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Nontechnical Competency Framework for Health Professionals in All-Hazard Emergency Environment: A Systematic Review

Published online by Cambridge University Press:  07 February 2020

Xuejun Hu ,
Changnan He ,
Huoliang Chen ,
Shu Liu ,
Wenqiang Li ,
Zhou Lu ,
Jieqiong Zhang  and
Min Yu
Xuejun Hu
Affiliation:
Department of Health Services Administration, Air Force Medical University, Xi’an, China
Changnan He
Affiliation:
Fangshan Liangxiang Hospital, Beijing, China
Huoliang Chen
Affiliation:
Department of Health Services Administration, Air Force Medical University, Xi’an, China
Shu Liu
Affiliation:
Department of Health Services Administration, Academy of Military Medical Sciences, Beijing, China
Wenqiang Li
Affiliation:
Department of Health Services Administration, Academy of Military Medical Sciences, Beijing, China
Zhou Lu
Affiliation:
Department of Health Services Administration, Air Force Medical University, Xi’an, China
Jieqiong Zhang
Affiliation:
Department of Health Services Administration, Air Force Medical University, Xi’an, China
Min Yu*
Affiliation:
Department of Health Services Administration, Academy of Military Medical Sciences, Beijing, China
*
Correspondence and reprint requests to Min Yu, No. 27 Taiping Road, Beijing, China 100850 (e-mail: yumin@bmi.ac.cn).
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Abstract

Objectives:

To summarize characteristics and commonalities of non-technical competency frameworks for health professionals in emergency and disaster.

Methods:

An electronic literature search was conducted in PubMed, MEDLINE, ERIC, Scopus, Cochrane database, and Google Scholar to identify original English-language articles related to development, evaluation or application of the nontechnical competency frameworks. Reviewers assessed identified articles for exclusion/inclusion criteria and abstracted data on study design, framework characteristics, and reliability/validity evidence.

Results:

Of the 9627 abstracts screened, 65 frameworks were identified from 94 studies that were eligible for result extraction. Sixty (63.8%) studies concentrated on clinical settings. Common scenarios of the studies were acute critical events in hospitals (44;46.8%) and nonspecified disasters (39;41.5%). Most of the participants (76; 80.9%) were clinical practitioners, and participants in 36 (38.3%) studies were multispecialty. Thirty-three (50.8%) and 42 (64.6%) frameworks had not reported evidence on reliability and validity, respectively. Fourteen of the most commonly involved domains were identified from the frameworks.

Conclusions:

Nontechnical competency frameworks applied to multidisciplinary emergency health professionals are heterogeneous in construct and application. A fundamental framework with standardized terminology for the articulation of competency should be developed and validated so as to be accepted and adapted universally by health professionals in all-hazard emergency environment.

Keywords

disaster medicinehealth emergencynontechnical competency

Information

Type
Systematic Review
Information
Disaster Medicine and Public Health Preparedness , Volume 15 , Issue 2 , April 2021 , pp. 255 - 265
Copyright
Copyright © 2020 Society for Disaster Medicine and Public Health, Inc.

Although there are numerous, varied, and inconsistent definitions of the term “competency” throughout the literature, it usually refers to a kind of skill, capacity, ability, and knowledge as well as their combinations. Reference Daily, Padjen and Birnbaum1,Reference Crowe, Wagoner and Rodriguez2 Nontechnical competency are the cognitive, social, and personal resource skills that complement technical skills. Reference Jirativanont, Raksamani and Aroonpruksakul3,Reference Flowerdew, Gaunt and Spedding4 Examples include leadership, communication, team interaction processes, and decision-making.

