en rekke alvorlige flyulykker. Siden den tid har konseptet blitt tatt i bruk og tilpasset andre industrier med høy risiko. Målet med CRM er å optimalisere den menneske ytelsesevnen ved å samarbeide i team og utnytte alle tilgjengelige ressurser for å oppnå høyest mulig sikkerhet. Forsking viser at CRM er effektivt, men så langt er det ikke empirisk bevist å ha effekt på organisatorisk nivå. CRM har tradisjonelt sett bare blitt implementert i den skarpe enden, mens resultater forventes på organisatorisk nivå. Denne casestudien har tatt sikte på å utforske utvidelsen av CRM inn i de ikke-operative delene i en organisasjon ved å forske på Team Resource Management (TRM) i CHC, som er en offshore helikopteroperatør. TRM er kort fortalt CRM for alle ansatte, både i den skarpe og butte enden av organisasjonen, med sikte på å besvare: Hvorfor bør CHC prioritere Team Resource Management? Gjennom intervjuer med ansatte i CHC, andre CRM-eksperter, samt dokumentanalyse er potensielle fordeler organisasjonen kan oppnå fra TRM identifisert. For måloppnåelse er det benyttet ulike teorier innen sikkerhets- og risikostyring for organisasjoner samt teorier innen feltet «human factors». Resultatene viser at de potensielle fordelene ved TRM kan øke organisasjonens pålitelighet ved å skape en pålitelig flyt av høykvalitetsinformasjon på tvers av avdelinger i organisasjonen. Dette øker sjansen for å oppnå en felles situasjonsbevissthet på organisatorisk nivå. Den pålitelige flyten av høykvalitetsinformasjon gjør det også mulig for de ulike aktørene i systemet å se hvor de er i organisasjonen og hvordan de ulike aktørene påvirker hverandre i et sikkerhetsperspektiv. De faktorene som kan hindre organisasjonen i å oppnå disse fordelene er en svak sikkerhetsledelse, forskjellen i risikopersepsjon i den butte og skarpe enden og et potensielt metningspunkt når det kommer til sikkerhetstiltak. Analysen fant ikke bare faktorer som kan hemme prosjektets suksess, men også skade organisasjonens sikkerhetskultur. Den endelige konklusjonen anbefaler CHC å prioritere TRM, da det viser å være et kostnadseffektivt sikkerhetstiltak som vil gi en helhetlig tilnærming til sikkerhetsstyring og kan øke organisasjonens pålitelighet.

This research is part of a multidisciplinary project to develop a virtual reality (VR) training environment in non-technical skills (NTS) for scrub nurses. The objective of this thesis was to provide the partners with the choice of NTS, to define training scenarios and to provide a first proof of concept on a targeted population. According to the literature and interviews with expert scrub nurses, the NTS selected for the scenarios are situation awareness (SA) and speaking up. Study 1, carried out with 13 scrub nurses and 16 non-experts, aims to assess the acceptability of the environment with the "instrumentation table" scenario (under VR helmet). Study 2, involving 18 scrub nursing students and 8 scrub nurses during an in-service course, aims to develop situation awareness, using the "virtual operating room of errors" scenario (under VR helmet). This scenario enables SA to be assessed and seems a suitable training tool for this NTS. Finally, Study 3, involving 33 scrub nursing students, aims to develop speaking up with a tablet scenario. Our results partially confirm the effect of status on the probability of speaking up and show an effect of status on the discomfort of speaking up. Each study involved numerous exchanges with the project's VR engineers and scrub nursing teachers in order to allow the construction of the environment and its future integration into the scrub nursing school pedagogy. Finally, for each study, specific assessment tools were used and simulation sessions were developed according to recommendations with briefing, simulation, debriefing (HAS, 2012).; Cette recherche s’inscrit dans un projet pluridisciplinaire dont l’objectif est le développement d’un environnement de formation en réalité virtuelle (RV) visant les compétences non techniques (CNT) des infirmier·es de bloc opératoire (IBODE). L’objectif de cette thèse a été de fournir aux partenaires le choix des CNT à mettre en jeu, de définir des scénarios de formation et d’apporter une première preuve du concept sur une population ciblée. D’après les travaux de la littérature et les entretiens avec des IBODE expertes, les CNT retenues pour les scénarios sont la conscience