D'Amore-McKim School of Business, Northeastern University, Boston, Massachusetts, USA.
Babson College, Wellesley, Massachusetts, USA.
Br J Surg. 2018 Jun;105(7):876-884. doi: 10.1002/bjs.10800. Epub 2018 Apr 6.
Non-technical skills are essential for safe and effective surgery. Several tools to assess surgeons' non-technical skills from the clinician's perspective have been developed. However, a reliable measurement tool using a patient-centred approach does not currently exist. The aim of this study was to translate the existing Non-Technical Skills for Surgeons (NOTSS) tool into a patient-centred evaluation tool.
Data were gathered from four cohorts of patients using an iterative four-stage mixed-methods research design. Exploratory and confirmatory factor analyses were performed to establish the psychometric properties of the tool, focusing on validity, reliability, usability and parsimony.
Some 534 patients were recruited to the study. A total of 24 patient-centred non-technical skill items were developed in stage 1, and reduced to nine items in stage 2 using exploratory factor analysis. In stage 3, confirmatory factor analysis demonstrated that these nine items each loaded on to one of three factors, with excellent internal consistency: decision-making, leadership, and communication and teamwork. In stage 4, validity testing established that the new tool was independent of physician empathy and predictive of surgical quality. Surgical leadership emerged as the most dominant skill that patients could recognize and evaluate.
A novel nine-item assessment tool has been developed. The Patients' Evaluation of Non-Technical Skills (PENTS) tool allows valid and reliable measurement of surgeons' non-technical skills from the patient perspective.
非技术技能对于安全有效的手术至关重要。已经开发了几种从临床医生角度评估外科医生非技术技能的工具。然而，目前尚不存在使用以患者为中心的方法的可靠测量工具。本研究的目的是将现有的外科医生非技术技能（NOTSS）工具翻译成以患者为中心的评估工具。
采用迭代四阶段混合方法研究设计，从四个患者队列中收集数据。进行探索性和验证性因素分析，以确定工具的心理测量特性，重点是有效性、可靠性、可用性和简约性。
共有 534 名患者参与了这项研究。在第 1 阶段开发了 24 项以患者为中心的非技术技能项目，在第 2 阶段使用探索性因素分析将其减少到 9 项。在第 3 阶段，验证性因素分析表明，这 9 项中的每一项都加载到三个因素中的一个上，具有极好的内部一致性：决策、领导以及沟通和团队合作。在第 4 阶段，有效性测试表明，新工具与医生同理心独立，并且可以预测手术质量。手术领导力成为患者能够识别和评估的最主要技能。
开发了一种新的九项评估工具。患者非技术技能评估工具（PENTS）可从患者角度对外科医生的非技术技能进行有效和可靠的测量。
