Objective Measures of Surgeon Nontechnical Skills in Surgery: A Scoping Review

2021 ◽  
pp. 001872082199531
Author(s):  
Jackie S. Cha ◽  
Denny Yu
Keyword(s):  
Situation Awareness ◽  
Cognitive Skills ◽  
Behavioral Science ◽  
Assessment Tools ◽  
Objective Measures ◽  
Communication Model ◽  
Eligibility Criteria ◽  
Surgical Performance ◽  
Nontechnical Skills ◽  
Objective Metrics

Objective The purpose of this study was to identify, synthesize, and discuss objective behavioral or physiological metrics of surgeons’ nontechnical skills (NTS) in the literature. Background NTS, or interpersonal or cognitive skills, have been identified to contribute to safe and efficient surgical performance; however, current assessments are subjective, checklist-based tools. Intraoperative skill evaluation, such as technical skills, has been previously utilized as an objective measure to address such limitations. Methods Five databases in engineering, behavioral science, and medicine were searched following PRISMA reporting guidelines. Eligibility criteria included studies with NTS objective measurements, surgeons, and took place within simulated or live operations. Results Twenty-three articles were included in this review. Objective metrics included communication metrics and measures from physiological responses such as changes in brain activation and motion of the eye. Frequencies of content-coded communication in surgery were utilized in 16 studies and were associated with not only the communication construct but also cognitive constructs of situation awareness and decision making. This indicates the underlying importance of communication in evaluating the NTS constructs. To synthesize the scoped literature, a framework based on the one-way communication model was used to map the objective measures to NTS constructs. Conclusion Objective NTS measurement of surgeons is still preliminary, and future work on leveraging objective metrics in parallel with current assessment tools is needed. Application Findings from this work identify objective NTS metrics for measurement applications in a surgical environment.

Debriefing Surgeons on Non-Technical Skills in the Operating Room - Results from a Pilot Study

2007 ◽  
Vol 51 (11) ◽  
pp. 663-667
Author(s):  
S. Yule ◽  
R. Flin ◽  
N. Maran ◽  
D. Rowley ◽  
G. Youngson ◽  
...  
Keyword(s):  
Operating Room ◽  
Cognitive Skills ◽  
Technical Skills ◽  
Assessment Tools ◽  
Valuable Adjunct ◽  
Surgical Trainees ◽  
Operative Surgery ◽  
Enhance Patient Safety ◽  
Behaviour Rating ◽  
Current Assessment

Briefing and debriefing are common practices for safety in high risk industries but are not systematically done in surgery. Regular debriefing of performance after operative surgery can greatly assist surgical trainees' development and help optimize learning from the limited time they spend in the Operating Room (OR). We developed and tested the NOTSS (Non-Technical Skills for Surgeons) behaviour rating system with subject matter experts. It allows surgeons to observe trainees' behaviour in the OR and provide them with structured feedback for improvement. This paper describes process of debriefing and the results of a pilot usability trial. The majority of participants reported that the NOTSS system was useful for debriefing trainees, provided a common language to discuss non-technical skills, and was a valuable adjunct to current assessment tools. Some surgeons found interpersonal skills more difficult to rate than cognitive skills. 73% felt that routine use of the system would enhance patient safety.

‘The face of the programme’: How local clinicians shape decisions about eligibility for a national caregiver support programme in the USA

2020 ◽  
pp. 135581962098337
Author(s):  
Nina R Sperber ◽  
Rebecca Bruening ◽  
Joshua Dadolf ◽  
Katherine Miller ◽  
Jennifer Henius ◽  
...  
Keyword(s):  
Social Services ◽  
Interdisciplinary Teams ◽  
Assessment Tools ◽  
Assessment Process ◽  
Therapeutic Relationships ◽  
Veterans Health ◽  
Health Administration ◽  
Eligibility Criteria ◽  
Caregiver Support ◽  
Potential Harm

