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An investigation into the most effective approaches for teaching non-technical skills to Medical students at the undergraduate level: An exploration of the role of simulation-based education

Riaz, Salman (2022) An investigation into the most effective approaches for teaching non-technical skills to Medical students at the undergraduate level: An exploration of the role of simulation-based education. Doctoral thesis, Staffordshire University.

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Abstract or description

Teaching and assessment of non-technical skills is a developing area in healthcare, as they enhance technical skills and are inevitable for the provision of safe healthcare services. This topic became of crucial importance because being deficient in non-technical skills can lead to compromised patient safety. While the non-technical skills can be best acquired through practice, most medical schools focus on training for technical skills to target the errors that occur due to a lack of clinical knowledge and skills. A paucity of evidence was found in the literature to address the issues regarding the training of non-technical skills and incorporating it into the undergraduate medical curriculum. Despite the reinforcements of teaching non-technical skills, the question remained unanswered that from which year should these skills be taught.

This research aimed to explore the understanding level of clinical year medical students about non-technical skills and how non-technical skills can be taught effectively at the undergraduate level by using simulation or other teaching methods. To fulfil this aim, three studies were conducted to address the following four objectives: (1) to explore the clinical year medical students’ understanding of non-technical skills and their attitudes towards learning these skills, (2) to explore teachers’ perspectives and understanding of the level of non-technical skills’ understanding in clinical year medical students and their attitudes towards practicing these skills, (3) to explore the undergraduate level or year at which each non-technical skill should be taught to students for them to achieve competence in these skills and (4) to explore teachers’ perceptions on the most effective teaching methods to train the students for non-technical skills.

The ontological assumption for this research was that reality is constructed socially, and a single observable reality does not exist. As this research is related to the field of medical education, which examines diverse and complex issues, these ontological assumptions were deemed most suitable as they allow for exploring and informing change and complexity in contextual dependent issues. Therefore, the appropriate epistemological assumption for the research was subjective which implies to use the constructivism research paradigm. Constructivism is a belief that knowledge is socially constructed instead of being discovered from the world and objects present in that world. Based on constructivism, the suitable methodology to conduct this research was the qualitative approach as it let the researcher understand the relational, social, and experiential phenomena in natural settings.

The data collection for this research was conducted at the Arabian Gulf University, Bahrain. Data was collected from clinical year medical students (n=35) in Study-1and medical teachers in Study-2 (n=20) and Study-3 (n=30) through semi-structured interviews and focus group discussions. Typical case sampling was used to select students and critical case sampling to select teachers. For data collection, interview schedules and questions were prepared after an extensive literature review. All the interviews and focus group discussions were audio-recorded and then transcribed verbatim. Data was analysed through deductive thematic analysis and using the six-phased model of Braun and Clarke (2006). For Study 1 and 2, a cross-thematic analysis was also conducted using the Cochran-Q test (P<0.05) to further understand the association and meaningful differences in responses. For Study-3, data from interviews and focus groups was triangulated with the purpose of confirmation or completeness of responses.

It was evident from the responses of both students and teachers that most of the undergraduate medical students in their clinical year do not possess an understanding of non-technical skills. Among the students, very few showed to have some understanding at a very basic level which was considered insufficient to prepare them for safe healthcare practice and patient safety. For non-technical skills training, teachers’ consensus was indicative of training students for communication, teamwork, leadership, and situation awareness from pre-clinical years and for decision-making and stress/fatigue management from clinical years. Simulation-based education was considered the most effective training method by teachers among other methods like didactic sessions, case-based discussions, video-assisted learning, and reflection exercises after the ward rounds. Integrating non-technical skills and technical skills, focusing on fewer learning outcomes, and ending the session with effective debriefing were considered important for designing effective simulation sessions.

The findings of this research indicated that designing simulation-based education using a spiral curriculum, where students revisit the material at increasing levels of complexity as they progress through the course, would be most appropriate to achieve the desired learning outcomes of non-technical skills. Complying with the spiral curriculum provision, training scheduled through all academic years can be suggested, by gradually teaching non-technical skills and increasing students’ proficiency and competence through further intricate exercises in later years.

Item Type: Thesis (Doctoral)
Faculty: School of Health and Social Care > Allied Health and Paramedic Science
Depositing User: Library STORE team
Date Deposited: 23 Sep 2022 14:37
Last Modified: 29 Sep 2022 10:34

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