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• Crew Resource Management training and perceived usefulness were scored highly. • Knowledge, skills and awareness of human factors changed significantly. • Observations showed safer teamwork after training. • Improving safety culture requires implementation and repeating the training. • Between the three specialty areas only limited differences were detected. Crew Resource Management (CRM) training aims to improve non-technical skills to reduce preventable errors in healthcare. This study evaluates a generic CRM training program for acute care settings by assessing its' effect on the four levels of Kirkpatrick. The intervention entails a theoretical part and a simulation-based multidisciplinary team training including debriefing. Pre-post measurements were taken using questionnaires, observations and interviews. 231 Belgian physicians, midwives and nurses participated. On level 1, respondents provided high scores and perceived the training as important. On level 2, a shift in knowledge, skills and awareness was found for 9/23 items. Observations showed safer teamwork on level 3 for all specialty areas. On level 4, a significant improvement was measured only for perceptions of management. Hierarchy and lack of a safety culture hinder the application of CRM in practice. A generic CRM-training invokes a positive reaction, changes attitude, knowledge, non-technical skills, and behavior. A one-time CRM-training is insufficient to change safety culture. The possibility of a generic training for acute specialty areas was confirmed. [ABSTRACT FROM AUTHOR]

The aim of this article is to introduce the concept of human factors training, illustrate the importance of human factors to safe surgical care, and clarify the relationship between human factors science and non-technical skills. [ABSTRACT FROM AUTHOR]

The shift from traditional apprenticeship models to competency-based curricula, compounded by working hour restrictions and rapid advances in surgical technology, has altered the delivery of early years surgical training. Simulation has been widely incorporated in other high-risk, high-reliability industries, but it has only just begun to be embedded in surgical programmes over the last two decades. In this article, we review key concepts in surgical simulation. Using Scotland's Core Surgical Training Programme as an example, we demonstrate the implementation of these concepts into a national integrated simulation strategy for early years surgical training. We highlight other global examples of simulation use in surgical curricula. The key messages for all stakeholders in surgical training are: (i) simulation is an adjunct to clinical training; (ii) simulation is a tool; however, it is not the tool that should be the main object of interest, but the learning for which it is used; and (iii) in the absence of a constructively aligned and purposeful programme that is valued by trainees, trainers and the training system, it is not enough to issue the kit, no matter how good the simulators are. [ABSTRACT FROM AUTHOR]

This article highlights some key principles in patient safety for the surgical trainee. The incidence of harm in healthcare and surgical practice in particular are outlined. The importance of clinical human factors is highlighted along with how this discipline has helped healthcare workers improve the care they provide to patients. Concepts of systems thinking are introduced; patient harm rarely comes from the isolated action of an individual but from deficiencies in the systems of which they are a part and with which they interact. The shifting paradigm of patient safety thinking is highlighted' with an increasing focus on reducing risk (safety II) rather than eliminating harm (safety I). Strategies for recording, analysing and learning from patient harms are discussed. Examples are provided of commonly used systems models to help clinicians in this area. A number of strategies that have been developed to enhance safety, trap errors and mitigate potential harm to surgical patients are discussed. Information is provided on several key national and international patient safety initiatives that have been instrumental in enhancing patient care by disseminating learning and collaboration between individual units, hospitals and health services. [ABSTRACT FROM AUTHOR]

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma's causes or the patient's personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients' and stakeholders' engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey's participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions. [ABSTRACT FROM AUTHOR]

In today's workforce, non-technical skills (NTS) are essential in determining an employee's ability to fit into an organization. However, it is unknown whether pharmacy students consider these skills essential to their future work or believe they are sufficiently trained. Therefore, this study evaluated student perceptions of the value of NTS as a pharmacist and their satisfaction with NTS training. A 45-item survey was distributed to 111 fourth-year pharmacy students at Texas A&M College of Pharmacy in March 2019. Given the diverse nature of NTS, this study collected student perceptions about the 2016 Accreditation Council for Pharmacy Education Standard 4 Key Elements: self-awareness, leadership, innovation, and professionalism. Results were analyzed utilizing descriptive statistics. Approximately 84% (n = 93) of students completed the survey. More students perceived professionalism as an important skill to have, followed by leadership, self-awareness, and innovation. Similar results were shown with students' satisfaction with NTS training. Also, results highlighted that students' satisfaction level with their NTS training and their belief regarding their strengths relied on two factors: the number of advanced pharmacy practice experiences (APPEs) where NTS training occurred and the amount of time spent practicing the NTS. These data add to the existing literature to support NTS training in experiential pharmacy education. While APPEs should not be the only setting where these skills are practiced in the curriculum, our study's findings may further guide curricular priorities and assessment strategies for NTS in the experiential setting. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to determine how hypoxia effects awareness of environment (AoE) in helicopter pilots operating at high altitude. Eight helicopter crews flew two operational flights in a flight simulator while breathing gas mixtures of 20.9% (equivalent to 0 m altitude) and 11.4% (equivalent to 4572 m or 15,000 ft altitude) oxygen in a single blinded, counterbalanced, repeated measures study. Each flight included five missions, during which environment items were introduced that the crews needed to be aware of, and respond to. In the 4572 m simulation, the crews missed overall 28 AoE items compared to 12 in the 0 m simulation (Z = −1.992; p =.046). In contrast, the crews' technical skills were not significantly effected by hypoxia. Remarkably, the majority of pilots did not notice they were hypoxic or recognise their hypoxia symptoms during the simulation flight at 4572 m. Practitioner summary We show that hypoxia has a detrimental effect on helicopter pilot's AoE and alertness. This can lead to an increased risk for flight safety. To mitigate this risk we recommend performing hypoxia training in a flight simulator, developing wearable systems for physiological monitoring of pilots and re-evaluating current altitude regulations. Abbreviations: ANOVA: Analysis of variance; AoE: awareness of environment; CSV: comma-separated values; HDU: helmet display unit; HR: heart rate; IQR: interquartile range; Mdn: median; NTS: non-technical skills; RNLAF: Royal Netherlands Air Force; PPM: parts per million; SpO2: oxygen saturation; SSS: Stanford sleepiness scale; TS: technical Skills [ABSTRACT FROM AUTHOR]

