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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]

The aim of this study was to identify and prioritize non-technical skills required by engineering disciplines of Urmia University. The statistical population of this study included industrial employers and engineering graduates of Urmia University, which was selected by stratified sampling method based on Morgan table. The research method used is descriptive-survey. The measurement tool and data collection tool in this study was a questionnaire whose validity and reliability were examined and confirmed in the present study. SPSS 23 software was used for data analysis. The results of data analysis show that the average of all non-technical skills of Urmia University graduates in terms of employers is higher than the theoretical average, which is at a desirable level. In the ranking of skills, by surveying graduates, in critical skills from the highest and in emotional intelligence skills from the lowest average, and from the point of view of employers, graduates had the highest in responsibility skills and lowest average in creativity skills. It is recommended that the approved curriculum that the university considers for engineering disciplines to improve non-technical skills should be such that the curriculum is designed in according with the current and future needs of engineering organizations. Holding class projects, education and training essential skills that can develop students’ emotional intelligence and creativity skills should be considered.

Abstract Background Cognitive skills and other non-technical skills are key for emergency medical services (EMS); however, there have been a limited number of their markers identified. This study aims to identify markers of cognitive skills—situation awareness and decision making—important for team leaders in EMS. The focus is on any markers of cognitive skills that are associated with quality and safety at EMS work. Method In-depth semi-structured interviews were conducted with 20 EMS team leaders (10 EMS physician team leaders and 10 paramedic team leaders) and analysed by the structured approach utilising the known framework of cognitive skill elements. Results The data analysis revealed a set of 50 markers falling into elements of situation awareness (gathering information, interpreting information, anticipating states), elements of decision making (identifying options, implementing decisions, re-evaluating decisions), and an additional cognitive element (maintaining standards). These markers represented cognitive processes, acts, and communications, therefore, some of them can be observable and others rather unobservable. The identified markers were not too specific, applicable mostly in various challenging situations with patients’ medical problems and in EMS team leaders working in ground ambulances in urban and rural/remote areas. Conclusion The findings provide a better understanding of EMS team leaders’ cognitive skills, and can aid in the development of assessment and training tools suited particularly to them.

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

Jennifer Pollard,1 Michal Tombs2 1Highland Medical Education Centre, University of Aberdeen, Inverness, UK; 2Centre for Medical Education, Cardiff University, Cardiff, UKCorrespondence: Michal Tombs, Centre for Medical Education, Cardiff University, Cardiff, UK, Email TombsM2@cardiff.ac.ukPurpose: Research suggests that medical students in the UK report a need to be better prepared for the non-technical skills required for the role of a junior doctor. A Simulated Ward Experience was developed in an attempt to address this need. The purpose of this study was (1) to evaluate the effectiveness of the Simulated Ward Experiences by examining students’ reactions regarding the quality of teaching and (2) to examine the main drivers of learning and the extent to which students felt it helped them prepare for their future training.Methods: A mixed method evaluation study was conducted using a questionnaire and focus groups. Final year students who participated in the Simulated Ward Experience were invited to contribute to the evaluation, out of which 25 completed the questionnaire and 13 took part in focus group interviews. Data analysis were conducted by means of descriptive statistics for questionnaire data and thematic analysis of focus group transcripts.Results: The median Likert scores for quality of teaching Non-Technical Skills were either very good or excellent, demonstrating that students were highly satisfied with the way in which these were taught. Qualitative data provided further insights into the aspects of the intervention that promoted learning, and these were categorised into four themes, including realism of the simulation; relevance for the role and responsibilities of the Foundation Year 1 Doctor (including Non-Technical Skills); learning from and with others; and supportive learning environment.Conclusion: This evaluation study provides further evidence of the value of learning in a simulated setting, particularly when it is closely aligned to the real clinical context and creates opportunities to practice skills that are perceived to be relevant by the learner. Study limitations are recognised and suggestions for further studies are provided.Keywords: evaluation, simulation, non-technical skills, preparedness

