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Health care requires the effort of a team, and nowhere is this more evident than in the care of the surgical patient. No single clinician can perform all aspects of the continuum of surgical care. The basic operating room (OR) team consists of nurses, technicians, surgeons, and anesthesiologists with unique and well-defined roles and expertise in perioperative care. The modern OR team continues to grow and evolve in size, diversity, and complexity to meet the needs of growing patient and procedural complexity. This growing complexity makes achieving optimal team performance paramount and challenging., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background and Importance: Use of video review in medicine is established in contexts such as surgery. Although not widely used in the emergency department (ED), some centres use it to evaluate non-technical skills (NTS) to support teaching and quality improvement., Objective: There is no consensus on assessment of NTS using video review in the ED and the purpose of this review was to identify tools used in this context., Design, Setting and Participants: Studies were identified using Embase, Medline, CINAHL and Google Scholar. Inclusion criterion for the review was NTS of resuscitation teams working within the ED were assessed using video review. A systematic search method was used, and results were synthesised after search criteria was checked by two independent reviewers. Authors settled on the same 9 studies eligible for inclusion., Outcome Measures and Analysis: Reliability and validity of tools identified for use in this context. Due to the heterogeneity of studies, no meta-analysis occurred., Main Results: There are 9 studies included in the review. The review was registered with PROSPERO (Ref No: CRD42022306129). Four unique tools were identified - 6 studies used T-NOTECHS, 1 used TTCA-24, 1 used CALM and 1 used the Communication tool. T-NOTECHS is validated in the literature for use in this context., Conclusion: T-NOTECHS is the tool of choice for assessing ED teams in this context., (© 2023. The Author(s).)

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

Gross anatomy education utilizing body donors and human specimens assists the acquisition of non-traditional, discipline-independent skills (NTDIS) such as teamwork, communication, and leadership. Alterations to anatomy curricula, such as those resulting from the COVID-19 pandemic, likely impact NTDIS acquisition, yet how this manifests is unclear. This study, therefore, explored anatomy educator perspectives on NTDIS acquisition as a response to changes in teaching delivery. Gross anatomy educators across different countries were recruited and took part in one-on-one, semi-structured interviews that were audio recorded and transcribed. Data were analyzed using the framework method. Basic statistical analyses were performed on demographic and categorical data. Fifteen educators from five continents were interviewed (average length 32.5 min, range 17-51 min). Educator experience ranged from 0-4 years (n = 3) to 20+ years (n = 7). Most taught using dissection (n = 14) with prosection use (n = 13) also common. Themes relating to NTDIS included expected content (respect for donors, teamwork, communication skills, humanistic values), assessable content, assessment challenges, and impact of curriculum changes; NTDIS unique to anatomy education included cultural, ethical, and social considerations around dead bodies, including boundaries, and social norms. Informed by curriculum alterations during the COVID-19 pandemic, this first empirical study of anatomy educator perspectives on NTDIS highlights the potentially adverse educational impacts of decreased interaction with body donors and human specimens on NTDIS acquisition and difficulties with NTDIS assessment. Findings support gross anatomy education as unique in providing NTDIS that cannot easily be replicated elsewhere. Recommendations around NTDIS-specific educator competencies and promoting NTDIS are provided., (© 2023 The Authors. Anatomical Sciences Education published by Wiley Periodicals LLC on behalf of American Association for Anatomy.)

