title: Structured Training to Improve Nontechnical Performance of Junior Surgical Residents in the Operating Room: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The objective of the study was to evaluate the effectiveness of structured training on junior trainees' nontechnical performance in an operating room (OR) environment.
  
  
  BACKGROUND
  Nontechnical skills (NTS) have been identified as critical competencies of surgeons in the OR, and regulatory bodies have mandated their integration in postgraduate surgical curricula. Strong evidence supporting the effectiveness of curricular NTS training, however, is lacking.
  
  
  METHODS
  Junior surgical residents were randomized to receive either conventional residency training or additional NTS training in a 2-month curriculum. Learning was assessed through a knowledge quiz and an attitudes survey. Nontechnical performance was evaluated by blinded assessment of standardized OR crisis simulations at baseline (BL) and posttraining (PT) using the Nontechnical Skills for Surgeons (NOTSS) and Objective Structured Assessment of Nontechnical Skills (OSANTS) rating systems. Results are reported as median (interquartile ranges).
  
  
  RESULTS
  Of 23 participants, 22 completed BL and PT assessments. Groups were equal at BL. At PT, curriculum-trained residents (n = 11) scored higher than conventionally trained residents (n = 11) in knowledge [12 (11-13) vs 8 (6-10), P < 0.001] and attitudes [4.58 (4.37-4.73) vs 4.20 (4.00-4.50), P = 0.008] about NTS. In a simulated OR, nontechnical performance of curriculum-trained residents improved significantly from BL to PT [NOTSS: 10 (7-11) vs 13 (10-15), P = 0.012; OSANTS: 23 (17-28) vs 31 (25-33), P = 0.012] whereas conventionally trained residents did not improve [NOTSS: 10 (10-13) vs 11 (9-14), P = 1.00; OSANTS: 26 (24-32) vs 24 (23-32), P = 0.713].
  
  
  CONCLUSIONS
  The results demonstrate the effectiveness of structured curricular training in improving nontechnical performance in the first year of surgical residency, supporting routine implementation of nontechnical components in postgraduate surgical curricula.
authors.affiliation: From the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Dedy
authors.forename: Esther M
authors.initials: EM
authors.lastname: Bonrath
authors.forename: Najma
authors.initials: N
authors.lastname: Ahmed
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009873:Operating Rooms; D016037:Single-Blind Method