Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
J Surg Educ. 2022 Sep-Oct;79(5):1237-1245. doi: 10.1016/j.jsurg.2022.04.010. Epub 2022 May 27.
The aims of this study were (1) to evaluate the feasibility of using the Non-Technical Skills for Surgeons (NOTSS) rating tool in assessing surgeons' non-technical skills behaviors in live operations, and (2) to describe the effect of NOTSS on intraoperative performance.
This study was conducted in an academic hospital in North America. Two observers independently conducted direct non-participant observations using the NOTSS rating tool to assess non-technical skills, and to document examples of effective or ineffective non-technical skills behaviors. Observers took field notes to document non-technical skill gaps that were not captured by the NOTSS rating tool, and situations or scenarios that presented challenges for accurate assessment. Interclass correlation estimates and 95% confidence intervals were calculated to assess the validity of the NOTSS rating tool. Deductive thematic qualitative data analysis was used for field notes and NOTSS behavior descriptions.
Participants were general surgeons performing either minimally invasive (robotic assisted or laparoscopic surgery), or open procedures.
We observed 18 surgeries, involving 6 surgeons, 11 residents and one fellow resulting in 37 hours of direct observations. The mean NOTSS score was 3.8 (SD 0.41) for situation awareness, 3.75 (SD 0.47) for decision-making, 3.71 (SD 0.39) for communication and teamwork, and 3.76 (SD 0.38) for leadership. The inter-rater reliability ranged between 0.65 and 0.80 for each NOTSS categories. The observers documented examples of effective non-technical skills behaviors and examples of behaviors that need improvement. Furthermore, we described the effect of each observed behavior on intraoperative performance. One challenge to NOTSS use in live surgery was that observers had to infer situation awareness, decision-making, and coping with pressure as these were not easily observed without attending surgeons articulating their underlying thought process.
The use of the NOTSS tool in live surgery is a valid and practical tool to document observed behaviors and their effect on intraoperative performance in order to provide constructive feedback to surgeons. One notable limitation is that without specific articulation by the surgeon of their underlying thought process the observer must infer specific elements. By documenting specific real-world events with high inter-rater reliability and adequate surgeon score variation the process can be used to provide useful feedback for improvement.
本研究的目的是：(1)评估在现场手术中使用外科非技术技能（NOTSS）评分工具评估外科医生非技术技能行为的可行性，以及 (2)描述 NOTSS 对手术操作性能的影响。
本研究在北美的一家学术医院进行。两名观察员使用 NOTSS 评分工具独立进行直接非参与式观察，以评估非技术技能，并记录有效或无效非技术技能行为的示例。观察员记录实地笔记，以记录 NOTSS 评分工具未捕捉到的非技术技能差距，以及对准确评估构成挑战的情况或场景。计算组内相关估计值和 95%置信区间以评估 NOTSS 评分工具的有效性。采用演绎主题定性数据分析方法对实地笔记和 NOTSS 行为描述进行分析。
参与者为实施微创（机器人辅助或腹腔镜手术）或开放手术的普通外科医生。
我们观察了 18 例手术，涉及 6 名外科医生、11 名住院医师和 1 名研究员，共进行了 37 小时的直接观察。情境意识的 NOTSS 平均得分为 3.8（SD 0.41），决策的 NOTSS 平均得分为 3.75（SD 0.47），沟通和团队合作的 NOTSS 平均得分为 3.71（SD 0.39），领导的 NOTSS 平均得分为 3.76（SD 0.38）。每个 NOTSS 类别的组内信度在 0.65 到 0.80 之间。观察员记录了有效非技术技能行为的示例和需要改进的行为示例。此外，我们描述了每个观察到的行为对手术操作性能的影响。NOTSS 在现场手术中使用的一个挑战是，观察者必须推断情境意识、决策制定和应对压力，因为如果外科医生不阐明其潜在思维过程，这些技能就不容易观察到。
在现场手术中使用 NOTSS 工具是一种有效的实用工具，可记录观察到的行为及其对手术操作性能的影响，以便为外科医生提供建设性反馈。一个值得注意的局限性是，如果没有外科医生对其潜在思维过程的具体说明，观察者必须推断出具体要素。通过记录具有高组内可靠性和足够外科医生评分变化的具体现实世界事件，可以使用该过程为改进提供有用的反馈。