Abstract Background Although there is an increasing amount of research on the use of structured behavioural assessment instruments for non-technical skills in a simulation or clinical setting, there is currently little research into how healthcare professionals experience using these instruments. The structured behavioural assessment instrument, Nurse Anaesthetists’ Non-Technical Skills-Norway, has recently been introduced to nurse anaesthesia education as a means of developing and assessing non-technical skills in clinical practice. The aim of this study was therefore to explore the experiences of Norwegian student nurse anaesthetists, their mentors and clinical supervisors on using the instrument in clinical practice. Methods This study has a qualitative descriptive design. Data was collected through semi-structured interviews with four focus groups comprising twelve student nurse anaesthetists and thirteen mentors and clinical supervisors. The interviews were recorded and then transcribed verbatim. Data was analyzed using qualitative content analysis and an inductive approach. Results Six categories were identified that represented the manifest content. One main theme: Forging a path towards clinical excellence was identified representing the latent content, and three themes that described the participants’ experiences with using the instrument: Promotion of excellent non-technical skills: Raising awareness of non-technical skills ensured professional suitability and shaping of a professional identity; internalizing the skills could lead to changes in behaviour. Promotion of cooperative learning: Mentoring was more structured, based on a common language and understanding and clearly defined roles; measurable progress enabled a more reliable and objective evaluation. Promotion of organizational acceptance: A lack of familiarity with the instrument, and challenges with scoring and the terminology impeded acceptance. Conclusion Increased awareness of non-technical skills when using Nurse Anaesthetists’ Non-Technical Skills-Norway contributes to a professionalization of the nurse anaesthetist role and mentoring/learning process in nurse anaesthesia education. Using Nurse Anaesthetists’ Non-Technical Skills-Norway promotes the ideal of clinical excellence, not only as an assessment instrument but also by guiding the student’s learning process. Despite a high level of commitment to using the instrument there is a need to promote further acceptance in the anaesthetic departments.

Global nursing shortages and increasing cultural diversity in healthcare necessitate the development of culturally sensitive nurses. Intercultural learning and exchange programs have been shown to enhance nursing students' intercultural knowledge, cultural awareness, and sensitivity. However, non-technical skills such as communication, leadership, and teamwork are less emphasized in existing programs, despite their importance in facilitating adaptation to clinical contexts and ensuring patient safety across different ethnic groups. This study aims to evaluate the effectiveness of a Collaborative Learning in a Student-led Global Classroom (CLSGC) program that employs video-based learning and student-led debriefings to enhance non-technical skills, and to explore the experiences of undergraduate nursing student participants from three different regions. Seventy-eight nursing students from the Hong Kong Polytechnic University, Malmo University, and La Trobe University participated in the program. The program included three webinars on teamwork, communication skills, and leadership, facilitated through student-led discussions and video simulations. Data were collected using the Team Strategies and Tools to Enhance Performance and Patient Safety Teamwork Attitudes Questionnaire, and qualitative methods including focus groups and reflective journals. A paired t -test and manifest content analysis were used to analyze the quantitative and qualitative data, respectively. The quantitative results indicated significant improvements in the students' attitudes towards teamwork, communication, and leadership. The qualitative data shed light on the students' learning experiences, highlighting the value of cultural exchanges in exploring the importance of non-technical skills in practice, and the effectiveness of the program structure. The CLSGC program effectively improved nursing students' non-technical skills and enriched their clinical practice. Integrating simulation-based learning and student-led debriefing sessions to enhance nursing students' knowledge and attitudes towards teamwork, communication, and leadership is recommended in nursing education. Continuous exposure to simulation should be part of nursing education to reinforce the significance of non-technical skills in practice. • Non-technical skills such as leadership, teamwork, and communication are less emphasized in existing intercultural programs within nursing education. • Video-based learning and student-led debriefing are essential for integrating non-technical skills into a program. • Non-technical skills should be incorporated into nursing curricula at the early stages of a course. [ABSTRACT FROM AUTHOR]

Abstract The assurance of patient safety in emergency general surgery remains challenging due to the patients’ high-risk underlying conditions and the wide variability in emergency surgical care provided around the globe. The authors of this article convened as an expert panel on patient safety in surgery at the 8th International Conference of the World Society of Emergency Surgery (WSES) in Edinburgh, Scotland, on September 7–10, 2021. This review article represents the proceedings from the expert panel discussions at the WSES congress and was designed to provide an international perspective on optimizing teamwork and non-technical skills in emergency general surgery.