Objective To examine the causes of variation for determining clinical eligibility for a national caregiver programme in the US Veterans Health Administration (VHA) and so help inform standardization of clinical eligibility assessment for support and establish conditions for more consistent caregiver experiences across the country. Methods We used mixed methods, including a national survey of caregiver support coordinators (CSCs) across VHA medical centres, semi-structured interviews with a purposive sample of 53 CSCs and interdisciplinary team members, and observations of four VHA medical centre sites. Results A majority (70%) of CSCs across VHA medical centres reported that they used interdisciplinary teams to conduct assessments. Interdisciplinary teams were seen to help mitigate potential harm to therapeutic relationships from eligibility decisions. Survey respondents reported using a range of assessment tools provided by the national VHA Caregiver Support Program office, but participants expressed concerns that the tools did not necessarily effectively assess clinical need. Some local sites had developed innovative person-centered approaches, in which the assessment process provided an opportunity to assess veterans’ holistic clinical needs, in contrast to a programme-centered approach, which focused on assessing whether veterans/their caregivers meet eligibility criteria. Conclusion Discretion by those involved in making decisions on programme eligiblity is important for implementing a national social services programme based on clinical need. Interdisciplinary teams can help mitigate potential harm to therapeutic relationships. Discretion allows for innovation. This work has implications for setting policy in other programme contexts in which applying eligibility criteria requires clinical judgment.

DEFINING ELIGIBILITY CRITERIA FOR FUNDING POLICIES AROUND IN VITRO FERTILIZATION

2015 ◽  
Vol 31 (6) ◽  
pp. 426-433 ◽  
Author(s):  
Devidas Menon ◽  
Alexa A. Nardelli ◽  
Tarek Motan ◽  
Kristin Klein ◽  
Tania Stafinski
Keyword(s):  
Maternal Age ◽  
Smoking Status ◽  
Cochrane Collaboration ◽  
Assessment Tools ◽  
Paternal Age ◽  
Eligibility Criteria ◽  
Vitro Fertilization ◽  
Funding Policies ◽  
The Impact

Objectives: This review aims to assess the state of the science around the potential impact of certain patient characteristics on the safety and effectiveness of in vitro fertilization (IVF).Methods: Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of reviews and recent primary studies examining the impact of paternal age and maternal age, smoking, and body mass index (BMI) on the safety and effectiveness of IVF was performed. Papers, published between January 2007 and June 2014, were independently reviewed and critically appraised by two researchers using published quality assessment tools for reviews and primary studies. Due to heterogeneity across papers (different study designs and patient selection criteria), a qualitative analysis of extracted information was performed.Results: Seventeen papers (ten systematic reviews and seven primary studies) were included. They comprised evidence from retrospective observational studies in which maternal age, BMI, and smoking status were explored as part of secondary analyses of larger studies. The majority of papers found that the likelihood of achieving a pregnancy was lower among women who were >40 years, had a BMI ≥ 25 and smoked. Advanced maternal age and BMI were also associated with higher rates of preterm birth and low birth weight.Conclusions: Based on available evidence, it may be appropriate to consider “maternal age” and “morbid obesity” in public funding policies that aim to maximize the effectiveness of IVF. However, given inconsistencies in the effect of smoking across different pregnancy-related outcomes, support for incorporating it into funding conditions appears weak.

scholarly journals Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021967 ◽  
Author(s):  
Michelle Gates ◽  
Aireen Wingert ◽  
Robin Featherstone ◽  
Charles Samuels ◽  
Christopher Simon ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Work Performance ◽  
Intraoperative Complications ◽  
Well Being ◽  
Current Evidence ◽  
Independent Practice ◽  
Eligibility Criteria ◽  
Surgical Performance ◽  
Insufficient Sleep ◽  
Physician Health