Surgery often looks to other domains of high performance such as the airline industry for ideas on how to improve surgical performance however little is written about what surgeons might learn from high performance sport. In this paper I offer some observations and ideas from my experience as an Olympic swimmer which I feel may be applicable to surgery and some thoughts on how these concepts might be introduced. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine if extended immersive ward‐based simulation programmes improve the preparedness of undergraduate bachelor's degree nursing students to be ward ready for professional practice as a registered nurse. Background: The practice readiness of new graduate nurses to enter the workforce continues to raise concern among educators and industry. Often the transition period is a vulnerable time when the reality of clinical practice bears little resemblance of their experiences as a student. Simulation of a busy ward offers the opportunity for pre‐registered nurses to practise a variety of situations they are likely to encounter once qualified in a safe and supportive learning environment. Methods: The review considered studies that investigated the experiences and learning outcomes of nursing students following participation in extended immersive ward‐based simulation. Databases searched included CINAHL, EMBASE, Medline and Scopus. Two reviewers independently assessed retrieved studies that matched inclusion criteria using standardised critical appraisal instruments. Reporting of review followed PRISMA checklist. Results: Fourteen studies met the inclusion criteria. The majority of studies used a quasi‐experimental mixed methods approach (10). Programme evaluations focused on self‐reporting in learning satisfaction and student perceptions of performance. Six studies used a pre‐ and post‐test design to compare the after effect on preparedness for professional practice. Two studies investigated student learning between simulated experiences and experiences gained during clinical placements. Conclusion: Learning satisfaction was high among students who participated in programmes that incorporated extended immersive ward‐based simulation experiences. Students are able to practise what they need to know and on what will be expected of them in professional practice. Evidence on whether these programmes make a difference in workplace performance, and retention of graduate nurses is yet to be established. Relevance to clinical practice: Extended immersive ward‐based simulation allows educators the opportunity to meet the perceived needs of students in preparation for professional practice. [ABSTRACT FROM AUTHOR]

Aim: To analyse non-technical skills of mobile medical teams during out-of-hospital cardiac arrests (OHCA) using the validated Team Emergency Assessment Measure (TEAM) tool. To research the correlation between non-technical skills and patient outcome. Methods: Adult patients who experienced an out-of-hospital cardiac arrest between July 2016, and June 2018, and were treated by a mobile medical team from the University Hospital Leuven, were eligible for the study. Resuscitations were video recorded from the team leader’s perspective. Video recordings were reviewed and scored by emergency physicians, using the TEAM evaluation form. Results: In total 114 OHCAs were analysed. The mean TEAM score was 34.4/44 (SD = 5.5). The mean item score was 3.1/4 (SD = 0.8). On average, ‘effective team communication’ had the lowest score (2.4), while ‘acting with composure and control’ and ‘following of approved standards/guidelines’ scored the highest (3.4). The average non-technical skills theme scores were 2.9 (SD = 0.9) for ‘Leadership’, 3.1 (SD = 0.8) for ‘Teamwork’ and 3.3 (SD = 0.7) for ‘Task management’. ‘Leadership’ was rated significantly lower than ‘Teamwork’ (p = 0.004) and ‘Task management’ (p

Background: Teaching non-technical skills (NTS) is an important part of the undergraduate medical curriculum. Resource intensive high-fidelity simulation has an established role in this. Alternative methods of delivering large scale simulation-based education should be considered to help further improve NTS and preparedness for clinical placements of medical students. Emerging technologies such as immersive virtual reality (VR) may have a role in this. Aim: To assess if a VR simulation-based teaching programme enhances understanding of NTS and preparedness for clinical placements in medical students at the University of Liverpool. Methods: A VR simulation-based teaching programme, consisting of 4 sessions of lecture-based simulation and a hi-fidelity simulation session was delivered to 3rd year medical students. The lecture-based sessions used pre-recorded, immersive clinical scenarios developed by the School of Medicine, with a focus on NTS. The hi-fidelity simulation session was delivered by local hospital trusts. A survey was sent to all students to assess their understanding of key NTS: decision making, task prioritisation and delegation and how the clinical environment works. Preparedness for clinical placement and confidence in the clinical environment was also assessed. A focus group further explored how students felt towards these NTS, with subsequent thematic analysis. Results: 101/281 students responded to the survey reporting a greater understanding in all NTS assessed. Students also described feeling better prepared for clinical placements. The focus group reported the programme provided a ‘safe space’ for learning alongside increasing understanding of role modelling and self-awareness. Discussion: Utilising emerging technology alongside hi-fidelity simulation increased students’ exposure to the clinical environment and enabled exploration of NTS by students. Additional work with larger focus groups will be required to further validate our results. Whilst restrictions are limiting clinical exposure due to the COVID-19 pandemic, we propose that VR simulation-based teaching programmes could provide an alternativeeducational tool.

