Department of Anaesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Innovation in Medical Education, University of Ottawa, ON, Canada.
Translational and Molecular Medicine Program, ON.
Br J Anaesth. 2018 Dec;121(6):1218-1226. doi: 10.1016/j.bja.2018.07.028. Epub 2018 Sep 6.
Non-technical skills, such as communication or leadership, are integral to clinical competence in anaesthesia. There is a need for valid and reliable tools to measure anaesthetists' non-technical performance for both initial and continuing professional development. This systematic review aims to summarise the measurement properties of existing assessment tools to determine which tool is most robust.
Embase (via OVID), Medline and Medline in Process (via OVID), and reference lists of included studies and previously published relevant systematic reviews were searched (through August 2017). Quantitative studies investigating the measurement properties of tools used to assess anaesthetists' intraoperative non-technical skills, either in a clinical or simulated environment, were included. Pairs of independent reviewers determined eligibility and extracted data. Risk of bias was assessed using the COSMIN checklist.
The search yielded 978 studies, of which 14 studies describing seven tools met the inclusion criteria. Of these, 12 involved simulated crisis settings only. The measurement properties of the Anaesthetists' Non-Technical Skills (ANTS) tool were most commonly assessed (n=9 studies), with studies of two types of validity (content, concurrent) and two types of reliability (internal consistency, interrater). Most of these studies, however, were at serious risk of bias.
Though there are seven tools for assessing the non-technical skills of anaesthetists, only ANTS has been extensively investigated with regard to its measurement properties. ANTS appears to have acceptable validity and reliability for assessing non-technical skills of anaesthetists in both simulated and clinical settings. Future research should consider additional clinical contexts and types of measurement properties.
沟通或领导力等非技术技能是麻醉临床能力的重要组成部分。需要有有效的、可靠的工具来衡量麻醉师的非技术表现，以进行初始和持续的专业发展。本系统综述旨在总结现有评估工具的测量特性，以确定哪种工具最稳健。
通过 OVID 检索 Embase、Medline 和 Medline in Process，以及纳入研究和先前发表的相关系统综述的参考文献列表（截至 2017 年 8 月）。纳入了调查用于评估麻醉师术中非技术技能的工具（无论是在临床环境还是模拟环境中）的测量特性的定量研究。由两名独立的审查员确定资格并提取数据。使用 COSMIN 清单评估偏倚风险。
搜索结果为 978 项研究，其中 14 项研究描述了符合纳入标准的 7 种工具。其中，12 项研究仅涉及模拟危机环境。评估麻醉师非技术技能的工具（ANTS）的测量特性最常被评估（n=9 项研究），涉及两种类型的有效性（内容、同期）和两种类型的可靠性（内部一致性、评分者间）。然而，这些研究中的大多数都存在严重的偏倚风险。
尽管有七种工具可用于评估麻醉师的非技术技能，但只有 ANTS 已广泛研究其测量特性。ANTS 似乎在模拟和临床环境中评估麻醉师的非技术技能方面具有可接受的有效性和可靠性。未来的研究应考虑其他临床环境和类型的测量特性。