de la situation et la communication. L’étude 1, réalisée auprès de 13 IBODE expertes et 16 non-expert·es, vise à mesurer l’acceptabilité de l’environnement avec le scénario « table d’instrumentation » (sous casque de RV). L’étude 2, réalisée auprès de 18 élèves IBODE en formation initiale et 8 IBODE en formation continue, vise à développer la conscience de la situation, à partir du scénario du « bloc virtuel des erreurs » (sous casque de RV). Ce scénario permet d’évaluer la conscience de la situation et semble être un outil de formation approprié pour cette CNT. Enfin, l’étude 3, réalisée auprès de 33 élèves IBODE en formation initiale, vise à développer la communication ouverte avec un scénario sur tablettes. Nos résultats confirment partiellement l’effet du statut sur la probabilité de signaler une erreur et montrent un effet du statut sur l’embarras à signaler cette erreur. Chaque étude a nécessité de nombreux échanges avec les ingénieur·es en RV du projet ainsi qu’avec les formateur·rices IBODE afin de permettre la construction de l’outil et son intégration future dans la pédagogie mise en œuvre à l’Ecole d’IBODE. Enfin, pour chacune d’entre elles, des outils de mesure spécifiques ont été utilisés et des séances de simulation ont été élaborées selon les recommandations de l’HAS avec briefing, simulation, débriefing (HAS, 2012).

The literature shows that healthcare errors are due to a lack of non-technical skills. Non-technical skills are interpersonal and cognitive skills, whose training in high-fidelity simulation environment, contributes to a safe and effective performance in the solution of diverse and adverse clinical situations. Although the literature reinforces the importance of non-technical skills training in the prevention of errors and consequently in the improvement of patient care delivery, there is not yet an effective and structured curricular integration that allows to develop, in a systematic way, these competences in healthcare education. In order to respond to World Health Organization concerns, particularly those related to patient safety issues, the promotion and implementation of nontechnical skills training programs is paramount. In this sense, the objective of this quasi-experimental investigation is to promote knowledge and training of acting strategies in clinical nursing practice, through the development and implementation of a non-technical skills training course in high-fidelity simulation context with nursing students. In order to evaluate the effectiveness of the developed course, some instruments were constructed, namely the Non-Technical Skills Assessment Scale in Nursing. Thus, according to the results obtained, the present investigation contributes to scientific evidence, reinforcing the importance of non-technical skills training in increasing knowledge, performance and confidence in patient care delivery in the experimental group after the implementation of the course, in comparison with the control group. The main implication for clinical practice is the promotion of patient safety. Based on the present investigation, future work may focus on the implementation of this course not only to nursing students but also to professionals in healthcare teams. On the other hand, it would be important to integrate these competences into structured and specialized curricular modules in nursing education, and in other healthcare areas, as high-quality clinical performance involves not only technical, but mainly non-technical skills. A literatura demonstra que a maioria dos erros em saúde se deve à falta de competências não-instrumentais. Estas, são competências interpessoais e cognitivas que, treinadas em ambiente de simulação de alta-fidelidade, contribuem para potenciar um desempenho seguro e eficaz na resolução de situações clínicas diversas e adversas. Apesar de a literatura reforçar a importância do seu treino na prevenção de erros e consequentemente na melhoria da prestação de cuidados ao doente, não existe ainda uma integração curricular efetiva e estruturada, que permita desenvolver, de forma sistemática, estas competências no ensino em saúde. Procurando dar resposta às normativas e preocupações da Organização Mundial de Saúde, nomeadamente às questões ligadas à segurança do doente, será premente a promoção e implementação de programas de formação em competências não-instrumentais. Neste sentido, o