Abstract Background SimUniversity competition is an innovative Society in Europe for Simulation Applied to Medicine (SESAM) initiative which has existed since 2014, with the aim of creating opportunities for undergraduate healthcare students to take part in a formative educational experience on an international platform. The main educational focus is on promoting non-technical skills such as leadership, situation awareness, decision making, communication, and assertiveness, but also clinical reasoning within a team. In preparation for the 2021 virtual conference, the team designed a new methodology to meet the same mission, and yet be offered remotely. Main text In this article, we describe the way in which we transformed the SimUniversity competition activity from face to face to a remote simulation. We relied on Zoom as the main communication technology to enable the distance component and followed the key elements of pre-briefing, simulation, and debriefing with the students being onsite together in one location and the faculty and simulator technologists in distant locations. Thirty-eight medical and nursing students formed 8 teams from 7 different countries. Two participating teams were based in Germany and one in Italy, Belgium, the Netherlands, Romania, Portugal, and Syria. Each team consisted of between 4 and 5 members and was self-selected to consist of either medical students alone or medical and nursing students together. The SimUniversity faculty team was composed of 5 physician educators, one nurse educator, one paramedic simulation technologist, and one industry simulation technologist. The faculty members facilitated each simulation synchronously in Zoom, while being based in different geographical locations within Europe (Germany, Switzerland, and the Netherlands) and the Middle East (Qatar and Lebanon). Conclusion We conclude that assuming there is access to adequate internet connectivity and minimal technical setup, conducting a remote simulation with virtual debriefing is achievable in supporting team-based learning, particularly when learners and/or faculty members are in distant locations. While the authors do not recommend this method to be superior to a face-to-face experience, we propose this model to be an alternative method to consider when educators are faced with imposed restrictions such as what we faced during the COVID-19 pandemic. We discuss lessons learned and highlight other potential benefits that this method may provide, to consider even when the restrictions are lifted.

Abstract Background Patient handover between prehospital care and the emergency department plays a key role in patient safety. Therefore, we aimed to create a validated tool for measuring quality of communication and interprofessional relations during handover in this specific setting. Methods Based on a theoretical framework a comprehensive item pool on information transfer and human factors in emergency department handovers was created and refined in a modified Delphi survey involving clinical experts. Based on a pre-test, items were again revised. The resulting Emergency Department Human Factors in Handover tool (ED-HFH) was validated in a field test at the emergency department of a German university hospital from July to December 2017. The ED-HFH was completed by emergency department and ambulance service staff participating in handovers and by an external observer. Description of item characteristics, exploratory factor analysis, analyses on internal consistency and interrater reliability by intraclass-correlation. Construct validity was analysed by correlation with an overall rating on quality of the handover. Results The draft of the ED-HFH contained 24 items, 90 of 102 eligible staff members participated in the field test completing 133 questionnaires on 38 observed handovers. Four items were deleted after analysis of item characteristics. Factor analysis supported a single factor explaining 39% of variance in the items. Therefore, a sum-score was calculated with a possible range between 14 and 70. The median value of the sum-score in the sample was 61.5, Cronbach’s α was 0.83, intraclass-correlation was 0.52, the correlation with the overall rating of hand-over quality was ρ = 0.83 (p ≤ 0.001). Conclusions The ED-HFH showed its feasibility, reliability and validity as a measure of quality of information transfer and human factors in handovers between ambulance services and the emergency department. It promises to be a useful tool for quality assurance and staff training.

Background: It is well understood that surgical skills largely define patient outcomes both in Minimally Invasive Surgery (MIS) and Robot-Assisted MIS (RAMIS). Non-technical surgical skills, including stress and distraction resilience, decision-making and situation awareness also contribute significantly. Autonomous, technologically supported objective skill assessment can be efficient tools to improve patient outcomes without the need to involve expert surgeon reviewers. However, autonomous non-technical skill assessments are unstandardized and open for more research. Recently, Surgical Data Science (SDS) has become able to improve the quality of interventional healthcare with big data and data processing techniques (capture, organization, analysis and modeling of data). SDS techniques can also help to achieve autonomous non-technical surgical skill assessments. Methods: An MIS training experiment is introduced to autonomously assess non-technical skills and to analyse the workload based on sensory data (video image and force) and a self-rating questionnaire (SURG-TLX). A sensorized surgical skill training phantom and adjacent training workflow were designed to simulate a complicated Laparoscopic Cholecystectomy task; the dissection of the cholecyst's peritonial layer and the safe clip application on the cystic artery in an uncomfortable environment. A total of 20 training sessions were recorded from 7 subjects (3 non-medicals, 2 residents, 1 expert surgeon and 1 expert MIS surgeon). Workload and learning curves were studied via SURG-TLX. For autonomous non-technical skill assessment, video image data with tracked instruments based on Channel and Spatial Reliability Tracker (CSRT) and force data were utilized. An autonomous time series classification was achieved by a Fully Convolutional Neural Network (FCN), where the class labels were provided by SURG-TLX. Results: With unpaired t-tests, significant differences were found between the two groups (medical professionals and control) in certain workload components (mental demands, physical demands, and situational stress, p < 0.0001 , 95% confidence interval, p < 0.05 for task complexity). With paired t-tests, the learning curves of the trials were also studied; the task complexity resulted in a significant difference between the first and the second trials. Autonomous non-technical skill classification was based on the FCN by applying the tool trajectories and force data as input. This resulted in a high accuracy (85%) on temporal demands classification based on the z component of the used forces and 75% accuracy for classifying mental demands/situational stress with the x component of the used forces validated with Leave One Out Cross-Validation. Conclusions: Non-technical skills and workload components can be classified autonomously based on measured training data. SDS can be effective via automated non-technical skill assessment. [ABSTRACT FROM AUTHOR]

