Comprehensive feedback on trainee surgeons' non-technical skills

Abstract

ObjectivesThis study aimed to explore the content of conversations, feedback style, and perceived usefulness of feedback to trainee surgeons when conversations were stimulated by a tool for assessing surgeons’ non-technical skills. MethodsTrainee surgeons and their supervisors used the Non-Technical Skills for Surgeons in Denmark tool to stimulate feedback conversations. Audio recordings of post-operation feedback conversations were collected. Trainees and supervisors provided questionnaire responses on the usefulness and comprehensiveness of the feedback. The feedback conversations were qualitatively analyzed for content and feedback style. Usefulness was investigated using a scale from 1 to 5 and written comments were qualitatively analyzed. ResultsSix trainees and six supervisors participated in eight feedback conversations. Eighty questionnaires (response rate 83 percent) were collected from 13 trainees and 12 supervisors. Conversations lasted median eight (2-15) minutes. Supervisors used the elements and categories in the tool to structure the content of the conversations. Supervisors tended to talk about the trainees’ actions and their own frames rather than attempting to understand the trainees’ perceptions. Supervisors and trainees welcomed the feedback opportunity and agreed that the conversations were useful and comprehensive. ConclusionsThe content of the feedback conversations reflected the contents of the tool and the feedback was considered useful and comprehensive. However, supervisors talked primarily about their own frames, so in order for the feedback to reach its full potential, supervisors may benefit from training techniques to stimulate a deeper reflection among trainees.

Integrating Technical and Nontechnical Skills in Hands-On Surgical Training

“…Teaching in the operating room is a challenging task in itself since the patient's safety is the most important aspect that often pushes teaching and training to the background [18]. Teaching as it occurs in the operating room is almost entirely focused on technical skills [15]. The same goes for debriefing sessions after the operation [19].…”

“…The same goes for debriefing sessions after the operation [19]. Nontechnical skills teaching remains to be undertaught [15] and surgical teachers are not sufficiently trained to teach nontechnical skills [1]. Nontechnical skills are not yet a part of the surgical educational culture and teachers are inclined to avoid it, often unaware.…”

“…All teaching has to occur in a calm, supportive, and respectful way to create a safe and effective teaching climate [13,14]. The use of neutral, nondisturbing language is essential in achieving this [15]. When teaching technical skills, the information density should be limited to how to perform the skill without focusing on other aspects or additive information (e.g., other options and the environment) [11].…”

“…Debriefing sessions are considered highly important for teaching nontechnical skills. Trainees receive feedback on their nontechnical skills performance, but also reflect on their nontechnical skills [15]. Teacher feedback on nontechnical skills has to be based on first-hand observations of trainees' performance and has to address specific strong points, weaknesses, and suggestions for improvement.…”

“…It should always be provided in a respectful way and with a neutral tone of voice. Teachers have to structure their feedback based on observations and evaluations according to nontechnical skills assessment tools [1,15]. Training is essential to enable surgical teachers to effectively analyze and teach nontechnical skills [1,2,15].…”