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

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

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

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

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

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

OBJECTIVES: This research focuses on assessing non-technical skills (NTS), comprising behavioral aspects that support an individual's expertise in personal and professional performance. Due to varied terminology, including "soft skills" and other terms, NTS is less understood, leading to a potential gap in the literature and limited attention to their development. This study establishes the need for a comprehensive evaluation of NTS to obtain an objective and complete profile of NTS in students pursuing medicine at the Universidad Central del Ecuador (UCE) during 2023, using a standardized and benchmarked psychometric instrument. METHODS: A cross-sectional study assessed 1035 students from the first to the 12th semester using the CompeTEA® Test, which evaluates 5 factors encompassing 20 competencies and includes sincerity as a reliability condition. Scores were corrected, analyzed, and standardized using TEAcorrige. RESULTS: The study group comprised 1035 undergraduate medical students (36.8% of students at UCE in 2023), with a mean age of 22.1 years (2.7 standard deviation), and 687 (66.4%) were female. We obtained an average score of 77.7 in sincerity. Factors such as intrapersonal, interpersonal, task development, and managerial skills showed variations throughout the course, with some competencies developing positively in intermediate clinical stages. At the same time, most exhibited a decrease toward the end of the program. Comparisons with population levels revealed 19 competencies at Level 2 and 1 competency predominantly at Level 1. CONCLUSION: The moderate to low development, with no significant differences based on demographic variables, suggests the need for specific interventions in NTS within comprehensive medical education. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) based simulation is emerging as an innovative tool for the training and education of healthcare professionals. However, pedagogical frameworks specific to this type of simulation are yet missing. This paper explores participants' experiences with VR-based simulation training in non-technical skills (VR-SIMI) and integrates them with established pedagogical theory. Non-technical skills refer to cognitive, social, and personal resource skills such as effective communication, relational competence, and stress management. An observational study was conducted involving 11 healthcare professionals in children and adolescents' mental healthwho attended four VR-SIMI sessions over one year. Data were collected through field notes during participant observation and informal conversations with the participants. Directed content analysis was conducted, informed by the established practice of VR-SIMI (including INACL standards of best practice simulation), Jeffries simulation theory, Kolb's experiential learning theory, and adult learning theory. The findings indicate that the participants positively evaluated the use of VR-SIMI. However, they also reported that the implementation and learning outcomes should be further refined. Based on these findings, an evidence-based and theory-driven pedagogical framework is proposed to guide and enhance the quality of VR-based simulations of non-technical skills for various of healthcare professionals, as well as inform future research. [ABSTRACT FROM AUTHOR]

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

Resumen: Introducción: existe un reconocimiento creciente de incorporar habilidades no técnicas durante el proceso formativo de un cirujano para incrementar su desempeño profesional futuro. Hay un vacío en la metodología educativa empleada. Se efectúa una revisión panorámica de la literatura para identificar el estado, los vacíos y oportunidades de investigación. Métodos: revisión panorámica de la literatura con la metodología del Joanna Briggs Institute. Se analizaron estudios que abordaron la instrucción, la medición, la evaluación de resultados y el impacto educacional de las habilidades no técnicas en los residentes. Resultados: los estudios se llevaron a cabo entre 2012 y 2021. Las habilidades estudiadas fueron el conocimiento situacional, la toma de decisiones, la comunicación, el trabajo en equipo y el liderazgo. Hay estudios en validación de instrumentos de medición e implementación de modelos de educación. Los vacíos de conocimiento identificados fueron la falta de estandarización de los métodos empleados para la formación y evaluación de estas competencias, al igual que la falta de estudios en Latinoamérica. Discusión: la enseñanza de las habilidades no técnicas es un tema pendiente en la formación de un cirujano. La relevancia del tema obliga a su estudio e incorporación en los currículos de estudio. Abstract: Introduction: There is a growing recognition of incorporating non-technical skills during the training process of a surgeon, as a strategy to increase their future professional performance. There is a gap in the educational methodology used. A panoramic review of the literature is carried out to identify the status, gaps and research opportunities. Methods: Panoramic review of the literature with the Joanna Briggs Institute methodology. Studies that addressed instruction, measurement, outcome evaluation, and the educational impact of non-technical skills on residents were analyzed. Results: The studies analyzed were carried out between 2012 and 2021. The skills studied were situational awareness, decision making, communication, teamwork, and leadership. There are studies on validation of instruments and implementation of education models. The knowledge gaps identified were the lack of standardization of the methods used for the training and evaluation of these competencies, as well as the lack of studies in Latin America. Discussion: The teaching of non-technical skills is a pending issue in the training of a surgeon. The relevance of the topic requires its study and incorporation into study curricula.

