消防指揮隊における非技術技能教育に関する事例研究

Introduction Good non-technical skills (NTS), are pivotal to delivering high quality care, particularly in acute situations. There have been attempts to introduce NTS training to the undergraduate curriculum through “pager” simulations and simulation ward rounds (Dickinson, 2014; Harris, 2013). However, to date, there has been no attempt to define NTS specifically relevant to medical students, or to gauge student understanding of them. This study aimed to develop a NTS behavioural marker system applicable to training and assessing medical students. Methods Following ethical approval, 16 final year medical students participated in high fidelity simulated scenarios. Subsequently, semi-structured interviews were conducted to assess awareness of NTS and identify key NTS and behaviours that demonstrated such skills. Interviews were transcribed and analysed using the behavioural marker system developed for newly qualified doctors ‘Foundation Non-Technical Skills’ (FoNTS) (Mellanby, 2013) as the initial coding template. The developing taxonomy was informed by a systematic review of literature relating to medical students’ NTS, and reviewed by two subject matter experts. Results Five categories of NTS were identified -- situational awareness, teamwork, leadership, task management and decision making. Twelve NTS elements were identified within these domains. Exemplar behaviours (markers) indicative of performance were developed for each element to produce a prototype behavioural marker system. During transcript analysis, students recognised teamwork, leadership and task management as key NTS. Situational awareness and decision making were less readily identified. Conclusions Final year medical students are aware of the NTS required for optimising patient safety in an acute care simulation scenario. The development of a behavioural marker system to assess NTS helps medical educators to be explicit when describing the behaviours that medical students should demonstrate in both simulated and real emergencies. The tool, used alongside clinical teaching in the undergraduate curriculum, is likely to improve understanding, recognition and application of NTS. References Dickinson M, Pimblett M, Hanson J, Davis M. Reflecting reality: pager ?simulations in undergraduate educations. The Clinical Teacher 2014;11(6):421–4. Harris D. Can patient simulator scenarios be utilized to improve teamwork and communication skills in first year medical students taking Medical Physiology? The FASEB J 2013;27:740.12 Mellanby E, Hume M, Glavin R, Skinner J, Maran N. Foundation non-technical skills- Development of a behavioural marker system for newly qualified doctors in managing acutely unwell patients [Online]. Clinical Skills Managed Clinical Network 2013. Available from: http://www.csmen.scot.nhs.uk/media/25660/project_report_19.08.14.pdf [Accessed: 14th December 2015]

Non-technical skills are interpersonal and cognitive skills involved in safe performance and preventing adverse events during surgery. it is necessary to dominate the non-technical skills to ensure patient safety. This study has aimed to assess the validity and reliability of Oxford Non-technical skills 2 system (Oxford NOTECHS 2) in Iran and to evaluate surgical teams' non-technical skills in orthopedic surgery wards. This cross-sectional study was conducted in Tehran, Iran during 2015. The level of evidence is III based on Canadian Task Force on the Periodic Health Examination. We followed the Beaton's guideline for Persian translation and cross-cultural adaptation of the checklist. In this study, 60 orthopedic surgical team members working in two selected public hospitals were selected by cluster random sampling method.Oxford NOTECHS 2 system which is consisted of four subscales including leadership and management, teamwork and collaboration, decision-makingand problem-solving, and situational awareness was used to collect the data. The overall mean score of non-technical skills was 69.52±6.64. The mean score for surgery, anesthesia, and nursing sub-teams were 24.98±3.71, 21.12±4.29, and 23.42±3.60, respectively. The teams' scores in total, leadership and management, teamwork and collaboration, problem solving and decision making, and situational awareness at the standard level were 74.70%, 76.95%, 73.75%, 66.87%, and 74.70% of maximum score, respectively. The validity and reliability of the Persian version of Oxford NOTECHS 2 scale in Iran was confirmed. The results of this study showed that surgical teams' non-technical skills were at a moderate level in orthopedic surgery wards. The minimum score of the surgical teams' non-technical skills belonged to anesthesia and maximum to surgery sub-team. Using the training programs and setup workshop is recommended to improve the surgical teams' non-technical skills, especially surgery-nursing sub-team.

