Devising a consensus definition and framework for non-technical skills in healthcare to support educational design: A modified Delphi study

Background Non-technical skills are a subset of human factors that focus on the individual and promote safety through teamwork and awareness. There is no widely adopted competency or outcome based framework for non-technical skills training in healthcare outside the surgical environment. The authors set out to devise such a framework and reach a consensus on a definition using a modified Delphi approach. Methods An exhaustive list of published and team suggested items was presented to the expert panel for ranking and to propose a definition. In the second round, a focused list was presented, as well as the proposed definition elements. The finalised framework was sent to the panel for review. Summary of results 16 experts participated (58% response rate). A total of 36 items of 105 ranked highly enough to present in round two. The final framework consists of 16 competencies for all and 8 specific competencies for team leaders. The consensus definition describes non-technical skills as ‘a set of social (communication and team work) and cognitive (analytical and personal behaviour) skills that support high quality, safe, effective and efficient inter-professional care within the complex healthcare system’. Conclusions The authors have produced a new competency framework, through the works of an international expert panel, which is not discipline specific. This consensus competency framework can be used by curriculum developers, educational innovators and clinical teachers to support developments in the field

Simulation in a high stakes clinical performance exam

Background: Hi-fidelity simulation is becoming accepted as a teaching tool for medical providers. Advanced simulations allow educators to test difficult clinical scenarios. The goal of this study was to test the diagnostic and treatment skills of a third-year medical student faced with a simulated patient having evidence of a stable pneumothorax. Students are then expected to evaluate the teaching simulation in comparison to traditional methods. Methods: The case was one of a 12 cases in the "high stakes" Clinical Performance Exam. The patient with evidence of a stable pneumothorax was chosen to evaluate both diagnostic abilities and decision making in therapeutic options. Students were assessed using a university-wide standardized checklist: diagnosis, management, and interaction with the simulator. Immediately following the simulation, the students evaluated the experience. Results: The exam was given to 117 students. The correct diagnosis was made by 115/117 (98%). Treatment was considered acceptable in a majority of students, Send patient to the Emergency Department 77%, Oxygen 26% and Analgesia 39%. The follow-up survey completed by 78% of the students revealed the students felt comfortable with the simulators, but had concerns about the exam. Students liked the simulator as an educational tool 88% of the time. Conclusions: Simulation was used in a year-end exam and majority of students chose the correct diagnosis and treatment plan. It was also found that a significant percentage of students performed an unnecessary and potentially harmful procedure. The survey revealed that students were concerned about distractions and realism, but overall expressed desire for more education using simulation