In Obstetrics and Gynecologic operating room emergencies, the surgeon cannot both operate and lead a suddenly expanded and redirected team response. However, one of the most often used approaches to interprofessional continuing education designed to improve teams' ability to respond to unanticipated critical events still emphasizes surgeon leadership. We developed Explicit Anesthesia and Nurse Distributed (EXPAND) Leadership to imagine a workflow that might better distribute emergency leadership task responsibilities and practices. The purpose of this exploratory study was to investigate teams' responses to distributing leadership during an interprofessional continuing education simulated obstetrical emergency. We used interpretive descriptive design in a secondary analysis of teams' post-simulation reflective debriefings. One-hundred sixty providers participated, including OB-Gyn surgeons, anesthesiologists, CRNAs, scrub technicians, and nurses. Using reflective thematic analysis, we identified three core themes: 1) The surgeon is focused on the surgical field, 2) Explicit leadership initiates a nurse transition from follower to leader in a hierarchical environment, and 3) Explicit distributed leadership enhances teamwork and taskwork. Continuing education which uses distributed leadership to improve teams' ability to respond to an obstetric emergency is perceived to enhance team members' response to the critical event . The potential for nurses' career growth and professional transformation was an unexpected finding associated with this continuing education which used distributed leadership. Our findings suggest that healthcare educators should consider ways in which distributed leadership may improve teams' response to critical events in the operating room., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Non-technical skills are cognitive and social skills that are necessary for safe and efficient practices in operating theatre. These skills are inseparable parts of circulating nurses' duties and help them have a good performance during surgical processes. Circulating nurses' non-technical skills have not been closely measured, and much uncertainty still exists about the quality of their skills. This study aimed to assess circulating nurses' non-technical skills., Methods: A cross-sectional study was conducted on 300 circulating nurses who worked in four public hospitals in Iran, during 2020. The data of demographics of the studied population were collected using a demographic questionnaire. Kalantari et al's Circulating Practitioner's List of Non-Technical Skills was used to assess the circulating nurses' non-technical skills., Results: The situational awareness domain had the highest score, while leadership was the domain with the lowest mean score. There was a moderate positive relationship between the mean score of non-technical skills and the number of working years as a circulating nurse., Conclusion: Although the circulating nurses had a moderate level of non-technical skills, they had low scores in several behaviours. However, they did well in some other behaviours. Educational interventions and policymaking solutions can help improve circulating nurses' non-technical skills., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: Aviation systems were developed to improve safety and have achieved remarkable results. Medicine has looked to replicate these systems; however, the gap in outcomes between the two industries remains vast. Bridging this chasm requires an in‐depth analysis of the applicability of the aviation safety model in surgery. This study uses qualitative methods to explore how aviation‐based practices may be adapted and applied more effectively in theatre. Methods: Data were collected using multiprofessional focus groups in a single centre. The focus groups involved discussion around teamwork and aviation‐based non‐technical skills. With consent, audio recordings were anonymized and transcribed. Qualitative (thematic) analysis was used to identify themes. Results: Five focus groups were conducted. Eight themes emerged, with a total of 18 sub‐themes. Themes were: current practice, customization, applicability, team performance, human factors, analogy, incidents and integration of skills. Extent and limitations of the aviation surgery analogy also emerged. Conclusions: The new insights gained through this qualitative analysis highlight the need to tailor aviation‐based practices to the operating theatre. To achieve this, we propose the 'aviation bundle' of non‐technical skills. This blueprint aims to promote a culture of safety and efficiency in surgical practice and could be developed into a training programme for theatre staff. [ABSTRACT FROM AUTHOR]

The present review examines the research literature on Non-Technical Skills (NTS) used by ships’ bridge officers in connection with navigation. The aim of the study was to (i) identify the cognitive and interpersonal skills which have been the focus of previous studies and (ii) explore how the content of these skills has been described. Databases searched included Academic Search Premier, PsycINFO, Science Direct, and Web of Science. Nineteen studies were included in the review. Five NTS were identified: situation awareness (SA), decision-making (DM), workload management (WM), communication, and leadership. In addition to discussing each skill, the review raises four overarching issues with the present literature for the bridge domain: (1) Have all the relevant skills been subject to exploration? (2) Have the skills identified been explored in detail? (3) There seems to be an uneven distribution of research between cognitive and interpersonal skills. (4) There is little research into understanding the skills as a complete taxonomy. Knowledge on how the skills are linked and interplay with one another is incomplete. Overall, further research on all these aspects of NTS in the maritime domain could increase scientific understanding and contribute to bridge operational practice and to the further development and evaluation of NTS training such as Bridge Resource Management (BRM). [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to describe process changes in surgical team performance and team members' attitudes to safety culture following hospital relocation and expansion of perioperative services. Methods: The study was a naturalistic study using structured observations and surveys to assess non-technical skills (NTS; i.e. communication, teamwork, situational awareness, decision making and leadership) in surgery. This interrupted time series design used mixed-linear regression models to examine the effect of phase (before and after hospital relocation) on surgical teams' NTS and their processes that may affect performance. Differences in self-reported teamwork and safety climate attitudes were also examined. Results: In all, 186 procedures (100 before and 81 after hospital relocation) were observed across teams working in general, paediatric, orthopaedic and thoracic surgeries. Interobserver agreement ranged from 86% to 95%. An effect of phase was found, indicating that there were significant improvements after relocation in the use of NTS by the teams observed (P = 0.020; 95% confidence interval 1.9–4.7). Conclusions: The improvements seen in surgical teams' NTS performance and safety culture attitudes may be related to the move to a new state-of-the-art perioperative department. What is known about the topic?: Patient safety in surgery relies on optimal team performance, underpinned by effective NTS. What does this paper add?: The NTS of surgical teams may be improved through ergonomic innovations that promote teams' shared mental models. What are the implications for practitioners?: Effective multidisciplinary teamwork relies on a combination of NTS and ergonomic factors, which inherently contribute to team performance and safety climate attitudes. [ABSTRACT FROM AUTHOR]

