Assessing nontechnical skills in otolaryngology emergencies through simulation-based training.

Objective: Nontechnical skills (NTS) are essential to emergency crisis management. Due to the rarity of true emergencies, they are challenging to teach and assess within a competency-based curriculum. Our purpose is to evaluate the utility of the Non-Technical Skills in Surgery (NOTSS) scale in NTS assessment in simulated otolaryngology and head and neck surgery (OTO-HNS) emergencies and identify common challenges that residents encounter.

Methods: Mixed methods analysis of 15 junior OTO-HNS resident teams in four simulated emergency scenarios. Six raters rated resident NTS performance using the NOTSS score. Constructivist-grounded theory was used to analyze scenario video transcripts to identify areas of learner difficulty to guide future simulation development.

Results: Residents scored highest in situational awareness and lowest in leadership domains. Raters showed good consistency and reliability overall (Cronbach's alpha = 0.885). There was no statistical difference in ratings between surgical experts and nonexperts. Qualitative analysis demonstrated challenges with closed-loop communication and handling transitions of leadership with the scenarios.

Conclusion: Simulation-based training is an effective modality to teach NTS in crisis resource management. The NOTSS rating scale is a reliable instrument for assessing NTS in simulated OTO-HNS emergencies. Incorporating the NOTSS scale for NTS assessment within a competency-based curriculum is recommended. Level of evidence: NA. Laryngoscope, 128:2301-2306, 2018.