Nontechnical competency is important for emergency health professionals performing urgent and critical tasks under complex, high-risk, time-pressured, dynamic conditions, Reference Daily, Padjen and Birnbaum1,Reference Rosenman, Ilgen and Shandro5-Reference Ellis, Bell and Ployhart7 including in-facility emergency situations (eg, emergency department, Reference Porter, Cant and Cooper8-Reference Munroe, Curtis and Murphy10 intensive care unit [ICU], Reference Zhuravsky11-Reference Kim, Neilipovitz and Cardinal14 , operating room Reference Dedy, Bonrath and Ahmed15-Reference Jankouskas, Haidet and Hupcey17 ) and out-of-facility incident responses (prehospital emergency medical services, Reference Crowe, Wagoner and Rodriguez2 medical evacuation, Reference Jernigan, Wallace and Novak18,Reference Myers, Powell and Psirides19 and on-site rescue, Reference Peller, Schwartz and Kitto20-Reference Cox and Danford22 as well as public health emergency Reference Klein, Ziegert and Knight6 ). With respect to the disciplines and professions, it has been emphasized for physicians, Reference Dent, Weiland and Paltridge27-Reference Schultz, Koenig and Whiteside29 surgeons, Reference Willems, Waxman and Bacon30-Reference Doumouras, Hamidi and Lung32 nurses, Reference Schultz, Koenig and Whiteside29,Reference Mosca, Sweeney and Hazy33,Reference Gordon, Jorm and Shulruf34 anaethetists, Reference Doumouras, Hamidi and Lung32,Reference Yee, Naik and Joo35 public health workers, Reference Tachibanai, Takemura and Sone24,Reference Cope, Frost and Richun26,36 response administration staff, Reference King, North and Larkin37,Reference King, Larkin and Fowler38 and so on.

A common fundamental competency framework would benefit the ongoing standardization process in education, certification, and accreditation in the field of emergency health. Such nontechnical framework must first consider the wide audience because education and training programs for emergency health professionals should be multidisciplinary and transdisciplinary. Reference Ripoll, Djalali and Foletti39

Numerous studies have tried to figure out the construct and structure of task-related or profession-specific nontechnical competency for health workers, Reference Ripoll, Djalali and Foletti39-Reference Mete and Brannick42 which could provide a better understanding of the nontechnical competency but also establish guidance for the education and training programs. Previous reviews are also available on the competences related to disaster health-care providers Reference Daily, Padjen and Birnbaum1 and health-care action teams Reference Rosenman, Ilgen and Shandro5 ; however, they failed to focus nontechnical competency, Reference Daily, Padjen and Birnbaum1,Reference Rimstad and Braut43,Reference Weller, Shulruf and Torrie44 and partially targeted a specific profession or setting. Reference Rosenman, Ilgen and Shandro5,Reference Chalwin and Flabouris40-Reference Mete and Brannick42,Reference Flowerdew, Brown and Vincent45-Reference Rehim, DeMoor and Olmsted47

Despite the crucial link between nontechnical competency and performance of emergency health professionals, the general fundamental components of nontechnical competencies applied to all professions working in emergency remains poorly understood. To address this gap, a systematic review was undertaken to summarize the characteristics of nontechnical competency frameworks designed to various health professionals in all-hazard emergency environment. By examining the domains of nontechnical competency frameworks, the framework structure and application, this review focuses on 2 research questions: (1) what are the common nontechnical competencies of the health professionals in all-hazard emergency environment? (2) How are these nontechnical competencies developed, structured, and applied?

METHODS

The present review was conducted in adherence with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards for systematic review. Reference Rosenman, Ilgen and Shandro5,Reference Liberati, Altman and Tetzlaff48

Data Sources

Relevant English-language studies were systematically searched in the following databases from inception through March 2018: PubMed, MEDLINE, ERIC, Scopus, Cochrane and Google Scholar. The search was carried out using a combination of keywords unique to each database (detailed in Appendix 1, which is available in the Supplementary Material). The major keywords were divided into 4 groups: nontechnical/ social/ cognitive, emergency/ disaster/ crisis/ incident, health/ medicine and competency/ skill/ ability/ knowledge. Finally, reference lists of all included articles were also searched.

FIGURE 1

Selection Process Used in A Systematic Review of Non-Technical Competency Frameworks for Health Professionals in All-Hazard Emergency Environment Published through March 2018.

Study Selection

Papers were included if they described nontechnical, social or cognitive competency frameworks, abilities, knowledge, skills, or attitudes for disaster medical team leaders. Papers were excluded that described competency frameworks: (1) limited to clinical skills, (2) not dealing with disasters or emergency environment; (3) not specific to health professionals; (4) case studies; (4) without a full-text available, such as abstracts and citations; and (5) that were not available in English. No publication date or status restrictions were imposed (see Figure 1 and Table 1).

TABLE 1

Inclusion and Exclusion Criterion for Studies

The initial search identified 9627 unique records. Eligibility assessment was performed independently by 2 reviewers (Xuejun Hu & Changnan He) and disagreements between reviewers were resolved by consensus.