Background: The Team Emergency Assessment Measure (TEAM) questionnaire is designed for rating the non-technical performance of emergency medical teams during emergencies, e.g., resuscitation or trauma management. Originally developed in Australia it has today been translated and validated into eleven languages, but a Swedish version is lacking. The aim was therefore to cross-culturally translate and evaluate the reliability and validity of the TEAM questionnaire in a Swedish health care setting. Methods: The instrument was forward and backward translated and adapted into a Swedish context according to established guidelines for cross-cultural adaptation of survey-based measures. The translated version was tested through 78 pairwise assessments of 39 high-priority codes at the emergency departments of two major hospitals. The raters observed the teams at work in real time and filled in the questionnaires immediately afterwards independently of each other. Psychometric properties of the instrument were evaluated. Results: The original instrument was translated by pairs of translators independently of each other and reviewed by an expert committee of researchers, nurses and physicians from different specialties, a linguist and one of the original developers of the tool. A few adaptations were needed for the Swedish context. A principal component factor analysis confirmed a single 'teamwork' construct in line with the original instrument. The Swedish version showed excellent reliability with a Cronbach's alpha of 0.955 and a mean inter-item correlation of 0.691. The mean item-scale correlation of 0.82 indicated high internal consistency reliability. Inter-rater reliability was measured by intraclass correlation and was 0.74 for the global score indicating good reliability. Individual items ranged between 0.52 and 0.88. No floor effects but ceiling effects were noted. Finally, teams displaying clear closed-loop communication had higher TEAM scores than teams with less clear communication. Conclusions: Real time observations of authentic, high priority cases at two emergency departments show that the Swedish version of the TEAM instrument has good psychometric properties for evaluating team performance. The TEAM instrument is thus a welcome tool for assessing non-technical skills of emergency medical teams. [ABSTRACT FROM AUTHOR]

Background: Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery. Methods: This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients. Results: Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = − 0.92, p < 0.001) but was not correlated with the surgeon's experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics. Conclusion: Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management. [ABSTRACT FROM AUTHOR]

Background: Adverse events in patient care are often caused by failures in teamwork. Simulation training and its debriefing can contribute to improving teamwork and thus patient care. When conducting debriefings, there are several design factors that can potentially influence learning outcomes. This study examines the use of a cognitive aid to help structure the content of debriefings and compares it with debriefings that are merely roughly structured. In addition, the feasibility of the debriefing, the satisfaction of the participants and their teamwork during the training are investigated. Methods: In a simulated night shift, seven teams of four to five medical students (n=32) took part in six cases that simulated common situations in an emergency medicine environment and received a debriefing on their teamwork after each case, either in the intervention condition with the help of the TeamTAG tool – a cognitive aid focusing on selected teamwork principles from Crisis Resource Management (CRM) – or in the control condition without it. The facilitators noted the topics of the debriefings and rated their experience of conducting them; the participants indicated their satisfaction with the debriefings, as well as their assessment of the importance of CRM principles. In addition, the quality of teamwork was assessed using the Team Emergency Assessment Measure (TEAM). Results: The analysis showed no difference in the number of teamwork principles discussed between the control and intervention conditions, but topics were repeated more frequently in the control group. The TeamTAG guideline was focused on and implemented by the tutors, who discussed the CRM principles included in the TeamTAG more consistently than in the control condition. The tutors in both conditions were satisfied with the implementation, and the use of TeamTAG facilitated time management. There were no differences in participants' satisfaction, their assessment of the importance of the teamwork principles, or the quality of teamwork between conditions. Conclusion: The use of a cognitive aid can help to direct the focus on certain topics or learning objectives and facilitate time management through pre-structuring; however, a difference in learning outcomes (in terms of the quality of teamwork) could not be identified. Besides the influence of a certain structure or script, a strong influence from the individual guiding the debriefing is likely. [ABSTRACT FROM AUTHOR]

The requirements concerning engine room resource management (ERM) have been introduced as mandatory requirements for engineers. The fundamental procedure of ERM training and evaluation methods is introduced in the International Maritime Organization (IMO) model course, and several studies have been carried out by maritime education institutes and universities. This study aims to propose a work load evaluation method and a quantitative evaluation method for non-technical skills of the participants regarding ERM training. The work load during training was evaluated through an objective evaluation using the VACP (visual, auditory, cognitive, and psychomotor) method and compared with a subjective evaluation applying the NASA-Task Load Index (NASA-TLX). The quantitative evaluation of non-technical skills was evaluated by 16 evaluators. The non-technical skill evaluation form is referred to as the IMO model course 2.07 2017 Edition evaluation. The results of the work load evaluation indicated that the proposed objective evaluation method can describe the work load of participants in different roles and their performance during ERM training. Further, the results of the quantitative evaluation method indicate the difference in score of non-technical skills on the roles and tasks of the participants by comparing the evaluation criteria. The relationship between the work load and non-technical skills was investigated, and the effectiveness of both the work load evaluation method and quantitative evaluation method during ERM training was discussed. [ABSTRACT FROM AUTHOR]

