A. Alken1, M. Weenk1, J. Luursema1, C. Fluit2, H. Van Goor1 1Radboud University Nijmegen Medical Center,Surgery,Nijmegen, GLD, Netherlands 2Radboud University Nijmegen Medical Center,Health Academy,Nijmegen, GLD, Netherlands
Introduction:
Shortcomings in non-technical skills are important contributors to errors in the operating room which emphasizes the importance of training these skills in simulation. Non-technical skills can be trained separately or combined with technical skills. Previous research of a highly demanding emergency surgery integrated skills training showed that surgical educators predominantly coached on technical and hardly on non-technical skills. This study aims to investigate whether priming educators could increase the amount of non-technical skills coaching during such training and whether this is dependent of the trainee level.
Methods:
We conducted a randomized controlled trial. Data were collected during the hands-on part of the Definitive Surgical and Anesthetic Trauma Care course, a highly realistic emergency surgery integrated skills training on anesthetized porcine models. 12 surgical teams participated, each with 1 surgical educator coaching 2 surgical trainees, 1 scrub nurse and an anesthetic team. All educators were Advanced Trauma Life Support certified teachers who finished non-technical skills training. 8 final year residents, 8 junior (0-5 years of experience) and 8 senior surgeons (>5 years of experience) participated as trainees. 6 surgical educators were primed on non-technical skills teaching. 6 others received no priming.
All coaching was recorded, reviewed and scored as technical, non-technical or other. For the primed and non-primed educators the amount of non-technical skills coaching was calculated as a percentage of the total amount of coaching. Per team we collected all non-technical skills coaching utterances, added the same amount of technical skills coaching utterances and sorted out to which trainee level each utterance was directed. We than calculated per trainee level what percentage was non-technical and analyzed how much this deviated from 50%.
Results:
Primed educators did not coach more often on non-technical skills than non-primed educators (4.4%; sd=3.2 vs. 4.4%; sd=4.3; Mann-Whitney U test, P= .71). Within the resident trainee level group 51.2% (+1.2) of the coaching was non-technical. For junior and senior surgeon trainees this was 50.6% (+0.6) and 50% (0) respectively. Differences between trainee levels were not statistically different (Kruskal-Wallis test, P= .37).
Conclusions:
Primed educators did not coach more often on non-technical skills than non-primed educators. We found no differences in the amount of non-technical skills coaching per trainee level. The intervention might have been too weak to cause an effect on coaching. Another explanation is that an emergency surgery integrated skills training on porcine models is too complex and ‘chaotic’ for combined technical and non-technical skills coaching. Our findings are a valuable contribution to the debate on whether non-technical skills training should happen independent from or combined with technical skills training in such simulation.