Data Abstraction

A data abstraction form was developed based on previous relevant systematic review. Reference Daily, Padjen and Birnbaum1,Reference Rosenman, Ilgen and Shandro5,Reference Ripoll, Djalali and Foletti39,Reference Al Thobaity, Plummer and Williams41,Reference Rehim, DeMoor and Olmsted47 Coding metrics of this form were discussed and revised several times by the reviewers. Each of the included articles were independently reviewed by 2 authors using the final data abstraction form. The 2 involved authors discussed and reached consensus on each code metric before a final score was assigned.

Information was abstracted on study characteristics (publication year, study objectives and methods, study settings, and study scenario) and study participant characteristics (professions, types, and specialties). Studies were also reviewed for detailed data on competency frameworks: (1) framework name, (2) scoring system, (3) comprehensive scoring, (4) behavior anchor, (5) assessment level (team or individual), (6) raters (external and self-assessment), and (7) reliability and validity.

A competency framework would be considered modified if its structure (format or item numbers) or anchors were changed. When a framework was modified from an existing instrument, it would be involved as a new one and information of it would be captured separately.

Data Analysis

Meta-analyses were infeasible because of study heterogeneity. Descriptive statistical analyses were performed to summarize characteristics of the studies and frameworks. Competency domains were abstracted from all the included frameworks and synthesized. Representative descriptions of those domains were reported.

RESULTS

Search Results and Study Characteristics

Of the 9627 studies initially identified, 94 met inclusion criteria (see Table 2 and detailed in Appendix 2).

TABLE 2

Characteristics of 94 Studies Included in a Systematic Review of Frameworks Used to Describe Nontechnical Competencies for Health Profession Workers in Emergency Environment Published Through August 2018

Table 2 presented the characteristics of the included studies. Studies dated as far back as 1999, although the majority (38; 40.4%) were published during the period from 2011 to 2015. Studies usually intended to develop new competency framework (43;45.7%) or apply existing framework (42;44.7%), while only 16 (17.0%) studies aimed to evaluate the framework. Most (60; 63.8%) of the studies concentrated on hospitals as study settings. Acute critical events in hospital (44;46.8%) or nonspecified disasters (39;41.5%) were the common scenarios. Over 8 methods were applied in these studies, and simulation (36; 38.3%), interview (26; 27.6%), along with questionnaire survey (21;22.3%) were more frequently used. Many studies targeted nurses (31;33.0%), administration staff (20; 21.3%), and residents (17;18.1%) as participants. Most of the participants (76; 80.9%) are practitioners such as nurses, doctors, and other clinical personnel. With regarding to the targeted specialties, the majority (36; 38.3%) were multispecialty, and nurse and public health accounted for 22.3% and 11.7%, respectively.

Competency Framework Characteristics

The 94 included studies described 65 unique competency frameworks (see Table 3 and detailed in Appendix 3). Several commonly used frameworks underwent minor modifications resulting in novel, but closely related, frameworks. The most frequently studied competency frameworks were “Anaesthesia Non-Technical Skills (ANTS)” (13; 13.8%), Reference Jirativanont, Raksamani and Aroonpruksakul3,Reference Taylor, Ferri and Yavorska13,Reference Jankouskas, Haidet and Hupcey17,Reference Doumouras, Hamidi and Lung32,Reference Yee, Naik and Joo35,Reference Savoldelli, Naik and Park49-Reference Boet, Bould and Bruppacher56 “Ottawa Global Rating Scale (GRS)” (5;5.3%), Reference Jirativanont, Raksamani and Aroonpruksakul3,Reference Kim, Neilipovitz and Cardinal14,Reference Kim, Neilipovitz and Cardinal57-Reference Clarke, Horeczko and Carlisle59 “Competencies For All Public Workers-1” (4;4.3%), Reference Mosca, Sweeney and Hazy33,36,Reference Gebbie, Merrill and Hwang60,Reference Hites, Lafreniere and Wingate61 and ” Non-Technical Skills for Surgeons” (4;4.3%). Reference Dedy, Bonrath and Ahmed15,Reference Bhangu, Bhangu and Stevenson31,Reference Doumouras, Hamidi and Lung32,Reference Briggs, Raja and Joyce62

TABLE 3

Characteristics of 65 Frameworks Used to Describe Nontechnical Competencies for Health Profession Workers in Emergency Environment Published Through August 2018

Of the 65 frameworks, more than half (33;50.8%) reported scoring system, such as 5-point scale, but only 40% presented how to calculate the overall score as a comprehensive result. A little more than 1/3 (26; 40%) of the frameworks described the behavior anchor to the competency domain.

In the aspect of the framework application, most (59; 90.8%) of them were intended to individual. Almost 1/3 of frameworks were used for rating by raters themselves (19; 29.2%) and external raters (19; 29.2%).

