背景:创伤患者的状况和及时复苏的迫切需要给创伤团队带来了独特的挑战。对于战斗环境中的军事创伤小组来说,这些困难更加严重。因此,需要继续改进创伤团队的非技术技能(NTS)培训.然而,当前的NTS评估方法依赖于主观评级,这可能会引入偏见。因此,需要客观的NTS评价方法。眼动追踪(ET)方法已被应用于研究通信,情境意识,以及许多医疗保健机构的领导力,并可用于研究创伤情况下的医生\'NTS。在这项研究中,我们旨在评估患者护理模拟过程中创伤团队负责人的客观注视模式和主观专家NTS评分之间的关系。
方法:机构审查委员会批准后,招募了来自一年级研究生普外科和急诊医学住院医师的9个创伤小组,以参加2个创伤模拟中的1个(困难的气道病例和多患者创伤)。每个场景持续约15分钟。所有团队负责人都穿着移动ET系统来评估凝视指标-首次固定时间(TTFF),平均固定时间(AFD),以及专注于感兴趣领域(AOI)的方案(TPS)的总百分比,其中包括病人,护理团队,诊断设备,和病人护理设备。训练有素的教师评估员完成了外科医生非技术技能(NOTSS)评估工具和创伤非技术技能(T-NOTECHS)量表。单向方差分析,Kruskal-Wallis,并进行适当的事后成对比较测试以评估AOI组之间ET指标之间的差异。使用Spearman的Rho检验来评估ET和主观NTS评级之间的相关性。
结果:与其他NTS域相比,创伤团队在T-NOTECHS(3.29$\pm$0.61,最大值=5)和NOTSS(2.87$\pm$0.66,最大值=4)的沟通得分相对较差。我们发现队友和患者之间的创伤团队负责人的TTFF存在显着差异(团队:1.56vs患者:29.82秒,P<.001)。诊断设备上的TTFF与主观NTS评估的多个指标呈负相关(P<.05)。AOI之间的AFD没有显着差异,队友的AFD与沟通和团队合作呈正相关(P<0.05)。大多数AOI对的TPS存在显着差异(P<0.05),患者固定的平均TPS最高(32%)。最后,其他ET和NTS指标之间有几个显著的相关性。
结论:本研究采用混合方法评估模拟急性护理创伤模拟中的创伤小组组长NTS。我们的结果为创伤团队负责人在患者护理模拟期间的NTS行为提供了一些客观见解。这种客观的见解提供了对NTS行为的更全面的了解,并且可以用来指导将来对创伤医师的NTS培训。需要更多的研究来应用这些方法从模拟和真实创伤环境中的更大团队样本中捕获NTS。
BACKGROUND: The condition of trauma patients and the urgent need for timely resuscitation present unique challenges to trauma teams. These difficulties are exacerbated for military trauma teams in combat environments. Consequently, there is a need for continued improvement of nontechnical skills (NTS) training for trauma teams. However, current approaches to NTS assessment rely on subjective ratings, which can introduce bias. Accordingly, objective methods of NTS evaluation are needed. Eye-tracking (ET) methods have been applied to studying communication, situation awareness, and leadership in many health care settings, and could be applied to studying physicians\' NTS during trauma situations. In this study, we aimed to assess the relationship between trauma team leaders\' objective gaze patterns and subjective expert NTS ratings during patient care simulations.
METHODS: After Institutional Review Board approval, 9 trauma teams from first-year post-graduate general surgery and emergency medicine residents were recruited to participate in 1 of 2 trauma simulations (a difficult airway case and a multi-patient trauma). Each scenario lasted approximately 15 minutes. All team leaders wore a mobile ET system to evaluate gaze metrics-time to first fixation (TTFF), average fixation duration (AFD), and total percentage of the scenario (TPS) focused on Areas of Interest (AOI), which included patient, care team, diagnostic equipment, and patient care equipment. Trained faculty raters completed the Non-Technical Skills for Surgeons (NOTSS) assessment tool and the Trauma Non-Technical Skills (T-NOTECHS) scale. One-way analysis of variance, Kruskal-Wallis, and appropriate post-hoc pairwise comparison tests were run to assess differences between ET metrics across AOI groups. Spearman\'s Rho tests were used to assess correlations between ET and subjective NTS ratings.
RESULTS: Compared to other NTS domains, trauma teams scored relatively poorly on communication across both T-NOTECHS (3.29$ \\pm $0.61, maximum = 5) and NOTSS (2.87$ \\pm $0.66, maximum = 4). We found significant differences in trauma team leaders\' TTFF between teammates and the patient (Team: 1.56 vs Patient: 29.82 seconds, P < .001). TTFF on the diagnostic equipment was negatively correlated (P < .05) to multiple measures of subjective NTS assessments. There were no significant differences in AFD between AOIs, and AFD on teammates was positively correlated (P < .05) to communication and teamwork. There were significant differences in TPS across most AOI pairs (P < .05), and the average TPS fixated was highest on the patient (32%). Finally, there were several significant correlations between additional ET and NTS metrics.
CONCLUSIONS: This study utilized a mixed methods approach to assess trauma team leaders\' NTS in simulated acute care trauma simulations. Our results provide several objective insights into trauma team leaders\' NTS behaviors during patient care simulations. Such objective insights provide a more comprehensive understanding of NTS behaviors and can be leveraged to guide NTS training of trauma physicians in the future. More studies are needed to apply these methods to capture NTS from a larger sample of teams in both simulated and real trauma environments.