ObjectivesFor physicians in independent practice, we synthesised evidence on the (1) impacts of insufficient sleep and fatigue on health and performance, and patient safety and (2) effectiveness of interventions targeting insufficient sleep and fatigue.DesignWe systematically reviewed online literature. After piloting, one reviewer selected studies by title and abstract; full texts were then reviewed in duplicate. One reviewer extracted data; another verified a random 10% sample. Two reviewers assessed risk of bias. We pooled findings via meta-analysis when appropriate or narratively.Data sourcesWe searched Medline, Embase, PsycINFO, CINAHL and PubMed for published studies in April 2016; Medline was updated in November 2017. We searched Embase for conference proceedings, and hand-searched meeting abstracts, association and foundation websites.Eligibility criteria for selecting studiesEnglish or French language primary research studies published from 2000 to 2017 examining the effect of fatigue-related or sleep-related exposures or interventions on any outcome among physicians in independent practice and their patients.ResultsOf 16 154 records identified, we included 47 quantitative studies of variable quality. 28 studies showed associations between fatigue or insufficient sleep and physician health and well-being outcomes. 21 studies showed no association with surgical performance, and mixed findings for psychomotor performance, work performance and medical errors. We pooled data from six cohort studies for patient outcomes. For sleep deprived versus non-sleep deprived surgeons, we found no difference in patient mortality (n=60 436, relative risk (RR) 0.98, 95% CI 0.84 to 1.15, I2=0% (p=0.87)) nor postoperative complications (n=60 201, RR 0.99, 95% CI 0.95 to 1.03, I2=0% (p=0.45)). The findings for intraoperative complications and length of stay were considerably heterogeneous.ConclusionsFatigue and insufficient sleep may be associated with negative physician health outcomes. Current evidence is inadequate to inform practice recommendations.

Psychological Aspects of Cancer Screening

2019 ◽  
Author(s):  
Christian von Wagner ◽  
Wouter Verstraete ◽  
Sandro Stoffel
Keyword(s):  
Cancer Screening ◽  
Behavioral Science ◽  
Informed Choice ◽  
Universal Coverage ◽  
Target Population ◽  
Sociodemographic Factors ◽  
Opportunity Costs ◽  
Eligibility Criteria ◽  
Screening Programs ◽  
Patient Reported

Cancer screening aims to detect cancer before the appearance of symptoms. Applying a proactive and systematic approach, cancer screening programs invite every person in the target population automatically. Many countries have established guidelines that define criteria and principles on whether to implement screening programs for specific conditions. Despite the universal coverage of these programs, inequalities have been observed in their uptake based on various sociodemographic factors: gender, age, ethnicity, socioeconomic status (SES), educational level, and marital status. Behavioral science provides key performance indicators of these programs. Psychological factors such as perceived benefits (e.g., ability of the program to diagnose early or even prevent cancer) and barriers (e.g., opportunity costs relating to test attendance or completion), as well as people’s cancer and screening-related beliefs and perceptions of their own susceptibility to cancer, play a crucial role in cancer screening uptake. Furthermore, there is increasing awareness among professional bodies for the need to balance the public health benefits against individual costs, including financial and opportunity costs associated with participation and potential longer-term harms, such as receiving a cancer diagnosis that would never have caused any symptoms or problems). These recent developments have led to stronger emphasis on monitoring patient-reported experiences and ensuring that participation is based on informed choice. In addition, some of these issues have also been addressed by more fundamental changes to the screening paradigm such as more personalized approaches (using additional genetic and epigenetic information) to establishing eligibility criteria. The acceptability of using this information and its implication to offer more or less intensive screening and developing effective ways to understand the ability of the program to communicate this information are key challenges for the clinical, research and policy making community.

scholarly journals Development of a Care Bundle for Stroke Survivors with Psychological Symptoms: Evidence Summary and Delphi Study

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Yiting Chen ◽  
Zheng Li ◽  
Jian Peng ◽  
Lanjun Shen ◽  
Juan Shi
Keyword(s):  
Delphi Study ◽  
Psychological Symptoms ◽  
Assessment Tools ◽  
Care Bundle ◽  
Stroke Survivors ◽  
Depression And Anxiety ◽  
Stroke Patients ◽  
Eligibility Criteria ◽  
Effective Response ◽  
Evidence Summary

