Background Failures in non-technical skills (NTS) contribute to adverse events in healthcare. Previous research has explored the assessment and training of these skills, and yet there is a lack of evidence for their impact on clinical outcomes. Gastrointestinal endoscopy is a high-pressure specialty, but to date there is little on the role of NTS in this area, or a method for their assessment. This MD project aims to measure NTS in endoscopy, explore their relationship with clinical outcomes, and identify those specific to this area of healthcare. Methods An observational study of endoscopy teams in real time, using the Oxford NOTECHS II assessment tool. Comparison of NTS performance with procedure outcomes and patient satisfaction. A qualitative interview study with staff members to establish the NTS specifically relevant to working in gastrointestinal endoscopy. Results Reliability of the Oxford NOTECHS II tool by a single rater in this environment was good. Positive relationships were found between NTS scores and polyp detection, scope withdrawal time and completion of items on a safety checklist. However, relationships with other outcomes, including patient satisfaction were weak, or inconclusive. The themes identified relating to NTS in gastrointestinal endoscopy were leadership, working together as a team, situation awareness, making decisions, the patient and communication. Conclusions Although few conclusive relationships were found between NTS performance and procedure outcomes, those positive associations found seem logical as they are likely to reflect increased care and vigilance. This may have been affected by a lack of variation in scores. The NTS relevant to this area are similar to other areas of healthcare. However, the interaction with and around the awake patient is unique to endoscopy and an important influence on the NTS that staff must possess. There is scope to develop a more specific tool for the assessment of NTS in endoscopy.

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.

It is well recognized that a certain component of surgical residency training has transitioned from the operating room to the surgical skills lab. Although a significant amount of important work has validated simulators as viable systems for teaching technical skills outside the operating room, the next step is integrating simulators into a comprehensive curriculum. Several frameworks for curricular design have been described in the literature; however, few curricula have been described or validated for minimally invasive surgical procedures. This study describes the design and validation of a comprehensive technical skills curriculum for laparoscopic colorectal surgery, an advanced laparoscopic procedure. The initial step in this project utilized the Delphi consensus methodology to develop a procedure-specific evaluation tool for laparoscopic colorectal surgery. This evaluation tool demonstrated reliability and validity in the context of expert and novice performance in the operating room. The next phase of the project also used the Delphi method to develop international consensus on a proficiency-based virtual reality program designed to teach the technical skills necessary to perform laparoscopic colorectal surgery. This virtual reality training program was then integrated into a comprehensive curriculum consisting of psychomotor training on the virtual reality simulator, as well as cognitive training and a cadaver lab. The final component of this project was a randomized single-blinded controlled trial that demonstrated that surgical residents who participated in the comprehensive curriculum exhibited superior technical skills in the operating room, and superior cognitive knowledge relating to laparoscopic colorectal surgery, compared to residents who received only conventional residency training.

It is well recognized that a certain component of surgical residency training has transitioned from the operating room to the surgical skills lab. Although a significant amount of important work has validated simulators as viable systems for teaching technical skills outside the operating room, the next step is integrating simulators into a comprehensive curriculum. Several frameworks for curricular design have been described in the literature; however, few curricula have been described or validated for minimally invasive surgical procedures. This study describes the design and validation of a comprehensive technical skills curriculum for laparoscopic colorectal surgery, an advanced laparoscopic procedure. The initial step in this project utilized the Delphi consensus methodology to develop a procedure-specific evaluation tool for laparoscopic colorectal surgery. This evaluation tool demonstrated reliability and validity in the context of expert and novice performance in the operating room. The next phase of the project also used the Delphi method to develop international consensus on a proficiency-based virtual reality program designed to teach the technical skills necessary to perform laparoscopic colorectal surgery. This virtual reality training program was then integrated into a comprehensive curriculum consisting of psychomotor training on the virtual reality simulator, as well as cognitive training and a cadaver lab. The final component of this project was a randomized single-blinded controlled trial that demonstrated that surgical residents who participated in the comprehensive curriculum exhibited superior technical skills in the operating room, and superior cognitive knowledge relating to laparoscopic colorectal surgery, compared to residents who received only conventional residency training.