Objective: To report our experience of an exercise designed to train newly appointed urology trainees in non‐technical skills on ward rounds as a part of a simulation ‘boot camp’, through a qualitative analysis of participant feedback on the utility of this method of training. Patients and Methods: The simulations took place in a high‐fidelity simulated ward bay. Forty‐eight doctors with formal urology training ranging between 2 and 60 months (mean 19.1 ± 11.6 months) took part. Thirty‐one participants were on a formal urology specialty training pathway. The remaining participants were core (pre‐specialty) surgical trainees. The entry requirement was that participants must be junior‐level urologists, ideally at the beginning of specialty training. Participants individually led a simulated ward round, which was devised using actors to play patients and a simulated ‘switchboard’ for telephone conversations. Distractions were introduced deliberately for participants to manage an emergent urology‐related scenario. ‘Freeze‐frames’ were used to ‘pause’ the ward round, whereby observing consultants provided feedback on performance. After the simulated exercises, a whole‐group structured debriefing took place. Non‐Technical Skills for Surgeons (NOTSS) scores were generated for participants by seven consultant urologists. Participants completed a two‐part feedback form. Part one involved nine questions scored on a Likert scale, and part two required free‐text responses. Results: The mean (± sd) itemized NOTSS scores for situational awareness, decision‐making, communication and teamwork, and leadership were 3.01 (±0.15), 2.95 (±0.16), 3.05 (±0.19), and 2.98 (±0.15), respectively. From the thematic analysis, participants commented positively on the number of scenarios per participant, the use of actors as patients and real staff, and the use of freeze‐frames for immediate feedback. Residents also provided suggestions for distractions to be considered in the future. Conclusions: This simulated ward round was generally well received by participants, and the obtained feedback provides an insight into how this can be adapted to maximize the benefits for new specialty residents. The mean NOTSS scores indicated that non‐technical skills performances could be improved. This supports our rationale to train non‐technical skills in a safe environment to bolster career transition into positions of greater decision‐making autonomy. [ABSTRACT FROM AUTHOR]

Many complaints come from employers regarding on non-technical skills among engineering graduates. Non-technical skills can be effectively developed during industrial training while they are still undergraduates. This paper is presenting the perspective of employers on factors that are developing the non-technical skills during industrial training. A qualitative study was done by interviewing five employers from electrical and electronics industries to gain the data. Thematic analysis was done after transcripting the interview protocols. The result shows that employers nowadays really need communication skills, critical thinking and problem-solving skills in an engineer. In addition, teamwork skills, lifelong learning, ethics and computing skills are the skills that are mentioned by the interviewed employers. In term of factor affecting students' non-technical skills during industrial training, they are two opinions for the first factor which is placement. Three out of five employers agreed the relevant industry to the course is crucial, but the rest disagreed. The reasons of disagreement are because the development of non-technical skills should base on the task given and the student's motivation in learning. All employers are agreed with six months duration, regular assessment, task given must be relevant with projects and presentation, and the learning outcomes must be revised regularly. [ABSTRACT FROM AUTHOR]

Graduate training programs often produce technically 'savvy' scientists with inadequate non-technical skill sets essential for workplace success. The challenges associated with lack of non-technical competency may be exacerbated in highly specialized fields such as seed science. This brief communication describes recent efforts conducted at the 12th Triennial Conference of the International Society for Seed Science to address non-technical skill development for pre-career professionals. Furthermore, I propose a few adaptable ideas to begin confronting the divide between graduate education and professional development. [ABSTRACT FROM AUTHOR]

Abstract Leadership and teamwork are essential components of surgical practice and now recognized in the Generic Professional Capabilities framework from the GMC. Surgical application of these skills can be usefully explored through the NOTSS (Non-Technical Skills for Surgeons) taxonomy. This identifies the essential elements of performance in key areas: exchanging information; establishing a shared understanding and co-ordinating team activities (for teamwork); and setting and maintaining standards, supporting others and coping with pressure (for leadership). In addition, there are a number of well-evidenced tools and techniques which can be utilized to improve performance. This includes team briefing and debriefing, closed loop communication, SBAR (situation, background, assessment, recommendation), graded assertiveness and 'flying by voice'. Practising and integrating these techniques into surgical practice can improve individual and overall team performance. Finally, to optimize our performance requires careful balancing of each non-technical element to stretch and develop teamwork while providing support and maintenance of a healthy working environment. And of course, always aligning these developments with the goal of improvement in patient care. [ABSTRACT FROM AUTHOR]

The study is based on a literature review of recent empirical research on crew resource management (CRM) training in the maritime industry, organised around what non-technical skills to learn and how. The review indicates that existing work is dominated by individualistic theories of learning with less focus on learning as a social process. Five main categories of skills that need to be trained are identified: assertiveness, decision-making, communication, situation awareness and team coordination. We argue that it is necessary to operationalise these broad concepts further, emphasising the work context and crew-specific needs. The review also shows that a combination of classroom lectures and simulator-based exercises is commonly used in maritime education and training in these skills. The learning effect seems to be suffering from training programmes that are exported ‘as is’ from aviation and not adjusted to the maritime domain or to operation-specific needs. This paper examines maritime crew resource management training from a social learning perspective, involving the view that learning is a context bound, social process that might take place in communities of practice (CoP). A CoP is a group (e.g. a crew) wherein members share an activity and learn from each other. It is argued that CRM training programmes will benefit from including a social learning perspective. Factors that enable the assessment of teams are discussed, and it is argued that the training should be tailored to existing crews, emphasising a learning environment as close to reality as possible. [ABSTRACT FROM AUTHOR]