Many of the 65 frameworks included multiple forms of validity and reliability evidence. Information on the reliability was reported for less than half of frameworks (32; 49.2%). Most (42; 64.6%) of the frameworks did not see the specific data on validity.

Nontechnical Competency Targeted

When provided, nontechnical competency themes, behaviors and descriptors were diverse. The 14 most commonly involved domains were identified and summarized based on the primary themes of the frameworks: (1) communication skills (60; 92.3%); (2) situation awareness ability (40; 61.5%); (3) collaborate, coordinate, and teamwork ability (37; 56.9%); (4) problem solving/decision-making skills (24; 36.9%); (5) incident command/disaster knowledge (23; 35.4%); (6) resource management skills (23; 35.4%); (7) personal character (19; 29.2%); (8) leadership (21; 32.3%); (9) task management skills (20; 30.8%); (10) performing one’s role (18; 27.7%); (11) planning skills (18; 27.7%); (12) cultural, ethnic, and legal knowledge (14; 21.5%); (13) adaptability/flexibility (12; 18.5%); and (14) personal protection skills (11; 16.9%) (see Table 4). Some other themes were also reported, although not that frequently, such as knowledge of short- and long-term considerations for recovery, skills of budgeting and finance, and the ability to organize education and training.

TABLE 4

Domains, Descriptions, and Frequency of Competencies Included in 65 Frameworks Used to Describe Nontechnical Skills for All Health Professionals in Emergence Response

DISCUSSION

Despite general agreement that nontechnical competency is an essential component of health professionals in all-hazard emergency environment, defining and measuring the universally applicable and fundamental nontechnical competencies remains a challenge, which is, however, significant to strengthen future nontechnical competency research and to provide foundations to educational programs for emergency healthcare professionals and students. This scoping review highlights 65 existing frameworks that articulated the critical constructs of nontechnical competency required for multispecialty health professionals working in crisis environment, and 14 common competency domains were identified from those frameworks.

Targeted Application Level

Included competency frameworks applied to either individual or team. The results of this review showed 90% of those frameworks focused on individuals. However, it is necessary to demonstrate the competency of the whole team which form is common in response to emergency and disaster situations. In some cases, it did not define the targeted audience level of the framework, Reference Hites, Lafreniere and Wingate61 or some frameworks were used to both individual and team. Reference Jankouskas, Bush and Murray50,Reference Flin and Maran55 More studies are in need to specify the nontechnical competency contents for various specialty team as a whole, and the frameworks should note the targeted level to ensure originally intended application. Reference Rosenman, Ilgen and Shandro5

Validity and Reliability Evidence

There is no doubt validity and reliability are the key indicators for a good framework. Among the 94 studies, however, few (17.0%) were aimed to evaluate the frameworks. Also, more than half of the identified frameworks did not see validity (64.6%) and reliability (50.8%) evidence in those studies. Several frameworks (n = 12) were repeatedly used across at least 2 studies, thus potentially providing the chance to build robust validity evidence. Nevertheless, those repeatedly applied frameworks usually underwent behavior anchor or/and even structural modifications with no detailed justifications for the changes. Moreover, the majority of the frameworks (n = 54) emerged in 1 study without reporting validation. In addition, numbers of competencies were proposed using qualitative methods such as focus group, thematical analysis, and Delphi, which is a consensus-building process and relies predominantly on the opinions of nominal experts. Reference Daily, Padjen and Birnbaum1,Reference Shewchuk, O’Connor and Fine63 Above all, a more systematic approach to framework test would help establish more robust and comparable validity and reliability evidence.

Targeted Application Audience

The majority of the included studies (63.8%) were performed in clinical settings (eg, emergency department and ICU) and based on a series of scenarios of acute and critical events (eg, acute shock, hypoxemic respiratory failure, and cardiac arrest). In contrast, there were relatively limited studies involved public health backgrounds. Also, much more included frameworks were designed to nurses, surgeons, physician residents, or other clinical practitioners than public health relevant staff. This may due to it is more practical to make access to the study environment and emergency events inside the hospitals than incident fields (eg, hurricanes and explosions) outside the facilities. Reference Daily, Padjen and Birnbaum1 For example, simulation, which are the most common methods used in the 94 studies, were generally in-hospital clinical scenarios, rather than disasters that infrequently occur in disparate settings and conditions. Future studies should pay more attention to fundamental competency factors that could generalize to multidisciplinary health professionals in all-hazard emergency environment, including in-hospital clinical and out-of-hospital health emergencies.

