Using training course as an educational intervention to improve nontechnical performance of obstetrics & gynecology residents in the operating room

Date of Award


Document Type


Degree Name

Master of Health Professions Education (MPHE)


Educational Development


Non-technical skills have been identified as critical competencies of surgeons in the oeration room. With increasing recognition of importance of nontechnical skills the p relatory bodies have mandated theses competencies to be incorporated in the curriculum of gu residents. However, a clear recommendation on how these non-technical skills competencies should be incorporated is still missing. Objective The objective of the study was to evaluate the effectiveness of training course on improving residents' nontechnical skill performance in the operating room. Methods The study was conducted by using a mixed-method research approach. The quantitative, phase, employs the single blinded randomized controlled trial using pretest and posttest method followed by qualitative phase in the form of focus group discussion. 28 eligible Obstetric and Gynecology residents were divided into two groups by using blocked randomization into conventional training and experimental training group. The experimental group received a five-week training course as an intervention. Non technical skillperformance was assessed by a blinded assessor in operation room by using NOTSS rating system while performing two procedures evacuation and Curettage and elective cesarean section at pre test and post test time. IBM SPSS statistic version 17 was used for statistical analysis. All the data sets were assessed for normality of the distribution by the Shaprio-Wilk test, which showed deviation from normal distribution. Therefore, nonparametric statistics were used to compare the scores of conventional and experimental IV groups in pretest and post-test phase. Descriptive statistics were presented as median (IQR). Wilcoxon- sign rank test was used to calculate p values. A p-value of < 0.05 was considered as significant. Cohen's formula was used for the mean difference in change scores. This was followed by a focus group discussion to see the perceived usefulness of the course. Result of focus group discussion was analyzed and themes were extracted. Results 28 participants randomized with 14 each in conventional and experimental training group completed the pre test and posttest. In pretest the scores of the conventional training group were higher as compared to the participants of experimental training group both for elective cesarean section (8.5 & 8 with p values of 0.361) and for evacuation and curettage (9 &8.75 with p-value of 0.779). In posttest the results of the experimental training group improved significantly than the conventional training group for elective cesarean section (8.5 & 10 with p-value of 0.003) and for evacuation and curettage (8.75 & 10.5 with p value of 0.006). The results of focus group discussion showed that the participants found the course useful and relevant to their practices and strongly recommended the course in early years of training. Conclusion The results demonstrate the effectiveness of a training course on non-technical skills as an intervention in improving nontechnical performance of Obstetrics and Gynecology residents, supporting implementation of nontechnical training in postgraduate competency based curricula.

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