Centre for Patient Safety and Service Quality, Imperial College London, London, UK.
Emerg Med J. 2013 Jun;30(6):437-43. doi: 10.1136/emermed-2012-201237. Epub 2012 Jun 15.
To evaluate a new tool to assess emergency physicians' non-technical skills.
This was a multicentre observational study using data collected at four emergency departments in England. A proportion of observations used paired observers to obtain data for inter-rater reliability. Data were also collected for test-retest reliability, observability of skills, mean ratings and dispersion of ratings for each skill, as well as a comparison of skill level between hospitals. Qualitative data described the range of non-technical skills exhibited by trainees and identified sources of rater error.
96 assessments of 43 senior trainees were completed. At a scale level, intra-class coefficients were 0.575, 0.532 and 0.419 and using mean scores were 0.824, 0.702 and 0.519. Spearman's ρ for calculating test-retest reliability was 0.70 using mean scores. All skills were observed more than 60% of the time. The skill Maintenance of Standards received the lowest mean rating (4.8 on a nine-point scale) and the highest mean was calculated for Team Building (6.0). Two skills, Supervision & Feedback and Situational Awareness-Gathering Information, had significantly different distributions of ratings across the four hospitals (p<0.04 and 0.007, respectively), and this appeared to be related to the leadership roles of trainees.
This study shows the performance of the assessment tool is acceptable and provides valuable information to structure the assessment and training of non-technical skills, especially in relation to leadership. The framework of skills may be used to identify areas for development in individual trainees, as well as guide other patient safety interventions.
评估一种新的评估急诊医师非技术技能的工具。
这是一项多中心观察性研究，使用在英格兰四个急诊部收集的数据。部分观察采用配对观察者来获得用于评估者间可靠性的数据。还收集了测试-重测可靠性、技能可观察性、每个技能的平均评分和评分分布的数据，以及医院之间技能水平的比较。定性数据描述了学员表现出的非技术技能的范围，并确定了评估者误差的来源。
完成了对 43 名高级学员的 96 次评估。在量表水平上，组内相关系数分别为 0.575、0.532 和 0.419，使用平均分数分别为 0.824、0.702 和 0.519。使用平均分数计算测试-重测可靠性的斯皮尔曼 ρ 为 0.70。所有技能的观察时间均超过 60%。技能标准维护的平均评分最低（9 分制中的 4.8 分），而团队建设的平均评分最高（6.0 分）。两个技能，监督和反馈以及情境意识-收集信息，在四个医院的评分分布有显著差异（分别为 p<0.04 和 0.007），这似乎与学员的领导角色有关。
本研究表明，评估工具的性能是可以接受的，并提供了有价值的信息来构建非技术技能的评估和培训，特别是在领导力方面。技能框架可用于确定个别学员的发展领域，并指导其他患者安全干预措施。
