The process of transitioning a medical student from academic to practicing professional is notoriously difficult. For years we have relied on an apprenticeship model, where students must learn on the job, how to apply their considerable knowledge to practical situations. The challenge we face today is to accelerate skill development, and do our best to ensure that interns are adequately prepared for the challenges to come, while providing the highest possible standards of patient safety.
The teaching of non-technical skills (which by their nature tend to be less tangible), presents perhaps the greatest challenge for trainers in preparing learners for safe professional practice. Non-technical skills include the cognitive skills (e.g. decision making and situation awareness) and social and personal resource skills (e.g. communication, teamwork, leadership, managing stress etc.) which compliment technical skills and are necessary for safe and effective performance in a real life clinical setting.
Informed by my experience of working with the US Navy, Irish medical interns, and in the development of the virtual patient platform, Medical Exam Tutor, here are 5 fundamental principles essential for effective teaching and learning of non-technical skills.
Non-technical skills are required for safe and effective performance
Technical skills are necessary, but not sufficient for safe and effective performance. There is considerable evidence across the healthcare industry that poor non-technical skills are associated with increased risk to patients. For example, in a review of surgical cases in which there was successful litigation, carried out by the U.S. Joint Commission, 87% of the failures included a breakdown in communication- most commonly occurring between healthcare professionals as opposed to with the patient.
Non-technical skills can be taught and improved
Just like a technical skill (e.g. prescribing) is something that can be taught, the same is true of non-technical skills. Some learners may be naturally good communicators or perform well under stress. However, with effective teaching and feedback it is also possible to develop and improve non-technical skills.
The teaching of non-technical skills requires more than PowerPoint slides and lectures
Teaching non-technical skills via PowerPoint will be of limited effectiveness. Learners must practice these skills in a simulated, or real, environment in order to improve them. We do not teach someone to drive via PowerPoint. The same should be the case for non-technical skills. Hi-fi manikin simulation, standardised patients (actors), virtual patients (computer/ online based) all offer ways to simulate scenarios that learners will experience in practice, and offer a far more effective learning experience for non-technical skills.
Learners must be given the opportunity to practice non-technical skills
In order to improve non-technical skills, the learner must be given the opportunity to practice, and receive feedback on their performance. These skills will become well developed with the benefit of real world experience, but simulation is essential to ensure skills are in development before the intern even begins practicing on real patients. A multi-faceted approach is most effective since no single method allows adequate practice of the required skills. Manikin based simulation is particularly effective in providing the opportunity to practice team skills. Simulated patients allow a focus on communication skills. Virtual patient platforms like Medical Exam Tutor offer the chance to develop decision making skills, and are especially useful since they allow the learner to practice repetitively in their own time, and are far less resource intensive than other forms of simulation.
Practice what you preach
Finally, and perhaps most importantly, trainers and educators should behave in a manner that is consistent with the information they are teaching. To illustrate, there is little point in teaching the interns to speak-up if they do not think that you are willing to listen to them when they do. Cultivating an honest and open learning environment will pay dividends in an intern’s skill development, confidence, and ultimately, their competence to practice safely and effectively.
To further discuss the development of non-technical skills in medical interns, or to see how Medical Exam Tutor can become an invaluable tool in preparing Interns, contact me at firstname.lastname@example.org.