The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. A pre-post design was used. The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

'Human factors' (non-technical skills such as communication and teamwork) have been strongly implicated in adverse events during labour and delivery. The importance of shared 'situation awareness' between team members is highlighted as a key factor in patient safety. Arising from an ethnographic study of safety culture in the delivery suites of four UK hospitals, the aim of this study is to describe the main mechanisms supporting team situation awareness (TSA) and examine contrasting configurations of supports. Stage I: 177 hours of lightly structured non-participant observation (sensitizing concepts: safety culture, non-technical skills, teamwork and decision making) analysed to identify a core organizing concept, main supporting categories and preliminary conceptual models. Stage II: (approximately 11 months after first observations) 104 hours of observation to test and elaborate stage I analyses. Handover, whiteboard use and a coordinator role emerged as the key processes facilitating work and team coordination. The interplay between these supporting processes and the contextual features of each site promoted or inhibited TSA. Three configurations of supports for TSA were evident. These are described. Context configurations of supporting mechanisms and artefacts influence TSA, with implications for the maintenance of patient safety on delivery suites. A balanced model of supports for TSA is commended. Examining contrasting configurations helps reveal how local mechanisms or organizational, environmental and temporal factors might be manipulated to improve TSA.

Circulating nurses are important members of surgical teams. They need to use nontechnical skills to work safely. This study aims to review the existing observational tools for the assessment of circulating nurses' nontechnical skills. Electronic resources, including Web of Sciences, PubMed, Scopus, ProQuest, CINAHL, Embase, and Google Scholar, were searched, including studies using tools for observational assessment of nontechnical skills in surgery published up to September 2019. The search process relied on the following keywords: circulating/scout/operating room nurse, observational, assessment tools, operating room nontechnical skills, task management, teamwork, communication, situational awareness, leadership, and decision making. The data were pooled from 30 eligible studies using tools for assessment of nontechnical skills in surgeries. Eight tools were found to assess nontechnical skills for the whole surgical team or individuals, including circulating nurses. Although general behaviors for all surgical team members within the tools have been recognized, there is no specific observational tool for the assessment of circulating nurses' nontechnical skills.

Evidence from other professions suggests that training in teamwork and general cognitive abilities, collectively described as non-technical skills, may reduce accidents and errors. The relationship between non-technical teamwork skills and technical errors was studied using a behavioural marker system validated in aviation and adapted for use in surgery. 26 elective laparoscopic cholecystectomies were observed. Simultaneous assessments were made of surgical technical errors, by observation clinical human reliability assessment (OCHRA) task analysis, and non-technical performance, using the surgical NOTECHS behavioural marker system. NOTECHS assesses four categories: (1) leadership and management, (2) teamwork cooperation, (3) problem-solving and decision-making, (4) situation awareness. Each subteam (nurses, surgeons and anaesthetists) was scored separately on each of the four dimensions. Two observers - one surgical trainee and one human factors expert - were used to assess intra-rater reliability. The mean NOTECHS team score was 35.5 (95% C.I. +/- 1.88). The mean subteam scores for surgeons, anaesthetists and nurses were 13.3 (95% C.I. +/- 0.64), 11.4 (95% C.I. +/- 1.05), and 10.8 (95% C.I. +/- 0.87), respectively, with a significant difference between surgeons and anaesthetists (U = 197, p = 0.009), and surgeons and nurses (U = 0.134, p <or= 0.001). Inter-rater reliability was found to be strong (alpha = 0.88). There were between zero and six technical errors per operation, with a mean of 2.62 (95% C.I. +/- 0.55), which were negatively correlated with the surgeons situational awareness scores (rho = -0.718, p < 0.001). Non-technical skills are an important component of surgical skill, particularly in relation to the development and maintenance of a surgeon's situational awareness. Experience from other industries suggests that it may be possible to improve the ability of surgeons to manage their own situation awareness, through training, intraoperative briefings and intraoperative workload management. In the future, it may be possible to use non-technical performance as a surrogate measure for technical performance, either for early identification of surgical difficulties, or as a method of evaluation by which non-surgically trained observers.

