Original ReportsAssessing the Nontechnical Skills of Surgical Trainees: Views of the Theater Team☆
Introduction
In the UK, the last decade has seen major reform in postgraduate medical education, notably a national move toward competency-based curricula. For the surgical specialties this has led to the launch of the Intercollegiate Surgical Curriculum Programme (ISCP) (www.iscp.ac.uk), which has transformed postgraduate training. ISCP enables the surgical trainee to record evidence of their training progression through the accumulation of specialty specific workplace-based assessments (WBAs) in technical surgical skills (Direct Observation of Procedural Skills and Procedure-Based Assessment [PBA]), Clinical diagnosis and management (mini-Clinical Evaluation Exercise) and an overall assessment of behavior and attitudes by colleagues (mini-Peer Assessment Tool). Recently, an assessment tool to assess trainee’s nontechnical skills has been introduced to ISCP as a pilot. Currently, nontechnical skills are informally acquired by surgical trainees through apprenticeship and observation rather than being explicitly addressed in training.1, 2 It is felt that this passive learning style needs transition to one of active knowledge acquisition with behavioral change. One of the key assessment tools of nontechnical skills available in literature is the nontechnical skills for surgeons (NOTSS), adapted from aviation Crew Resource Management.3, 4 It is a rating system based on skill taxonomy, with examples of good and poor behavioral markers. Ratings and feedback are given on 4 categories of nontechnical skills; situation awareness, decision making, communication and teamwork, and leadership.
There are, however, various questions that need to be addressed before the integration of NOTSS assessment in the surgical curriculum, namely, whom should take on the role of assessor (should they exclusively be surgeons or should nonsurgeons be recruited); should raters obtain formal training in NOTSS assessment and the effect of the presence of a more senior surgeon in theater, during the assessment on the rating of the trainee’s nontechnical skills. Engagement with NOTSS and how to ensure “buy-in” from members of the theater team, particularly trainees, is also an important consideration.
In this study, we present a survey among the surgical theater team that explores current views regarding the need to introduce an assessment tool of nontechnical skills of surgical trainees in the theater environment. In addition, the familiarity of members of the surgical theater team with the concept of NOTSS as well as their previous training in this area is explored.
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Data Collection
This survey was conducted in South Yorkshire, UK between November 2014 and February 2015. Ethical approval was granted by University of Sheffield Medical School (No. SMBRER287). Theater teams at 1 teaching and 2 district general hospitals were invited to participate in the survey and to provide their views on NOTSS assessment as well as their experience of nontechnical skills. The participants were divided into 4 professional groups: consultant surgeons, surgical trainees, consultants
Results
In all, 198 staff members were approached and 160 responded, corresponding to a response rate of 81% (25 consultant surgeons, 51 trainees (grades CT1-ST8), 26 anesthetists, and 58 theater staff (Fig. 2). A total of 38 staff members did not return the questionnaires (5 consultant surgeons, 12 trainees, 3 anesthetists, and 18 theater staff).
Overall, 123 respondents (77%) were not aware of the NOTSS assessment tool with only 14 (9%) reporting to have previously used the NOTSS tool and just 4 (3%)
Discussion
Analyses of adverse events in healthcare have revealed that there is more often failure in nontechnical aspects of performance rather than a lack of technical expertise.6, 7 It has been shown that poor nontechnical skills in the operating theater result in a reduction in technical skill8 adverse events and poor clinical outcomes.9, 10, 11, 12 Communication has been found to be a causal factor in 43% of errors made in surgery.12 One of the key outcomes for all surgical trainees is “professional
Conclusion
Our survey demonstrates acceptability among the theater team for the introduction of the NOTSS tool into the surgical curriculum. Adequate provision of training on assessing NOTSS is required before an introduction and the findings of this survey can inform appraisal of the utility of NOTSS assessment tool that is being piloted via the ISCP.
Acknowledgments
The authors would like to thank members of South Yorkshire Surgical Research Group Collaborative who facilitated data collection in South Yorkshire, namely, Charlotte Gunner, Matthew Lee, Khalil Madbak, Mohamed El-Sharif, Emma Nofal, Vicky Proctor, and Stuart Stokes.
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Cited by (0)
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On behalf of the South Yorkshire Surgical Research Group (SYSuRG) Collaborative.