Application Feasibility

Scoring system and behavior anchor determine the operability of competency frameworks that were designed for ability evaluation. Although half of the included frameworks had a scoring system, most (39; 60%) did not describe the behavior anchor. Another factor that could reduce the framework feasibility is 31(47.7%) frameworks did not specify the assessor (self- /external assessment). To help assessors precisely capture the competency nature, each domain should be defined clearly and the assessor type should also be originally taken into consideration.

Competency Domains

A total of 14 domains were identified. There was broad agreement on 3 domains: communication, situation awareness, collaboration/coordination and teamwork, among the reviewed frameworks. Little agreement was found, however, on the rest of 11 domains. This is possibly due to lack of standard terminology, clear definitions, and detailed articulation, which could lead to missing to precisely capture the domains and impede the comparison and integration of competencies among the frameworks reviewed. Reference Daily, Padjen and Birnbaum1,Reference Ripoll, Djalali and Foletti39,Reference Birnbaum64 Also, it may be related to an incomplete understanding of the a competency hierarchical structure composed by a systematically grouped competency domain, which is further broken down into subcompetencies or specified with behavioral indicators. Reference Daily, Padjen and Birnbaum1,Reference Westera65

Additionally, some competencies are obviously more significant or essential than others for a particular profession, organization, and emergency environment. But it does not mean it is needless to build up a common fundamental competency framework applicable to all levels and functions among various emergency health workers in all-hazards environments. To resolve this issue, proficiency levels for the various behavioral descriptors of the fundamental competencies should be clarified and differentiated according to various targeted groups and specified context. In addition to the fundamental competencies, additional competencies should be figured out, as a supplement package, to meet special requirements related to specific profession, task, discipline, and context.

Despite of the lack of terminology standardization, the variability of competency structures, and diversity in targeted groups, previous works have provided a valuable groundwork for the development of a common framework for cross-cutting competencies applied to all emergency health professionals.

STRENGTHS AND LIMITATIONS

Several limitations to this review should be considered. First, frameworks were limitedly sourced from published literature available in English, thus possibility of publication bias cannot be excluded. Also, while disaster- and emergency-related terms were used for record searching, alternate terms (eg, hurricanes and earthquake) in otherwise relevant papers could not identify them for inclusion. Moreover, this study is restricted to the field of health. Although many of the nontechnical competencies required of other emergency professionals are applicable to health professionals, these were not within the purview of this review. In addition, heterogeneity of the included studies’ designs and the variability in their data reporting make it limited to draw more extensive comparisons across the studies. Accordingly, it leads to being impossible to rate the methodological study quality.

There are several strengths in the present review. A total of 9627 records were widely collected from 6 major data sources as well as the reference lists of the included studies. Search strategy and inclusion/exclusion criteria were developed to reflect the multidisciplinary and cross-sector nature of health professionals, which helped maximize result applicability.

IMPLICATIONS FOR FUTURE RESEARCH AND PRACTICE

This review provides a comprehensive look at competency frameworks for health professionals working in various disaster/emergency environment regardless of their professional sector, discipline, role, or category, and it highlights several important considerations for future research and competency cultivation. The vast majority of competency frameworks reviewed are still directed to specific target groups. Due to imprecise, insufficient, and inconsistent articulation of the competency domain and its corresponding behaviors, reaching consensus on the common fundamental nontechnical competencies for all emergency health professionals is challenging but essential. For universal acceptance and application, further efforts should be directed to setting up standard terminology, clarified definitions, and detailed behavior anchors as well as supplementary competencies for particular targeted groups. Also, methodical collection of validity evidence is required when originally developing or modifying frameworks, which is significant to make comparisons in validity across studies.

Author Contribution

Xuejun Hu and Changnan He are co-primary authors.

Conflicts of Interest

The authors have no conflict of interests to declare.