objetivo da presente investigação, do tipo quase-experimental, é o de promover o conhecimento e treino de estratégias de atuação na prática clínica em enfermagem através do desenvolvimento e implementação de uma ação de formação em competências não-instrumentais em contexto de simulação de alta-fidelidade a estudantes de enfermagem. Com o intuito de avaliarmos a sua eficácia foram construídos alguns instrumentos, dos quais destacamos o Questionário de Competências Não-Instrumentais. Desta forma, de acordo com os resultados obtidos, a presente investigação constitui um contributo para a evidência científica, reforçando a importância do treino de competências não-instrumentais no aumento do conhecimento, do desempenho e da confiança na prestação de cuidados, do grupo experimental após a implementação da formação, em comparação com o grupo de controlo, tendo como principal implicação para a prática clínica a promoção da segurança do doente. Com base na presente investigação, futuros trabalhos poderão focar-se na implementação desta formação não só a estudantes como a profissionais de saúde, nomeadamente a equipas de trabalho constituídas. Por outro lado, seria importante a integração desta temática em módulos curriculares estruturados e especializados em competências não-instrumentais no ensino de estudantes de enfermagem, e de outras áreas da saúde, na medida em que o desempenho clínico de alta qualidade envolve não só competências instrumentais, mas sobretudo competências não-instrumentais. Programa Doutoral em Psicologia

Tese de Doutoramento em Políticas de Desenvolvimento dos Recursos Humanos Esta tese foca-se no Bridge Resource Management (BRM) e na sua edificação no contexto operacional da Marinha Portuguesa. Pretende avaliar o potencial de treino de simuladores ao nível de desenvolvimento de competências não-técnicas e analisar como evoluem a consciência situacional, o estilo de tomada de decisão e a memória transitiva ao longo de fases sucessivas de treino de equipa. O estudo 1 propôs que os simuladores utilizados no treino de militares embarcados podem contribuir para o desenvolvimento de competências não-técnicas, tendo-se verificado que as tarefas treinadas nos simuladores são afetadas pelo decaimento de competências e da eficácia do treino de forma distinta. O estudo 2 pretendeu testar a evolução positiva da consciência situacional e do estilo de tomada de decisão ao longo de fases sucessivas de treino de equipas. Os resultados obtidos não evidenciam este efeito. A consciência situacional emerge como uma competência fundamental para operar em contexto marítimo, sendo o estilo de tomada de decisão predominante é o estilo evitativo. O estudo 3 propôs que o estilo de tomada de decisão e a memória transitiva se podem desenvolver, de forma positiva, ao longo de sucessivas fases de treino de equipa. Os resultados deste estudo indicam que tanto o estilo de tomada de decisão como a memória transitiva não apresentam uma evolução positiva ao longo das fases sucessivas de treino, emergindo o estilo evitativo como o estilo de tomada de decisão predominante. Os resultados dos três estudos, complementados com uma revisão teórica da aplicabilidade do BRM como potenciador de operações seguras em contexto marítimo, evidenciam o papel importante que o BRM pode ter como metodologia de treino em contexto marítimo. É evidenciada a exequibilidade da sua aplicação no contexto operacional da Marinha Portuguesa e destacadas as mais-valias para a organização. This dissertation entails the edification of the Bridge Resource Management in the Portuguese Navy. Its aims were to investigate the training potential of simulators for the development of non-technical skills and investigate the development of situational awareness, decision-making style and transactive memory during consecutive temporal team training periods. In the first study, we proposed that simulators can be used for non-technical skills development. Our results showed that task training using simulation-based training can be affected by skills decay and loss of training effectiveness. In the second study we proposed that situational awareness and decision-making style can positively evolve throughout successive temporal phases of team training. Our results did not evidence this effect. Situational awareness emerged as a fundamental skill for operating in maritime context, while avoidant