Background: Surgeons’ nontechnical skills are critical for patient safety in the operating room (OR) and have been included in resident training requirements. The optimal approach to their training and assessment though is unknown. The goal of this thesis was to develop a structured approach to the training and assessment of nontechnical skills in surgical education.
Methods: Objectives were: (1) to establish the prevalence of nontechnical training components in postgraduate curricula; (2) to develop a reliable tool for the criterion-referenced assessment of residents’ nontechnical performance; (3) to determine surgical residents’ innate nontechnical skills and how these relate to personality; (4) to evaluate the effectiveness of a strategy for competency-based training of nontechnical skills in surgical residency.
Results: (1) One-third of responding residency programs reported nontechnical training components; (2) the Objective Structured Assessment of Nontechnical Skills (OSANTS) tool was developed to assess resident-specific skills. Good psychometric properties were demonstrated, both in simulation and in the real OR; (3) large inter-individual differences in nontechnical performance were found among 31 junior surgical residents. Some variability could be explained by personality traits; (4a) a basic skills curriculum was evaluated in a randomized trial. Curriculum trained first-year residents (n=11) outperformed conventionally trained peers (n=11) in knowledge and attitudes about nontechnical skills. Curriculum-trained residents’ performance in a simulated OR improved significantly from baseline to post-training (OSANTS: (median 23(interquartile range 17-28) vs. 31(25-33), p=0.012), while conventionally trained residents did not improve (OSANTS, 26(24-32) vs. 24(23-32), p=0.713); (4b) In an interrupted time-series study, observed nontechnical performance of senior residents (n=11) in the OR improved significantly following one debriefing and feedback session.
Conclusion: Based on the results, a combined approach to nontechnical education in surgical postgraduate education is proposed, with a basic skills curriculum in the first year, and debriefing and feedback in formative assessments throughout residency training.Ph.D
