J. W. Scott1,4, G. Ntakiyiruta3, Z. Mutabazi3, D. S. Smink1,2, R. Riviello1,4, S. Yule1,2 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Brigham And Women’s Hospital,STRATUS Center For Medical Simulation,Boston, MA, USA 3Kigali Univerity Teaching Hospital,Academic Department Of Surgery, University Of Rwanda,Kigali, KIGALI, Rwanda 4Harvard Medical School,Program For Global Surgery & Social Change,Boston, MA, USA
Introduction:
Non-technical skills (NTS) have been identified as critical to high-quality surgical performance in high-income countries (HICs), but the role of NTS for surgeons in low- and middle-income countries (LMICs) has not been evaluated. Specifically, little is known about the NTS used by providers in LMICs or how to adapt existing NTS educational tools to the LMIC context. The aim of this study was to characterize the attitudes of Rwandan surgical care providers on existing and modified NTS curricula.
Method:
We conducted 35 interviews with Rwandan surgeons, anesthetists, and nurses and observed >50 hours in Rwandan operating rooms (ORs). We used these data to adapt the existing Non-Technical Skills for Surgeons (NOTSS) curriculum for the Rwandan context. These findings were presented to 30 Rwandan clinicians and trainees at a one-day NOTSS masterclass at the Kigali University Teaching Hospital. The masterclass utilized simulated OR videos from HICs to reinforce learning of NTS. We then surveyed participants regarding their impressions of the NOTSS skill categories (situation awareness, decision making, teamwork/communication, leadership), the 4 newly identified contextual factors, and applicability of a NOTSS-like course to the Rwandan surgical context. Clinicians’ attitudes regarding the accuracy, contextual applicability, and preferred use of a NTS curriculum in Rwanda were assessed using questionnaires with a 4-point Likert scale.
Results:
Survey completion rate was 83% (25/30). Participants found the existing NOTSS skill categories highly consistent with their experience (agreement ranged from 87% for situation awareness to 100% for teamwork and communication). The existing NOTSS videos, however, were less representative with only 20% of respondents reporting strong clinical similarity to their context and 32% reporting little or no similarity to their context. 92% of respondents would prefer videos filmed in Rwanda with more applicable clinical scenarios. Regarding the 4 contextual factors identified through interviews and observations, participants identified ‘multi-lingual communication skills’ (96% agree) and ‘dynamically changing provider roles’ (94% agree) as the two most consistent with their daily experience—though 83% reported both ‘resource variability’ and ‘diminished capacity for rescue’ were also consistent. Nearly all (96%) participants would like a variant of NOTSS to be taught in Rwanda, and the vast majority (76%) prefer a context-specific curriculum.
Conclusion:
Rwandan clinicians in a NTS masterclass report that a NOTSS-like curriculum is applicable and should be used; but such a curriculum should be context-specific, integrating unique aspects of the LMIC context and relevant clinical scenarios. These findings should be used to adapt NOTSS to LMIC contexts and tested for usability, reliability, and effectiveness in improving surgeons’ NTS throughout the world.