Objective: The Royal College of Anesthesiologists of Thailand (RCAT) has performed the study called "The Perioperative Anesthetic Adverse Events Study in Thailand (PAAd Thai)". It was a multi-center, prospective, observational trial conducted in 22 hospitals throughout Thailand in 2015. This study is a part of the PAAd Thai which specifically aimed to focus on failed intubation with the view of technical skills and Anesthetists' Non-Technical Skills (ANTS). Materials and Methods: The PAAd Thai working group created a standardized incident record form. Each incident including failed intubation was reported directly to a center of data management using this form. Two anesthesiologists (SN, PP) separately used the ANTS behavioral rating tool (4 categories, 15 elements) to assess performances of the healthcare providers involved in each incident report of failed intubation. Results: Among 2,206 incident reports, there were 16 cases (0.7%) of failed intubation. Overall incidence per 10,000 with 95% CI was 0.74 (0.38 -1.10). More than half of them were not obese. Difficult intubation was predicted in 56.25% of the cases. McIntosh blade was the most frequently used equipment. Five cases were cancelled while 11 went on for surgery using either a laryngeal mask airway (55%) or tracheostomy (45%). The 2 most common complications were hypoxia (43.75%) and esophageal intubation (12.50%). No cardiac arrest happened. With ANTS, there was 0 case which the 2 authors had the same ratings for all elements. Moreover, none of the elements were marked with the same ratings by the 2 authors. Identifying options as well as balancing risks and selecting options (decision making) were rated in concordance for 12 incident reports. Conversely, prioritizing (task management) as well as using authority and assertiveness (team working) accounted for 0 agreement. Conclusion: The incidence of failed intubation was low and no case experienced very serious complications. Using the ANTS scoring system to evaluate performances of anesthetic practitioners from the incident reports showed various agreements between the 2 authors. [ABSTRACT FROM AUTHOR]

Background and Purpose: Driven by the positive results of randomized, controlled trials of endovascular stroke therapies (EVT) in stroke patients with large vessel occlusion, different approaches to speed up the workflow for EVT candidates are currently being implemented worldwide. We aimed to assess the effect of a simple stroke network-wide workflow improvement project, primarily focusing on i.v. thrombolysis, on process times for patients undergoing EVT. Methods: In 2015, we conducted a network-wide, peer-to-peer acute stroke workflow improvement program for i.v. thrombolysis with the main components of implementing a binding team-based algorithm at every stroke unit of the regional network, educating all stroke teams about non-technical skills and providing a stroke-specific simulation training. Before and after the intervention we recorded periprocedural process times, including patients undergoing EVT at the 3 EVT-capable centers (January – June 2015, n = 80 vs. July 2015 – June 2016, n = 184). Results: In this multi-centric evaluation of 268 patients receiving EVT, we observed a relevant shortening of the median time from symptom onset to EVT specifically in patients requiring secondary transfer by almost an hour (300 min, 25–75% interquartile range [IQR] 231–381 min to 254 min, IQR 215.25–341 min; p = 0.117), including a reduction of the median door-to-groin time at the EVT-capable center in this patient group by 15.5 min (59 min, IQR 35–102 min to 43.5 min, IQR 27.75–81.25 min; p = 0.063). In patients directly admitted to an EVT-capable center, the median door-to-groin interval was reduced by 10.5 min (125 min, IQR 83.5–170.5 min to 114.5 min, IQR 66.5–151 min; p = 0.167), but a considerable heterogeneity between the centers was observed (p < 0.001). Conclusions: We show that a simple network-wide workflow improvement program primarily directed at fast i.v. thrombolysis also accelerates process times for EVT candidates and is a promising measure to improve the performance of an entire stroke network. [ABSTRACT FROM AUTHOR]

Background: Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes.Method: This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia. Two concurrent four-year periods, before and after implementation of a simulation based multidisciplinary trauma team training program were compared for differences in time to critical operations, Emergency Department (ED) length of stay (LOS) and patient mortality.Results: There were 2389 major trauma patients admitted to the hospital during the study, 1116 in the four years preceding trauma team training (the PREgroup) and 1273 in the subsequent 4 years (the POST group). There were no differences between the groups with respect to gender, body region injured, incidence of polytrauma, and pattern of arrival to ED. The POST group was older (median age 54 versus 43 years, p < 0.001) and had a higher incidence of falls and assaults (p < 0.001). There was a reduction in time to critical operation, from 2.63 h (IQR 1.23-5.12) in the PRE-group to 0.55 h (IQR 0.22-1.27) in the POST-group, p < 0.001. The overall ED LOS increased, and there was no reduction in mortality. Post-hoc analysis found LOS in ED was reduced in the cohort requiring critical operations, p < 0.001.Conclusion: The implementation of trauma team training was associated with a reduction in time to critical operation while overall ED length of stay increased. Simulation is promoted as a platform for training teams; but the complexity of trauma care challenges efforts to demonstrate direct links between multidisciplinary team training and improved outcomes. There remain considerable gaps in knowledge as to how team training impacts health service delivery and patient outcomes.Level Of Evidence: Retrospective comparative therapeutic/care management study, Level III evidence. [ABSTRACT FROM AUTHOR]

