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

RationaleHow do non-technical core competencies and interprofessionalism apply to disaster environments?

Research Questions1. 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

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

Interprofessionalismin

Disaster Teams

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

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

AcknowledgementsAnneliese 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