Interventions to Improve Nontechnical Skills in Surgery: A Systematic Review And Meta-Analysis

Area of Science:

• Surgical Education
• Patient Safety
• Human Factors in Medicine

Background:

• Surgical adverse events frequently stem from deficiencies in nontechnical skills.
• Enhancing surgeon nontechnical skills is a priority for training organizations.
• Evidence guiding effective nontechnical skill improvement interventions is limited.

Purpose of the Study:

• To systematically review and synthesize evidence on the effectiveness of interventions aimed at improving surgeon nontechnical skills.
• To evaluate interventions for overall nontechnical skill improvement and specific skill domains.

Main Methods:

• A systematic search of Embase, Med-line, and PsycINFO databases was conducted.
• Included studies were randomized controlled trials (RCTs), non-RCTs, and pre-post cohort studies.
• Data were extracted and pooled using a random-effects model for meta-analysis.

Main Results:

• Sixty-five studies (20 RCTs, 45 non-RCTs) were included.
• Interventions significantly associated with nontechnical skill improvement included practice with debrief/feedback, coaching, checklists/standardized procedures, and didactic/workshop methods.
• Practice with debrief/feedback, coaching, and curriculum interventions showed a trend towards improving individual nontechnical skill domains.

Conclusions:

• This meta-analysis provides evidence supporting the effectiveness of multiple intervention types for improving surgeon nontechnical skills.
• These findings can inform the development of targeted nontechnical skill improvement strategies in surgical training.
• Effective interventions identified can guide future practice in real-world surgical settings.