Development of the Team-Ents (Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills) Framework

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Aims Teamworking is crucial to team performance and has been demonstrated to improve the quality and safety of care. Non-technical Skills (NTS) are integral to teamworking and NTS frameworks have been used to support training and assessment in healthcare. The aim of this study was to develop a novel team-based NTS framework in endoscopy – TEAM-ENTS (Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills). Methods A qualitative mixed-methods study was conducted to ascertain the core NTS relevant to endoscopy teams. This was undertaken in two phases: 1) a detailed literature review of team-based NTS frameworks in the literature and, 2) an interview study of endoscopists and endoscopy nurses utilising Cognitive Task Analysis (CTA). Transcribed interviews were analysed by two researchers using framework analysis involving both joint and independent coding. A codebook of relevant skills and behaviours was created which formed the basis for the TEAM-ENTS framework. Results After screening of 1162 articles, 36 were reviewed encompassing 14 team-based NTS frameworks across the medical literature. In total, 13 semi-structured interviews were completed involving 7 endoscopists and 6 nurses. The mean number of years in role was 15.2 and mean lifetime procedure count was 9571. Following joint review, 88 codes were identified from transcribed interviews. These fell into 5 major categories: 1) Communication, 2) Planning, decision-making and problem-solving, 3) Leadership and coordination, 4) Situation awareness and 5) Teamwork, cooperation and support. A hierarchical framework was created of overarching categories, split into elements and characterised by behavioural descriptors informed by the literature review (see [ Table 1 ]). The final TEAM-ENTS framework consists of 5 categories, 17 elements and 58 behavioural descriptors. Tab. 1 COMMUNICATION Information exchange Maintaining open dialogue Patient communication Effective information exchange between team members Maintaining open lines of communication between team members Communicating with the patient (if able to do so) PLANNING, DECISION-MAKING & PROBLEM-SOLVING Preparation Joint decision-making Reviewing outcomes Preparing team members for events and actions. Ensuring everyone is ready Team members making decisions together Reviewing outcomes of decisions LEADERSHIP & COORDINATION Control and responsibility Role delegation Team adaptation Team diagnosis Maintaining control and responsibility over a situation Team members aware of roles and skill mix Adapting the team to the task or task to the team Recognising issues or limitations within the team SITUATION AWARENESS Problem recognition and focus Shared understanding Anticipating events Detection of issues, having a wider awareness of the environment and maintaining focus Ensuring the team have a shared understanding of events Identifying future problems and thinking ahead TEAMWORK, COOPERATION & SUPPORT Teambuilding and trust Cohesion Support Assertion Building the team to be a functioning unit, developing trust between team members Team members working together, valuing each other and conflict resolution Team members providing and seeking support Appropriate assertion of opinion to other team members Conclusions The TEAM-ENTS framework contains the core NTS relevant to endoscopy teams. Further work is underway to refine the tool through an online Delphi study followed by an observational validation study. Citation: Ravindran S , Cavilla R, Healey C et al. eP197 DEVELOPMENT OF THE TEAM-ENTS (TEAMWORK IN ENDOSCOPY ASSESSMENT MODULE FOR ENDOSCOPIC NON-TECHNICAL SKILLS) FRAMEWORK. Endoscopy 2021; 53: S161. Publication History Publication Date: 19 March 2021 (online) © 2021. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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