Background: Device-related interruptions in the operating room (OR) may create stress among health care providers and delays. Although non-technical skills (NTS) of the OR teams, such as situational awareness and communication, are expected to influence device-related interruptions, empirical data on this relationship are limited. Methods: We performed a prospective cohort study of 144 consecutive elective laparoscopic operations during 13 months. A data capture system called the OR Black Box® was used to characterize device-related interruptions, NTS, and distractions. Device-related interruptions were classified according to a priori established categories. Positive and negative NTS instances were identified according to validated measurement tools specific for nurses and surgeons. We assessed the relationship between NTS and device-related interruptions after adjusting for potential confounders. Results: A total of 86 device-related interruptions occurred in 48 of 144 operations (33%). They were most frequently classified as device failure (54%) followed by improper assembly (19%) and disconnection (14%). Medians of 1 [interquartile range (IQR) 0–3] and 1 (IQR 0–2) negative NTS instance per operation were demonstrated by nurses and surgeons, respectively. Medians of 28 (IQR 15–38) and 40 (IQR 28–118) positive NTS instances per operation were demonstrated by nurses and surgeons. In a multivariable analysis, a higher frequency of negative NTS instances demonstrated by nurses was associated with device-related interruptions after risk adjustment (Odds Ratio 1.33, p = 0.02). Conclusions: In elective laparoscopic operations, an increased likelihood of device-related interruptions in the OR was associated with more frequent negative NTS demonstrations by nursing teams. [ABSTRACT FROM AUTHOR]

Background: Written material remains one of the most common methods of education, however the current generation of learners may benefit from additional different media. In our study, we aim to quantify the effects of an innovative video instruction on subsequent resident performance in a burn patient simulation.Methods: Following IRB approval, 60 Plastic Surgery residents were randomly assigned to two groups. The control group ("non-video" group) (n = 30) was given only written material as preparation. The experimental group ("video" group) (n = 30) was provided access to video training materials in addition to the written material on technical and non-technical skills. Their videotaped performances on simulation were evaluated by a blinded surgical faculty member. The comparison of variables between the two groups was performed using a Mann-Whitney test for non-normal distributions of quantitative variables, and Fisher's Exact Probability test for qualitative data. Statistical significance was set at p < 0.05.Results: Compared to the non-video group, the video group achieved significantly higher scores in the technical skills of assessment of breathing (p = 0.015), disability (p = 0.023), and exposure (p = 0.005) and in the non-technical skills of decision-making (p = 0.035).Conclusions: In residents participating in burn patient simulations, video training in advance of the simulation significantly improved their assessments of breathing, disability, and exposure as well as decision-making. Our video is a valuable tool to enhance trainees' technical and non-technical competencies in managing burn patient simulations. [ABSTRACT FROM AUTHOR]

Workplaces in the oil and gas (O&G) industry have evolved to become part of the modern complex sociotechnical system that characterises onshore and offshore facilities today. The intense interactions between workers, systems, equipment and processes have made companies in this sector more productive. However, significant and complex risks have also emerged. Managing them requires a methodology capable of understanding and recognising how this entire sociotechnical system works. This research uses the FRAM to model the activities performed by drillers, from the perspective of their workplace, inside the drilling unit of an offshore oil rig—a complex sociotechnical system. The interviews, on-board observations and data gathering performed as part of this study provided information that was used to build a FRAM model capable of representing the real work done by drillers inside the doghouses on offshore oil rigs. Through this model, the variability of human behaviour could be analysed in the context of the different situations that may happen, enabling researchers to understand the specific demands of the work and the correlation between WAI and WAD that naturally emerges. This FRAM-based analysis acknowledges that human factors and non-technical skills are responsible for the productive and safe execution of the work in both normal and critical operations situations, and identifies the impact of this variability—positive or negative—in the execution of daily tasks. It shows that workers' varied responses can properly deal with complex system demands both in normal situations and in emergencies. [ABSTRACT FROM AUTHOR]

Background: Evidence for surgical coaching has yet to demonstrate an impact on surgeons' practice. We evaluated a surgical coaching program by analyzing quantitative and qualitative data on surgeons' intraoperative performance. Methods: In the 2018–2019 Surgical Coaching for Operative Performance Enhancement (SCOPE) program, 46 practicing surgeons in multiple specialties at four academic medical centers were recruited to complete three peer coaching sessions, each comprising preoperative goal-setting, intraoperative observation, and postoperative debriefing. Coach and coachee rated the coachee's performance using modified Objective Structured Assessment of Technical Skills (OSATS, range 1–5) and Non-Technical Skills for Surgeons (NOTSS, range 4–16). We used generalized estimating equations to evaluate trends in skill ratings over time, adjusting for case difficulty, clinical experience, and coaching role. Upon program completion, we analyzed semi-structured interviews with individual participants regarding the perceived impact of coaching on their practice. Results: Eleven of 23 coachees (48%) completed three coaching sessions, three (13%) completed two sessions, and six (26%) completed one session. Adjusted mean OSATS ratings did not vary over three coaching sessions (4.39 vs 4.52 vs 4.44, respectively; P = 0.655). Adjusted mean total NOTSS ratings also did not vary over three coaching sessions (15.05 vs 15.50 vs 15.08, respectively; P = 0.529). Regarding patient care, participants self-reported improved teamwork skills, communication skills, and awareness in and outside the operating room. Participants acknowledged the potential for coaching to improve burnout due to reduced intraoperative stress and enhanced peer support but also the potential to worsen burnout by adding to chronic work overload. Conclusions: Surgeons reported high perceived impact of peer coaching on patient care and surgeon well-being, although changes in coachees' technical and non-technical skills were not detected over three coaching sessions. While quantitative skill measurement warrants further study, longitudinal peer surgical coaching should be considered a meaningful strategy for surgeons' professional development. [ABSTRACT FROM AUTHOR]