Supplementary Material

To view supplementary material for this article, please visit https://doi.org/10.1017/dmp.2019.146

References

REFERENCES

Daily, E, Padjen, P, Birnbaum, M. A review of competencies developed for disaster healthcare providers: limitations of current processes and applicability. Prehosp Disaster Med. 2010;25(5):387-395.CrossRefGoogle ScholarPubMed
Crowe, RP, Wagoner, RL, Rodriguez, SA, et al. Defining components of team leadership and membership in prehospital emergency medical services. Prehosp Emerg Care. 2017;21(5):645-651.CrossRefGoogle ScholarPubMed
Jirativanont, T, Raksamani, K, Aroonpruksakul, N, et al. Validity evidence of non-technical skills assessment instruments in simulated anaesthesia crisis management. Anaesth Intensive Care. 2017;45(4):469-475.CrossRefGoogle ScholarPubMed
Flowerdew, L, Gaunt, A, Spedding, J, et al. A multicentre observational study to evaluate a new tool to assess emergency physicians’ non-technical skills. Emerg Med J. 2013;30(6):437-443.CrossRefGoogle ScholarPubMed
Rosenman, ED, Ilgen, JS, Shandro, JR, et al. A systematic review of tools used to assess team leadership in health care action teams. Acad Med. 2015;90(10):1408-1422.CrossRefGoogle ScholarPubMed
Klein, KJ, Ziegert, JC, Knight, AP, et al. Dynamic delegation: shared, hierarchical, and deindividualized leadership in extreme action teams. Admin Sci Q. 2016;51(4):590-621.CrossRefGoogle Scholar
Ellis, APJ, Bell, BS, Ployhart, RE, et al. An evaluation of generic teamwork skills training with action teams: effects on cognitive and skill-based outcomes. Pers Psychol. 2005;58(3):641-672.CrossRefGoogle Scholar
Porter, JE, Cant, RP, Cooper, SJ. Rating teams’ non-technical skills in the emergency department: a qualitative study of nurses’ experience. Int Emerg Nurs. 2018;38:15-20.CrossRefGoogle ScholarPubMed
Thoma, B, Poitras, J, Penciner, R, et al. Administration and leadership competencies: establishment of a national consensus for emergency medicine. CJEM. 2015;17(2):107-114.CrossRefGoogle ScholarPubMed
Munroe, B, Curtis, K, Murphy, M, et al. A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation. J Clin Nurs. 2016;25(15-16):2262-2274.CrossRefGoogle ScholarPubMed
Zhuravsky, L. Crisis leadership in an acute clinical setting: Christchurch Hospital, New Zealand ICU experience following the February 2011 earthquake. Prehosp Disaster Med. 2015;30(02):131-136.CrossRefGoogle Scholar
Linton, J, Farrell, MJ. Nurses’ perceptions of leadership in an adult intensive care unit: a phenomenology study. Intensive Crit Care Nurs. 2009;25(2):64-71.CrossRefGoogle Scholar
Taylor, KL, Ferri, S, Yavorska, T, et al. A description of communication patterns during CPR in ICU. Resuscitation. 2014;85(10):1342-1347.CrossRefGoogle ScholarPubMed
Kim, J, Neilipovitz, D, Cardinal, P, et al. A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: the University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study. Crit Care Med. 2006;34(8):2167-2174.CrossRefGoogle ScholarPubMed
Dedy, NJ, Bonrath, EM, Ahmed, N, et al. Structured training to improve nontechnical performance of junior surgical residents in the operating room: a randomized controlled trial. Ann Surg. 2016;263(1):43-49.CrossRefGoogle ScholarPubMed
Dedy, NJ, Szasz, P, Louridas, M, et al. Objective structured assessment of nontechnical skills: reliability of a global rating scale for the in-training assessment in the operating room. Surgery. 2015;157(6):1002-1013.CrossRefGoogle ScholarPubMed
Jankouskas, TS, Haidet, KK, Hupcey, JE, et al. Targeted crisis resource management training improves performance among randomized nursing and medical students. Simul Health. 2011;6(6):316-326.CrossRefGoogle ScholarPubMed
Jernigan, PL, Wallace, MC, Novak, CS, et al. Measuring intangibles: defining predictors of non-technical skills in critical care air transport team trainees. Mil Med. 2016;181(10):1357-1362.CrossRefGoogle ScholarPubMed
Myers, JA, Powell, DM, Psirides, A, et al. Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument--an observational study. Scand J Trauma Resusc Emerg Med. 2016;24:24.CrossRefGoogle ScholarPubMed