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This paper presents evidence of employer and graduate attitudes on the skill set requirements for professional accountants, and whether university accounting programs develop these skills, and in particular emotional intelligence (EI) skills. We use priority indices and strategic mapping to evaluate the positioning of 31 skills. This analysis suggests that university accounting programs could consider increasing the emphasis placed on particular EI and non-emotional intelligence (non-EI) skills while other skills could be de-emphasised. While non-EI skills were ranked higher than EI skills, some non-EI skills are considered well developed in graduates and others are viewed as important but not well developed. While employers expect correspondence between the skills seen as important in the workplace and their expected development in university, there was also reverse correspondence in that employers do not expect universities to develop skills considered less important in the workplace. [ABSTRACT FROM PUBLISHER]

Objectives: Farming is a high-risk sector with up to 170,000 worldwide fatalities reported per year; it is therefore vital to identify methods of mitigating the dangers of this industry. Research within high-risk industries, such as aviation, shipping, and agriculture, has identified the importance of non-technical skills (NTS) in maintaining effective, safe performance and reducing error and injury. However, there is a lack of research evaluating factors that may contribute to NTS attitudes and behaviors. As a first step to address this literature gap, the current study evaluated a range of individual and environmental factors as potential predictors of attitudes toward NTS in agriculture. Method: A sample of 170 farmers from within the United Kingdom and Ireland were surveyed using an online questionnaire. The questionnaire included measures of personality, stress, attitudes toward safety (safety climate, motivation, and risk), environmental stressors (workload, work-life imbalance), and non-technical skills (team and lone worker). Results: Attitudes toward safety climate, compliance, and motivation showed a significant association with both team-based and lone worker NTS. Conscientiousness correlated positively with the majority of the NTS elements. Multiple regression analysis indicated neuroticism and conscientiousness demonstrated capacity to predict NTS attitudes. Concerns about costs and equipment, attitudes toward safety climate, and safety motivation were also found to be significant predictors of NTS attitudes. Conclusion: The results indicate the utility of individual characteristics and environmental factors when predicting farming NTS attitudes. As a result, these elements could be important when evaluating engagement with NTS and developing NTS training initiatives in agriculture. [ABSTRACT FROM AUTHOR]

Human factors in anaesthesia were first highlighted by the publication of the Anaesthetists Non-Technical Skills Framework, and since then an awareness of their importance has gradually resulted in changes in routine clinical practice. This review examines recent literature around human factors in anaesthesia, and highlights recent national reports and guidelines with a focus on team working, communication, situation awareness and human error. We highlight the importance of human factors in modern anaesthetic practice, using the example of complex trauma. [ABSTRACT FROM AUTHOR]

The introduction of non-technical skills during nursing education is crucial to prepare nurses for the clinical context and increase patient safety. We found no instrument developed for this purpose. Objectives: to construct, develop and validate a non-technical skills assessment scale in nursing. Method: methodological research. Based on the literature review and experience of researchers on non-technical skills in healthcare and the knowledge of the principles of crisis resource management, a list of 63 items with a five-point Likert scale was constructed. The scale was applied to 177 nursing undergraduate students. Descriptive statistics, correlations, internal consistency analysis and exploratory factor analysis were performed to evaluate the psychometric properties of the scale. Results: scale items presented similar values for mean and median. The maximum and the minimum values presented a good distribution amongst all response options. Most items presented a significant and positive relationship. Cronbach alpha presented a good value (0.94), and most correlations were significant and positive. Exploratory factor analysis using the Kaiser-Meyer-Olkin test showed a value of 0.849, and the Bartlett's test showed adequate sphericity values (χ²=6483.998; p=0.000). One-factor model explained 26% of the total variance. Conclusion: non-technical skills training and its measurement could be included in undergraduate or postgraduate courses in healthcare professions, or even be used to ascertain needs and improvements in healthcare contexts. [ABSTRACT FROM AUTHOR]

• The social non-technical skills leadership, communication and teamwork were confirmed as relevant for safe chainsaw operations. • Cognitive skills situation awareness, decision-making, task management and cognitive readiness were also shown to be important for chainsaw forestry work. • Original element of psychological safety identified as vital to enable staff to speak up and discuss task approaches. • Factors such as time pressure, adverse weather and distraction can adversely impact non-technical skill performance within forestry. Non-technical skills (NTS) are the cognitive and social skills considered vital for safe and effective work performance alongside technical knowledge. The current study seeks to explore these skills in the high-risk domain of felling tasks within the UK forestry context. Semi-structured interviews encompassing the critical incident technique were conducted with 25 forestry employees (9 chainsaw operators, 6 supervisors, 10 managers). The results emphasise the relevance of NTS for chainsaw operations within the forestry context. A range of both social (leadership, teamwork & communication) and cognitive (situation awareness, decision-making, task management, cognitive readiness) NTS were identified. The elements and associated codes within each skill category illustrate the fit of these skills with the specific forestry context, with some elements entirely unique to chainsaw operations. A range of factors that could adversely impact NTS performance were also identified across five categories (external pressure, training and experience, environmental conditions, cognitive influences, individual constraints). The results represent the first step towards developing a NTS framework and associated behavioural marker system for forestry chainsaw operations. Further research and development are required to produce a full system that can be used to support training and assessment of NTS in practice. However, the current results can be used to raise awareness of these skills within the forestry industry, and as support for the inclusion of NTS within chainsaw operator training programs. [ABSTRACT FROM AUTHOR]

