ABSTRACT
Objective: The aims of this study were to describe the process of integrating 2 established training programs, Nontechnical skills for surgeons, and a traditional essential surgical skills course and to measure the impact of this integrated course on the behaviors of interprofessional surgical teams in Rwandan district hospitals. Background: Surgical errors and resulting adverse events are due to variability in both technical and nontechnical surgical skills. Providing technical and nontechnical skills training to the perioperative team may enhance the learning of both of these skills and promote safe intraoperative patient care. Methods: A quality improvement framework guided the process of integrating essential surgical skills and nontechnical skills into a single training program for surgical teams. The resulting 2-day training program was delivered to 68-person teams from 17 hospitals. Nontechnical skills for surgeons was taught through didactics and in the operating room, where preoperative briefing, intraoperative interactions, and postoperative debriefing were used as essential and nontechnical skills teaching moments. Postcourse surveys, follow-up interviews, focus groups, and direct observation of participants in the operating room were conducted to assess how participants implemented the knowledge and skills from the training into practice. Results: Ninety-seven percent of the participants reported that they were satisfied with the course. Follow-up participant interviews and focus groups reported that the course helped them to improve their preoperative planning, intraoperative communication, decision-making, and postoperative debriefing. Conclusions: It is possible to implement an integrated essential surgical skills and nontechnical skills training course. Integrating nontechnical skills into essential surgical skills courses may enhance learning of these skills.
ABSTRACT
OBJECTIVE: Nontechnical skills, such as situation awareness, decision making, leadership, communication, and teamwork play a crucial role on the quality of care and patient safety in the operating room (OR). In our previous work, we developed an interdisciplinary training program, based on the NOTSS (Non-Technical Skills for Surgeons) taxonomy. The aim of this study was to understand the challenges faced by Rwandan surgical providers, who had undergone NOTSS training, to apply these nontechnical skills during subsequent operative surgery. SETTING DESIGN: A sequential exploratory mixed method study design was used to assess how participants who took the NOTSS in Rwanda applied nontechnical skills in surgical care delivery. The qualitative phase of this study deployed a constructivist grounded theory approach. Findings from the qualitative phase were used to build a quantitative survey tool that explored themes that emerged from the first phase. PARTICIPANTS: Participants were nurses and resident from the departments of Surgery, Anesthesia, Obstetric, and Gynecology, from the University of Rwanda who attended the NOTSS course in March 2018. RESULTS: A total of 25 participants and 49 participants were respectively enrolled in the qualitative phase and quantitative phase. Participants noted that nontechnical skills implementation in clinical practice was facilitated by working with other personnel also trained in NOTSS, anticipation, and preparation ahead of the time; while lack of interdisciplinary communication, hierarchy, work overload, and an inconsistently changing environment compromised nontechnical skills implementation. Nontechnical skills were useful both inside and outside the operating. Participants reported that nontechnical skills implementation resulted in improved team dynamics, safer patient care, and empowerment. CONCLUSION: Surgical care providers who took the NOTSS course subsequently implemented nontechnical skills both inside and outside of the OR. Human and system-based factors affected the implementation of nontechnical skills in the clinical setting.
