ABSTRACT

Non-technical skills (NTS) are cognitive and interpersonal skills that complement technical skills and 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, time-intensive, and checklistbased.

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 measurement of NTS. To develop an objective model of surgeons’ NTS, subjective and objective behavioral data of surgeons was collected in the operating room and prediction models were developed.

Results found that objective metrics such as team communication features and speech features can be used to predict subjective NTS. Furthermore, objective task features such as time and number of incidences during an operation can also model subjective NTS, and these task features can be predicted by the behavioral metrics. This shows the potential of removing the need for checklist-based assessment and 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 applied and expanded upon for further NTS assessment of clinical teams.