Background. Psychological symptoms such as depression and anxiety are quite common among stroke survivors and have great negative impacts on patients. Objective. To develop a care bundle through reviewing and integrating care strategies for psychological symptoms after stroke and then improve the bundle by Delphi study. Methods. A structured search of the literature was performed to identify studies evaluating interventions for stroke patients with psychological symptoms such as depression and anxiety. Two trained researchers screened papers through the titles, abstracts, and full-texts independently. All studies complying with the eligibility criteria were appraised using quality assessment tools. Related interventions with evaluated evidence levels formed the preliminary bundle. Afterward, the Delphi study was carried out to improve the bundle, and the experts were contacted by e-mail. Ten clinical experts specialized in stroke and psychological rehabilitation were recruited. The reliability of experts was represented by the effective response rate and authority coefficient (Cr). The consensus was deemed to be reached when the mean score for item importance is all equal or above 3.50 and the coefficient of variation (CV) is all equal or below 0.20. The Kendall coefficient W test was adopted to evaluate the consensus on agreement among the experts as well. Data analysis was performed using SPSS V.22.0. Results. Through a systematic evidence summary and two-round Delphi study, the items that were given high scores and got consensus by experts were chosen for the bundle. The iDAME bundle consisted of five interventions eventually: maintaining Interaction, tailored Diet, Acupressure, mindfulness Meditation, and physical Exercise. Conclusion. The development of an evidence-based and consensus-based iDAME bundle which integrated western and traditional Chinese medicine intervention was described. Evidence summary made the bundle become scientific, while the Delphi study made it more maneuverable. Based on these results, the bundle would be potentially implemented in stroke patients for their psychological symptoms.

scholarly journals Physiological Measurements of Situation Awareness: A Systematic Review

2020 ◽  
pp. 001872082096907
Author(s):  
Ting Zhang ◽  
Jing Yang ◽  
Nade Liang ◽  
Brandon J. Pitts ◽  
Kwaku O. Prakah-Asante ◽  
...  
Keyword(s):  
Situation Awareness ◽  
Assessment Method ◽  
Measurement Information ◽  
Eligibility Criteria ◽  
Physiological Measurement ◽  
Assessment Technique ◽  
Wide Range ◽  
Physiological Sensing ◽  
Future Work ◽  
The Relationship

Objective The goal of this review is to investigate the relationship between indirect physiological measurements and direct measures of situation awareness (SA). Background Assessments of SA are often performed using techniques designed specifically to directly measure SA, such as SA global assessment technique (SAGAT), situation present assessment method (SPAM), and/or SA rating technique (SART). However, research suggests that physiological sensing methods may also be capable of inferring SA. Method Seven databases were searched. Eligibility criteria included human–subject experiments that used at least one direct SA assessment technique as well as at least one physiological measurement. Information extracted from each article were the physiological metric(s), direct SA measurement(s), correlation between these two metrics, and experimental task(s). Results Twenty-five articles were included in this review. Eye tracking techniques were the most commonly used physiological measures, and correlations between conscious aspects of eye movement measures and direct SA scores were observed. Evidence for cardiovascular predictors of SA was mixed. Only three electroencephalography (EEG) studies were identified, and their results suggest that EEG was sensitive to changes in SA. Overall, medium correlations were observed among the studies that reported a correlation coefficient between physiological and direct SA measures. Conclusion Reviewed studies observed relationships between a wide range of physiological measurements and direct assessments of SA. However, further investigations are needed to methodically collect more evidence. Application This review provides researchers and practitioners a summary of observed methods to indirectly assess SA with sensors and highlights research gaps to be addressed in future work.

scholarly journals Teamwork Assessment Tools in Modern Surgical Practice: A Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
George Whittaker ◽  
Hamid Abboudi ◽  
Muhammed Shamim Khan ◽  
Prokar Dasgupta ◽  
Kamran Ahmed
Keyword(s):  
Skill Acquisition ◽  
Literature Search ◽  
Skills Training ◽  
Assessment Tools ◽  
Formal Training ◽  
Systematic Literature Search ◽  
Accurate Evaluation ◽  
Surgical Practice ◽  
Nontechnical Skills ◽  
School Curricula

Introduction. Deficiencies in teamwork skills have been shown to contribute to the occurrence of adverse events during surgery. Consequently, several teamwork assessment tools have been developed to evaluate trainee nontechnical performance. This paper aims to provide an overview of these instruments and review the validity of each tool. Furthermore, the present paper aims to review the deficiencies surrounding training and propose several recommendations to address these issues.Methods. A systematic literature search was conducted to identify teamwork assessment tools using MEDLINE (1946 to August 2015), EMBASE (1974 to August 2015), and PsycINFO (1806 to August 2015) databases.Results. Eight assessment tools which encompass aspects of teamwork were identified. The Nontechnical Skills for Surgeons (NOTSS) assessment was found to possess the highest level of validity from a variety of sources; reliability and acceptability have also been established for this tool.Conclusions. Deficits in current surgical training pathways have prompted several recommendations to meet the evolving requirements of surgeons. Recommendations from the current paper include integration of teamwork training and assessment into medical school curricula, standardised formal training of assessors to ensure accurate evaluation of nontechnical skill acquisition, and integration of concurrent technical and nontechnical skills training throughout training.

