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15 Non-technical skills: developing a behavioural marker system to assess medical student performance within high fidelity simulation
  1. MC MacCrossan,
  2. AH Hamilton,
  3. JK Kerrins,
  4. VT Tallentire
  1. NHS Lothian, UK


Introduction Good non-technical skills (NTS), are pivotal to delivering high quality care, particularly in acute situations. There have been attempts to introduce NTS training to the undergraduate curriculum through “pager” simulations and simulation ward rounds (Dickinson, 2014; Harris, 2013). However, to date, there has been no attempt to define NTS specifically relevant to medical students, or to gauge student understanding of them. This study aimed to develop a NTS behavioural marker system applicable to training and assessing medical students.

Methods Following ethical approval, 16 final year medical students participated in high fidelity simulated scenarios. Subsequently, semi-structured interviews were conducted to assess awareness of NTS and identify key NTS and behaviours that demonstrated such skills. Interviews were transcribed and analysed using the behavioural marker system developed for newly qualified doctors ‘Foundation Non-Technical Skills’ (FoNTS) (Mellanby, 2013) as the initial coding template. The developing taxonomy was informed by a systematic review of literature relating to medical students’ NTS, and reviewed by two subject matter experts.

Results Five categories of NTS were identified -- situational awareness, teamwork, leadership, task management and decision making. Twelve NTS elements were identified within these domains. Exemplar behaviours (markers) indicative of performance were developed for each element to produce a prototype behavioural marker system. During transcript analysis, students recognised teamwork, leadership and task management as key NTS. Situational awareness and decision making were less readily identified.

Conclusions Final year medical students are aware of the NTS required for optimising patient safety in an acute care simulation scenario. The development of a behavioural marker system to assess NTS helps medical educators to be explicit when describing the behaviours that medical students should demonstrate in both simulated and real emergencies. The tool, used alongside clinical teaching in the undergraduate curriculum, is likely to improve understanding, recognition and application of NTS.


  1. Dickinson M, Pimblett M, Hanson J, Davis M. Reflecting reality: pager ?simulations in undergraduate educations. The Clinical Teacher 2014;11(6):421–4.

  2. Harris D. Can patient simulator scenarios be utilized to improve teamwork and communication skills in first year medical students taking Medical Physiology? The FASEB J 2013;27:740.12

  3. Mellanby E, Hume M, Glavin R, Skinner J, Maran N. Foundation non-technical skills- Development of a behavioural marker system for newly qualified doctors in managing acutely unwell patients [Online]. Clinical Skills Managed Clinical Network 2013. Available from: [Accessed: 14th December 2015]

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