decision-making style is the predominant style among team elements. In the third study we considered the positive effect of time on decision-making style and transactive memory development. Our results do not show any positive effect of successive training phases on the development of these two skills, with avoidant decision-making style being the prevailing one. Overall, the results of our three studies, in addition to the theoretical review of the applicability of BRM as the base for safer maritime operations, contributed for evidencing the important role that BRM can play as a training methodology in the maritime context. In addition, it is evidenced the feasibility of its application in the Portuguese Navy operational context as well as its added value for the organization. N/A

Introduktion: Under de senaste 20 åren har icke-tekniska färdigheters betydelse för patientsäkerheten belysts mer och mer i forskningen. Interprofessionell utbildning med CRM som simulatorkoncept används för att träna icke-tekniska färdigheter och teamarbete men att träna under pågående operation är ovanligt. Syfte: Syftet är att utvärdera hur deltagarna upplever användandet av icke-tekniska färdigheter under en interprofessionell lärandeaktivitet på en dagkirurgisk operation. Metod: Tvärsnittsstudie med enkät som deltagarna (N=239) blev tillfrågade att svara på efter deltagande vid operation. Enkäten utvärderas deltagarnas upplevelse av kommunikation och teamarbete. Deskriptiv statistik och analys med Chi2, Wilcoxon sign rank test och Kruskal-Wallis användes. Resultat: Användandet av kommunikation inom och mellan professionerna har rankats som mycket högt av majoriteten av deltagarna i alla frågor, vid kontroll med Chi2 analys är det statistiskt signifikanta svar. Deltagarna upplever en ökad förståelse för andra professioner i teamet efter deltagande och de flesta anser att de blir en mer effektiv medlem i teamet och samt att patienter har fördel av att ett team löser patientens problem. Ingen statistisk signifikant skillnad sågs mellan professionerna. Slutsats: Träning under en pågående operation är möjligt att genomföra samt är uppskattat av deltagarna och viktigt för deras utveckling av icke-tekniska färdigheter Nyckelord: Icke-tekniska färdigheter, interprofessionellt lärande, CRM, SBAR, closed-loop-kommunikation. Introduction: During the past two decades, there has been increased interest in non-technical skills and how they affect patient safety. The number of articles published in the field has increased. Interprofessional education with the concept of CRM has been shown to be an effective way to train non-technical skills and teamwork, but training during ongoing surgery is uncommon. Purpose: The purpose is to evaluate how the participants experienced the use of non-technical skills in an interprofessional learning activity during ambulatory surgery. Method: This was a cross-sectional study in which the participants (N=239) were asked to answer an evaluation survey following ambulatory surgery, concerning their experience of communication and teamwork. Descriptive statistics and inferential statistics with chi-square, Wilcoxon signed-rank test and Kruskal-Wallis were used to analyse the material. Results: The use of communication within and between the professions was ranked as very high by the majority of the participants in all the questions in the survey, and control using chi-square showed the results to be statistically significant. The participants experienced an increased understanding of the other professions in the team, and deemed that they had become more effective team members. They were also of the opinion that patients have an advantage when a medical team solves their problems. There were no statistically significant results between the professions. Conclusion: Training can be implemented during ongoing surgery. This is a popular activity with participants, and is vital for their development of non-technical skills. Keywords: Non-technical skills, interprofessional education, CRM, SBAR, closed-loop communication

