Objectives: The objective of this study was to evaluate the effect of nontechnical skills (NTS) training on performance in advanced life support (ALS) simulation. Furthermore, we aimed to determine the ideal frequency of training sessions for an optimal retention and the value of debriefing.Methods: A systematic search was performed using PubMed, EMBASE, WoS, ERIC, CINAHL, and the Cochrane Library conducted through August 1, 2018. All primary studies mentioning NTS in ALS education were included. Three reviewers independently extracted data on study design and outcome. The MERSQI approach was used to evaluate the overall quality of evidence.Results: Of the 10,723 identified articles, 40 studies were included with a combined total of 3,041 participants, ranging from students to experts. Depending on the focus of the study, articles were categorized in NTS (n = 25), retention (n = 8), and feedback (n = 10). Incorporating NTS during ALS simulation showed significant improvements in timing for performing critical first steps. Furthermore, good leadership skills had a favorable effect on overall technical performance and teamwork during simulation improved team dynamics and performance. Finally, debriefing also had a beneficial effect on team performance. One particular type of debriefing does not appear to be superior to other types of debriefing.
Conclusion:Team simulation training resulted in improved NTS and a reduction in the time required to complete a simulated cardiac arrest. Therefore, a formal NTS program should be introduced into ALS courses. Feedback and repetitive practice are key factors to train NTS. The impact of training on team behaviors can persist for at least 3 to 6 months. In conclusion, understanding and improving NTS may help to create more effective teams. The effect on patient outcome requires further investigation.S urvival from out-of-hospital cardiac arrest (CA) remains low around 10.3% with survival depending on location of arrest, initial rhythm, and patient and rescue factors. 1 Therefore, the American Heart Association (AHA) and European Resuscitation Council (ERC) guidelines emphasize the importance of technical skills (TS). 2 However, errors are frequently the result of failure in nontechnical skills (NTS). 3 Therefore, the quality of NTS in terms of teamwork, leadership, communication, and situational awareness is likely just as important for achieving a better patient outcome. [3][4][5][6][7] As a result, NTS training was recently included in several medical courses, including the advanced life support (ALS) course. [8][9][10][11] This training can potentially reduce patient morbidity and mortality by enabling