Department of Neurosurgery, Rennes University Hospital, Rennes, France; INSERM MediCIS, Unit U1099 LTSI, Rennes 1 University, Faculty of Medicine, Rennes, France.
INSERM MediCIS, Unit U1099 LTSI, Rennes 1 University, Faculty of Medicine, Rennes, France.
World Neurosurg. 2019 Oct;130:e726-e736. doi: 10.1016/j.wneu.2019.06.204. Epub 2019 Jul 5.
Undesirable events in the neurosurgery operating theater have less often been the result of a technical error than of a dysfunction linked to nontechnical skills (NTSs). The essential aim of our study was to perform a systematic review of the reported data on NTS in neurosurgery. Our secondary objective was to identify the NTSs more specific to neurosurgery to define the training needs of neurosurgery trainees.
The MEDLINE and Cochrane Database of Systematic Reviews were searched according to the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. The search initially identified 2132 reports, of which 21 were eligible for systematic study. Data were extracted from the report regarding study design, sample size, NTSs assessed, and assessment tools, and the key results were collected.
Interpersonal skills (communication, teamwork), cognitive skills (decision making, situational awareness), and personal resource factors (coping with stress or fatigue) were specifically identified. No study had used assessment tools such as NOTECHS (nontechnical skills), NOTSS (nontechnical skills for surgeons), or OTAS (observational teamwork assessment for surgery). They were performed in a real environment in 11 cases, in a simulated environment in 9, and during theoretical teaching in 1 case.
Very few studies have been performed concerning neurosurgical NTSs, despite the increasing the number of studies during the past few years on NTSs in other domains of surgery. Society has been concentrating more and more on the quality and safety of medical care. The development and application of NTS assessment tools is, therefore, essential to provide assistance in the training of future neurosurgeons.
神经外科手术室中的不良事件较少是由于技术错误，而是由于与非技术技能（NTS）相关的功能障碍所致。我们研究的主要目的是对神经外科中报告的 NTS 数据进行系统评价。我们的次要目标是确定更特定于神经外科的 NTS，以确定神经外科受训者的培训需求。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，在 MEDLINE 和 Cochrane 系统评价数据库中进行搜索。最初搜索到 2132 份报告，其中 21 份符合系统研究的条件。从报告中提取有关研究设计、样本量、评估的 NTS 和评估工具的数据，并收集关键结果。
专门确定了人际交往技能（沟通、团队合作）、认知技能（决策、情境意识）和个人资源因素（应对压力或疲劳）。没有研究使用过 NOTECHS（非技术技能）、NOTSS（外科医生的非技术技能）或 OTAS（手术观察性团队评估）等评估工具。其中 11 项在真实环境中进行，9 项在模拟环境中进行，1 项在理论教学中进行。
尽管近年来其他外科领域的 NTS 研究数量不断增加，但针对神经外科 NTS 的研究却很少。社会越来越关注医疗保健的质量和安全性。因此，开发和应用 NTS 评估工具对于为未来神经外科医生的培训提供帮助至关重要。
