Department of Anaesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands.
Emerg Med J. 2017 Nov;34(11):728-733. doi: 10.1136/emermed-2016-205754. Epub 2017 Aug 26.
Non-technical skills, such as task management, leadership, situational awareness, communication and decision-making refer to cognitive, behavioural and social skills that contribute to safe and efficient team performance. The importance of these skills during cardiopulmonary resuscitation (CPR) is increasingly emphasised. Nonetheless, the relationship between non-technical skills and technical performance is poorly understood. We hypothesise that non-technical skills become increasingly important under stressful conditions when individuals are distracted from their tasks, and investigated the relationship between non-technical and technical skills under control conditions and when external stressors are present.
In this simulator-based randomised cross-over study, 30 anaesthesiologists and anaesthesia residents from the VU University Medical Center, Amsterdam, the Netherlands, participated in two different CPR scenarios in random order. In one scenario, external stressors (radio noise and a distractive scripted family member) were added, while the other scenario without stressors served as control condition. Non-technical performance of the team leader and technical performance of the team were measured using the 'Anaesthetists' Non-technical Skill' score and a recently developed technical skills score. Analysis of variance and Pearson correlation coefficients were used for statistical analyses.
Non-technical performance declined when external stressors were present (adjusted mean difference 3.9 points, 95% CI 2.4 to 5.5 points). A significant correlation between non-technical and technical performance scores was observed when external stressors were present (r=0.67, 95% CI 0.40 to 0.83, p<0.001), while no evidence for such a relationship was observed under control conditions (r=0.15, 95% CI -0.22 to 0.49, p=0.42). This was equally true for all individual domains of the non-technical performance score (task management, team working, situation awareness, decision-making).
During CPR with external stressors, the team's technical performance is related to the non-technical skills of the team leader. This may have important implications for training of CPR teams.
非技术技能，如任务管理、领导力、态势感知、沟通和决策，是指有助于团队安全高效运作的认知、行为和社交技能。心肺复苏（CPR）期间，这些技能的重要性日益凸显。尽管如此，非技术技能与技术表现之间的关系仍知之甚少。我们假设，当个体因任务分心而处于压力状态时，非技术技能会变得更加重要，并在控制条件和存在外部应激源的情况下，研究非技术技能与技术技能之间的关系。
在这项基于模拟器的随机交叉研究中，来自荷兰阿姆斯特丹VU 大学医学中心的 30 名麻醉师和麻醉住院医师以随机顺序参与了两个不同的 CPR 场景。在一个场景中，添加了外部应激源（无线电噪音和干扰脚本的家庭成员），而另一个没有应激源的场景作为对照条件。使用“麻醉师非技术技能”评分和最近开发的技术技能评分，测量团队领导的非技术表现和团队的技术表现。采用方差分析和 Pearson 相关系数进行统计学分析。
当存在外部应激源时，非技术表现下降（调整平均差异 3.9 分，95%置信区间 2.4 至 5.5 分）。当存在外部应激源时，非技术表现和技术表现评分之间存在显著相关性（r=0.67，95%置信区间 0.40 至 0.83，p<0.001），而在对照条件下则没有证据表明存在这种关系（r=0.15，95%置信区间 -0.22 至 0.49，p=0.42）。这种关系在非技术表现评分的所有个体领域（任务管理、团队合作、态势感知、决策制定）中都是如此。
在有外部应激源的 CPR 中，团队的技术表现与团队领导的非技术技能相关。这可能对 CPR 团队培训具有重要意义。