IntroductionA crisis team management (CTM) simulation course was developed by volunteers from Health Volunteers Overseas for physicians and nurses at Angkor Hospital for Children (AHC) in Siem Reap, Cambodia. The framework for the course was adapted from crisis resource management (1, 2), crisis team training (3), and TeamSTEPPs© models (4). The CTM course focused on teaching physicians and nurses on the development of team performance knowledge, skills, and attitudes. Challenges to providing this course at AHC included availability of simulation equipment, cultural differences in learning, and language barriers. The purpose of this project was to evaluate the impact of a CTM simulation course at AHC on attitudes and perceptions of participants on concepts related to team performance.MethodsEach of the CTM courses consisted of three lectures, including team performance concepts, communication, and debriefing followed by rotation through four simulation scenarios. The evaluation instrument used to evaluate the AHC CTM course was developed for Cambodian staff at AHC based on TeamSTEPPs© instruments evaluating attitude and perceptions of team performance (5). CTM team performance concepts included in lectures, debriefing sessions, and the evaluation instrument were: team structure, leadership, situation monitoring, mutual support, and communication. The Wilcoxon signed-rank test was used to analyze pre- and post-test paired data from participants in the course.ResultsOf the 54 participants completing the three CTM courses at AHC, 27 were nurses, 6 were anesthetists, and 21 were physicians. Attitude and perception scores were found to significantly improve (p

Background: Healthcare increasingly recognises and focusses on the phenomena of ‘safe practice’ and ‘patient safety.’ Success with non-technical skills (NTS) training in other industries has led to widespread transposition to healthcare education, with communication and teamwork skills central to NTS frameworks. Objective: This study set out to identify how the context of interprofessional simulation learning influences NTS acquisition and development of ‘safety’ amongst learners. Methods: Participants receiving a non-technical skills (NTS) safety focussed training package were invited to take part in a focus group interview which set out to explore communication, teamwork, and the phenomenon of safety in the context of the learning experiences they had within the training programme. The analysis was aligned with a constructivist paradigm and took an interactive methodological approach. The analysis proceeded through three stages, consisting of open, axial, and selective coding, with constant comparisons taking place throughout each phase. Each stage provided categories that could be used to explore the themes of the data. Additionally, to ensure thematic saturation, transcripts of observed simulated learning encounters were then analysed. Results: Six themes were established at the axial coding level, i.e., analytical skills, personal behaviours, communication, teamwork, context, and pedagogy. Underlying these themes, two principal concepts emerged, namely: intergroup contact anxiety – as both a result of and determinant of communication – and teamwork, both of which must be considered in relation to context. These concepts have subsequently been used to propose a framework for NTS learning. Conclusions: This study highlights the role of intergroup contact anxiety and teamwork as factors in NTS behaviour and its dissipation through interprofessional simulation learning. Therefore, this should be a key consideration in NTS education. Future research is needed to consider the role of the affective non-technical attributes of intergroup contact anxiety and teamwork as focuses for education and determinants of safe behaviour. Abbreviations: AUM: Anxiety/uncertainty management; NTS: Non-technical skills; TINSELS: Training in non-technical skills to enhance levels of medicines safety

Background: Non-technical skills (NTS) are being increasingly recognised as vital for safe surgical practice. Numerous NTS rating systems have been developed to support effective training and assessment. Yet despite the additional challenges posed by robotic surgery, no NTS rating systems have been developed for this unique surgical environment. This study reports the development and validation of the first NTS behavioural rating system for robotic surgery.Methods: A comprehensive index of all relevant NTS behaviours in robotic surgery was developed through observation of robotic theatre and interviews with robotic surgeons. Using a Delphi methodology, a panel of 16 expert surgeons was consulted to identify behaviours important to NTS assessment. These behaviours were organised into an appropriate assessment template. Experts were consulted on the feasibility, applicability and educational impact of ICARS. An observational trial was used to validate ICARS. 73 novice, intermediate and expert robotic surgeons completed a urethrovesical anastomosis within a simulated operating room. NTS were tested using four scripted scenarios of increasing difficulty. Performances were video recorded. Robotic and NTS experts assessed the videos post hoc using ICARS and the standard behavioural rating system, NOn-Technical Skills for Surgeons (NOTSS).Results: 28 key non-technical behaviours were identified by the expert panel. The finalised behavioural rating system was organised into four principle domains and seven categories. Expert opinion strongly supported its implementation. ICARS was found to be equivalent to NOTSS on Bland-Altman analysis and accurately differentiated between novice, intermediate and expert participants, p = 0.01. Moderate agreement was found between raters, Krippendorff's alpha = 0.4. The internal structure of ICARS was shown to be consistent and reliable (median Cronbach alpha = 0.92, range 0.85-0.94).Conclusion: ICARS is the first NTS behavioural rating system developed for robotic surgery. Initial validation has shown it to be an effective and reliable tool. Implementation of ICARS will supported structured training and assessment of NTS within the robotic surgical curriculum. [ABSTRACT FROM AUTHOR]