Research has shown that lack of non-technical skills (also called, Crew Resource Management – CRM) contributes to most personal and process safety incidents in high-risk industries. Situational awareness in the most influential non-technical skill. Authors developed a disruptive program to generate situational awareness competencies and improve non-technical skills of front-line employees. The program is called: Permanent Attention. It combines best practices adapted from high-risk industries and industrial psychology science to generate statistically significant improvements in situational awareness competencies through a sustainable approach. The paper shows real case applications from two organizations where the Permanent Attention program has generated significant improvement in the participants’ situational awareness competency and non-technical skills (CRM) acquisition and retention. The program is executed with the learner at the centre of the process. The Situation Awareness Global Assessment Technique (SAGAT, Endsley, and Garland, 2000) is used to measure the levels of situational awareness competency before and after the training, to determine the impact achieved through the program. The ‘Repeated measures – ANOVA’ statistic model is used to scientifically demonstrate the significant impact of the process in the three elements of situational awareness: Attention, Comprehension and Anticipation. The training sessions in-between SAGATs contain theoretical information and practical exercises that equip the participant(s) with fundamentals. Exercises for each element of the situational awareness have been designed to obtain optimal skills. To complement the practice of non-technical skills, employees are exposed to simulations of critical operational situations, so they can demonstrate their leadership, communications, teamwork, decision-making skills in group and learn how to manage stress in such situations. The levels of situational awareness competencies are periodically monitored via practical field-based SAGAT exercises after the training, to ensure a sustained improvement in the participants’ competencies. The feedback provided immediately after each SAGAT is key to let the participant focus on the element(s) of situational awareness that require improvement. Once the feedback is received, the participant is requested to self-evaluate her level on each element of situational awareness. This reinforces self-consciousness and encourages a sense of commitment to improve by conviction, not by imposition. This novel methodology gives the organization a clear metric on the return on the investment the program offers and allows very specific interventions to improve individual and group level non-technical skills across the organization. A truly disruptive method. The paper shows how the Permanent Attention instructional design combines Endsley's research from the aviation and nuclear industries, with Knowles’ andragogy (2015) theory to achieve competency acquisition and retention. Novel approaches such as the SAGAT, are used with scenarios that are familiar to the target population. Participants’ levels of situational awareness competency are measured before and after the training to determine whether a statistically significant impact was achieved through the program. Permanent Attention has been implemented in organizations with a wide range of maturity. Case-studies are presented to illustrate the process, results, and limitations in two leading drilling companies, in which 60 to 70% of incidents had situational awareness as a contributing factor, over last five years. The implementation of the program has brought statistically significant improvements in the competency of employees and the pilot in Colombia has shown early signs of accident reduction.

IntroductionEmpirical data on the effectiveness of BRM trainings is still sparse and as far as studies were published, not very encouraging. Both O’Connor (2011) and Rottger, Vetter & Kowalski (201...

Impact of sleep deprivation on anaesthesia residents’ non-technical skills: a pilot simulation-based prospective randomized trial

Teaching surgeons about non-technical skills

Non-technical skills in oral and maxillofacial and head and neck surgery: systematic review

