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      Teamwork Assessment Tools in Modern Surgical Practice: A Systematic Review

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          Abstract

          Introduction. Deficiencies in teamwork skills have been shown to contribute to the occurrence of adverse events during surgery. Consequently, several teamwork assessment tools have been developed to evaluate trainee nontechnical performance. This paper aims to provide an overview of these instruments and review the validity of each tool. Furthermore, the present paper aims to review the deficiencies surrounding training and propose several recommendations to address these issues. Methods. A systematic literature search was conducted to identify teamwork assessment tools using MEDLINE (1946 to August 2015), EMBASE (1974 to August 2015), and PsycINFO (1806 to August 2015) databases. Results. Eight assessment tools which encompass aspects of teamwork were identified. The Nontechnical Skills for Surgeons (NOTSS) assessment was found to possess the highest level of validity from a variety of sources; reliability and acceptability have also been established for this tool. Conclusions. Deficits in current surgical training pathways have prompted several recommendations to meet the evolving requirements of surgeons. Recommendations from the current paper include integration of teamwork training and assessment into medical school curricula, standardised formal training of assessors to ensure accurate evaluation of nontechnical skill acquisition, and integration of concurrent technical and nontechnical skills training throughout training.

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          Most cited references31

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          Non-technical skills for surgeons in the operating room: a review of the literature.

          This review examines the surgical and psychological literature on surgeons' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons' non-technical skills. A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect. A number of "core" categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons. Further work is required to develop a valid taxonomy of individual surgeons' non-technical skills for training and feedback.
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            Anaesthetists' Non-Technical Skills (ANTS): evaluation of a behavioural marker systemdagger

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              Observational teamwork assessment for surgery: content validation and tool refinement.

              Effective teamwork is crucial for safe surgery. Failures in nontechnical and teamwork skills are frequently implicated in adverse events. The Observational Teamwork Assessment for Surgery (OTAS) tool assesses teamwork of the entire team in the operating room. Empirical testing of OTAS has yet to explore the content validity of the tool. This was a cross-sectional observational study. Data were collected in 30 procedures by 2 trained researchers. Five teamwork behaviors were scored (ie, communication, leadership, cooperation, coordination, and monitoring) and behavior exemplar completion was recorded (phase 1). Expert operating room personnel (5 surgeons, 5 anesthesiologists, and 5 scrub nurses) assessed the content validity of the OTAS exemplar behaviors. Finally, a panel of operating room patient-safety experts refined the exemplars (phase 2). In total, the observability (presence/absence) of 130 exemplars was assessed by 2 blinded observers in 30 general surgical cases. Observer agreement was high (Cohen's κ ≥ 0.41) for 83.85% (109 of 130) of exemplar behaviors; 60.77% (79 of 130) of exemplar behaviors were observed frequently with high observer agreement. The majority of the exemplars were rated by expert operating room practitioners and an expert panel as substantial contributors to teamwork and patient safety. Based on expert consensus, 21 behavior exemplars were removed from OTAS and an additional 23 were modified. The exemplars of OTAS demonstrated very good content validity. Taken together with recent evidence on the construct validity of the tool, these findings demonstrate that OTAS is psychometrically robust for capturing teamwork in the operating room. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Surg Res Pract
                Surg Res Pract
                SRP
                Surgery Research and Practice
                Hindawi Publishing Corporation
                2356-7759
                2356-6124
                2015
                3 September 2015
                : 2015
                : 494827
                Affiliations
                1School of Medical Education, King's College London, London SE1 1UL, UK
                2Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RT, UK
                3MRC Centre for Transplantation, King's College London, London SE1 9RT, UK
                Author notes

                Academic Editor: Eelco de Bree

                Article
                10.1155/2015/494827
                4573989
                c27a6b31-d0fd-462c-98be-43c2ebd497d2
                Copyright © 2015 George Whittaker et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 June 2015
                : 21 August 2015
                : 23 August 2015
                Categories
                Review Article

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