Background: Parents can assess residents' non-technical skills (NTS) in pediatric emergency departments (EDs). There are no assessment tools, with validity evidence, for parental use in pediatric EDs. The purpose of this study was to develop the Parents' Assessment of Residents Enacting Non-Technical Skills (PARENTS) educational assessment tool and collect three sources of validity evidence (i.e., content, response process, internal structure) for it. Methods: We established content evidence for the PARENTS through interviews with physician-educators and residents, focus groups with parents, a literature review, and a modified nominal group technique with experts. We collected response process evidence through cognitive interviews with parents. To examine the internal structure evidence, we administered the PARENTS and performed exploratory factor analysis. Results: Initially, a 20-item PARENTS was developed. Cognitive interviews led to the removal of one closed-ended item, the addition of resident photographs, and wording/formatting changes. Thirty-seven residents and 434 parents participated in the administration of the resulting 19-item PARENTS. Following factor analysis, a one-factor model prevailed. Conclusions: The study presents initial validity evidence for the PARENTS. It also highlights strategies for potentially: (a) involving parents in the assessment of residents, (b) improving the assessment of NTS in pediatric EDs, and (c) capturing parents' perspectives to improve the preparation of future physicians. [ABSTRACT FROM AUTHOR]

Background In nursing, non-technical skills are recognized as playing an important role to increase patient safety and successful clinical outcomes (Pearson and McLafferty, 2011 ). Non-technical skills are cognitive and social resource skills that complement technical skills and contribute to safe and efficient task performance (Flin et al., 2008 ). In order to effectively provide non-technical skills training, it is essential to have an instrument to measure these skills. Methodology An online search was conducted. Articles were selected if they referred to and/or described instruments assessing non-technical skills for nurses and/or prelicensure nursing students in educational, clinical and/or simulated settings with validation evidence (inclusion criteria). Results Of the 53 articles located, 26 met the inclusion criteria. Those referred to and/or described 16 instruments with validation evidence developed to assess non-technical skills in multidisciplinary teams including nurses. Conclusion Although articles have shown 16 valid and reliable instruments, to our knowledge, no instrument has been published or developed and validated for the assessment of non-technical skills of only nurses in general, relevant for use in high-fidelity simulation-based training for prelicensure nursing students. Therefore, there is a need for the development of such an instrument. [ABSTRACT FROM AUTHOR]

Background Errors in healthcare are a major patient safety issue, with incident reporting a key solution. The incident reporting system has been integrated within a new medical curriculum, encouraging medical students to take part in this key safety process. The aim of this study was to describe the system and assess how students perceived the reporting system with regards to its role in enhancing safety. Methods Employing a thematic analysis, this study used interviews with medical students at the end of the first year. Thematic indices were developed according to the information emerging from the data. Through open, axial and then selective stages of coding, an understanding of how the system was perceived was established. Results Analysis of the interview specified five core themes: (1) Aims of the incident reporting system; (2) internalized cognition of the system; (3) the impact of the reporting system; (4) threshold for reporting; (5) feedback on the systems operation. Selective analysis revealed three overriding findings: lack of error awareness and error wisdom as underpinned by key theoretical constructs, student support of the principle of safety, and perceptions of a blame culture. Conclusions Students did not interpret reporting as a manner to support institutional learning and safety, rather many perceived it as a tool for a blame culture. The impact reporting had on students was unexpected and may give insight into how other undergraduates and early graduates interpret such a system. Future studies should aim to produce interventions that can support a reporting culture. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of a decision support technology on teamwork and associated non-technical (NTS) and technical skills when teams manage post-partum haemorrhage (PPH) in the simulated environment.Methods: Multidisciplinary (MDT) maternity teams were taught how to manage post partum haemorrhage. They were randomised to the intervention: using a decision support mobile digital platform or a control group. Each team managed a post-partum simulation, which was recorded and reviewed by assessors. Primary outcome measures to assess teams NTS were the validated Global Assessment of Obstetric Team Performance (GAOTP) and Clinical Teamwork Scale (CTS). Secondary outcome measures were the 'friends and family test', technical skills, and the System Usability Scale (SUS). Sample size estimation was calculated by using 80% power 5% significance two tailed test (p1=85% p2=40%) n=34.Results: 38 teams from August 2014-February 2016, were recruited, technical issues with failure of recording equipment meant 4 teams were excluded from teamwork analysis (1 intervention 3 control). Teamwork improved across all domains with the intervention (using a decision support mobile digital platform) p <0.01. CTS improved between 6.7-16.8% (average 14.2%) and GAOTP between 8.6-17.1% (average 13.5%) for all domains. Using the control group as baseline, the intervention improved teamwork by 25% using CTS and 22% using GAOTP. Fewer technical skills were missed with the intervention (p<0.01). There was no statistical difference in the time technical skills were achieved. Assessors were more likely to recommend intervention teams 87.5% (77/88) than control teams 63.6% (56/88) p<0.01 to their friends or family. The SUS was 'Good' (69) becoming excellently 'Usable' (81.6) over the study period.Conclusion: We report a decision support system, which improved NTS when managing PPH. Lack of teamwork is often cited as the cause of failures in care and we report a usable technology that assists with and improves teamwork during an emergency. [ABSTRACT FROM AUTHOR]