Recent literature shows that non-technical skills are as critical to success in the data analytics field as technical skills, but academia does not always include or highlight the teaching of non-technical skills in data analytics courses. This study explored the perceptions of faculty members who teach data analytics in regard to the non-technical skills they find critical, techniques they use for teaching non-technical skills, and their perceptions on the importance of non-technical skills for the entry into the data analytics profession. Ten faculty members in data analytics programs from seven colleges/universities in Pennsylvania were interviewed. Findings indicate that participants found non-technical skills to be of high importance for the data analytics field. Critical non-technical skills were identified as interpreting data effectively, communicating verbally, translating to different audiences, communicating to a non-technical audience, understanding what data to include in a data visualization, and working as part of a team. Recommendations for techniques to use to teach non-technical skills are provided. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

• Decontextualized simulation offers an innovative method for enhancing non technical skills (NTS) training in healthcare. • Harness the gaming environnement to encourage sustained attention, engagement, knowledge retention and feedback. • Integrate decontextualized simulation within educational programs and training to enhanced team performance. • Versatility and easy implementation make decontextualized simulation a valuable tool for perioperative quality and safety. [ABSTRACT FROM AUTHOR]

The importance of NTS has been realised in many safety critical industries. Recently the maritime domain has also embraced the idea and implemented an NTS training course for both merchant marine deck and engineering officers. NTS encompass both interpersonal and cognitive skills such as situational awareness, teamwork, decision making, leadership, managerial skills, communication and language skills. Well-developed NTS training allow ship’s officers to recognise quickly when a problem is developing and manage the situation safely and efficiently with the available team members. As a result, the evaluation and grading of deck officers’ NTS is necessary to assure safety at sea, reduce the effects of human error on-board ships, and allow ship board operations to be performed safely. This paper identifies the skills necessary for deck officers to effectively perform their duties on the bridge of a ship. To achieve this, initially, a taxonomy of deck officers’ NTS is developed through a review of relevant literature and the conducting of semi-structured interviews with experienced seafarers. Subsequently, NTS weighting data is collected from experienced seafarers to allow the weight of each element of the taxonomy to be established by the use of the Analytical Hierarchy Process (AHP).

Abstract Background Non-Technical Skills (NTS) are becoming more important in medical education. A lack of NTS was identified as a major reason for unsafe patient care, favouring adverse events and team breakdown. Therefore, the training of NTS should already be implemented in undergraduate teaching. The goal of our study was to develop and validate the Anaesthesiology Students’ Non-Technical Skills (AS-NTS) as a feasible rating tool to assess students’ NTS in emergency and anaesthesiology education. Methods The development of AS-NTS was empirically grounded in expert- and focus groups, field observations and data from NTS in medical fields. Validation, reliability and usability testing was conducted in 98 simulation scenarios, during emergency and anaesthesiology training sessions. Results AS-NTS showed an excellent interrater reliability (mean 0.89), achieved excellent content validity indexes (at least 0.8) and was rated as feasible and applicable by educators. Additionally, we could rule out the influence of the raters’ anaesthesiology and emergency training and experience in education on the application of the rating tool. Conclusions AS-NTS provides a structured approach to the assessment of NTS in undergraduates, providing accurate feedback. The findings of usability, validity and reliability indicate that AS-NTS can be used by anaesthesiologists in different year of postgraduate training, even with little experience in medical education.

Simulator-based training assumes a very important role in the maritime domain, particularly in the education of Officers Of the Watch (OOW). In the Portuguese Navy, most of the cadet’s skills as future OOW rely on the success of this training. Beyond theory and technical training, the development of non-technical skills is a key factor for obtaining officers capable of identifying and solving problems. To optimize the training and development of non-technical skills, using the Portuguese Naval Academy Simulator, a previously designed Behavioral Marker System model was further assessed. The revised model, which comprises new parameters such as the effectiveness of the task, was validated through a set of simulated sessions, where 11 instructors and 48 students participated. After each session, data was collected with questionnaires and focus group discussion, focusing on the quality and usability of the model and on the design of the scenario. The results show that the revised model, positively addresses the limitations found on the previous version, and it has received encouraging feedback from both instructors and cadets. This new model is now under implementation in all the Naval Academy course programs, and future research aims to digitalize the behavior markers.

Abstract Background Virtual patients are a recent addition to the educational arsenal to develop non-technical skills in undergraduate health professionals. The Virtual Simulated Patient Resource (www.vspr.net.au) is a web-based resource that uses branching, narrative virtual patients to develop knowledge, attitude and practice of all categories of non-technical skills in undergraduate health professionals. However, there is limited literature exploring how the interaction with a virtual patient influences the development of knowledge, attitude and practice of non-technical skills in undergraduate nursing students. Methods An intrinsic case study method, using focus groups and individual interviews, enabled exploration of the experience of undergraduate nursing students when interacting with a virtual patient to develop non-technical skills. Purposive sampling identified participants to address the research question. Framework analysis supported by a codebook enabled deductive and inductive data analysis. Results Forty-five first-year and 31 third-year students consented to participate. Findings indicated that the different years interacted differently with the virtual patients. Four themes were recognised in the data: how the virtual patients enabled learning non-technical skills, learning surrounding the virtual patient encounter, changing the way students perceive practice and potential limitations to learning. Conclusions Interactions with virtual patients influence learning knowledge, attitudes and practice of non-technical skills in undergraduate nursing students via authenticity in the virtual patient interaction, socialisation to the professional role, vicarious learning and learning by making mistakes. Potential limitations to learning from virtual patient interactions include fear, overconfidence, groupthink and confusion. To manage limitations to learning, facilitation approaches, opportunities for reflection, constructive feedback and debriefing may be key. This study demonstrates learning non-technical skills via interactions with virtual patients can change the way students perceive practice, with learning transferable to the clinical setting to support safe and competent patient care.