Background Simulation is known as an important tool for the learning of technical and non-technical skills without endangering patient safety. In Portugal, a National Pedagogical Plan for Anesthesiology Residents was created based on simulation training. This plan was designed according to the objectives set forth by the Portuguese Board of Anesthesiology. This study aimed to evaluate the impact of simulation training courses on the non-technical skills of medical residents in Anesthesiology. Methods Confidential questionnaires, pre- and post-course, were answered by all the residents that attended the different modules of the simulation training program at Centro Hospitalar e Universitário de Coimbra Biomedical Simulation Centre, Portugal, from February 2011 to March 2018. Results A total of 344 questionnaires were answered. In the group of questions regarding the need for help, mistakes, and self-efficacy over time, students recognized an increase over time in the need for support and the self-assessment of the number of mistakes (p

Purpose Non-technical skills have gained attention, since enhancement of these skills is presumed to improve the process of trauma resuscitation. However, the reliability of assessing non-technical skills is underexposed, especially when using video analysis. Therefore, our primary aim was to assess the reliability of the Trauma Non-Technical Skills (T-NOTECHS) tool by video analysis. Secondarily, we investigated to what extent reliability increased when the T-NOTECHS was assessed by three assessors [average intra-class correlation (ICC)] instead of one (individual ICC). Methods As calculated by a pre-study power analysis, 18 videos were reviewed by three research assistants using the T-NOTECHS tool. Average and individual degree of agreement of the assessors was calculated using a two-way mixed model ICC. Results Average ICC was ‘excellent’ for the overall score and all five domains. Individual ICC was classified as ‘excellent’ for the overall score. Of the five domains, only one was classified as ‘excellent’, two as ‘good’ and two were even only ‘fair’. Conclusions Assessment of non-technical skills using the T-NOTECHS is reliable using video analysis and has an excellent reliability for the overall T-NOTECHS score. Assessment by three raters further improve the reliability, resulting in an excellent reliability for all individual domains.

Introduction: High Fidelity Simulations (HFS) are increasingly used to develop Non-Technical Skills (NTS) in healthcare providers, medical and nursing students. Instruments to measure NTS are needed to evaluate the healthcare providers' (HCPs) performance during HFS. The aim of this systematic review is to describe the domains, items, characteristics and psychometric properties of instruments devised to evaluate the NTS of HCPs during HFS., Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Studies were retrieved from PubMed, Cinahl, Web of Science, Cochrane Library, ProQuest and PubPsych. Studies evaluating the measurement properties of instruments used to assess NTS during HFS training were included. Pairs of independent reviewers determined the eligibility, extracted and evaluated the data. Risk of bias and appraisal of the methodological quality of the studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and the quality of the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)., Results: A total of 3,953 articles were screened. A total of 110 reports were assessed for eligibility and 26 studies were included. Studies were conducted in Europe/United Kingdom ( n = 13; 50%), North America/Australia ( n = 12; 46%) and Thailand ( n = 1; 4%). The NTS instruments reported in this review included from 1 to 14 domains (median of 4, Q 1 = 3.75, Q 3 = 5) and from 3 to 63 items (median of 15, Q 1 = 10, Q 3 = 19.75). Out of 19 NTS assessment instruments for HFS, the Team Emergency Assessment Measure (TEAM) can be recommended for use to assess NTS. All the other instruments require further research to assess their quality in order to be recommended for use during HFS training. Eight NTS instruments had a positive overall rating of their content validity with at least a moderate quality of evidence., Conclusion: Among a large variety of published instruments, TEAM can be recommended for use to assess NTS during HFS. Evidence is still limited on essential aspects of validity and reliability of all the other NTS instruments included in this review. Further research is warranted to establish their performance in order to be reliably used for HFS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gawronski, Thekkan, Genna, Egman, Sansone, Erba, Vittori, Varano, Dall’Oglio, Tiozzo and Chiusolo.)