Caring for critically ill patients requires non-technical skills such as teamwork, communication, and task management. The Behaviorally Anchored Rating Scale (BARS) is a brief tool used to assess non-technical skills. The investigators determined inter- and intra-rater reliability of the BARS when used to assess medical students in simulated scenarios. The investigators created simulation scenarios for medical students during their pediatric clerkship. Content experts reviewed video recordings of the simulations and assigned BARS scores for four performance components (Situational Awareness, Decision-Making, Communication, and Teamwork) for the leader and for the team as a whole. Krippendorff's alpha with ordinal difference was calculated to measure inter- and intra-rater reliability. Thirty medical students had recordings available for review. Inter- and intra-rater reliability for performance components were, respectively, Individual Situational Awareness (0.488, 0.638), Individual Decision-Making (0.529, 0.691), Individual Communication (0.347, 0.473), Individual Teamwork (0.414, 0.466), Team Situational Awareness (0.450, 0.593), Team Decision Making (0.423, 0.703), Team Communication (0.256, 0.517), and Team Teamwork (0.415, 0.490). The BARS demonstrated limited reliability when assessing medical students during their pediatric clerkship. Given the unique needs of this population, a modified or new objective scoring system for assessing non-technical skills may be needed for medical students. [ABSTRACT FROM AUTHOR]

Background: Robot-assisted surgery is expanding worldwide. Most research in this field concentrates on surgeons' technical skills and patient outcome, but research from open and laparoscopic surgery shows that teamwork is crucial for patient safety. Team composition is changed in robot-assisted surgery with the surgeon placed away from the bedside, potentially altering teamwork and workflow in the operating theatre. This scoping review aimed to explore how factors affecting workflow as well as team members' social and cognitive skills during robot-assisted surgery are reported in the literature. Methods: A systematic search was performed in the databases Medline, EMBASE, PsycINFO, and Web of Science. Reports were screened according to the Preferred Reporting Item for Systematic reviews and Meta-Analysis for Scoping Review guidelines. Inclusion criteria were robot-assisted surgery, multi-professional teams, and workflow, flow disruptions, or non-technical skills. Results: A total of 12,527 references were screened, and 24 articles were included in the review. Articles were heterogeneous in terms of aim, methods and focus. The studies concentrated on two main fields: flow disruptions and the categorization of their causes and incidences; and non-technical skills describing the challenges of communication and effects on situation awareness. Conclusion: Many studies focused on flow disruptions and found that communication, coordination, training, and equipment/technology were the most frequent causes. Another focus of studies was non-technical skills—primarily communication and situation awareness. Future studies could focus on how to prevent the most harmful flow disruptions and develop interventions for improving workflow. [ABSTRACT FROM AUTHOR]

Cognitive aids have been shown to facilitate adherence to evidence-based guidelines and improve technical performance of teams when managing simulated critical events. Few studies have explored the effect of cognitive aids on non-technical skills, such as teamwork and communication. The current study sought to explore the effects of different decision support tools (DST), a type of cognitive aid, on the technical and non-technical performance of teams. The current study represents a randomized, blinded, control trial of the effects of three versions of an electronic DST on team performance during multiple simulations of perioperative emergencies. The DSTs included a version with only technical information, a version with only non-technical information and a version with both technical and non-technical information. The technical performance of teams was improved when they used the technical DST and the combined technical and non-technical DST when compared to memory alone. The technical performance of teams was significantly worse when using the non-technical DST. All three versions of the DST had a negligible effect on the non-technical performance of teams. The technical performance of teams in the current study was affected by different versions of a DST, yet there was no effect on the teams' non-technical performance. The use of a DST, including those that focused on non-technical information, did not impact the non-technical performance of the teams. [ABSTRACT FROM AUTHOR]

