Exploring medical students’ understanding of non-technical skills: a thematic analysis Exploring medical students’ understanding of NTS
Main Article Content
Non-technical skills (NTS) are a developing area of clinical education, partly due to the recognition that poor NTS can contribute to adverse patient events. Simulation is an appropriate teaching environment to consider these skills. Post-scenario discussions often focus on specific NTS, but these may not necessarily be what the participants think of when considering NTS. The aim of this study was therefore to analyse what one group of healthcare professionals, medical students, focused on when observing the NTS of their colleagues in simulated clinical scenarios.
Medical students from two English universities were asked to observe simulated acute medicine scenarios. They were instructed to document their observations on written worksheets focusing on specific NTS comprising communication, teamwork, task management, decision making, situational awareness and, for the last scenario, a general worksheet asking the students to consider all the NTS discussed so far. These worksheets were then transcribed and analysed using thematic analysis to elicit themes that best outlined the students’ perceptions.
Five themes were discovered from analysis of the five NTS from all six worksheets: team dynamics, team communication, awareness of self and events, coping under pressure and misinterpretation of NTS. These themes showed a difference between what the students concentrated on compared to what they were asked to consider. Analysis of these themes gave us an initial understanding of the prior knowledge and assumptions medical students bring with them to discussions on NTS.
Understanding prior assumptions and interpretations of NTS can better help us understand how to teach the skills effectively and build upon what our students consider important, to help construct new knowledge and skills. As analyses of adverse events in clinical practice often point to errors of NTS as causative factors, improving these skills is an essential aspect of clinical education.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Bada, S.O. and Olusegun, S., 2015. Constructivism learning theory: A paradigm for teaching and learning. Journal of Research & Method in Education, 5(6), pp.66-70. https://vulms.vu.edu.pk/Courses/EDU201/Downloads/EDU%20201%20(Assignment%202).pdf
Braun, V. and Clarke, V., 2006. Using thematic analysis in psychology. Qualitative research in psychology, 3(2), pp.77-101. https://jnoll.nfshost.com/7COM1085-spring-21/readings/Braun_2006_Using.pdf
Castanelli, D.J., 2009. The rise of simulation in technical skills teaching and the implications for training novices in anaesthesia. Anaesthesia and intensive care, 37(6), pp.903-910. https://journals.sagepub.com/doi/pdf/10.1177/0310057X0903700605
Dennick, R., 2016. Constructivism: reflections on twenty five years teaching the constructivist approach in medical education. International journal of medical education, 7, p.200. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939219/
Department of health. 2008. High quality care for all: NHS next stage review final report. London UK https://www.gov.uk/government/publications/high-quality-care-for-all-nhs-next-stage-review-final-report
Department of health. 2011. A framework for technology enhanced learning. London, UK https://www.gov.uk/government/publications/a-framework-for-technology-enhanced-learning
Flin, R., O’connor, P. and Crichton, M., 2017. Safety at the sharp end: a guide to non-technical skills. CRC Press.
Flin, R., Patey, R., Glavin, R. and Maran, N., 2010. Anaesthetists' non-technical skills. British journal of anaesthesia, 105(1), pp.38-44. https://www.sciencedirect.com/science/article/pii/S000709121733564X
Gawande, A.A., Zinner, M.J., Studdert, D.M. and Brennan, T.A., 2003. Analysis of errors reported by surgeons at three teaching hospitals. Surgery, 133(6), pp.614-621.
Gordon, M., Darbyshire, D. and Baker, P., 2012. Non‐technical skills training to enhance patient safety: a systematic review. Medical education, 46(11), pp.1042-1054.
Härgestam, M., Lindkvist, M., Brulin, C., Jacobsson, M. and Hultin, M., 2013. Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training. BMJ open, 3(10), p.e003525. https://bmjopen.bmj.com/content/bmjopen/3/10/e003525.full.pdf
Holloway, I., & Galvin, K. 2017. Qualitative research in nursing and healthcare. Chichester, West Sussex, UK: Wiley Blackwell.
Hull, L., Arora, S., Aggarwal, R., Darzi, A., Vincent, C. and Sevdalis, N., 2012. The impact of nontechnical skills on technical performance in surgery: a systematic review. Journal of the American College of Surgeons, 214(2), pp.214-230. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.876.6824&rep=rep1&type=pdf
Kiger, M.E. and Varpio, L., 2020. Thematic analysis of qualitative data: AMEE Guide No. 131. Medical teacher, 42(8), pp.846-854.
Lave, J. and Wenger, E., 1991. Situated learning: Legitimate peripheral participation. Cambridge university press.
Lee, A., Finstad, A., Gawad, N., Boet, S., Raiche, I. and Balaa, F., 2021. Nontechnical skills (NTS) in the undergraduate surgical and anesthesiology curricula: are we adequately preparing medical students?. Journal of Surgical Education, 78(2), pp.502-511.
Lewis, R., Strachan, A. and Smith, M.M., 2012. Is high fidelity simulation the most effective method for the development of non-technical skills in nursing? A review of the current evidence. The open nursing journal, 6, p.82. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415625/
Mishra, A., Catchpole, K., Dale, T. and McCulloch, P., 2008. The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy. Surgical endoscopy, 22(1), pp.68-73.
Pearson, E. and McLafferty, I., 2011. The use of simulation as a learning approach to non-technical skills awareness in final year student nurses. Nurse education in practice, 11(6), pp.399-405.
Peddle, M., Bearman, M. and Nestel, D., 2016. Virtual patients and nontechnical skills in undergraduate health professional education: an integrative review. Clinical Simulation in Nursing, 12(9), pp.400-410.
Scalese, R.J., Obeso, V.T. and Issenberg, S.B., 2008. Simulation technology for skills training and competency assessment in medical education. Journal of general internal medicine, 23(1), pp.46-49. https://link.springer.com/article/10.1007/s11606-007-0283-4
Ziv, A., Wolpe, P.R., Small, S.D. and Glick, S., 2003. Simulation-based medical education: an ethical imperative. Academic medicine, 78(8), pp.783-788. https://desarrollodocente.uc.cl/wp-content/uploads/2020/03/SBMedical_Education_Ethical.pdf