Development of a behavioural marker system for the non-technical skills of junior doctors in acute care
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Date
27/11/2015Author
Mellanby, Edward Alexander
Metadata
Abstract
Introduction:
Newly qualified doctors are frequently first to the scene in managing acutely unwell
in-patients. Failures in clinical assessment, basic management and early escalation of
care lead to avoidable patient morbidity and mortality. Analyses of adverse events
have highlighted the importance of non-technical skills training to improve patient
safety. These are a combination of cognitive (such as decision making) and social
skills (such as team working), which complement knowledge and technical ability,
and contribute to safe and effective care. In order to train and assess junior doctors in
these skills, we must first have an accurate understanding of what they involve. This
research project was designed to identify the critical non-technical skills required by
junior doctors to manage acutely unwell patients safely and effectively. It aimed to
develop a tool to observe these skills that could be used in training, assessment and
research.
Method:
A literature review was used to develop an initial framework to categorise the non-technical
skills required in this domain. Twenty-nine in depth semi-structured
interviews were then completed with junior doctors. A critical incident technique
was utilised: Junior doctors were asked to recall a challenging case in which they
managed an acute medical emergency. Interviews were transcribed and coded using
template analysis. A panel of subject matter experts were then consulted in order to
refine this framework and develop an assessment tool for observing these skills. This
involved two focus groups and an iterative process, returning to the original data to
verify any changes.
Results:
Four categories of critical non-technical skills were identified: Situation awareness,
decision-making, task management and teamwork. Each of these had between three
and four sub-categories. Descriptors, exemplar behaviours and an assessment scale
were developed to allow these non-technical skills to be observed and rated using a
behavioural marker system. During the development of this tool, exploration of the
data revealed the influence of factors such as hierarchy and culture on the behaviour
of junior doctors.
Conclusions:
The performance of newly qualified doctors in acute care is influenced by the
complex clinical environments in which they work. This can have profound
implications for patient outcomes. The framework developed by this research allows
us to be explicit about the types of behaviours that are required to keep patients safe.
If this tool can be integrated into clinical training, then it could be used by clinicians
to support the development of safe and effective skills and reduce the current level of
avoidable patient harm.