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BackgroundEye-tracking is a behavioural analysis tool which may reveal insights inaccessible to the traditional observer. Established in industry, medical applications remain relatively unexplored. We tested feasibility using ambulant subjects, in a simulated operating theatre. We also attempted to validate the technique by comparing the performance of junior and senior anaesthetists. A fixation duration of ≥200 ms allows recognition and higher cortical processing of visual targets.1 This provides a unique ability to examine disparities between problem recognition and action.MethodologyEthical approval was obtained. 7 junior and 7 senior anaesthetists undertook a standardised simulated difficult airway scenario. All wore eye-tracking glasses (ErgoneersTM). 2 monitoring changes (88% desaturation and ventricular tachycardia) were introduced at set times. Monitor SpO2 and ECG traces were defined as ‘areas of interest’ (AOI). Primary endpoints were time to first fixation (TFF) on AOI following change, and time to act (TTA). Post scenario questionnaires assessed user acceptability. Parametric data was compared using an unpaired t-test and non-parametric data using the Mann-Whitney U test.ResultsMean TFF(s) was less for seniors than juniors, for SpO2 (12.0 vs 29.5, p = 0.05) and ECG (4.1 vs 8.9, p = 0.11). TTA was less for seniors for SpO2 (15.4 vs 53.3, p = 0.02) and ECG (12.9 vs 50.0, p = 0.02). TFF/TTA interval was also less for seniors (SpO2: 21.1 vs 41, p = 0.07. ECG: 8.7 vs 41.2, p = 0.04). 86% of candidates stated the glasses had no impact on their normal behaviour.ConclusionsEye-tracking is acceptable for users and deliverable in a dynamic, simulated environment. It is a valid tool to discriminate certain aspects of performance. A prolonged recognition/action interval in juniors, provides a new insight into critical incident behaviour. It may reflect less efficient clinical interpretation, decision-making and action planning. Further scrutiny of this recognition/action phase, may facilitate approaches to improve response times in critical incidents.ReferenceSalvucci DD, Goldberg JH. Identifying fixations and saccades in eye-tracking protocols. ETRA 2000: Proceedings of the 2000 symposium on eye-tracking research and applications. New York: ACM, 2000: 71–78

Time and motion studies have been conducted to address system failures within an organisation,1 but never before as a course development needs analysis process. Simulation is increasingly used to teach human factors and strategies to cope with pressures on a busy ward. This study can provide real time data of junior doctors’ work schedule, to increase the realism of simulation to reflect accurately work conditions on a busy ward, and help identify training needs and design courses to target specific learning strategies to improve efficiency. Methodology Following cg approval and signed consent, two observers shadowed individually fourteen doctors during their shift in the acute assessment unit, for 5 h each, recording and timing all tasks performed. Statistics were carried out to identify times spent in different tasks, individually and categorised. The different levels of doctors were then compared by using a x2 test. Results Nearly 1/3 of time was spent in communication, 1/3 on direct patient tasks. Training time was only 8%, and lots of time was ‘’wasted’’ in admin tasks. A detailed breakdown of the associations between groups will be presented. Reccommendations We propose a comprehensive plan of improving training oppurtunities while increasing efficiency on the wards by: Reducing the time spent in administrative tasks and increasing the effectiveness of communication through one day simulation course on time management and prioritisation for junior doctors working in an acute medicine. Increasing the time spent on procedures other than cannulation, (provide repeated small group simulation based procedural courses, and simultaneously appoint nurse practitioners for cannulation tasks). A limitation is that this study applies particularly to acute medicine. However, we believe that the results are reproducible, as proven by similar studies abroad.2,3 Our protocol can be followed in other medical units around the country and wider results can be obtained. References Patton WM Jr. ‘’Developing tima and motion study for a lean healthcare environment’’, 2011, University of Kentucky Master’s Thesis, paper 163 Westbrook JI, Ampt A, Kearney L, Rob MI. ‘’All in a day’s work: an observational study to quantify how and with whom doctors on hospital wards spend their time’’, MJA 2008;188:506–509 Ammenwerth E, ‘’The time needed for clinical documentation versus direct care’’. Methods Int Medicine 2009;48:84–91

Background Non-technical skills are the cognitive, social and personal resource skills that complement technical skills.1 There is increasing empirical evidence linking non technical skills to patient safety.2 Poor performance of non technical skills has been shown to be a significant contributor to medical error.3 Objective Hull institute of learning and simulation offers Leadership Fellowship training programs in Simulation. To prepare the fellows for the post, we provide formal training in NTS. We explored fellows perceptions of changes in their non technical skills performance using a non technical skills questionnaire. Methods We followed seven Fellows over a period of one year. Non technical questionnaire was given at the start of training. They rated their non technical skills, based on Likert scale, on leadership, management, interpersonal effectiveness, teamwork, assertiveness, communication, time management, influencing, negotiation and engagement. Questionnaire was repeated at the end of year for comparison. Results The questionnaires revealed that the fellows particularly lacked confidence in leadership, assertiveness, time management and influencing at the beginning and this improved by the year end. There was particular increase in confidence levels in leadership (p = 0.216), time management (p = 0.103) and communication (p = 0.154) using chi square test. All Fellows felt that this post has helped them develop non technical skills which can be transferred to their future clinical work place. Conclusion We have demonstrated that registrars perceive a lack of confidence in key NTS such as leadership, assertiveness and time management. Over a period of year with focused training, NTS performance can improve. We believe that our experience can be adapted and used to embed formal training in NTS in the curriculum. We acknowledge there are limitations to our results as it is perceptions not actual improvement. But it can form basis for future research in this area. References Flin R, O’Connor R, Crichton M. Safety at the Sharp End: A Guide to Non-TechnicalSkills. Farnham: Ashgate, 2008 Flowerdew L, Brown R, Vincent C, et al. Identifying non-technical skills associated with safety in the emergency department: a scoping review of the literature. Ann Emerg Med 2012;59:386–94 Andersen PO, Jensen MK, Lippert A, et al. Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams. Resuscitation 2010;81:695–70

In the UK, postgraduate training for doctors has undergone significant changes over the past decade general practice, etc. During this period, hospital admission rates and bed occupancy have also increased.