Training and Assessment of Non-Technical Human Factor Skills Among Anesthesiology Residents: An Exploratory Educational Quality Improvement Initiative

Abstract

Introduction. Safe anesthesia requires technical and non-technical skills to prevent adverse events. Non-technical skills training is not routinely incorporated into formal anesthesia education in the United States. This quality educational improvement initiative aimed to provide clinical anesthesia (CA) residents with non-technical skills training.

Methods. Three anesthesiologists completed virtual Anaesthetists’ Non-Technical Skills (ANTS) training in May 2023. An anesthesiologist developed two high-stress simulation scenarios. Fourteen residents were randomized into dyads for the first simulation/post-simulation survey, followed by a two-part didactic seminar on human factors based on the ANTS framework and a post-didactic survey. One hundred twenty days later, residents were re-randomized for a second simulation and another post-simulation survey. Two ANTS-trained anesthesiologists reviewed video recordings of both simulations.

Results. Cohen’s kappa demonstrated moderate agreement (κ = 0.43; 95% CI, 0.36-0.49; p <0.001) between evaluators. Wilcoxon signed-rank tests indicated improved non-technical skill use among CA1 residents, while senior residents generally performed better during the first simulation. Fisher’s exact tests showed no significant associations in resident knowledge or confidence following training.

Conclusions. Non-technical skills training may benefit residents early in CA training, while senior residents may have different learning needs. Simulation-based training appears feasible; however, formal, recurring, and consistent education may be needed to reinforce these skills throughout residency.