scholarly journals Tapping into Bloom Taxonomy’s Higher-Order Cognitive Processes: The Case for Multiple Choice Questions as a Valid Assessment Tool in the ESP Classroom

2021 ◽  
pp. 160-171
Author(s):  
Iryna Lenchuk ◽  
Amer Ahmed
Keyword(s):  
Cognitive Processes ◽  
Cognitive Skills ◽  
Assessment Tool ◽  
Multiple Choice ◽  
Higher Order Thinking ◽  
Thinking Skills ◽  
Higher Order ◽  
Assessment Tools ◽  
Multiple Choice Questions ◽  
Higher Order Thinking Skills

This article describes the results of Action Research conducted in an ESP classroom of Dhofar University located in Oman. Following the call of Oman Vision 2040 to emphasize educational practices that promote the development of higher-order cognitive processes, this study raises the following question: Can an online multiple choice question (MCQ) quiz tap into the higher-order cognitive skills of apply, analyze and evaluate? This question was also critical at the time of the COVID-19 pandemic when Omani universities switched to the online learning mode. The researchers administered an online MCQ quiz to 35 undergraduate students enrolled in an ESP course for Engineering and Sciences. The results showed that MCQ quizzes could be developed to tap into higher-order thinking skills when the stem of the MSQ is developed as a task or a scenario. The study also revealed that students performed better on MCQs that tap into low-level cognitive skills. This result can be attributed to the prevalent practice in Oman to develop assessment tools that tap only into a level of Bloom’s taxonomy, which involves the cognitive process of retrieving memorized information. The significance of the study lies in its pedagogical applications. The study calls for the use of teaching and assessment practices that target the development of higher-order thinking skills, which is aligned with the country’s strategic direction reflected in Oman vision 2040.

scholarly journals Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review

10.2196/13179 ◽  
2020 ◽  
Vol 8 (8) ◽  
pp. e13179
Author(s):  
Ronelle Jansen ◽  
Marianne Reid
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Communication Technology ◽  
Technology Use ◽  
Communication Technologies ◽  
Assessment Tools ◽  
Positive Behavior ◽  
Health Issues ◽  
Eligibility Criteria ◽  
Mental Health Issues

Background Caregivers of adolescents with mental health issues experience challenges that may result in the caregivers having a variety of unmet needs. There is a growing need to support these caregivers. Effective support to strengthen positive caregiving behavior in caregivers may address their challenges. Communication technologies offer novel opportunities to assist these caregivers and may contribute to strengthening caregiver behavior. However, little is known about the use of communication technologies among caregivers of adolescents with mental health issues. Objective The study aimed to answer the question: “What is the best evidence available to strengthen positive behavior of caregivers of adolescents with mental health issues using communication technology.” Methods A systematic review of articles published between January 2007 and August 2018 was conducted. Searches included articles of multiple study designs from EBSCO Host and Scopus platforms with prespecified eligibility criteria. Methodological quality was evaluated using the applicable Critical Appraisal Skills Programme and Joanna Briggs Institute assessment tools. Results The search yielded 1746 articles. Altogether, 5 articles met the eligibility criteria and were included in the review for data synthesis. Data analysis and synthesis identified three thematic conclusions reflecting the types of communication technologies used, caregivers as the target population, and strengthening of positive behavior through determinants of the Integrated Model of Behavior Prediction. Conclusions The review reported the usefulness of communication technology by caregivers. Caregivers also demonstrated improvement in self-efficacy, knowledge, parent-child communication, and parental skills reflecting positive behavior. Although the use of communication technology is expanding as a supportive intervention to address caregivers’ needs, the evidence for usefulness among caregivers of adolescents with mental health issues is still scarce. More research and information related to preferred methods of communication delivery among caregivers of adolescents is still needed.

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