PDF(Sci-hub)
Abstract：
BACKGROUND: Most surgical assessment has been aimed at technical proficiency. However, non-technical skills also affect patient safety and clinical effectiveness. The NOTSS (Non-Technical Skills for Surgeons) assessment instrument was developed specifically to assess the non-technical skills of individual surgeons in the operating theatre. This study evaluated NOTSS as a real-world assessment, with a mix of minimally trained assessors. The evaluation criteria were feasibility, validity and psychometric reliability.
METHODS: In a standard evaluation of NOTSS, 56 anaesthetists, 39 scrub nurses, two surgical care practitioners and three independent assessors provided 715 assessments of 404 surgical cases of 15 index procedures across six specialties performed by 85 surgical trainees.
RESULTS: The assessment was feasible, but important implementation challenges were highlighted. Most respondents considered the method valid, but with reservations about assessing cognition. The factor structure of scores, and their positive relationships with other measures of experience and performance, supported validity. Trainees\' non-technical skill scores were relatively procedure-independent and achieved good reliability (generalizability coefficient 0·8 or more) when six to eight assessors observed one case each.
CONCLUSIONS: Minimally trained assessors, who are typically present in operating theatres, were sufficiently discriminating and consistent in their judgements of trainee surgeons\' non-technical skills to provide reliable scores based on an achievable number of observations.
METHODS: In a standard evaluation of NOTSS, 56 anaesthetists, 39 scrub nurses, two surgical care practitioners and three independent assessors provided 715 assessments of 404 surgical cases of 15 index procedures across six specialties performed by 85 surgical trainees.
RESULTS: The assessment was feasible, but important implementation challenges were highlighted. Most respondents considered the method valid, but with reservations about assessing cognition. The factor structure of scores, and their positive relationships with other measures of experience and performance, supported validity. Trainees\' non-technical skill scores were relatively procedure-independent and achieved good reliability (generalizability coefficient 0·8 or more) when six to eight assessors observed one case each.
CONCLUSIONS: Minimally trained assessors, who are typically present in operating theatres, were sufficiently discriminating and consistent in their judgements of trainee surgeons\' non-technical skills to provide reliable scores based on an achievable number of observations.
摘要：
背景：大多数手术评估都是针对技术熟练程度。然而,非技术技能也会影响患者的安全性和临床效果。NOTSS（外科医生非技术技能）评估工具是专门为评估手术室中个别外科医生的非技术技能而开发的。这项研究将NOTSS评估为真实世界的评估，混合了受过最低限度训练的评估员。评价标准是可行性，效度和心理测量信度。
方法：在NOTSS的标准评估中，56名麻醉师,39名磨砂护士，两名外科护理从业人员和三名独立评估员提供了715项评估,评估了由85名外科受训人员在6个专业中进行的15项指标程序的404例外科病例.
结果：评估是可行的，但强调了重要的实施挑战。大多数受访者认为该方法有效，但对评估认知有所保留。分数的因素结构，以及它们与其他经验和绩效指标的积极关系，支持有效性。受训者的非技术技能得分相对独立于程序，并且当六至八名评估者各观察一个案例时，具有良好的可靠性（泛化系数0·8或更高）。
结论：经过最少训练的评估员，他们通常出现在手术室，对实习外科医生的非技术技能的判断具有足够的区别性和一致性，可以根据可实现的观察数量提供可靠的评分。
方法：在NOTSS的标准评估中，56名麻醉师,39名磨砂护士，两名外科护理从业人员和三名独立评估员提供了715项评估,评估了由85名外科受训人员在6个专业中进行的15项指标程序的404例外科病例.
结果：评估是可行的，但强调了重要的实施挑战。大多数受访者认为该方法有效，但对评估认知有所保留。分数的因素结构，以及它们与其他经验和绩效指标的积极关系，支持有效性。受训者的非技术技能得分相对独立于程序，并且当六至八名评估者各观察一个案例时，具有良好的可靠性（泛化系数0·8或更高）。
结论：经过最少训练的评估员，他们通常出现在手术室，对实习外科医生的非技术技能的判断具有足够的区别性和一致性，可以根据可实现的观察数量提供可靠的评分。