Abstract Background Training in teamwork behaviour improves technical resuscitation performance. However, its effect on patient outcome is less clear, partly because teamwork behaviour is difficult to measure. Furthermore, it is unknown who should evaluate it. In clinical practice, experts are obliged to participate in resuscitation efforts and are thus unavailable to assess teamwork quality. Consequently, we sought to determine if raters with little clinical experience and experts provide comparable evaluations of teamwork behaviour. Methods Novice and expert raters judged teamwork behaviour during 6 emergency medicine simulations using the Teamwork Emergency Assessment Measure (TEAM). Ratings of both groups were analysed descriptively and compared with U and t tests. We used a mixed effects model to identify the proportion of variance in TEAM scores attributable to rater status and other sources. Results Twelve raters evaluated 7 teams rotating through 6 cases, for a total of 84 observations. We found no significant difference between expert and novice ratings for 7 of the 11 items of the TEAM or in the sums of all item scores. Novices rated teamwork behaviour higher on 4 items and overall. Rater status accounted for 11.1% of the total variance in scores. Conclusions Experts’ and novices’ ratings were similarly distributed, implying that raters with limited experience can provide reliable data on teamwork behaviour. Novices show a consistent, but slightly more lenient rating behaviour. Clinical studies and real-life teams may thus employ novices using a structured observational tool such as TEAM to inform their performance review and improvement.

Abstract Background Deficient non-technical skills (NTS) among providers of critical care in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment. A previous study indicated that physicians underwent less frequent training compared to pilots and HEMS crew members (HCM) and that all professional groups in Norwegian HEMS received limited training in how to cope with fatigue. Since then, training initiatives and a fatigue risk management project has been initiated. Our study aimed to explore if the frequency of simulation-based training and assessment of NTS in Norwegian HEMS has changed since 2011 following these measures. Methods A cross-sectional web-based survey from October through December 2016, of physicians, HCM and pilots from all civilian Norwegian HEMS-bases reporting the overall extent of simulation-based training and assessment of NTS. Results Of 214 invited, 109 responses were eligible for analysis. The frequency of simulation-based training and assessment of NTS has increased significantly for all professional groups in Norwegian HEMS, most prominently for the physicians. For all groups, the frequency of assessment is generally lower than the frequency of training. Conclusions Physicians in Norwegian HEMS seem to have adjusted to the NTS training culture of the other crew member groups. This might be a consequence of improved NTS training programs. The use of behavioural marker systems systematically in HEMS should be emphasized.

Every year, incident management teams (IMTs) coordinate the response to hundreds of emergency events across Australasia. Larger scale emergencies such as a storms, floods, wildfires, oil spills and chemical explosions can place a lot of pressure on an IMT. Non‐technical skills play a central role in the performance of these teams. This article reviewed the broader non‐technical skills (NTS) literature before focusing on the NTS required for emergency management. It was found that most NTS frameworks share four to five common skill categories, although there were greater differences at the element and behavioural marker level. A variety of issues were identified in the literature that highlight that emergency management is very different from other domains where NTS systems have been developed. The literature on NTS in conjunction with this set of issues was used to develop a proposed NTS framework for emergency IMTs. This framework comprises 7 skill categories (i.e. communication, coordination, cooperation, decision‐making, situation awareness, leadership and coping, stress and fatigue management). The 7 skills can be further delineated into 16 elements and 44 behavioural markers. The framework provides a prototype that can form the basis for further research in this area. [ABSTRACT FROM AUTHOR]

Objective: In the last decade non-technical skills (NTS) have emerged as a vital area for improvement within surgery. This study aims to develop and evaluate a Non-technical Skills for Urological Surgeons (NoTSUS) training curriculum and assessment scale. Methods: This international, longitudinal and observational study began with a 3-round Delphi methodology to refine curriculum contents and rating scale. Sessions with up to four participants were delivered where each candidate undertook an independent scenario within the validated full immersion simulation environment. Candidates were assessed using both the NoTSS (Non-technical Skills for Surgeons) and NoTSUS rating scales by NTS-trained and non-trained experts. A post-training evaluation survey was distributed. Results: 62 participants comprising trainees (n = 43) and specialists (n = 19) undertook the NoTSUS course. The NoTSS and NoTSUS scales correlated well, with a mean difference of 3.3 in the overall total (p = 0.10, r = 0.53). However, there was significant differences in scores between the NoTSS-trained and non-trained raters (n = 28, p = 0.03). A one-way ANOVA test revealed significant improvement throughout the four simulation scenarios in each session (p = 0.02). The NoTSUS curriculum received positive feedback from participants and demonstrated educational value and acceptability. Conclusions: The NoTSUS curriculum has demonstrated high educational value for NTS training aimed at urologists, with marked improvement throughout sessions. Correlation of NoTSUS and NoTSS scales proves its suitability for evaluating NTS in future training. Demonstration of inter-rater reliability indicates that the scale is reliable for use in assessment by expert faculty members. Furthermore, qualitative feedback from participants suggests gain of transferrable skills over the course. [ABSTRACT FROM AUTHOR]

