提高外科非技术技能的干预措施：系统回顾和荟萃分析

IF 2.1 3区医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES

Journal of Surgical Education Pub Date : 2025-06-21 DOI:10.1016/j.jsurg.2025.103586

Jesse Ey BHlthMed Hons , Ellie Treloar BMedSC Hons , Victoria Kollias MBBS , Octavia Lee MBBS , Stevie Young MBBS , Suzanne Edwards GDipMedStat , Adam Wells PhD , Martin Bruening MS , Guy Maddern PhD

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引用次数: 0

摘要

目的许多手术不良事件是由于非技术技能的失败。提高非技术技能已成为外科培训机构的优先事项，但几乎没有证据来指导改进活动。本综述的目的是调查干预措施的有效性，以提高外科医生的非技术技能的整体和个别领域。采用预定义的搜索策略对Embase、Med-line（包括PubMed）和PsycINFO进行系统搜索。从数据库建立到2025年2月3日，随机对照试验（rct）、非rct和干预前后队列研究报告了在改善干预背景下外科医生非技术技能的变化。两位独立审稿人首先按标题和摘要筛选所有文章，然后按全文筛选。所有分歧都由第三位独立审查员解决。数据由2名独立审稿人根据PRISMA和MOOSE指南的预定义数据提取模板提取。任何分歧都由第三位审稿人解决。数据采用随机效应模型汇总。荟萃分析的主要结果是干预前后或对照与干预前后测量的总体非技术技能的变化。次要结果包括通过叙述性回顾探索的非技术技能领域的变化。结果共纳入2682项研究，筛选后纳入65项，包括20项随机对照试验和45项非随机对照试验。Meta分析显示，非技术技能提高与4种干预类型有统计学意义的关联：汇报/反馈练习（SMD:1.80, 95%CI: 1.18,2.41）、教练（SMD:0.82, 95%CI: 0.25,1.40）、检查表/标准化程序（SMD:0.53, 95%CI: 0.12, 0.94）和教学/研讨会（SMD:1.26, 95%CI:0.49,2.04）。通过汇报/反馈、指导和课程干预的实践表明，NTS的各个领域都有改善的趋势。结论：本荟萃分析的结果证明了几种干预类型在整体和个别领域提高手术非技术技能的有效性。这些有效的干预措施可用于指导未来在实际手术环境中的非技术技能提高活动。

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Interventions to Improve Nontechnical Skills in Surgery: A Systematic Review And Meta-Analysis

Objective

Many surgical adverse events are due to failures in nontechnical skills. Improving nontechnical skills has become a priority for surgical training organizations, yet there is little evidence to guide improvement activities. aim of this review was to investigate the effectiveness of interventions to improve surgeon nontechnical skills overall and by individual domains.

Design

A systematic search of Embase, Med-line (including PubMed), and PsycINFO were conducted using a predefined search strategy. Randomized controlled trials (RCTs), non-RCTs, and pre vs post intervention cohort studies from data-base inception to February 3, 2025, reporting change in surgeon nontechnical skills in the context of an improvement intervention were included. Two independent reviewers screened all articles first by title and abstract, then by full text. All disagreements were resolved by a third independent reviewer. Data was extracted by 2 independent reviewers in accordance with a predefined data extraction template in accordance with both PRISMA and MOOSE guidelines. Any disagreements were resolved by a third reviewer. Data was pooled using a random-effects model. Main outcome for meta-analysis was change in overall nontechnical skills measured either pre vs post intervention or control vs intervention. Secondary outcomes included change in nontechnical skill domains explored through narrative review.

Results

About 2682 studies were identified, after screening 65 were included comprised of 20 RCT's and 45 non-RCT's. Meta analysis demonstrated statistically significant association between nontechnical skill improvement and 4 intervention types: practice with debrief/feedback (SMD:1.80, 95%CI: 1.18,2.41), coaching (SMD:0.82, 95%CI: 0.25,1.40), checklists/standardized procedures (SMD:0.53, 95%CI: 0.12, 0.94), and didactic/workshop (SMD:1.26, 95%CI:0.49,2.04). Practice with debrief/feedback, coaching, and curriculum interventions demonstrated a trend towards improving individual NTS domains.

Conclusions

The results of this meta-analysis provide evidence of the effectiveness of several intervention types to improve surgical nontechnical skill both overall and by individual domain. These effective interventions can be used to guide future non- technical skill improvement activities in real-world surgical settings.

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来源期刊

Journal of Surgical Education EDUCATION, SCIENTIFIC DISCIPLINES-SURGERY

CiteScore

5.60

自引率

10.30%

发文量

261

审稿时长

48 days

期刊介绍： The Journal of Surgical Education (JSE) is dedicated to advancing the field of surgical education through original research. The journal publishes research articles in all surgical disciplines on topics relative to the education of surgical students, residents, and fellows, as well as practicing surgeons. Our readers look to JSE for timely, innovative research findings from the international surgical education community. As the official journal of the Association of Program Directors in Surgery (APDS), JSE publishes the proceedings of the annual APDS meeting held during Surgery Education Week.