Director, Medical Education and Training Training in Professional Skills (TIPS): Outcomes of a Non Technical Skills (NTS) course for Surgical Education and Training (SET) trainees A/Prof Robert O’Brien Director, Medical Education and Training

ACKNOWLEDGEMENTS Mr Adrian Anthony 2 Prof Debra Nestel3 Mr David Birks 2 Mr Phil Moreau 2 MrPhil Truskett 2 Julian van Dijk 1 Prof John Cartmill 2 1 St Vincent's Hospital, 2 Royal Australasian College of Surgeons 3 Monash University, 4 Southern Simulation Centre Prof Debra Nestel3 A/Prof Brendan Flanagan 4 ADMINISTRATION Ellen Webber2 Jess Murphy2 Oana Cochrane2

AIM OF TIPS Utilise a range of education methods, including simulation, to provide opportunities for SET trainees to increase their understanding of the importance of Non Technical Skills (NTS) in contributing to patient safety and good professional practice.

WHY?

What are professional / non technical skills Cognitive functioning and observable behaviors that underpin safe ad effective clinical practice. They include without being limited to: Communication Leadership Teamwork Situational awareness and decision making Resource management Safe practice, adverse event minimization / mitigation professionalism

One of the challenges of surgical training has been to ensure that trainees are cognisant of the core non-technical skills and are exposed to the opportunity to develop their expertise in these skills.   The TIPS course is designed to explore six of the nine core competencies: Professionalism Scholar / Teacher Management and leadership Collaboration Communication Judgement - Clinical decision making

A range of interactive lectures, facilitated discussions, small group activities, and simulation scenarios involving simulated patients are used to build on the knowledge and skills throughout the course. Faculty are from a range of backgrounds including consultant surgeons, physicians and medical educators at a ratio of 2:1 participants to instructors. TIPS was conducted as a pilot on four occasions before being launched and is currently conducted four times per year with 12 participants per course

Course Day 1 Day 2 Course Objectives Understand the importance of professional skills in surgical practice Recognise what constitutes professional skills Develop competencies relating to professional skills Day 1 Define patient centred communication Discuss informed consent and open disclosure as examples of patient centred communication Identify effective techniques in patient centred communication Consider strategies for difficult communication settings Day 2 Develop an understanding of what a team is and how it operates Discuss how teams communicate identify effective techniques for conflict resolution and negotiation define and describe the key elements of situational awareness

How are these being taught? Error Disclosure Immersive Simulation Simulated patients Error disclosure Family meeting – end of life Informed consent Communicating while operating Situational awareness Games / puzzles Link to the Clinical Environment via debrief

Trainee Perceptions Learning Objectives Day 1 Recognise the importance of structure in consultations Describe skills for effective explaining Outline responsibilities in obtaining informed consent Discuss benefits and challenges associated with obtaining informed consent including explaining risk Outline responsibilities associated with communicating with conscious patients while operating Discuss benefits and challenges associated with team communication while operating Outline responsibilities during error disclosure Identify skills for sensitive and difficult communications Practice and reflect on skills used in the above contexts

Major Learning Points 110 comments listed Strategies for dealing with emotions ISBAR – communication framework Graded assertiveness and use of CUSS Communication styles Open disclosure – saying sorry Patient Centred Communication

Educational Methods Introduction Ice breaker – role play Presentation: Patient-centred communication Scenario on informed consent including feedback and discussion Scenario on communicating while operating including feedback and discussion Scenario on error disclosure including feedback and discussion Scenario on end of life, family meeting including feedback and discussion Large group discussion Written materials (inc. pre-reading)

Error Disclosure - SP Simulated patients Simulation Debrief

Operating while communicating

Trainee Perceptions Learning Objectives Day 2 Recognise the importance of structure in consultations Describe skills for effective explaining Outline responsibilities in obtaining informed consent Discuss benefits and challenges associated with obtaining informed consent including explaining risk Outline responsibilities associated with communicating with conscious patients while operating Discuss benefits and challenges associated with team communication while operating Outline responsibilities during error disclosure Identify skills for sensitive and difficult communications Practice and reflect on skills used in the above contexts

Trainee Perceptions Learning Objectives Day 2 Discuss the importance of effective teamwork in surgical practice Describe teamwork skills relevant to surgical practice including leadership and role delegation Discuss the benefits of effective team oriented communication skills, including debriefing, graded assertiveness and task focused communication Describe a standardised approach for communicating patient information via the telephone Practice and reflect on skills used in the above contexts

Major Learning Points 109 comments made by participants Graded assertiveness CUSS ISBAR Importance of situational awareness Fixation error HALT

Educational Methods Introduction Teamwork activity and presentation Communicating in teams presentation Communication activity – block game Conflict resolution presentation Scenario on resuscitation including feedback and discussion Scenario on conflict resolution including feedback and discussion Scenario using lego including feedback and discussion Situational awareness presentation Introduction to simulation Immersive clinical scenario and debrief Just a routine operation summary/wrap-up

Learning Points ISBAR Strategies for difficult communications Previewing / bow shots Structured communication Patient V disease Graded Assertiveness Working in teams and the impact of leadership

? Activity: white board responses to the last point: Lets map out what’s achievable

Training in Professional Skills (TIPS): Outcomes of a Non Technical Skills (NTS) course for Surgical Education and Training (SET) trainees A/Prof Robert O’Brien robert.obrien@svhm.org.au ph:0419 597 245