Article Text

13 Development and validation of a multi-disciplinary orthopaedic non-technical skills course
  1. Kalpesh Vaghela,
  2. J Lee,
  3. K Akhtar
  1. Royal London Hospital, UK


Introduction Adverse events in surgery often occur due to failures in Non-technical skills rather than a deficiency in technical knowledge. The Non-technical skills for Surgeons (NOTSS) behaviour rating tool incorporates situation awareness, decision making, communication skills, team-working and leadership for safe surgical practice. Non-technical skills, whilst recognised, are not explicitly addressed in Orthopaedic curricula. The aim was to develop a multidisciplinary orthopaedic non-technical skills course using immersive simulation scenarios and then validate it using the NOTSS behaviour-rating tool.

Methods Six simulation scenarios were developed using reported adverse events and were mapped to the eleven-point crisis resource management (CRM) framework. High fidelity ward and clinic rooms were used along with a fully-immersive simulated operating room. A multi-disciplinary faculty of orthopaedic surgeons, anaesthetists and scrub nurses trained in CRM used the NOTSS rating tool to provide feedback to the participants during post-scenario debriefing. The Intra-class Correlation Coefficient(ICC) was calculated to assess inter-rater reliability. Participants also completed an pre/post course questionnaires to assess face validity and acceptability.

Results 18 orthopaedic registrars and 6 allied healthcare professionals attended three, one-day courses. Pre-course questionnaires found that none of participants had prior non-technical skills training. There was high inter-rater reliability amongst the multidisciplinary faculty with an ICC of 0.85 (p < 0.001). 100% of the orthopaedic registrars rated the multi-disciplinary approach to learning non-technical skills as ‘very beneficial’. 85% of Orthopaedic registrars rated the scenarios as being ‘very realistic’. The structured de-briefing post-scenario sessions were rated ‘very useful’ by 92%. The allied healthcare professionals found that the course enhanced team working with the orthopaedic surgeons.

Conclusion This one-day orthopaedic non-technical skills course demonstrates high face validity and is acceptable to orthopaedic surgeons and allied health care professions. The data collected demonstrates that non-technical skills and human factors training would be beneficial to all levels of orthopaedic surgeon.

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