Peller, J, Schwartz, B, Kitto, S. Nonclinical core competencies and effects of interprofessional teamwork in disaster and emergency response training and practice: a pilot study. Disaster Med Public Health Prep. 2013;7(4):395-402.CrossRefGoogle ScholarPubMed
Wickramasinghe, KK, Ishara, MH, Liyanage, P, et al. Outcome-based approach in development of a disaster management course for healthcare workers. Ann Acad Med Singapore. 2007;36(9):765-769.Google ScholarPubMed
Cox, RS, Danford, T. The need for a systematic approach to disaster psychosocial response: a suggested competency framework. Prehosp Disaster Med. 2014;29(2):183-189.CrossRefGoogle ScholarPubMed
Walsh, L, Subbarao, I, Gebbie, K, et al. Core competencies for disaster medicine and public health. Disaster Med Public Health Prep. 2012;6(1):44-52.CrossRefGoogle ScholarPubMed
Tachibanai, T, Takemura, S, Sone, T, et al. Competence necessary for Japanese public health center directors in responding to public health emergencies. Nihon Koshu Eisei Zasshi. 2005;52(11):943-956.Google ScholarPubMed
Savoia, E, Testa, MA, Biddinger, PD, et al. Assessing public health capabilities during emergency preparedness tabletop exercises: reliability and validity of a measurement tool. Public Health Rep. 2009;124(1):138-148.CrossRefGoogle ScholarPubMed
Cope, JR, Frost, M, Richun, L, et al. Assessing knowledge and application of emergency risk communication principles among public health workers in China. Disaster Med Public Health Prep. 2014;8(3):199-205.CrossRefGoogle ScholarPubMed
Dent, AW, Weiland, TJ, Paltridge, D. Australasian emergency physicians: a learning and educational needs analysis. Part Four: CPD topics desired by emergency physicians. Emerg Med Australas. 2008;20(3):260-266.Google ScholarPubMed
Flowerdew, L, Brown, R, Vincent, C, et al. Development and validation of a tool to assess emergency physicians’ nontechnical skills. Ann Emerg Med. 2012;59(5):376-385.CrossRefGoogle ScholarPubMed
Schultz, CH, Koenig, KL, Whiteside, M, et al. Development of national standardized all-hazard disaster core competencies for acute care physicians, nurses, and EMS professionals. Ann Emerg Med. 2012;59(3):196-208.CrossRefGoogle ScholarPubMed
Willems, A, Waxman, B, Bacon, AK, et al. Interprofessional non-technical skills for surgeons in disaster response: a qualitative study of the Australian perspective. J Interprof Care. 2013;27(2):177-183.CrossRefGoogle ScholarPubMed
Bhangu, A, Bhangu, S, Stevenson, J, et al. Lessons for surgeons in the final moments of Air France Flight 447. World J Surg. 2013;37(6):1185-1192.CrossRefGoogle ScholarPubMed
Doumouras, AG, Hamidi, M, Lung, K, et al. Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises. Br J Surg. 2017;104(8):1028-1036.CrossRefGoogle ScholarPubMed
Mosca, NW, Sweeney, PM, Hazy, JM, et al. Assessing bioterrorism and disaster preparedness training needs for school nurses. J Public Health Manag Pract. 2005;(Suppl):S38-S44.CrossRefGoogle ScholarPubMed
Gordon, CJ, Jorm, C, Shulruf, B, et al. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(1):218.CrossRefGoogle ScholarPubMed
Yee, B, Naik, VN, Joo, HS, et al. Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education. Anesthesiology. 2005;103(2):241-248.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Bioterrorism & emergency readiness: competencies for all public health workers. 2002. https://www.hsdl.org/?view&did=770983. (Accessed December 24, 2019).Google Scholar
King, RV, North, CS, Larkin, GL, et al. Attributes of effective disaster responders: focus group discussions with key emergency response leaders. Disaster Med Public Health Prep. 2010;4(4):332-338.CrossRefGoogle ScholarPubMed
King, RV, Larkin, GL, Fowler, RL, et al. Characteristics of effective disaster responders and leaders: a survey of disaster medical practitioners. Disaster Med Public Health Prep. 2016;10(5):720-723.CrossRefGoogle ScholarPubMed
Ripoll, GA, Djalali, A, Foletti, M, et al. Core competencies in disaster management and humanitarian assistance: a systematic review. Disaster Med Public Health Prep. 2015;9(4):430-439.CrossRefGoogle Scholar
Chalwin, RP, Flabouris, A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J. 2013;43(9):962-969.CrossRefGoogle ScholarPubMed