Background: There are limited opportunities for surgeons to engage in active learning programs once they achieve Fellowship, especially for non‐technical skills such as communication. This study aims to address this gap by evaluating a peer‐based coaching program in non‐technical skill using video‐recorded patient consultations from a routine outpatient clinic. Methods: Standard outpatient consultations between consultant surgeons and patients were video recorded. The surgeon viewed the videos with a peer‐coach (senior surgeon) who helped identify areas of strength and areas for improvement. To test the effect of the coaching session, outpatient consultations were recorded roughly 1 month later. Pre and post‐coaching videos were assessed using the Maastricht History‐Taking and Advice Scoring – Global Rating List (MAAS), a common tool for evaluating non‐technical skills in clinicians. Results: A total of 12 surgeons consented to participate. Coaching significantly improved MAAS scores (mean difference = −0.61; 95% CI (−0.88, −0.33); P < 0.0001). Surgeons were generally positive about the experience. All found the method of learning suitable, and most thought the process improved their skills. Most thought that coaching would improve patient outcomes and the majority thought they would participate in ongoing coaching as part of their employment. Conclusion: This supports the concept of surgical coaching as an effective tool to improve communication skills and the quality of surgical consultation. The next step is to expand beyond a voluntary cohort and link surgical coaching to improved patient outcomes. We sought to understand if a peer‐based coaching program can better the non‐technical skills of surgeons in the outpatient clinic environment. This interventional pilot study assessed 12 surgeons and was conducted at The Queen Elizabeth Hospital (TQEH) in Adelaide, Australia. Our results support the concept that a video‐based peer‐coaching program can act as an effective tool to improve the communication skills of consultant surgeons and improve the quality of surgical consultation. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the impact of interprofessional in situ simulations on the technical and non-technical skills of pediatric burn teams in acute burn management.Methods: This quasi-experimental study consisted of a one-group pre- and post-test design conducted in a pediatric burn center in Turkey. The sample consisted of nine interprofessional burn team members. Data collection tools consisted of the following: descriptive data form, burn technical skills checklists, simulation evaluation form, and Anesthesiologists' non-technical skills in Denmark rating form.Results: We found no statistically significant difference between the pre- and post-test scores for technical (p = 0.285) and non-technical skill (p = 0.180) scores. Burn team members evaluated the highest score in almost all criteria for in situ simulations.Conclusion: The interprofessional in situ simulations did not improve the burn teams' acute burn management; however, according to a self-report, burn team members were satisfied with the interprofessional in situ simulation experiences and achieved their own gains. [ABSTRACT FROM AUTHOR]

Background: The role of medical emergency team (MET) in managing deteriorating patients and enhancing patient safety is greatly affected by teamwork. Aims: To identify teamwork‐related needs of the MET from MET nurses' perspectives. To assess the associations between MET nurses' perceptions of teamwork and their work experience and education. Study design: A quantitative, descriptive correlational design. Methods: Registered intensive care unit (ICU) nurses (n = 50) who were members of the MET in an acute tertiary care hospital answered a modified version of the team assessment questionnaire in 2017. Data were analysed using descriptive statistics, the Kruskal‐Wallis test, and the univariate analysis of variance method. The reporting of this study adheres to the strengthening the reporting of observational studies (STROBE) guidelines. Results: Participants showed least agreement with the items presenting leadership skills (mean = 2.6, SD = 0.68). Approximately 50% nurses disagreed that the MET had adequate resources, training, and skills. The majority of nurses (80%) felt that their responsibilities as a MET member interfered with taking care of their own ICU patients. Many nurses (64%) felt that they did not have a voice in MET's decision‐making process. Approximately 50% nurses felt that they were not recognized for their individual contribution, and they were uncertain regarding MET's policies for dealing with conflicts. The amounts of MET nurses' work experience and education were associated with MET skills and function, respectively. Conclusion: Key teamwork elements of the MET that need improvements include decision‐making and conflict resolution skills, valuing team members, and team leadership. Practicing shared mental models, implementing the TeamSTEPPS curricula at hospitals for training ICU nurses, and simulation‐based team‐training programmes may be beneficial in improving teamwork of MET members. Relevance to clinical practice: This study revealed key teamwork elements of the MET that need improvements. Our findings may contribute to improve teamwork, thereby optimizing MET function, and enhancing patient outcomes. [ABSTRACT FROM AUTHOR]