Managing obstetric shoulder dystocia requires swift action using correct maneuvers. However, knowledge of obstetric teams' performance during management of real-life shoulder dystocia is limited, and the impact of non-technical skills has not been adequately evaluated. We aimed to analyze videos of teams managing real-life shoulder dystocia to identify clinical challenges associated with correct management and particular non-technical skills correlated with high technical performance. We included 17 videos depicting teams managing shoulder dystocia in two Danish delivery wards, where deliveries were initially handled by midwives, and consultants were available for complications. Delivery rooms contained two or three cameras activated by Bluetooth upon obstetrician entry. Videos were captured 5 min before and after activation. Two obstetricians assessed the videos; technical performances were scored as low (0-59), average (60-84), or high (85-100). Two other assessors evaluated non-technical skills using the Global Assessment of Team Performance checklist, scoring 6 (poor) to 30 (excellent). We used a spline regression model to explore associations between these two score sets. Inter-rater agreement was assessed using interclass correlation coefficients. Interclass correlation coefficients were 0.71 (95% confidence interval 0.23-0.89) and 0.82 (95% confidence interval 0.52-0.94) for clinical and non-technical performances, respectively. Two teams had low technical performance scores; four teams achieved high scores. Teams adhered well to guidelines, demonstrating limited head traction, McRoberts maneuver, and internal rotation maneuvers. Several clinical skills posed challenges, notably recognizing shoulder impaction, applying suprapubic pressure, and discouraging women from pushing. Two non-technical skills were associated with high technical performance: effective patient communication, with teams calming the mother and guiding her collaboration during internal rotational maneuvers, and situation awareness, where teams promptly mobilized all essential personnel (senior midwife, consultant, pediatric team). Team communication, stress management, and task management skills were not associated with high technical performance. Videos capturing teams managing real-life shoulder dystocia are an effective tool to reveal challenges with certain technical and non-technical skills. Teams with high technical performance are associated with effective patient communication and situational awareness. Future training should include technical skills and non-technical skills, patient communication, and situation awareness.

Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy: Team Perspectives

Background Nontechnical skills are necessary for clinicians' safe performance and prevention of errors in the operating room. Educational intervention is a useful way to improve these skills, which are a vital area for improvement. Circulating nurses are surgical team members whose work depends heavily on using nontechnical skills. This study is aimed at assessing the effect of an educational intervention on the improvement of circulating nurses' nontechnical skills. Methods This semiexperimental study was conducted on 300 circulating nurses divided into the intervention and no intervention groups each containing 150 participants. The nontechnical skills were assessed using the circulating practitioners' list of nontechnical skills. Then, the intervention group received training regarding these skills, and the two groups were evaluated again. After all, the data were entered into the SPSS 24 software and were analyzed using descriptive statistics and Wilcoxon and Mann–Whitney tests. Furthermore, Kendall's tau, independent sample t-test, and one-way ANOVA were used for assessment of relationship between median scores and demographics. Results The results revealed a significant improvement in the scores of all domains of nontechnical skills in the intervention group (p < 0.05). The highest and lowest improvements were observed in teamwork (42%) and situational awareness (16.7%), respectively. After the intervention, the scores of some of the behaviors were still below the average level or were not improved significantly. Conclusions Circulating nurses' nontechnical skills can be improved by educational interventions. However, regarding the low scores or no improvements in the scores of some behaviors, other intervention types such as policymaking and correcting the existing hierarchies in the operating room can be useful to complete the educational interventions.

Non-technical skills are the cognitive and social skills required in any operational task involving decision making and team work, such as aviation or surgical medicine. This study identified the key non-technical skills required in anaesthesia, and developed a behavioural marker system (Anaesthetists' Non-Technical Skills (ANTS)) for their assessment in theatre, in the simulator or from video recordings. It comprises four skill categories (task management, team working, situation awareness and decision making) divided into fifteen elements, each with example behaviours. A first stage evaluation was conducted by asking 50 consultant anaesthetists to rate the behaviour of a target anaesthetist using the prototype ANTS system in eight videos of simulated anaesthetic scenarios. The system appeared to be complete, and the skills were observable, and could be rated with acceptable levels of agreement and accuracy. The second stage evaluation is now testing the usability of the behavioural rating system in the operating theatre environment.