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

Abstract Backgrounds Team leadership skills of physicians working in high-performing medical teams are directly related to outcome. It is currently unclear how these skills can best be developed. Therefore, in this multi-national cross-sectional prospective study, we explored the development of these skills in relation to physician-, organization- and training characteristics of Helicopter Emergency Medicine Service (HEMS) physicians from services in Europe, the United States of America and Australia. Methods Physicians were asked to complete a survey regarding their HEMS service, training, and background as well as a full Leader Behavior Description Questionnaire (LBDQ). Primary outcomes were the 12 leadership subdomain scores as described in the LBDQ. Secondary outcome measures were the association of LBDQ subdomain scores with specific physician-, organization- or training characteristics and self-reported ways to improve leadership skills in HEMS physicians. Results In total, 120 HEMS physicians completed the questionnaire. Overall, leadership LBDQ subdomain scores were high (10 out of 12 subdomains exceeded 70% of the maximum score). Whereas physician characteristics such as experience or base-specialty were unrelated to leadership qualities, both organization- and training characteristics were important determinants of leadership skill development. Attention to leadership skills during service induction, ongoing leadership training, having standards in place to ensure (regular) scenario training and holding structured mission debriefs each correlated with multiple LBDQ subdomain scores. Conclusions Ongoing training of leadership skills should be stimulated and facilitated by organizations as it contributes to higher levels of proficiency, which may translate into a positive effect on patient outcomes. Trial registration Not applicable.

Abstract Background Resuscitation is a team effort, and it is increasingly acknowledged that team cooperation requires training. Staff shortages in many healthcare systems worldwide, as well as recent pandemic restrictions, limit opportunities for collaborative team training. To address this challenge, a learner-centred approach known as flipped learning has been successfully implemented. This model comprises self-directed, asynchronous pre-course learning, followed by knowledge application and skill training during in-class sessions. The existing evidence supports the effectiveness of this approach for the acquisition of cognitive skills, but it is uncertain whether the flipped classroom model is suitable for the acquisition of team skills. The objective of this study was to determine if a flipped classroom approach, with an online workshop prior to an instructor-led course could improve team performance and key resuscitation variables during classroom training. Methods A single-centre, cluster-randomised, rater-blinded study was conducted on 114 final year medical students at a University Hospital in Germany. The study randomly assigned students to either the intervention or control group using a computer script. Each team, regardless of group, performed two advanced life support (ALS) scenarios on a simulator. The two groups differed in the order in which they completed the flipped e-learning curriculum. The intervention group started with the e-learning component, and the control group started with an ALS scenario. Simulators were used for recording and analysing resuscitation performance indicators, while professionals assessed team performance as a primary outcome. Results The analysis was conducted on the data of 96 participants in 21 teams, comprising of 11 intervention groups and 10 control groups. The intervention teams achieved higher team performance ratings during the first scenario compared to the control teams (Estimated marginal mean of global rating: 7.5 vs 5.6, p

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

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

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

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

A human factors (HF) approach can help optimize individual and team performance in healthcare and across related professions that work together. Trauma and orthopaedic surgeons carry out high-stakes tasks within a cognitively and physically demanding environment. This is compounded by the challenges of working in complex healthcare systems. Error is a 'normal' part of being human, and must be managed in order to prevent harm to patients and staff. HF is the science of how people work within their teams, and in the workplace. It examines interactions with equipment, and the processes used to achieve the desired outcome. It uses theory from fields as diverse as ergonomics, psychology and engineering in order to achieve these aims. This article outlines key topics relevant to surgeons striving to help improve patient safety and wellbeing within teams. These include theories of error in healthcare, systems-based approaches, performance-limiting factors, and non-technical skills. [ABSTRACT FROM AUTHOR]