Students, particularly those in science, technology, engineering and mathematics (STEM) and healthcare‐related programs, should develop proficient interpersonal skills, including communication. To help students develop effective communication skills, instructors need to consider the value students give to learning these skills. The Student Attitudes Toward Communication Skills Survey (SATCSS) was developed to measure how undergraduate students value learning communication skills based on Expectancy‐Value Theory across three modes of communication (verbal, written, non‐verbal). The survey was given to students interested in healthcare professions and enrolled in an undergraduate anatomy and physiology (A&P) course (n = 233) at a Midwest research active university. The survey showed evidence of validity, measuring two components: (1) "Value to Profession" (attainment and utility value) and (2) "Value to Self" (intrinsic value and cost). There was a significant difference in sub‐scores among the four task values such that students thought that learning communication skills was important and relevant (high attainment and utility value) but not interesting (low intrinsic value) and costly. Students with high total scores valued communication skills across all four task values. As total value scores decreased, it was first due to students finding learning communication skills to be time prohibitive and then a lack of interest in learning communication skills. Based on these results, it is recommended that instructors incorporate communication skills training into content that is already part of their A&P course to reduce time concerns. Additional recommendations include using reflective activities and humor to increase student interest. [ABSTRACT FROM AUTHOR]

The primary aim of this review was to identify, analyse and codify the prominence and nature of human factors and ergonomics within difficult airway management algorithms. A directed search across OVID Medline and PubMed databases was performed. All articles were screened for relevance to the research aims and according to predetermined exclusion criteria. We identified 26 published airway management algorithms. A coding framework was iteratively developed identifying human factors and ergonomic specific words and phrases based on the Systems Engineering Initiative for Patient Safety model. This framework was applied to the papers to delineate qualitative and quantitative results. Our results show that human factors are well represented within recent airway management guidelines. Human factors associated with work systems and processes featured more prominently than user and patient outcome measurement and adaption. Human factors are an evolving area in airway management and our results highlight that further considerations are necessary in further guideline development. [ABSTRACT FROM AUTHOR]

Arts-based training programs can aid in building observational skills, communication, team building, and leadership through targeted analysis of works of art. Furthermore, arts-based training programs are unique in that they highlight non-technical skills (NTS). The goal of this study was to investigate the extent to which NTS were developed through an arts-based training program among entry-level occupational therapy doctorate (OTD) students. This study used a mixed methodological approach to analyze retrospective data. Quantitative analysis of the Kentucky Inventory of Mindfulness Skills (KIMS) assessment was conducted. Qualitative analysis was completed through analysis of the participants’ reflection papers. Quantitative results (n = 69) from the KIMS show significance (p = 0.011; 0.013), and qualitative analysis (n = 32) resulted in five central themes: evolution of thinking, holistic approach, diverse perspective, lived reality of context, and development of NTS (collaboration, self-awareness, mindful of others, creativity, and effective communication). Quantitative and qualitative findings suggest arts-based training programs can improve students’ ability to reduce their bias through implementation of a mindfulness lens. Results and recommendations from this study can be used as an example for occupational therapy academic programs to implement an evidence-based teaching methodology. [ABSTRACT FROM AUTHOR]

Introduction: Trauma team performance, measured by the non-technical skills scale T-NOTECHS, has been shown to impact patient outcomes. We assess how personnel movements affect non-technical skills and time of resuscitation(TOR) using trauma video review., Methods: A prospective study of blunt and/or penetrating trauma activations recorded between May and November 2023 ​at a Level-I trauma center. Regressions controlling for confounders were used to measure the association between foot traffic and the outcomes of interest 1 : TOR 2 T-NOTECHS score(Smith et al., 2015; Mackenzie et al., 2007; Maiga et al., 2024; Vella et al., 2024; Pucher et al., 2014; Dumas et al., 2020; Succar et al., 2024; Steinemann et al., 2012; Andersson et al., 2012; Conrad et al., 2010; Lies and Zhang, 2015) .5-155-15 RESULTS: We identified 77 trauma activations, with 40 ​%(n ​= ​32/77) penetrating injuries. There was a median of 17[14-18] individuals at the start of trauma activations. During resuscitations, individuals entered the room a median of 12[8-18] times and exited the room 17[11-22] times. The median TOR was 8[6-10] min and the median T-NOTECHS was 7[6-8]. Regression analysis showed foot traffic was independently associated with increased TOR(β 0.34, p-value <0.01) and worse total T-NOTECHS score(β 0.06, p ​< ​0.01)., Conclusions: Higher foot traffic is associated with poorer team performance and delays in resuscitation. Future directions should further explore environmental and personal factors that may impede performance metrics., Competing Interests: Conflicts of interest Dr Herbert Zeh is on the Surgical Safety Technologies Scientific Advisory Board for which he received stock options. Dr Ryan Dumas is a paid strategic advisor for Surgical Safety Technologies., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Research indicates that poor communication accounts for almost half of errors made during surgery. Despite this, formal training in the cognitive and interpersonal aspects of operating is lacking in the surgical curriculum. Non-Technical Skills for Surgeons (NOTSS) is a behaviour rating system designed to evaluate surgeons on their non-technical skills in the operating room. This rating system splits intraoperative non-technical skills into four domains: situation awareness, decision-making, communication and teamwork, and leadership. Assessors score surgical trainees on each of these domains, using these ratings to inform a structured debrief. NOTSS has been shown to have a robust construct, content and concurrent validity, accurately predicting the risk of adverse events in surgery. Its reliability is threatened by considerable inter-rater variance, particularly in the cognitive domains of the taxonomy, which makes it difficult to defend its use as a summative assessment, but it is relatively procedure-independent as an assessment tool. The feasibility of incorporating NOTSS into the surgical curriculum depends on the viability and financial cost of training assessors across the United Kingdom (UK) in its use, which is currently unknown. It has been received positively by assessors and trainees alike as a formative tool to facilitate a deeper understanding of non-technical skills in theatre, but its acceptability as a barrier to progression has not been examined. Promisingly, a small study has demonstrated NOTSS assessments to have a positive impact on trainees' non-technical proficiency in surgery, but further research is warranted before any definitive conclusions can be drawn about its educational value., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gittins et al.)

