Resident performance of nontechnical skills in level 1 traumas

Forty-six percent of fatal medical errors can be attributed to nontechnical skills (NTS), and surgical residency programs are increasingly emphasizing the role of NTS in residency training. The goal of our study was to evaluate the resident performance of nontechnical skills in level 1 traumas using the trauma nontechnical skills (T-NOTECH) assessment tool.

A retrospective video review of all level 1 traumas at a large academic hospital was performed from 09/01/2020 to 02/01/2021. Each trauma was independently assessed by two reviewers using T-NOTECH scoring.

A total of 74 level 1 trauma videos were included for review; 81% of the traumas were led by a resident (n = 14) with 19% led by an attending surgeon (n = 5). The intraclass correlation coefficient between the reviewers was 0.81. Residents performed best at situational awareness and coping with stress (4.6) and scored lowest on communication and interaction (3.9). There were no significant differences in any T-NOTECH categories based on subset analysis by PGY level 3–5, gender, or subspecialty interest. Attendings scored significantly higher in all categories compared to residents (p > 0.05). There was a significant negative correlation with T-NOTECH score and time of completion of the primary examination and FAST examination (p = 0.01 and 0.04, respectively). T-NOTECH scores were significantly lower in patients with a death in the first 30 days (19.6 vs. 21.5, p < 0.04).

Although outperformed by attendings in all categories, residents performed best at situational awareness and coping with stress and worst on communication and interactions. Higher T-NOTECH scores correlated with improved process measures and decreased 30-day mortality.