Development and application of a non-technical skills coaching intervention framework for surgeons: A pilot quality improvement initiative.

Non-technical skills (NTS) challenges experienced by surgeons may degrade performance, ultimately impacting the safety and quality of care delivered to patients. The objectives of this work were to develop a framework for NTS coaching for surgeons and implement a coaching program utilizing the developed NTS coaching framework. Leveraging adult learning and self-determination theories, a specialty-agnostic NTS coaching framework was developed for individual coaching sessions with robotic surgeons.

Nontechnical Skills Assessment in Acute Care Trauma Simulations: A Mixed Methods Approach Using Eye Tracking and Behavioral Marker Systems.

Introduction: The condition of trauma patients and the urgent need for timely resuscitation present unique challenges to trauma teams. These difficulties are exacerbated for military trauma teams in combat environments. Consequently, there is a need for continued improvement of nontechnical skills (NTS) training for trauma teams.

Eye tracking and audio sensors to evaluate surgeon's non-technical skills: An empirical study.

Non-Technical Skills (NTS) of medical teams are currently measured using subjective and resource-intensive ratings given by experts. This study explores if objective NTS assessment approaches with eye-tracking and audio sensors can measure teamwork and communication skills in surgery. Eight surgeons participated in a simulated two-phase surgical scenario developed to assess their NTS.

Utilizing Eye Tracking to Assess Medical Student Non-Technical Performance During Scenario-Based Simulation: Results of a Pilot Study.

Background: Non-technical skills (NTS) are essential for safe surgical patient management. However, assessing NTS involves observer-based ratings, which can introduce bias. Eye tracking (ET) has been proposed as an effective method to capture NTS.

Augmenting mental imagery for robotic surgery using neurofeedback: results of a randomized controlled trial.

Background: Mental imagery (MI) can enhance surgical skills. Research has shown that through brain-computer interface (BCI), it is possible to provide feedback on MI strength. We hypothesized that adding BCI to MI training would enhance robotic skill acquisition compared with controls.

Relationship between stress and resident non-technical skills during interdisciplinary trauma simulations.

Background: Non-technical skills, such as communication and situation awareness, are vital for patient care and effective surgical team performance. Previous research has found that residents' perceived stress is associated with poorer non-technical skills; however, few studies have investigated the relationship between objectively assessed stress and non-technical skills. Accordingly, the purpose of this study was to assess the relationship between objectively assessed stress and non-technical skills.

Detailing experienced nurse decision making during acute patient care simulations.

Introduction: Nurse decision making (DM) is critical for patient safety. Eye-tracking methods can effectively assess nurse DM. The purpose of this pilot study was to use eye-tracking methods to assess nurse DM during a clinical simulation.

Objective Nontechnical Skills Measurement Using Sensor-based Behavior Metrics in Surgical Teams.

Objective: The purpose of this study was to identify objective measures that predict surgeon nontechnical skills (NTS) during surgery.

Background: NTS are cognitive and social skills that impact operative performance and patient outcomes. Current methods for NTS assessment in surgery rely on observation-based tools to rate intraoperative behavior.

Emotional Regulation in Surgery: Fostering Well-Being, Performance, and Leadership.

Emotional regulation is increasingly gaining acceptance as a means to improve well-being, performance, and leadership across high-stakes professions, representing innovation in thinking within the field of surgical education. As one part of a broader cognitive skill set that can be trained and honed, emotional regulation has a strong evidence base in high-stress, high-performance fields. Nevertheless, even as Program Directors and surgical educators have become increasingly aware of this data, with emerging evidence in the surgical education literature supporting efficacy, hurdles to sustainable implementation exist.

Resilience matters: Student perceptions of the impact of COVID-19 on medical education.

Introduction: We assessed students' perception of the impact of the pandemic on their well-being, education, academic achievement, and whether grit and resilience alter students' ability to mitigate the stress associated with disruptions in education. We hypothesized that students would report a negative impact, and those with higher grit and resilience scores would be less impacted.

Methods: A multidisciplinary team of educators created and distributed a survey to medical students.

Current Research Priorities in Healthcare Simulation: Results of a Delphi Survey.

Introduction: In 2011 and 2017, the Society for Simulation in Healthcare Research Committee convened summits to develop a forward-thinking agenda for simulation research. After the second summit, the Society for Simulation in Healthcare Research Committee sought expert opinion on the most important research questions in healthcare simulation. This study used systematic methodology to develop a prioritized research agenda for healthcare simulation.

Measurement of Nontechnical Skills During Robotic-Assisted Surgery Using Sensor-Based Communication and Proximity Metrics.

This cohort study uses sensor-based communication and proximity metrics to assess surgeon nontechnical skills during robotic-assisted surgery.

Does the advanced training in laparoscopic suturing enhance laparoscopic suturing skill beyond fundamentals of laparoscopic surgery?

