Assessing nontechnical skills in otolaryngology emergencies through simulation-based training

Area of Science:

• Medical Education
• Surgical Simulation
• Emergency Medicine

Background:

• Nontechnical skills (NTS) are crucial for effective emergency crisis management.
• Teaching and assessing NTS in rare emergency situations within competency-based curricula presents significant challenges.
• Simulated environments offer a viable platform for NTS training and evaluation.

Purpose of the Study:

• To evaluate the utility of the Non-Technical Skills in Surgery (NOTSS) scale for assessing NTS in simulated otolaryngology and head and neck surgery (OTO-HNS) emergencies.
• To identify common challenges encountered by residents during simulated OTO-HNS emergencies.
• To inform the development of future simulation-based NTS training.

Main Methods:

• A mixed-methods approach was employed, analyzing 15 junior OTO-HNS resident teams across four simulated emergency scenarios.
• Six raters utilized the NOTSS scale to assess resident NTS performance.
• Constructivist-grounded theory was applied to video transcripts to identify learner difficulties.

Main Results:

• Residents achieved the highest scores in situational awareness and the lowest in leadership.
• The NOTSS scale demonstrated good inter-rater reliability (Cronbach's alpha = 0.885), with no significant difference between expert and non-expert raters.
• Qualitative analysis revealed challenges in closed-loop communication and leadership transitions during scenarios.

Conclusions:

• Simulation-based training is an effective method for teaching NTS in crisis resource management.
• The NOTSS scale is a reliable tool for assessing NTS in simulated OTO-HNS emergencies.
• Integrating the NOTSS scale into competency-based curricula for NTS assessment is recommended.