Teamwork performance is an essential component for the clinical efficiency of multi-professional teams in obstetric care. As patient safety is related to teamwork performance, it has become an important learning goal in simulation-based education. In order to improve teamwork performance, reliable assessment tools are required. These can be used to provide feedback during training courses, or to compare learning effects between different types of training courses. The aim of the current study is to (1) identify the available assessment tools to evaluate obstetric teamwork performance in a simulated environment, and (2) evaluate their psychometric properties in order to identify the most valuable tool(s) to use. We performed a systematic search in PubMed, MEDLINE, and EMBASE to identify articles describing assessment tools for the evaluation of obstetric teamwork performance in a simulated environment. In order to evaluate the quality of the identified assessment tools the standards and grading rules have been applied as recommended by the Accreditation Council for Graduate Medical Education (ACGME) Committee on Educational Outcomes. The included studies were also assessed according to the Oxford Centre for Evidence Based Medicine (OCEBM) levels of evidence. This search resulted in the inclusion of five articles describing the following six tools: Clinical Teamwork Scale, Human Factors Rating Scale, Global Rating Scale, Assessment of Obstetric Team Performance, Global Assessment of Obstetric Team Performance, and the Teamwork Measurement Tool. Based on the ACGME guidelines we assigned a Class 3, level C of evidence, to all tools. Regarding the OCEBM levels of evidence, a level 3b was assigned to two studies and a level 4 to four studies. The Clinical Teamwork Scale demonstrated the most comprehensive validation, and the Teamwork Measurement Tool demonstrated promising results, however it is recommended to further investigate its reliability. [ABSTRACT FROM AUTHOR]

Objectives: Simulation-based medical training is associated with superior educational outcomes and improved cost efficiency. Self- and peer-assessment may be a cost-effective and flexible alternative to expert-led assessment. We compared accuracy of self- and peer-assessment of untrained raters using basic evaluation tools to expert assessment using advanced validation tools including validated questionnaires and post hoc video-based analysis. Methods: Twenty-eight simulated emergency airway management scenarios were observed and video-recorded for further assessment. Participants consisted of 28 emergency physicians who were involved in four different airway management scenarios with different roles: One scenario as a team leader, one as an assisting team member, and two as an observer. Non-technical skills (NTS) and technical skills (TS) were analyzed by three independent groups: 1) the performing team (PT) consisted of the two emergency physicians acting either in the role of team leader or team member (self-assessment); 2) the observing team (OT), consisted of two of the participating emergency physicians not involved in the current clinical scenario (peer-assessment) and assessment occurred during (OT) or directly after (PT) the simulation without prior specific interpretational training but using standardized questionnaires; and 3) the expert team (ET) consisted of two specifically trained external observers (one psychologist and one emergency physician) using video-assisted objective assessment combined with standardized questionnaires. Results: Intragroup reliability demonstrated by intra-class correlation (ICC) was moderate to good for TS (ICC 0.42*) and NTS (ICC 0.55*) in PT and moderate to good for TS (ICC 0.41*) or poor for NTS (ICC 0.27) in OT. ET showed an excellent intragroup reliability for both TS (ICC 0.78*) and NTS (ICC 0.81*). Interrater reliability was significantly different between ET and PT and between ET and OT for both TS and NTS. There was no difference between OT and PT for neither TS nor NTS; *p < 0.05. Conclusions: Expert assessment of simulation-based medical training scenarios using validated checklists and performance of post hoc video-based analysis was superior to self- or peer-assessment of untrained observers for both TS and NTS. [ABSTRACT FROM AUTHOR]

Background. Due to the challenge of conducting observations of drilling team behaviours on an offshore installation during actual operations, a high fidelity simulator provided the opportunity to observe team behaviours when managing complex and uncertain situations. Aim. This article describes how such observations were used to develop a team behavioural marker framework subsequently used for debriefing. Method. Team behaviours and interactions were recorded during 25 simulator-based training exercises which had been integrated into a technical training course. These were then analysed, and four dimensions, with example behaviours, were identified. Results. The behavioural markers formed the basis of training objectives, and provided structure for debriefing team performance. The use of the simulator provided concrete examples of both effective and ineffective behaviours. Conclusions. Notable improvements in drilling team interactions and behaviours were noted over the course of five exercises, which ranged in complexity and uncertainty, throughout the training course. Enhancing team non-technical skills will lead to safer and more effective performance, and facilitate the transfer from training to actual operations. Team members also became more familiar with the concepts and terminology of non-technical skills and integrated behavioural markers into workplace practices such as Tool Box Talks, Stop Work Authority, and Time-Outs. [ABSTRACT FROM AUTHOR]