Objectives There is substantial lack of guidance when it comes to the implementation of non-technical skills (NTS) in undergraduate medical education. This review aimed to identify and critically evaluate published literature on learning strategies for NTS in undergraduate medical education and to derive a training framework targeted towards standardizing future training interventions. Methods A systematic review of the MEDLINE database was performed using a prospective protocol following PRISMA guidelines. Studies evaluating undergraduate medical students exposed to NTS interventions, which measured subjective or objective outcomes in selected attributes, were included. Results Initial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria. A total of 24 NTS were identified, with communication skills being the most commonly reported skill evaluated (n = 37). A variety of educational tools were used (n = 32), noteworthy being the use of simulated patients. Great heterogeneity was also observed in measured outcomes and methods of assessment. A ‘triad of outcomes’ in NTS training was devised (knowledge, skill performance and attitude towards skills) and used for classification of all reported outcomes. Extracted data were used to design a non-technical skill training framework. Conclusions The existing literature describes a plethora of NTS interventions in undergraduate medical education, with varied outcomes and assessments. We hereby propose the ‘NTS Training Framework’, in an attempt to coordinate future research and catalyze the identification of an ideal NTS course structure to form tomorrow's physicians., Highlights • Initial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria. • A total of 24 non-technical skills (NTS) were identified, with communication skills being the most commonly reported skill. • A ‘triad of outcomes’ in NTS training was devised (knowledge, skill performance and attitude towards skills). • We propose a unified framework for NTS training, with the objective of guiding future research.

Background Despite the growing importance of medical simulation in education, there is limited guidance available on how to develop medical simulation environments, particularly with regard to technical and non-technical skills as well as to multidisciplinary operating room (OR) team training. We introduce a cognitive task analysis (CTA) approach consisting of interviews, structured observations, and expert consensus to systematically elicit information for medical simulator development. Specifically, our objective was to introduce a guideline for development and application of a modified CTA to obtain task demands of surgical procedures for all three OR professions with comprehensive definitions of OR teams’ technical and non-technical skills. Methods To demonstrate our methodological approach, we applied it in vertebroplasty, a minimally invasive spine procedure. We used a CTA consisting of document reviews, in situ OR observations, expert interviews, and an expert consensus panel. Interviews included five surgeons, four OR nurses, and four anesthetists. Ten procedures were observed. Data collection was carried out in five OR theaters in Germany. Results After compiling data from interviews and observations, we identified 6 procedural steps with 21 sub-steps for surgeons, 20 sub-steps for nurses, and 22 sub-steps for anesthetists. Additionally, we obtained information on 16 predefined categories of intra-operative skills and requirements for all three OR professions. Finally, simulation requirements for intra-operative demands were derived and specified in the expert panel. Conclusions Our CTA approach is a feasible and effective way to elicit information on intra-operative demands and to define requirements of medical team simulation. Our approach contributes as a guideline to future endeavors developing simulation training of technical and non-technical skills for multidisciplinary OR teams. Electronic supplementary material The online version of this article (10.1186/s41077-018-0077-2) contains supplementary material, which is available to authorized users.

Background Resource allocation in patient care relies heavily on individual judgements of healthcare professionals. Such professionals perform coordinating functions by managing the timing and execution of a multitude of care processes for multiple patients. Based on advances in simulation, new technologies that could be used for establishing realistic representations have been developed. These simulations can be used to facilitate understanding of various situations, coordination training and education in logistics, decision-making processes, and design aspects of the healthcare system. However, no study in the literature has synthesized the types of simulations models available for non-technical skills training and coordination of care. Methods A systematic literature review, following the PRISMA guidelines, was performed to identify simulation models that could be used for training individuals in operative logistical coordination that occurs on a daily basis. This article reviewed papers of simulation in healthcare logistics presented in the Web of Science Core Collections, ACM digital library, and JSTOR databases. We conducted a screening process to gather relevant papers as the knowledge foundation of our literature study. The screening process involved a query-based identification of papers and an assessment of relevance and quality. Results Two hundred ninety-four papers met the inclusion criteria. The review showed that different types of simulation models can be used for constructing scenarios for addressing different types of problems, primarily for training and education sessions. The papers identified were classified according to their utilized paradigm and focus areas. (1) Discrete-event simulation in single-category and single-unit scenarios formed the most dominant approach to developing healthcare simulations and dominated all other categories by a large margin. (2) As we approached a systems perspective (cross-departmental and cross-institutional), discrete-event simulation became less popular and is complemented by system dynamics or hybrid modeling. (3) Agent-based simulations and participatory simulations have increased in absolute terms, but the share of these modeling techniques among all simulations in this field remains low. Conclusions An extensive study analyzing the literature on simulation in healthcare logistics indicates a growth in the number of examples demonstrating how simulation can be used in healthcare settings. Results show that the majority of studies create situations in which non-technical skills of managers, coordinators, and decision makers can be trained. However, more system-level and complex system-based approaches are limited and use methods other than discrete-event simulation.

