Non-technical competencies for
surgeons in disaster response: a
qualitative study
Anneliese Willems
Bruce Waxman
Andrew Ba...
Data Collection & Analysis
 Semi-structured interviews (n=20)
 45mins-2hrs duration
 Face-to-face or telephone intervie...
Results - Effective Teamwork
 Learning to work with unfamiliar professionals
 ‘I’ve never really worked with paramedics…...
Summary
 16 non-technical attributes
for surgeons in disaster
response identified in this
research
 Interprofessionalism...
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Non technical core competencies for surgeons in disaster response- the need for a training program- Waxman

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Non technical core competencies for surgeons in disaster response- the need for a training program- Waxman

  1. 1. Non-technical competencies for surgeons in disaster response: a qualitative study Anneliese Willems Bruce Waxman Andrew Bacon Simon Kitto Department of Surgery Outline 1. Rationale 2. Research Questions 3. Qualitative Design 4. Research Outcomes 5. Implications for IPE 6. Summary 7. Questions Rationale  Natural disasters are increasing in frequency  Prompting calls for rigorous research in Disaster Medicine  Health professionals need to be equipped with appropriate skills  Non-technical competencies and interprofessionalism associated with best-practice in mainstream surgery Rationale How do non-technical core competencies and interprofessionalism apply to disaster environments? Research Questions 1. What are the perceptions of health professionals of the required non-technical core competencies of Australian surgeons in disaster response? 2. What are the facilitators of effective interprofessional practice in disaster response? 3. What elements should be addressed in training surgeons to work in disaster response? Qualitative Design and Sampling  Thematic Content Analysis  Including matrix analysis  Purposeful sampling strategy comprising:  Snowball sampling  Maximum variation sampling  Inclusion Criteria:  Australian health professionals with disaster response/education experience
  2. 2. Data Collection & Analysis  Semi-structured interviews (n=20)  45mins-2hrs duration  Face-to-face or telephone interviews  Digitally recorded and transcribed  Themes explored were disaster experiences, perceptions on non-technical skills for surgeons, effective team structures and potential training strategies Data Collection & Analysis  Qualitative Analysis  Field notes  Coding  Memos  Matrix analysis – Conceptual Clustered Matrices Health Professions Interviewed • Surgeons (6) • Physicians (6) • Nurses & Paramedics (5) • Public Health Specialists (3) Results (1) Newly identified non-technical attributes for Australian surgeons in disaster response Results (1) Newly identified non-technical attributes for Australian surgeons in disaster response Cognitive Strategies • ‘Big Picture’ thinking • Situational Awareness • Critical Thinking • Problem Solving • Creativity Results (1) Newly identified non-technical attributes for Australian surgeons in disaster response Austere Environment Skills • Physical Self- Care/Survival Skills • Psychological Self- Care • Flexibility • Adaptability • Innovation • Improvisation Results (2). Interprofessional Practice was identified as important in Disaster Teams Interprofessionalism in Disaster Teams
  3. 3. Results - Effective Teamwork  Learning to work with unfamiliar professionals  ‘I’ve never really worked with paramedics…and our firemen that came as well, I’d never really worked alongside them either‘  Blurred personal and professional boundaries  ‘You are going to live with them, you are going to sleep and eat with them’  Permissive environment essential  ‘You have to allow a permissive environment where people feel free to say look I don’t think this is right, or that is not right, should we do this….’  Mutual respect between professions  ‘Respect for each other and acknowledgement of each other’s skills that are brought to the environment are very important.’ Results - Good Leadership  Leadership should be designated based on the situation and personal experience  ‘People who are used to being bosses need to become [team players] on occasions’  Not necessarily a surgeon or doctor  Psychological leadership  ‘responsible for setting the tone for all the other team member’s interactions….responsible for role modelling being calm’  Appropriate leadership styles vary  Authoritarian, Participative, Transformational, Transactional Results - Professional Role Adjustment  Procedural and status changes to roles  ‘Role extension’  ‘Complete change of professional role’  ‘Inclusion of less glamorous tasks’  Precipitant to role changes was a chaotic, fluctuating and austere environment  Emphasis for professionals to work within their capabilities to promote safe practice Results - Conflict Resolution  Most frequent causes were ‘individual factors’ and ‘resource allocation’  ‘We found out we had four suture kits, I mean they were literally in a zip lock bag and I had trouble containing myself at that point’  Conflict resolution methods  'Negotiation and discussion’  ‘Removing or relocating individuals’  ‘Humour’ Results (3)- Training Surgeons for Disaster Response  Perceived Need:  Training surgeons in non-technical core competencies for disaster response recommended  Multi-disciplinary format with a focus on interprofessional interactions  Form:  Introductory elements in the RACS competency curriculum  Full training could be incorporated into existent disaster programmes (e.g. EMST, DCST)  Educational Styles:  Lectures, simulations/exercises, group work, tabletop exercises, mentoring and ‘expectations training’ Results (4) Implications for Interprofessional education (IPE)  IPE is essential in disaster education  Understanding of other professions and potential role adjustment  Exploration of non-traditional leaders and leadership styles  Understanding of appropriate conflict management methods in an austere environment  Effective training strategies include simulation training
  4. 4. Summary  16 non-technical attributes for surgeons in disaster response identified in this research  Interprofessionalism identified as a facilitator of team best practice in disaster environments  Surgeons’ disaster training should potentially incorporate non-technical core competencies and an interprofessional focus Recommendation RACS/ADF develop a multidisciplinary Disaster Response Course incorporating  non-technical attributes for a surgeon  components of interprofessional education  multiple educational styles and simulation Acknowledgements Anneliese Willems BMed Science Monash University Andrew Bacon Anaesthetist and Displan Medical Coordinator Victoria Simon Kitto Postdoctoral Fellow, Qualitative Research Department of Surgery, Monash University Bruce Waxman Director, Academic Surgical Unit Monash University, Southern Health RAAF Specialist Reserve

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