Background: Cardiopulmonary resuscitation (CPR) training is crucial for nursing students as future nurses are the first responders in the ambulatory and hospital care chain. Simulation-based learning has been shown to be more effective in acquiring the knowledge and technical and non-technical skills required for CPR. The present study aims to evaluate the impact of high-fidelity simulation-based adult CPR training on the acquisition and retention of knowledge and the development of technical and non-technical skills of nursing students at the Higher Institute of Nursing Professions and Health Techniques in Fez, Morocco., Methods: We conducted an interventional study with 49 nursing students. Twenty-five students (51.02%) in the simulation group received both traditional CPR training (theoretical lecture and demonstration of procedures) and simulation CPR training, while 24 students (48.97%) in the control group received only traditional training. Data were obtained using a questionnaire on theoretical knowledge of CPR, a technical skills assessment grid, and the Team Emergency Assessment Measure (TEAM) for non-technical skills., Results: The post-test scores for theoretical knowledge immediately after simulation were significantly higher for the simulation group (16.41±1.73 out of 20) than for the control group (13.15±1.96 out of 20). Mean CPR knowledge retention scores 30 days after training were significantly higher in the simulation group (15.60±1.71) compared with the control group (11.38±1.93). Assessment of technical skills on a high-fidelity mannequin showed a considerable advantage for the simulation group (30.88±1.64 out of 34) over the control group (18.00±0.78 out of 34). In addition, the results demonstrated a significant difference between the TEAM score of the simulation group (37.84±2.67 out of 44) and the control group (22.33±0.96 out of 44) and a significant difference between the Global Team Performance of the simulation group (8.16±0.68) out of 10 and the control group (4.83±0.38)., Conclusion: The findings demonstrated that adult CPR training using high-fidelity simulation was superior to the traditional method with regard to knowledge acquisition and retention and the development of technical and non-technical skills in undergraduate nursing students., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Hospital-University Ethics Committee of Fez, Laboratory of Anatomy, Surgery and Anesthesiology, Faculty of Medicine, Pharmacy and Dental Medicine of Fez, Sidi Mohamed Ben Abdellah University, and the Regional Directorate of Health and Social Protection of Fez Meknes issued approval N°32/22 and N°5997. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, El Ougli et al.)

Background: Timely management of trauma patients is crucial. Better team performance means faster care, but roles of specific communication practices remain unclear. We hypothesized that overlapping communication is associated with less efficient resuscitations., Methods: This single-center prospective observational study included hypotensive trauma patients from June-September 2023. Data were collected using Trauma Video Review. The association between overlapping communication and resuscitation length was assessed using multivariable linear regression adjusting for demographics, injury mechanism, Injury Severity Score (ISS), vitals, and number of procedures performed., Results: We included 87 patients with median ISS 26.0 [interquartile range IQR: 14.0-34.0] and median systolic blood pressure 84.0 [70.0-90.5]. Median resuscitation length was 19.1 [15.4-23.1] minutes. Overlapping communication occurred for median 1.22 [0.7-2.1] minutes. Overlapping communication was associated with longer resuscitations (p ​< ​0.0001)., Conclusions: Overlapping communication was associated with less efficient resuscitations in hypotensive trauma patients. Training for trauma teams should target "one voice at a time"., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Abstract Background Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether—and how—these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact. Methods This scoping review, guided by PRISMA-ScR and Arksey & O’Malley’s framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis. Results Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams. Conclusion This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation. Graphical abstract