Background: Laparoscopic suturing is associated with a steep learning curve. Hence, many general surgery graduate residents entering fellowship have reportedly not been able to proficiently suture laparoscopically despite achieving Fundamentals of Laparoscopic Surgery certification. To address this deficiency, the Advanced Training in Laparoscopic Suturing curriculum was developed.

Identifying factors that nurses consider in the decision-making process related to patient care during the COVID-19 pandemic.

Background: Nurse identification of patient deterioration is critical, particularly during the COVID-19 pandemic, as patients can deteriorate quickly. While the literature has shown that nurses rely on intuition to make decisions, there is limited information on what sources of data experienced nurses utilize to inform their intuition. The objectives of this study were to identify sources of data that inform nurse decision-making related to recognition of deteriorating patients, and explore how COVID-19 has impacted nurse decision-making.

A Competency-based Laparoscopic Cholecystectomy Curriculum Significantly Improves General Surgery Residents' Operative Performance and Decreases Skill Variability: Cohort Study.

Objective: To demonstrate the feasibility of implementing a CBE curriculum within a general surgery residency program and to evaluate its effectiveness in improving resident skill.

Summary Of Background Data: Operative skill variability affects residents and practicing surgeons and directly impacts patient outcomes. CBE can decrease this variability by ensuring uniform skill acquisition.

Stress and resident interdisciplinary team performance: Results of a pilot trauma simulation program.

Background: Excessive stress negatively impacts surgical residents' technical performance. The effect of stress on trainee nontechnical skills, however, is less well studied. Given that nontechnical skills are known to impact clinical performance, the purpose of this study was to assess the relationship between residents' perceived stress and nontechnical skills during multidisciplinary trauma simulations.

Mastering Stress: Mental Skills and Emotional Regulation for Surgical Performance and Life.

Mental skills and emotional regulation training are gaining acceptance in surgical education as vital elements of surgeon development. These skills can effectively enhance technical skill development, improve well-being, and promote career longevity. There is evidence emerging in the surgical education literature to support the incorporation of mental skills and emotional regulation training curricula in residency training.

Characterizing robotic surgical expertise: An exploratory study of neural activation during mental imagery of robotic suturing.

Background: Mental imagery (MI) aids skill acquisition, however, it is unclear to what extend MI is used by experienced surgeons. The purpose of this study was to assess differences in MI of participants with varying surgical expertise in robotic surgery.

Methods: Students, residents, and surgeons completed the Mental Imagery Questionnaire to assess MI for robotic suturing.

Surgeon stress negatively affects their non-technical skills in the operating room.

Background: Poor surgeons' non-technical skills (NTS) and excessive stress and workload are known contributors to surgical errors. Our aim was to examine the relationship between surgeons' stress and workload, and their observed NTS intraoperatively.

Methods: Surgeon's NTS were rated in the operating room (OR) by trained observers.

Association of Medical Students' Stress and Coping Skills With Simulation Performance.

Introduction: Medical students are vulnerable to experience stress, as they are routinely confronted with stressors. Acute stress can reduce students' performance on examinations, and chronic stress can contribute to cognitive disorders. Conversely, stress coping skills can reduce trainees' anxiety.

How resilient is your team? Exploring healthcare providers' well-being during the COVID-19 pandemic.

Background: The global COVID-19 pandemic has placed tremendous physical and mental strain on the US healthcare system. Studies examining the effects of outbreaks have demonstrated both an increased prevalence and long-term development of Post-Traumatic Stress Disorder (PTSD) symptoms in healthcare providers. We sought to assess the impact of the COVID-19 pandemic on the psychological well-being of medical providers, medical trainees, and administrators at a large academic center to identify stressors and moderators to guide future mental health and hospital-system interventions.

Optimizing Assessment of Surgical Knot Tying Skill.

Objectives: Knot tying is a fundamental surgical skill. Existing knot tying models assess tying efficiency and errors but do not address respect for tissue. Development of a model that assesses tissue displacement during knot tying may provide a good surrogate for respect for tissue, allow detection of expertise, and offer an improved training platform for skill acquisition.

Optimizing learner engagement during mental skills training: A pilot study of small group vs. individualized training.

Background: Mental skills limit surgical residents' skill decay resulting from stress. However, optimal mental skills delivery is unknown. We sought to compare the impact of implementing our curriculum in small groups and individually.

A video anchored rating scale leads to high inter-rater reliability of inexperienced and expert raters in the absence of rater training.

Background: Our objective was to assess the impact of incorporating videos in a behaviorally anchored performance rating scale on the inter-rater reliability (IRR) of expert, intermediate and novice raters.

Methods: The Intra-corporeal Suturing Assessment Tool (ISAT) was modified to include short video clips demonstrating poor, average, and expert performances. Blinded raters used this tool to assess videos of trainees performing suturing on a porcine model.