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Nontechnical Skills
The learning model can incorporate nontechnical skills, which are often harder to
teach and even harder to assess. Since the technical aspect of the learning often
comes first, teaching and evaluation of nontechnical skills assume some level of
independence. Evaluation and teaching of nontechnical skills are best suited for
more senior residents. However, the learning environment can encourage observa-
tion and identification of nontechnical skills for junior residents especially in an
active learning environment, which points out these essential skills. Examples of
nontechnical skills include:
- Forward planning: the ability to anticipate needs and think ahead to set up the
operative field in an optimum fashion [ 47 ] - Self-direction: refers to the demeanor of the trainee
- Professional conduct
- Staying focused
- Slow down when appropriate
Expert surgeons are able to slow down and transition from fast and rote tasks
toward more focused and analytic behavior [ 48 ]. Fatigue, distractions, lack of
experience, failing to recognize critical information, overconfidence, and favor-
ing speed can compromise this ability: - Accept and respond to feedback
- Recognizes when to seek help/advice
- Judgment and patient safety: the ability to recognize and solve problems and to
avoid and recover from errors and unexpected events [ 49 ] - Assess and interpret cues and provide team leadership: best practice, resource
usage, and time management
The assessment of these abilities can be made by direct observations in the oper-
ating room or also in simulation exercises. These skills incorporate into a learning
model, which encourages the resident to articulate the steps of the case in a needs
assessment exercise and also during the operation. Facilitating steps can be taken.
For example, attendings should also allow pauses so the resident is prompted to
think of the next step. Often as residents are completing a part of the case, the
attending physician is preparing for the next step.
The attending can also prompt the forward progress by asking “what should you
be thinking of next as you finish...?” or “what if you were not able to identify the
ureter as the peritoneum is incised...?” By allowing responding to prompts, the resi-
dent can demonstrate critical slowing down. Additionally, the attending can discern
lack of confidence or tameness from a fundamental knowledge gap or lack of
experience.
Response to feedback is very insightful for all level of learners. This has been
covered in the earlier section of the chapter. Feedback needs to be constructive from
the teacher. The acceptance of feedback shows a willingness to improve and also
regard for the teacher, which helps in the “sizing up” and helps the teacher be more
committed to the learning environment.
M. Mirza and J.F. Koenig