一种内镜非技术技能（ENTS）行为标记系统的开发与影响
Development and impact of an endoscopic non-technical skills (ENTS) behavioural marker system.
作者信息
Ravindran Srivathsan, Haycock Adam, Woolf Katherine, Thomas-Gibson Siwan
机构信息
Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
出版信息
BMJ Simul Technol Enhanc Learn. 2020 Mar 6;7(1):17-25. doi: 10.1136/bmjstel-2019-000526. eCollection 2021.
BACKGROUND
Non-technical skills (NTS) are crucial to effective team working in endoscopy. Training in NTS has been shown to improve team performance and patient outcomes. As such, NTS training and assessment are now considered essential components of the endoscopy quality assurance process. Across the literature, other specialties have achieved this through development of behavioural marker systems (BMS). BMS provide a framework for assessing, training and measuring the NTS relevant to healthcare individuals and team. This article describes the development and impact of a novel BMS for endoscopy: the endoscopic non-technical skills (ENTS) system.
METHODS
The initial NTS taxonomy for endoscopy was created through a combination of literature review, staff focus groups and semi-structured interviews, incorporating the critical decision method. Framework analysis was conducted with three individual coders and generated a skills list which formed the preliminary taxonomy. Video observation of Bowel Cancer Screening endoscopists was used to identify exemplar behaviours which were mapped to relevant skills in the NTS taxonomy. Behavioural descriptors, derived from video data, were added to form the basis of the ENTS system.
RESULTS
A taxonomy of 33 skills in 14 separate categories were identified through framework analysis. Following video analysis and behaviour mapping, 4 overarching categories and 13 behavioural elements were identified which formed the ENTS framework. The endoscopy (directly observed procedural skills) 4-point rating scale was added to create the final ENTS system. Since its development in 2010, the ENTS system has been validated in the assessment of endoscopy for trainees nationally. ENTS informs a number of training initiatives, including a national strategy to improve NTS for all endoscopists.
CONCLUSIONS
The ENTS system is a clinically relevant tool, validated for use in trainee assessment. The use of ENTS will be important to the future of training and quality assurance in endoscopy.
背景
非技术技能（NTS）对于内镜检查中的有效团队协作至关重要。已证明非技术技能培训可提高团队绩效和患者预后。因此，非技术技能培训和评估现已被视为内镜检查质量保证过程的重要组成部分。在整个文献中，其他专业通过开发行为标记系统（BMS）实现了这一点。行为标记系统为评估、培训和衡量与医疗保健个人及团队相关的非技术技能提供了一个框架。本文描述了一种用于内镜检查的新型行为标记系统——内镜非技术技能（ENTS）系统的开发及其影响。
方法
通过文献综述、员工焦点小组和半结构化访谈相结合的方式，并采用关键决策方法，创建了内镜检查的初始非技术技能分类法。由三名独立编码员进行框架分析，并生成了一个技能列表，该列表构成了初步分类法。通过对肠癌筛查内镜医师的视频观察，识别出可映射到非技术技能分类法中相关技能的典型行为。从视频数据中得出的行为描述符被添加进来，构成了ENTS系统的基础。
结果
通过框架分析确定了14个不同类别的33项技能分类法。经过视频分析和行为映射，确定了4个总体类别和13个行为要素，构成了ENTS框架。添加了内镜检查（直接观察操作技能）4级评定量表，创建了最终的ENTS系统。自2010年开发以来，ENTS系统已在全国范围内用于培训学员的内镜检查评估中得到验证。ENTS为多项培训举措提供了依据，包括一项提高所有内镜医师非技术技能的国家战略。
结论
ENTS系统是一种与临床相关的工具，已验证可用于学员评估。ENTS的使用对于内镜检查培训和质量保证的未来将很重要。
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