Hälso- och sjukvården är en komplex och riskfylld verksamhet där mänskliga faktorer och brister i kommunikation och samverkan kan orsaka vårdskador och onödigt lidande för patienten. För att öka patientsäkerheten inom anestesiologisk omvårdnad behöver specialistsjuksköterskan agera med ett visst beteende, de behöver så kallade non-technical skills [NTS]. Syftet med studien var att göra en begreppsanalys av NTS inom anestesiologisk omvårdnad. Metoden har utgått från Walker och Avants begreppsanalys i åtta steg och datainsamlingen har skett genom en variation av sökningar från ordböcker, litteratur, webbpublikationer samt vetenskapliga artiklar.   Resultatet visar att NTS beskrivs som kognitiva förmågor och sociala beteenden. Det finns sju kategorier: situationsmedvetenhet, beslutsfattande, hantera stress, hantera trötthet, kommunikation, teamarbetet och ledarskap med tillhörande element för att beskriva NTS. Attributen för NTS är 1) Anestesisjuksköterskan mobiliserar nödvändiga kognitiva förmågor vid omhändertagande av patienten. 2) Anestesisjuksköterskan uppvisar säkra sociala beteenden vid omhändertagande av patienten. 3) Anestesisjuksköterskan använder en kombination av kognitiva förmågor och sociala beteenden för ett säkert omhändertagande av patienten. Konsekvensen av NTS är patientsäker vård. Slutligen har anestesisjuksköterskans empiriska kännetecken sammanfattats och fallbeskrivningar skapats för att demonstrera hur begreppet framträder i verkligheten.   Slutsatsen är att NTS kan definieras som patientsäkra förmågor och beteenden. När anestesisjuksköterskan använder sig av NTS uppstår patientsäker vård. I framtiden behövs djupare beskrivningar om hur anestesisjuksköterskan skapar situationsmedvetenhet och fattar beslut, hur strukturerade kommunikationsverktyg används och hur barriärer för att våga kommunicera med det multidisciplinära teamet kan ta sig i uttryck. Det behövs också tydligare beskrivningar av specialistsjuksköterskans ledarskap inom anestesiologisk omvårdnad. / Health care is a complex organization where human factors and deficiencies in communication and collaboration can cause unnecessary suffering for the patient. In order to increase patient safety in anesthesiologic care the specialist nurse need to act with a certain behavior, they need non-technical skills [NTS]. The aim of this study was to do a conceptual analysis of NTS in anesthesiologic care. The method was based on Walker and Avant's conceptual analysis in eight steps, and data was collected from dictionaries, literature, web publications and scientific articles.   The result shows that NTS is described as cognitive abilities and social behaviors. Seven categories: situation awareness, decision-making, managing stress, coping with fatigue, communication, teamwork and leadership with related elements describes NTS. The attributes of NTS are 1) The nurse anesthetist mobilizes the necessary cognitive abilities in the care of the patient. 2) The nurse anesthetist exhibits safe social behavior when caring for the patient. 3) The nurse anesthetist uses a combination of cognitive abilities and social behaviors for the safe care of the patient. The consequence of NTS is patient-safe care.   The conclusion is that NTS can be defined as patient-safe abilities and behaviors. When the nurse anesthetist uses NTS, patient-safe care arises. In the future deeper descriptions are needed about how the nurse anesthetist creates situational awareness and about the decision-making process, there is also a need to examine how structured communication tools are used and how barriers to daring to communicate within the multidisciplinary team can be expressed. Also, a clearer description of the leadership role of the specialist nurse in anesthesiologic care are needed.

Rater training (RT) improves the reliability of assessment tools, but has not been well studied for technical skills. This study assessed whether RT improved the psychometric properties of surgical skill assessments. Surgeons (N=47) were randomized to RT or non-training groups. The RT group underwent frame-of-reference training. Participants assessed trainees performing a suturing and knot-tying task using four assessment tools. Inter-rater reliability, initial and delayed rater agreement, and construct validity were assessed between groups. There was no significant effect of RT on the assessment tools’ reliability and validity. Reliability and validity were most robust for the global rating scale. Although there were trends towards improved reliability and validity with RT, confidence intervals were wide and overlapping. Reliability remained below the minimum desired level of 0.8 required for high-stakes testing. Although RT may represent a way to improve reliability, further study is needed to determine effective training methods. / February 2017

Os objetivos do trabalho foram, com relação a jovens atletas de basquetebol do sexo feminino com idades de 14 à 17 anos de duas categorias competitivas diferentes (mirim e infanto-juvenil): 1) Descrever as características antropométricas, tempo de prática na modalidade, idade cronológica, idade de menarca e fundamentos técnicos por categoria competitiva; 2) Verificar o efeito das categorias competitivas sobre as variáveis antropométricas e fundamentos técnicos; 3) Verificar a relação entre os fundamentos técnicos e as variáveis antropométricas, tempo de prática na modalidade, idade cronológica. Em média as atletas da categoria infanto-juvenil apresentam melhores resultados que as atletas da categoria mirim na maioria das variáveis consideradas; porém só foram verificadas diferenças significativas entre os grupos nos testes de arremesso, drible e passe, o teste de movimentos defensivos apresentou valor significante marginal (p=0,05). Os fundamentos técnicos apresentaram correlações significantes com as variáveis de tempo de prática na modalidade e idade cronológica, por outro lado as variáveis antropométricas apresentaram baixas correlações não significantes com os testes de fundamentos técnicos. Assim, conclui-se que o estudo permitiu uma reflexão sobre a importância dos fundamentos técnicos na formação de jovens atletas de basquetebol do sexo feminino / The purposes of this study were: 1) to describe anthropometrics characteristics variables, time of practical in basketball, chronological age, age of menarca and technical skills; 2) to verify the effect of the competitive categories on the variables anthropometrics and technical skills; 3) to calculate the correlation among technical skills, anthropometrics characteristics, time of practical in basketball and chronological age. The sample composed by 34 youth female basketball players aged 14 to 17 years old, from two competitive young categories. It was observed significant differences between the groups for tests of shooting, dribbling and passing, the test of defensive movements showed marginal significant value (p=0.05). The technical skills showed significant correlations with the variables of time in practice in basketball and chronological age. However, anthropometric variables showed low correlations with the tests of technical skills. In conclusion, our results provided the opportunity to think about basketballs technical skills in the process of development of the female young basketball players