Medical emergency teams are essential in responding to acute deterioration of patients in hospitals, requiring both clinical and non-technical skills. This study aims to assess the non-technical skills of medical emergency teams during hospital ward emergencies and explore team members perceptions and experiences of the use non-technical skills during medical emergencies. A multi-methods study was conducted in two phases. During phase one observation and assessment of non-technical skills used in medical emergencies using the Team Emergency Assessment Measure (TEAM™) was conducted; and in the phase two in-depth interviews were undertaken with medical emergency team members. Based on 20 observations, mean TEAM™ ratings for non-technical skill domains were: 'leadership' 5.0 out of 8 (±2.0); 'teamwork' 21.6 out of 28 (±3.6); and 'task management' 6.5 out of 8 (±1.4). The mean 'global' score was 7.5 out of 10 (±1.5). The qualitative findings identified three areas, 'individual', 'team' and 'other' contributing factors, which impacted upon the non-technical skills of medical emergency teams. Non-technical skills of hospital medical emergency teams differ, and the impact of the skill mix on resuscitation outcomes was recognised by team members. These findings emphasize the importance non-technical skills in resuscitation training and well-developed processes for medical emergency teams. [ABSTRACT FROM AUTHOR]

Industry's demand for cybersecurity workers with non-technical knowledge, skills, and abilities (KSAs) that complement technical prowess is not new. The purpose of this study was to connect with cybersecurity practitioners to determine which non-technical KSAs should be emphasized by educators to help meet workforce demands. This research applies a novel application of the Ground Truth Expertise Development Model (GTEDM) for exploring suitable non-technical and particularly soft KSAs necessary for cybersecurity professional development programs. This study focused on the definition and competency determination step and provided foundational KSA prioritization for further research. The field overwhelmingly agreed that non-technical skills were essential to a cybersecurity worker's success. The qualitative process produced three themes as non-technical KSA areas of the most significant import to the cybersecurity field. These KSA themes required included critically using information, communications skills, and collaboration to pursue customer/client success. The findings produce a more comprehensive list of hard, soft, and mixed non-technical skills that will benefit the public, private, and academic sector organizations as they develop cybersecurity curricula. [ABSTRACT FROM AUTHOR]

Background Non-technical skills (NTS) are the cognitive and social skills that complement technical skills in safe and efficient practice, and include leadership, teamwork, task management, decision-making and situation awareness. Other areas within healthcare have heavily invested in producing taxonomies to aid training and assessment of NTS within their disciplines, and have found them to be essential for improving patient safety. In pharmacy, no validated taxonomy has been produced, nor has the existing literature been appraised to aid the future development of a validated taxonomy. Objective(s) To examine the literature on NTS within a community pharmacy setting and establish the research conducted thus far on each NTS and how they are applied by community pharmacists. Methods: A literature search of six electronic databases (EMBASE, PsychINFO, Medline, SCOPUS, CINAHL Plus and HMIC) using the generic list of NTS identified in previous studies. Only empirical studies were included. Examples of behaviours or skills were extracted and categorised within each NTS. Key findings: Seventeen studies were identified that contained one or more examples of NTS specific to community pharmacy practice. Altogether, 16 elements were extracted. Four elements were identified within leadership and task management. A further three were identified within situation awareness and decision-making, and a final two within teamwork and communication. Conclusion A framework consisting of the skills and how they're applied has been presented which describe the NTS required by community pharmacists from the published literature. This framework can provide a foundation for further investigation into NTS use within pharmacy practice. [ABSTRACT FROM AUTHOR]

Objective: to assess the evidence from multidisciplinary simulation team training in obstetrics that integrates human's factors components on patient outcome.Introduction: It has been stated that simulation-based education has the potential to improve technical and nontechnical skills. Reports from enquiries into maternal and newborn adverse outcomes, highlight that the majority of incidents are due to a breakdown of communication and a lack of crisis resource management skills (CRM). It is therefore reasonable to think that a better training on teamwork based on simulation will ultimately improve obstetrics care. In order to explore further that idea, we conducted a literature review on patient outcome after a multidisciplinary simulation training in obstetrics.Method: Pubmed, Advances in health sciences education, BMC in medical education, BMC in pregnancy and Childbirth, BMJ open, BMJ Simulation and technology enhanced learning were searched from inception to May 2020 for full-text publications in English on interprofessional, multidisciplinary, obstetrics, simulation training, non-technical skills, CRM. Searches were limited to studies with a report on patient outcome after a multidisciplinary simulation program that included elements of CRM.Result: Out of the ten studies selected in our review, five were single site before and after prospective studies and five were cluster before and after randomized trials. All the single site studies reported a positive outcome in low and high resource countries. Three single site studies reported a reduction between 41 and 50 % of blood transfusion after simulation team training. Two single studies reported a reduction of maternal mortality by 34 % and a decrease in an adverse obstetrics index outcome from 0.052 to 0.048 with a p-value of 0.05. Cluster studies showed either no change or some improvement in patient outcomes such as a 37 % improvement on weighted obstetrics adverse outcome, a 17 % reduction in the incidence of PPH and a 47 % reduction in the incidence of retained placenta. Stillbirths rate was reduced by 34 % while newborn deaths was down by 62 %. There was also a 15 % reduction of maternal mortality in favor of the trained team after adjustment to the secular mortality trend. Neonatal death from 24 weeks during the first 24 h was also reduced by 83 % in the intervention site compare with an increase by 18 % in the control site.Conclusion: There is evidence that simulation team training that includes CRM is associated with better patient outcome. In order to consolidate this finding, appropriate methodology should be used in future studies with the support of health authorities. [ABSTRACT FROM AUTHOR]

