Resident Non Technical Skills And Trauma Bay Outcomes
Posted Date: Jul 20, 2021
- Investigator: Lane Frasier
- Type of Study: Observational/Survey
Surgeons have traditionally attributed patient outcomes to technical skill; however, nontechnical skills, defined as behaviors including communication, leadership, teamwork, and situational awareness, which are separate from the motor actions required to perform a complex task, are increasingly recognized for their critical role in patient care. Surgeons whose peers reported unprofessional behavior experience worse patient outcomes compared to peers without these reports.  Additionally, surgeons’ patterns of thinking and behavior have been linked with patient outcomes in bariatric surgery.  The popularity of leadership courses and programs [3,4] attest to surgeons’ desire to refine their nontechnical skills. Surgery residents must acquire and apply nontechnical skills across multiple clinical settings for maximal effectiveness as surgeons. However, current training paradigms provide few formal mechanisms for nontechnical skill development and assessment and nontechnical skills are often informally taught as part of the “hidden curriculum” of training, resulting in significant institution and individual variation in skill attainment. The acquisition of nontechnical skills during residency, and the impact of resident nontechnical skills on patient outcomes, are not described in the literature and represent a gap in our knowledge. Further, most literature on surgeons’ nontechnical skill focuses on operative settings. The trauma bay is a high-stakes environment where nontechnical skills impact outcomes: effective trauma team leadership and team communication are associated with improved processes of care and shorter time to completion of necessary tasks and procedures.  Surgery residents often act as trauma team leader and must utilize nontechnical skills including collaboration, communication, situation awareness, and decision-making to facilitate timely care and identify and treat patients’ life-threatening injuries. The trauma bay, therefore, represents an ideal environment to evaluate surgery residents’ nontechnical skills. Here, we focus on the surgery chief resident acting as trauma team leader. Technical and nontechnical skill acquisition is influenced by multiple factors including baseline skill, learner motivation, opportunities for practice, and formal and informal feedback mechanisms. Learners undergo skill decay during periods of skill non-use; in this case, nontechnical skills and behaviors most relevant to the trauma bay are expected to decay when residents rotate off the trauma service. Assessment of resident nontechnical skill over the course of an academic year represents a unique opportunity to investigate nontechnical skill acquisition and decay and evaluate the effectiveness of interventions to mitigate nontechnical skill decay.
Resident Physicians In General Surgery Who Are Completing Their Fourth Clinical Year Are Eligible.
Non Technical Skills, Resident Physician, Trauma
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