Objective Measurement of Non-Technical Skills in Surgery

Non-technical skills (NTS) are cognitive and interpersonal skills that are relevant to task completion such as situation awareness, decision-making, teamwork, and leadership. NTS in clinical environments, such as surgery, have been identified to contribute to patient safety and team performance, which in turn affects clinical outcomes. Assessment tools of these skills in surgery exist; however, current evaluations are limited in that they require trained raters, are subjective, are time-intensive, and are checklist-based. Therefore, there is a need for objective measurement of NTS that addresses the limitations of the rating-based techniques. The purpose of this Ph.D. dissertation work is to identify physiological and behavioral metrics that measure NTS objectively and investigate the application of objective metrics to measure intraoperative NTS of surgeons. Through a scoping review of engineering, behavioral science, and medical literature, behavioral and physiological metrics that quantified NTS constructs of surgeons were identified. The synthesized literature was used to build a framework integrating objective metrics to NTS constructs. To develop an objective model of surgeons’ NTS, subjective and objective behavioral data of surgeons were collected in the operating room and prediction models were created. Results found that objective metrics such as communication, speech, and proximity features can be used to predict subjective NTS. Furthermore, objective task features (e.g., time and number of incidents during an operation) has the potential to also model subjective NTS, and these task features can be predicted by the behavioral metrics; thus, triangulation is obtained with the three NTS metrics: subjective score, objective behavioral metrics, and task performance metrics. The relationship between the two objective metrics shows the possibility of achieving a fully objective model of surgeons’ NTS. The consolidation of current objective measurement techniques can provide a foundation in further understanding NTS beyond assessments based on observed behaviors, and the developed models can be expanded and implemented for real-time NTS assessment of clinical teams to improve patient care.