Background: This study outlines key aspects of professional development among health professionals in low- and middle-income countries (LMIC). LMICs need support in developing their continuing medical education, and non-technical skills (NTS) that have been neglected in this respect. Given the nature of NTS, educational methods should be used experientially. This study aims to explore an interactive educational approach to increase NTS among health care professionals in an LMIC setting. Methods: A design-based research approach was applied to develop an educational method. Key NTS concepts were identified, which directed the selection of research-based surveys. A series of workshops was designed in which a survey-based experiential approach was developed. The educational process followed a pattern of individual reflection, small group discussion and relating the concepts to the local practice in a wider group. Results: An approach to increase NTS in LMIC settings emerged in iterative development through conducting workshops with health care teams in the Balkans. The topics could be grouped into individual, team, and organisational dimensions. The approach can be described as survey-based experiential learning involving steps in recurring interaction with participants. The steps include identifying concepts in individual, team and organization dimensions and contextualising them using experiential learning on the individual and group levels. Conclusion: An overarching approach has been developed that addresses NTS in an LMIC setting. The survey-based experiential learning approach can be beneficial for raising professional awareness and the development of sustainable healthcare settings in LMICs. [ABSTRACT FROM AUTHOR]

Background: Many studies are investigating the role of living and nonliving models to train microsurgeons. There is controversy around which modalities account for the best microsurgical training. In this study, we aim to provide a systematic literature review of the practical modalities in microsurgery training and compare the living and nonliving models, emphasizing the superiority of the former. We introduce the concept of non-technical skill acquisition in microsurgical training with the use of living laboratory animals in the context of a novel proposed curriculum. Methods: A literature search was conducted on PubMed/Medline and Scopus within the past 11 years based on a combination of the following keywords: "microsurgery," "training," "skills," and "models." The online screening process was performed by two independent reviewers with the Covidence tool. A total of 101 papers was identified as relevant to our study. The protocol was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Living models offer the chance to develop both technical and non-technical competencies (i.e., leadership, situation awareness, decision-making, communication, and teamwork). Prior experience with ex vivo tissues helps residents consolidate basic skills prior to performing more advanced techniques in the living tissues. Trainees reported a higher satisfaction rate with the living models. Conclusions: The combination of living and nonliving training microsurgical models leads to superior results; however, the gold standard remains the living model. The validity of the hypothesis that living models enhance non-technical skills remains to be confirmed. Level of evidence: Not ratable. [ABSTRACT FROM AUTHOR]

Paramedics are frequently present at the death of patients and are in a position to provide grief support to family members who are suddenly bereaved, but existing education and system resources have failed to provide paramedics with the necessary tools to do so. Although the literature emphasizes the importance of providing grief training from initial education, through clinical placements and into continuing professional development opportunities, the current state across all health professions is a patchwork of elective, brief, and siloed opportunities. With new interprofessional partnerships developing between paramedicine and palliative care, there is a unique opportunity to better prepare paramedics to adequately participate in the death and dying process and address developing competency in grief support in a more strategic and integrated manner. We suggest employing a multi-faceted approach, focused on recruitment, initial and continuing education, and continued support in clinical practice. Importantly, paramedics will require support from interprofessional colleagues in palliative, grief and bereavement care to provide expertise in educational programs, clinical placements, and support at the patient's bedside. Now is the time to address grief support across the full continuum of paramedic practice to ensure paramedics are competent to support recently bereaved families. [ABSTRACT FROM AUTHOR]

Objective: Sequelae of medical errors are a significant problem in acute care. Human-factor-based events are frequent but avoidable causes. Thus, non-technical skills are crucial. In 2008, crisis-resource-management (CRM)-based simulation training was established for the medical staff of the Lower Austria Regional Hospitals, one of the largest hospital operators in Europe. Methods: Implementation and development of simulation training from 2008 until today are described, costs and performance data retrospectively analysed over a 10-year period. The applied methodology and organisational aspects of CRM training are highlighted. To complete the picture, activities triggered through CRM training throughout the hospitals with potential to further improve patient safety are shown. Results: With an initial funding of €100,000 by the Landeskliniken Holding and course rates of €350 to €500, a simulation programme was established for approximately 1,900 co-workers in the acute care setting. In the past 10 years, more than 2,300 doctors and nurses took part in one of the courses, held by 14 qualified trainers. Training was held in the simulation centre as well as in hospitals. Over the time, simulation facilities have been expanded to 8 different manikins, high-fidelity ventilation and monitoring simulation. In addition, a variety of patient safety activities like implementation of critical incident reporting, OR checklists and anaesthesia briefing was accompanied by the trainer team. The total cost of the project was just under €20, 00,000. Conclusion: Simulation-based CRM training was successfully introduced and sustainably institutionalised at the NOE LKH group of hospitals. The demand for and acceptance of the training were both excellent. The previous costs of training were relatively low; the organisational model of an independent, non-profit registered association allowed the training activities to be implemented without reducing the availability of the instructors in their clinical roles. [ABSTRACT FROM AUTHOR]

This scoping review aims to identify which non‐technical skills have been empirically identified in the literature, to create the first list of empirically identified non‐technical skills for paramedics and allied health personnel. A five‐stage scoping literature was undertaken in March 2020. The search retrieved a total of 4756 citations. A total of 93 studies met the inclusion criteria and were analyzed for data charting. A total of 26 non‐technical skills were identified in the literature. The top five non‐technical skills included decision‐making (33%, n = 31), communication (24%, n = 23), empathy (17%, n = 16), leadership (12%, n = 12), and ethics (10%, n = 10). Furthermore, only five studies investigated the assessment or measurement of non‐technical skills. This scoping review identified 26 non‐technical skills that had been investigated in the paramedic literature to create the first list of empirically based desirable non‐technical skills for a paramedic. Subsequently, research can then begin to focus on identifying the link that these have to paramedic practice and patient safety. [ABSTRACT FROM AUTHOR]