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

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

This study presents a scoping review of research on artificial intelligence (AI)- driven virtual patients (VPs) for communication skills training of healthcare students. We aimed to establish what is known about these emergent learning tools, to characterise their design and implementation into training programmes. The preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews framework was consulted. Searches occurred in six online databases to capture relevant articles from 2014 to 2024. Eight articles from five disciplines met inclusion criteria. A variety of design approaches, creation tools and VP appearances exist. Educational considerations such as consultation of educational theory, curricular integration and provision of feedback was overall lacking. Neutral to positive evaluations of satisfaction and acceptance of the VPs were provided by most students. Emerging literature suggests AI-driven VPs are increasingly being utilised for communication skills training, although their effectiveness is not established. Careful consideration of technological design features, educational theory and evidence regarding communication skill development should occur by clinical educators wishing to include AI-driven VPs in their training programmes. Further empirical research involving key stakeholders is needed to learn more about this technology. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

Background Non-technical skills are pivotal in ensuring patient safety during anaesthesia crisis resource management. Simulation-based training has emerged as a promising educational approach for enhancing these skills. This study protocol outlines a prospective randomised comparative study aimed at assessing the impact of simulation-based training on the performance of anaesthesia residents during anaesthesia crisis resource management, with a focus on task management, teamwork, situational awareness, and decision-making skills, using the Assessment of Non-Technical Skills (ANTS) scoring system. Methods Anesthesia residents in postgraduate years 1 and 2 from the Department of Anesthesia at Acharya Vinoba Bhave Rural Hospital will be included as study participants. Informed consent will be obtained, and no exclusion criteria will be applied. Participants will undergo an orientation session covering essential crisis management and simulation knowledge. The study will employ advanced simulation equipment, including a Human Patient Simulator (HPS) mannequin, an anaesthesia machine, and a simulated operating room. Faculty members have selected six distinct perioperative emergency scenarios for simulation sessions. Participants will be grouped in pairs and exposed to three scenarios during each session. Debriefing and feedback will follow each scenario, reinforcing non-technical skills. Experienced staff anesthesiologists, trained in the Assessment of Non-Technical Skills (ANTS) scoring system, will serve as assessors to evaluate participant performance. Expected outcomes Data collected will include ANTS scores, debriefing feedback, and post-test results. Statistical analysis will be employed to assess the effectiveness of simulation-based training in enhancing non-technical skills among anaesthesia residents during anaesthesia crisis resource management.

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

In this article we will introduce human factors, a human factors approach and patient safety in cardiac surgery. Key concepts, important terms and their application to clinical practice, with specific reference to cardiac surgery, will be discussed. Human factors and ergonomics is a broad subject area and in-depth analysis of this area of study is beyond the scope of this review. Our aim is to highlight key research, areas within which to develop your own practice in relation to human factors in surgery, and useful resources. [ABSTRACT FROM AUTHOR]

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

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

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

Objective: To assess the impact of a hysteroscopic myoma resection (HMR) two-day training course on non-technical (cognitive) surgical skills among gynecologists. Materials and methods: A 2-day educational course was held in which 95 consultant gynecologic surgeons and beginner infertility fellowship residents took part. Among all 80 participants (84.2%) had ever performed diagnostic hysteroscopy and 30 (31.3%) had performed non-resectoscopic operative hysteroscopy. The training program included instructive speeches, simulated surgical presentations, and a live hands-on myomectomy workshop. Non-technical skills were assessed two times, once before and the other after the course through two written tests with 10 multiple-choice questions for each. Results: Concerning the 95 participants, 43 (47.3%) took the pre-course test and all of them (100%) took the post-course one. The mean score improved significantly from 3 (interquartile range [IQR], 0–4.0) to 7 (IQR, 5.0– 8.0) [bootstrap p

Abstract 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.