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      Developing a novel framework for non-technical skills learning strategies for undergraduates: A systematic review

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          Abstract

          Objectives

          There is substantial lack of guidance when it comes to the implementation of non-technical skills (NTS) in undergraduate medical education. This review aimed to identify and critically evaluate published literature on learning strategies for NTS in undergraduate medical education and to derive a training framework targeted towards standardizing future training interventions.

          Methods

          A systematic review of the MEDLINE database was performed using a prospective protocol following PRISMA guidelines. Studies evaluating undergraduate medical students exposed to NTS interventions, which measured subjective or objective outcomes in selected attributes, were included.

          Results

          Initial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria. A total of 24 NTS were identified, with communication skills being the most commonly reported skill evaluated (n = 37). A variety of educational tools were used (n = 32), noteworthy being the use of simulated patients. Great heterogeneity was also observed in measured outcomes and methods of assessment. A ‘triad of outcomes’ in NTS training was devised (knowledge, skill performance and attitude towards skills) and used for classification of all reported outcomes. Extracted data were used to design a non-technical skill training framework.

          Conclusions

          The existing literature describes a plethora of NTS interventions in undergraduate medical education, with varied outcomes and assessments. We hereby propose the ‘NTS Training Framework’, in an attempt to coordinate future research and catalyze the identification of an ideal NTS course structure to form tomorrow's physicians.

          Highlights

          • Initial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria.

          • A total of 24 non-technical skills (NTS) were identified, with communication skills being the most commonly reported skill.

          • A ‘triad of outcomes’ in NTS training was devised (knowledge, skill performance and attitude towards skills).

          • We propose a unified framework for NTS training, with the objective of guiding future research.

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          Most cited references130

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          AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both

          The number of published systematic reviews of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions. Systematic reviews are subject to a range of biases and increasingly include non-randomised studies of interventions. It is important that users can distinguish high quality reviews. Many instruments have been designed to evaluate different aspects of reviews, but there are few comprehensive critical appraisal instruments. AMSTAR was developed to evaluate systematic reviews of randomised trials. In this paper, we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic reviews, including those based on non-randomised studies of healthcare interventions.
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            To Err Is Human : Building a Safer Health System

            (2000)
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              The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

              Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement-a reporting guideline published in 1999-there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (www.prisma-statement.org) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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                Author and article information

                Contributors
                Journal
                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                Annals of Medicine and Surgery
                Elsevier
                2049-0801
                09 October 2018
                December 2018
                09 October 2018
                : 36
                : 29-40
                Affiliations
                [a ]Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, Whitechapel, London, E1 2AT, United Kingdom
                [b ]Faculty of Life Sciences and Medicine, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
                [c ]Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
                [d ]Imperial College London, Faculty of Medicine, Department of Surgery and Cancer, South Kensington Campus, London, SW7 2AZ, UK
                [e ]Experimental Research Centre ELPEN, 95 Marathonos Avenue, 19009, Pikermi, Greece
                [f ]Obstetrics and Gynecology, London Deanery, United Kingdom
                Author notes
                []Corresponding author. Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, Whitechapel, London, E1 2AT, United Kingdom. m.nicolaides@ 123456smd16.qmul.ac.uk
                [1]

                Equal contributors, senior authors.

                Article
                S2049-0801(18)30211-5
                10.1016/j.amsu.2018.10.005
                6199815
                30370054
                14d9bec4-587d-4be8-9caf-7caa8f16ff37
                © 2018 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                Categories
                Review Article

                non-technical skills,communication skills,undergraduate medical education,framework,learning

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