Os objetivos do trabalho foram, com relação a jovens atletas de basquetebol do sexo feminino com idades de 14 à 17 anos de duas categorias competitivas diferentes (mirim e infanto-juvenil): 1) Descrever as características antropométricas, tempo de prática na modalidade, idade cronológica, idade de menarca e fundamentos técnicos por categoria competitiva; 2) Verificar o efeito das categorias competitivas sobre as variáveis antropométricas e fundamentos técnicos; 3) Verificar a relação entre os fundamentos técnicos e as variáveis antropométricas, tempo de prática na modalidade, idade cronológica. Em média as atletas da categoria infanto-juvenil apresentam melhores resultados que as atletas da categoria mirim na maioria das variáveis consideradas; porém só foram verificadas diferenças significativas entre os grupos nos testes de arremesso, drible e passe, o teste de movimentos defensivos apresentou valor significante marginal (p=0,05). Os fundamentos técnicos apresentaram correlações significantes com as variáveis de tempo de prática na modalidade e idade cronológica, por outro lado as variáveis antropométricas apresentaram baixas correlações não significantes com os testes de fundamentos técnicos. Assim, conclui-se que o estudo permitiu uma reflexão sobre a importância dos fundamentos técnicos na formação de jovens atletas de basquetebol do sexo feminino / The purposes of this study were: 1) to describe anthropometrics characteristics variables, time of practical in basketball, chronological age, age of menarca and technical skills; 2) to verify the effect of the competitive categories on the variables anthropometrics and technical skills; 3) to calculate the correlation among technical skills, anthropometrics characteristics, time of practical in basketball and chronological age. The sample composed by 34 youth female basketball players aged 14 to 17 years old, from two competitive young categories. It was observed significant differences between the groups for tests of shooting, dribbling and passing, the test of defensive movements showed marginal significant value (p=0.05). The technical skills showed significant correlations with the variables of time in practice in basketball and chronological age. However, anthropometric variables showed low correlations with the tests of technical skills. In conclusion, our results provided the opportunity to think about basketballs technical skills in the process of development of the female young basketball players

Piano teachers tend to approach pedagogy by treating technical studies and repertoire as separate parts of the curriculum, often using etudes by Charles-Louis Hanon, Josef Pischna, and Carl Czerny to build the student's technique. Yet, although these methods are popular, pedagogues disagree about their value. In any case, many pieces suitable for intermediate pianists integrate technique and musicality, such as Friedrich Burgmüller's 25 Etudes, Op. 100, Muzio Clementi's Preludes and Exercises, Op. 43, and Ignaz Moscheles's 24 Etudes, Op. 70. Although these exercises can indeed build technique through intermediate-level recital pieces, many similar piano works from the Russian school are rarely used, and yet they could better serve students who will eventually move on to the advanced Russian piano repertoire. This paper provides a pedagogical guide for introducing technical skills through various levels of the Russian piano repertoire. The guide focuses on technique in the context of musical expression, especially tone production, wrist motion, and finger technique, progressing systematically through elementary, intermediate, and advanced Russian piano pieces, composed in a Romantic style—both elegant and rich with melody and expression. The repertoire used as examples should develop the finger technique as well as the musicality of the student. The examples come from nineteenth-century Russian Piano School composers such as Reinhold Glière, Alexander Goedicke, Samuel Maykapar, Semyon Barmotin, and Anton Arensky.

No / The nature of Higher Education (HE) has seen many changes throughout the last decade. The agenda for widening participation in HE has led to an increase in the number of students with a broader range of educational backgrounds. At the same time there has been a surge in the development of digitalisation and the convergence of computing and telecommunications technologies available for use in education. This paper discusses the outcomes of a case study, conducted in a School of Health Studies within a northern English University, which identified the extent to which `non-traditional¿ students access on-line learning facilities, such as virtual learning environments and library networks, and what factors enhanced or formed barriers to access. `Non-traditional¿ students, for the purpose of this study, were defined as mature students who were returning to higher education after a considerable break. The outcomes indicated that skill deficit is a major obstacle for many `non-traditional¿ students. The paper explores this issue in depth and suggests potential ways forward for the delivery of technology supported learning for `non-traditional¿ students in Higher Education.