Yihan Lin1, John W Scott2, Sojung Yi3, Kathryn K Taylor3, Georges Ntakiyiruta4, Faustin Ntirenganya4, Paulin Banguti5, Steven Yule6, Robert Riviello7. 1. Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Surgery, University of Colorado School of Medicine, Denver, Colorodo. Electronic address: yihan.lin@mail.harvard.edu. 2. Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 3. Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts. 4. Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda. 5. Department of Anesthesia, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda. 6. Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts. 7. Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda; STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts.
Abstract
OBJECTIVE: A substantial proportion of adverse intraoperative events are attributed to failures in nontechnical skills. To strengthen these skills and improve surgical safety, the Non-Technical Skills for Surgeons (NOTSS) taxonomy was developed as a common framework. The NOTSS taxonomy was adapted for low- and middle-income countries, where variable resources pose a significant challenge to safe surgery. The NOTSS for variable-resource contexts (VRC) curriculum was developed and implemented in Rwanda, with the aim of enhancing knowledge and attitudes about nontechnical skills and promoting surgical safety. DESIGN: The NOTSS-VRC curriculum was developed through a rigorous process of integrating contextually appropriate values. It was implemented as a 1-day training course for surgical and anesthesia postgraduate trainees. The curriculum comprises lectures, videos, and group discussions. A pretraining and posttraining questionnaire was administered to compare knowledge and attitudes regarding nontechnical skills, and their potential to improve surgical safety. SETTING: The setting of this study was in the tertiary teaching hospital of Kigali, Rwanda. PARTICIPANTS: Participants were residents of the University of Kigali. A total of 55 residents participated from general surgery (31.4%), obstetrics (25.5%), anesthesia (17.6%), and other surgical specialties (25.5%). RESULTS: In a paired analysis, understanding of NOTSS improved significantly (55.6% precourse, 80.9% postcourse, p<0.01). All residents reported that the course would improve their ability to provide safer patient care, and 97.4% believed developing nontechnical skills would improve patient outcomes. CONCLUSIONS: Nontechnical skills must be highlighted in surgical training in low- and middle-income countries. The NOTSS-VRC curriculum can be implemented without additional technology or significant financial cost. Its deliberate design for resource-constrained settings allows it to be used both as an educational course and a quality improvement strategy. Our research demonstrates it is feasible to improve knowledge and attitudes about NOTSS through a 1-day course, and represents a novel approach to improving global surgical safety.
OBJECTIVE: A substantial proportion of adverse intraoperative events are attributed to failures in nontechnical skills. To strengthen these skills and improve surgical safety, the Non-Technical Skills for Surgeons (NOTSS) taxonomy was developed as a common framework. The NOTSS taxonomy was adapted for low- and middle-income countries, where variable resources pose a significant challenge to safe surgery. The NOTSS for variable-resource contexts (VRC) curriculum was developed and implemented in Rwanda, with the aim of enhancing knowledge and attitudes about nontechnical skills and promoting surgical safety. DESIGN: The NOTSS-VRC curriculum was developed through a rigorous process of integrating contextually appropriate values. It was implemented as a 1-day training course for surgical and anesthesia postgraduate trainees. The curriculum comprises lectures, videos, and group discussions. A pretraining and posttraining questionnaire was administered to compare knowledge and attitudes regarding nontechnical skills, and their potential to improve surgical safety. SETTING: The setting of this study was in the tertiary teaching hospital of Kigali, Rwanda. PARTICIPANTS: Participants were residents of the University of Kigali. A total of 55 residents participated from general surgery (31.4%), obstetrics (25.5%), anesthesia (17.6%), and other surgical specialties (25.5%). RESULTS: In a paired analysis, understanding of NOTSS improved significantly (55.6% precourse, 80.9% postcourse, p<0.01). All residents reported that the course would improve their ability to provide safer patient care, and 97.4% believed developing nontechnical skills would improve patient outcomes. CONCLUSIONS: Nontechnical skills must be highlighted in surgical training in low- and middle-income countries. The NOTSS-VRC curriculum can be implemented without additional technology or significant financial cost. Its deliberate design for resource-constrained settings allows it to be used both as an educational course and a quality improvement strategy. Our research demonstrates it is feasible to improve knowledge and attitudes about NOTSS through a 1-day course, and represents a novel approach to improving global surgical safety.
Authors: Shehnaz Alidina; Pritha Chatterjee; Noor Zanial; Sakshie Sanjay Alreja; Rebecca Balira; David Barash; Edwin Ernest; Geofrey Charles Giiti; Erastus Maina; Adelina Mazhiqi; Rahma Mushi; Cheri Reynolds; Meaghan Sydlowski; Florian Tinuga; Sarah Maongezi; John G Meara; Ntuli A Kapologwe; Erin Barringer; Monica Cainer; Isabelle Citron; Amanda DiMeo; Laura Fitzgerald; Hiba Ghandour; Magdalena Gruendl; Augustino Hellar; Desmond T Jumbam; Adam Katoto; Lauren Kelly; Steve Kisakye; Salome Kuchukhidze; Tenzing N Lama; Gopal Menon; Stella Mshana; Chase Reynolds; Hannington Segirinya; Dorcas Simba; Victoria Smith; Steven J Staffa; Christopher Strader; Leopold Tibyehabwa; Alena Troxel; John Varallo; Taylor Wurdeman; David Zurakowski Journal: BMJ Qual Saf Date: 2021-02-05 Impact factor: 7.035