Bakgrunn: Operasjonssykepleiere arbeider sammen med anestesisykepleiere, anestesileger og kirurger i det kirurgiske team. Dårlig kommunikasjonen mellom teammedlemmene, manglende respekt og liten arbeidserfaring påvirker teamarbeidet negativt. Det mangler kunnskap om hva som fremmer et godt kirurgisk teamarbeid. Det er derfor behov for mer kunnskap om hvilke erfaringer og oppfatninger operasjonssykepleiere har om hva som er fremmende for teamarbeidet på operasjonsstua. Hensikt: Å få mer kunnskap om hvordan operasjonssykepleiere erfarer og oppfatter det å arbeide i det kirurgiske team, og belyse hva som kan fremme teamarbeidet. Metode: Studien har et utforskende og beskrivende kvalitativt design. Åtte semistrukturerte individuelle intervju med operasjonssykepleiere fra to sykehus i Helse Vest ble gjennomført i februar 2021. Kvalitativ innholdsanalyse ble benyttet i dataanalysen. Resultater: I analysen kom det frem fire kategorier: betydningen av en god tone og trivsel på operasjonsstua, pasienten i fokus, lydhør og tydelig ledelse, og trygghet i yrkesrollen. I kategorien betydningen av en god tone og trivsel på operasjonsstua ble det identifisert tre underkategorier: god og tydelig kommunikasjon, respekt og likeverd, og ulike personligheter i et team. Konklusjon: Operasjonssykepleierne erfarte at god kommunikasjon mellom medlemmene i det kirurgiske team var avgjørende for et godt teamarbeid. Respekt og likeverd skapte en god tone og gjorde det lettere å stille spørsmål og ha konstruktiv kommunikasjon. Personlige egenskaper, en støttende ledelse og trygghet i yrkesrollen var viktig for et godt teamarbeid. Felles teamtrening med alle profesjonene i teamet vil kunne bidra til å utvikle gode ikke-tekniske ferdigheter. ENGLISH ABSTRACT Promoting teamwork in the operating theatre—a qualitative study of operating room nurses’ experiences and perceptions Background: The surgical team consists of operating room nurses, anesthesia nurses, surgeons, and anesthetists. Research shows that collaboration within the interdisciplinary surgical team in the operating theatre can be a challenge and may influence the teamwork negatively. Aim: To gain more knowledge about what operating room nurses’ experience as important to promote surgical teamwork. Methods: The study had a qualitative design with eight semi-structured interviews. Qualitative content analysis was used to analyze the data. Results: Operating room nurses experiences of promoting surgical teamwork were categorized in four main categories: (1) the meaning of a good atmosphere in the operating theatre, (2) the patient in focus, (3) sensitive and clear leadership, and (4) confidence in the professional role. Conclusion: Achieving sufficient communication in the multidisciplinary surgical team is crucial to enhance the quality of the teamwork and patient safety. Promoting teamwork is complex, and personal characteristics, supportive leadership, and confidence in the professional role are significant aspects. To maintain a pleasant atmosphere in the operating theatre, respect and equality between the members of the team is essential. Joint team training may contribute to the development of non-technical skills within the surgical team.

Purpose Caring for critically ill patients requires non-technical skills such as teamwork, communication, and task management. The Behaviorally Anchored Rating Scale (BARS) is a brief tool used to assess non-technical skills. The investigators determined inter- and intra-rater reliability of the BARS when used to assess medical students in simulated scenarios.Method The investigators created simulation scenarios for medical students during their pediatric clerkship. Content experts reviewed video recordings of the simulations and assigned BARS scores for four performance components (Situational Awareness, Decision-Making, Communication, and Teamwork) for the leader and for the team as a whole. Krippendorff’s alpha with ordinal difference was calculated to measure inter- and intra-rater reliability.Results Thirty medical students had recordings available for review. Inter- and intra-rater reliability for performance components were, respectively, Individual Situational Awareness (0.488, 0.638), Individual Decision-Making (0.529, 0.691), Individual Communication (0.347, 0.473), Individual Teamwork (0.414, 0.466), Team Situational Awareness (0.450, 0.593), Team Decision Making (0.423, 0.703), Team Communication (0.256, 0.517), and Team Teamwork (0.415, 0.490).Conclusions The BARS demonstrated limited reliability when assessing medical students during their pediatric clerkship. Given the unique needs of this population, a modified or new objective scoring system for assessing non-technical skills may be needed for medical students.

IntroductionHigh 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.MethodsA 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).ResultsA 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, Q1 = 3.75, Q3 = 5) and from 3 to 63 items (median of 15, Q1 = 10, Q3 = 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.ConclusionAmong 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.