Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate Students

Introduction: Non-technical skills (NTS) are essential to maintain best patient care and to enhance patient safety. Therefore, the early integration and implementation of non-technical skills (NTS) training during undergraduate medical education has not only been repeatedly emphasized but is crucial...

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Main Authors: Parisa Moll-Khosrawi, Josephine Küllmei, Christian Zöllner, Leonie Schulte-Uentrop
Format: Article
Language:English
Published: MDPI AG 2023-08-01
Series:Education Sciences
Subjects:
Online Access:https://www.mdpi.com/2227-7102/13/9/853
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author Parisa Moll-Khosrawi
Josephine Küllmei
Christian Zöllner
Leonie Schulte-Uentrop
author_facet Parisa Moll-Khosrawi
Josephine Küllmei
Christian Zöllner
Leonie Schulte-Uentrop
author_sort Parisa Moll-Khosrawi
collection DOAJ
description Introduction: Non-technical skills (NTS) are essential to maintain best patient care and to enhance patient safety. Therefore, the early integration and implementation of non-technical skills (NTS) training during undergraduate medical education has not only been repeatedly emphasized but is crucial to ensure patient safety. However, there is a gap in knowledge on how to effectively convey and thereby enhance NTS in under- or postgraduate medical training. Although medical educators are eager to convey NTS, the best approach to do so is yet to be found. Next to didactic and teaching approaches, the design of the curriculum, in the sense of an integrated curricula, might have an influence in conveying NTS effectively. Therefore, we investigated if repetitive simulation-based training enhanced the NTS of medical undergraduates. Methods: 945 undergraduate students in their 1st, 2nd, 3rd and 4th year of medical studies who attended mandatory emergency simulation trainings at the medical faculty in Hamburg participated in this prospective observational study. The trainings are designed to align to a learning spiral (vertically integrated curriculum) and build upon each other, resulting in repetitive and advanced training. Each training has a preset training-specific standardized simulation scenarios. To determine progress in NTS performance, the NTS of the students were assessed during each training with the Anaesthesiology Students’ NTS (AS-NTS) taxonomy, which is composed of three dimensions. Differences in performance between the investigated cohorts of students were calculated with an analysis of variance (Welch’s ANOVA) and with a follow-up post hoc test (Games-Howell), and the significant differences were analysed. Results: The NTS of the undergraduate students improved with every ascending training and, hence, year of medical school. The overall NTS performance of the 4thyear undergraduate students differed significantly compared to the 1st, 2nd and 3rd year undergraduate students performances, F = 6.72 (4, 439.6), <i>p</i> ≤ 0.001. The greatest improvement was detected on dimension one of the AS-NTS (“Planning tasks, prioritising and problem-solving”) (F = 6.75 (4, 434.5), <i>p</i> ≤ 0.001), where 4th year undergraduates performed at a significantly higher skill level than the 1st, 2nd and 3rd year undergraduate students. On dimension two (“Teamwork and Leadership”) and three (“Team orientation”), significant differences were pronounced between the 4th year and 1st year undergraduate students (F = 3.56 (4, 442.9), <i>p</i> = 0.010; F = 4.50 (4, 441.0), <i>p</i> = 0.001). The lowest skill improvement was observed on dimension two. Conclusions: NTS are essential skills to complement technical skills and hereby ensure patient safety. The early longitudinal and vertical integration of NTS training in undergraduate medical curricula (learning spiral) is an effective approach to enhance and foster the NTS of future doctors.
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spelling doaj.art-c1c0a01f7e694187b56de85f803b24c32023-11-19T10:18:33ZengMDPI AGEducation Sciences2227-71022023-08-0113985310.3390/educsci13090853Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate StudentsParisa Moll-Khosrawi0Josephine Küllmei1Christian Zöllner2Leonie Schulte-Uentrop3Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyDepartment of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyDepartment of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyDepartment of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyIntroduction: Non-technical skills (NTS) are essential to maintain best patient care and to enhance patient safety. Therefore, the early integration and implementation of non-technical skills (NTS) training during undergraduate medical education has not only been repeatedly emphasized but is crucial to ensure patient safety. However, there is a gap in knowledge on how to effectively convey and thereby enhance NTS in under- or postgraduate medical training. Although medical educators are eager to convey NTS, the best approach to do so is yet to be found. Next to didactic and teaching approaches, the design of the curriculum, in the sense of an integrated curricula, might have an influence in conveying NTS effectively. Therefore, we investigated if repetitive simulation-based training enhanced the NTS of medical undergraduates. Methods: 945 undergraduate students in their 1st, 2nd, 3rd and 4th year of medical studies who attended mandatory emergency simulation trainings at the medical faculty in Hamburg participated in this prospective observational study. The trainings are designed to align to a learning spiral (vertically integrated curriculum) and build upon each other, resulting in repetitive and advanced training. Each training has a preset training-specific standardized simulation scenarios. To determine progress in NTS performance, the NTS of the students were assessed during each training with the Anaesthesiology Students’ NTS (AS-NTS) taxonomy, which is composed of three dimensions. Differences in performance between the investigated cohorts of students were calculated with an analysis of variance (Welch’s ANOVA) and with a follow-up post hoc test (Games-Howell), and the significant differences were analysed. Results: The NTS of the undergraduate students improved with every ascending training and, hence, year of medical school. The overall NTS performance of the 4thyear undergraduate students differed significantly compared to the 1st, 2nd and 3rd year undergraduate students performances, F = 6.72 (4, 439.6), <i>p</i> ≤ 0.001. The greatest improvement was detected on dimension one of the AS-NTS (“Planning tasks, prioritising and problem-solving”) (F = 6.75 (4, 434.5), <i>p</i> ≤ 0.001), where 4th year undergraduates performed at a significantly higher skill level than the 1st, 2nd and 3rd year undergraduate students. On dimension two (“Teamwork and Leadership”) and three (“Team orientation”), significant differences were pronounced between the 4th year and 1st year undergraduate students (F = 3.56 (4, 442.9), <i>p</i> = 0.010; F = 4.50 (4, 441.0), <i>p</i> = 0.001). The lowest skill improvement was observed on dimension two. Conclusions: NTS are essential skills to complement technical skills and hereby ensure patient safety. The early longitudinal and vertical integration of NTS training in undergraduate medical curricula (learning spiral) is an effective approach to enhance and foster the NTS of future doctors.https://www.mdpi.com/2227-7102/13/9/853patient safetyemergency managementnon-technical skillshuman error
spellingShingle Parisa Moll-Khosrawi
Josephine Küllmei
Christian Zöllner
Leonie Schulte-Uentrop
Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate Students
Education Sciences
patient safety
emergency management
non-technical skills
human error
title Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate Students
title_full Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate Students
title_fullStr Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate Students
title_full_unstemmed Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate Students
title_short Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate Students
title_sort efficacy of an integrated simulation based education approach to train non technical skills in medical undergraduate students
topic patient safety
emergency management
non-technical skills
human error
url https://www.mdpi.com/2227-7102/13/9/853
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AT christianzollner efficacyofanintegratedsimulationbasededucationapproachtotrainnontechnicalskillsinmedicalundergraduatestudents
AT leonieschulteuentrop efficacyofanintegratedsimulationbasededucationapproachtotrainnontechnicalskillsinmedicalundergraduatestudents