Background Inadequate non-technical skills (NTSs) among employees in the Norwegian prehospital emergency medical services (EMSs) are a risk for patient and operational safety. Simulation-based training and assessment is promising with respect to improving NTSs. The frequency of simulation-based training in and assessment of NTSs among crewmembers in the Norwegian helicopter emergency medical service (HEMS) has gained increased attention over recent years, whereas there has been much less focus on the Norwegian ground emergency medical service (GEMS). The aim of the study was to compare and document the frequencies of simulation-based training in and assessment of seven NTSs between the Norwegian HEMS and GEMS, conditional on workplace and occupation. Method A comparative study of the results from cross-sectional questionnaires responded to by employees in the Norwegian prehospital EMSs in 2016 regarding training in and assessment of NTSs during 2015, with a focus on the Norwegian GEMS and HEMS. Professional groups of interest are: pilots, HEMS crew members (HCMs), physicians, paramedics, emergency medical technicians (EMTs), EMT apprentices, nurses and nurses with an EMT licence. Results The frequency of simulation-based training in and assessment of seven generic NTSs was statistically significantly greater for HEMS than for GEMS during 2015. Compared with pilots and HCMs, other health care providers in GEMS and HEMS undergo statistically significantly less frequent simulation-based training in and assessment of NTSs. Physicians working in the HEMS appear to be undergoing training and assessment more frequently than the rest of the health trust employees. The study indicates a tendency for lesser focus on the assessment of NTSs compared to simulation-based training. Conclusion HEMS has become superior to GEMS, in terms of frequency of training in and assessment of NTSs. The low frequency of training in and assessment of NTSs in GEMS suggests that there is a great potential to learn from HEMS and to strengthen the focus on NTSs. Increased frequency of assessment of NTSs in both HEMS and GEMS is called for.

Purpose The purpose of this paper is to evaluate the effectiveness of negotiation training delivered to senior clinicians, managers and executives, by exploring whether staff members implemented negotiation skills in their workplace following the training, and if so, how and when. Design/methodology/approach This is a qualitative study involving face-to-face interviews with 18 senior clinicians, managers and executives who completed a two-day intensive negotiation skills training course. Interviews were transcribed verbatim, and inductive interpretive analysis techniques were used to identify common themes. Research setting was a large tertiary care hospital and health service in regional Australia. Findings Participants generally reported positive affective and utility reactions to the training, and attempted to implement at least some of the skills in the workplace. The main enabler was provision of a Negotiation Toolkit to assist in preparing and conducting negotiations. The main barrier was lack of time to reflect on the principles and prepare for upcoming negotiations. Participants reported that ongoing skill development and retention were not adequately addressed; suggestions for improving sustainability included provision of refresher training and mentoring. Research limitations/implications Limitations include self-reported data, and interview questions positively elicited examples of training translation. Practical implications The training was well matched to participant needs, with negotiation a common and daily activity for most healthcare professionals. Implementation of the skills showed potential for improving collaboration and problem solving in the workplace. Practical examples of how the skills were used in the workplace are provided. Originality/value To the authors’ knowledge, this is the first international study aimed at evaluating the effectiveness of an integrative bargaining negotiation training program targeting executives, senior clinicians and management staff in a large healthcare organization.