Al Thobaity, A, Plummer, V, Williams, B. What are the most common domains of the core competencies of disaster nursing? A scoping review. Int Emerg Nurs. 2017;31:64-71.CrossRefGoogle ScholarPubMed
Mete, I, Brannick, MT. Estimating the reliability of nontechnical skills in medical teams. J Surg Educ. 2017;74(4):596-611.CrossRefGoogle ScholarPubMed
Rimstad, R, Braut, GS. Literature review on medical incident command. Prehosp Disaster Med. 2015;30(2):205-215.CrossRefGoogle ScholarPubMed
Weller, J, Shulruf, B, Torrie, J, et al. Validation of a measurement tool for self-assessment of teamwork in intensive care. Br J Anaesth. 2013;111(3):460-467.CrossRefGoogle ScholarPubMed
Flowerdew, L, Brown, R, Vincent, C, et al. Development and validation of a tool to assess emergency physicians’ nontechnical skills. Ann Emerg Med. 2012;59(5):376-385.CrossRefGoogle ScholarPubMed
Yule, S, Flin, R, Paterson-Brown, S, et al. Non-technical skills for surgeons in the operating room: a review of the literature. Surgery. 2006;139(2):140-149.CrossRefGoogle ScholarPubMed
Rehim, SA, DeMoor, S, Olmsted, R, et al. Tools for assessment of communication skills of hospital action teams: a systematic review. J Surg Educ. 2017;74(2):341-351.CrossRefGoogle ScholarPubMed
Liberati, A, Altman, DG, Tetzlaff, J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRefGoogle ScholarPubMed
Savoldelli, GL, Naik, VN, Park, J, et al. Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback. Anesthesiology. 2006;105(2):279-285.CrossRefGoogle ScholarPubMed
Jankouskas, T, Bush, MC, Murray, B, et al. Crisis resource management: evaluating outcomes of a multidisciplinary team. Simul Healthc. 2007;2(2):96-101.CrossRefGoogle ScholarPubMed
Riem, N, Boet, S, Bould, MD, et al. Do technical skills correlate with non-technical skills in crisis resource management: a simulation study. Br J Anaesth. 2012;109(5):723-728.CrossRefGoogle ScholarPubMed
Fox-Robichaud, AE, Nimmo, GR. Education and simulation techniques for improving reliability of care. Curr Opin Crit Care. 2007;13(6):737-741.CrossRefGoogle ScholarPubMed
Wunder, LL. Effect of a nontechnical skills intervention on first-year student registered nurse anesthetists’ skills during crisis simulation. AANA J. 2016;84(1):46-51.Google ScholarPubMed
Watkins, SC, Roberts, DA, Boulet, JR, et al. Evaluation of a simpler tool to assess nontechnical skills during simulated critical events. Simul Healthc. 2017;12(2):69-75.CrossRefGoogle ScholarPubMed
Flin, R, Maran, N. Identifying and training non-technical skills for teams in acute medicine. Qual Saf Health Care. 2004;13(Suppl 1):i80-i84.CrossRefGoogle ScholarPubMed
Boet, S, Bould, MD, Bruppacher, HR, et al. Looking in the mirror: self-debriefing versus instructor debriefing for simulated crises. Crit Care Med. 2011;39(6):1377-1381.CrossRefGoogle ScholarPubMed
Kim, J, Neilipovitz, D, Cardinal, P, et al. A comparison of global rating scale and checklist scores in the validation of an evaluation tool to assess performance in the resuscitation of critically ill patients during simulated emergencies (abbreviated as “CRM simulator study IB”). Simul Healthc. 2009;4(1):6-16.CrossRefGoogle Scholar
Doumouras, AG, Engels, PT. Early crisis nontechnical skill teaching in residency leads to long-term skill retention and improved performance during crises: a prospective, nonrandomized controlled study. Surgery. 2017;162(1):174-181.CrossRefGoogle ScholarPubMed
Clarke, S, Horeczko, T, Carlisle, M, et al. Emergency medicine resident crisis resource management ability: a simulation-based longitudinal study. Med Educ Online. 2014;19:25771.CrossRefGoogle ScholarPubMed
Gebbie, K, Merrill, J, Hwang, I, et al. Identifying individual competency in emerging areas of practice: an applied approach. Qual Health Res. 2002;12(7):990-999.CrossRefGoogle Scholar
Hites, LS, Lafreniere, AV, Wingate, MS, et al. Expanding the public health emergency preparedness competency set to meet specialized local and evolving national needs: a needs assessment and training approach. J Public Health Manag Pract. 2007;13(5):497-505.CrossRefGoogle ScholarPubMed
Briggs, A, Raja, AS, Joyce, MF, et al. The role of nontechnical skills in simulated trauma resuscitation. J Surg Educ. 2015;72(4):732-739.CrossRefGoogle ScholarPubMed
Shewchuk, RM, O’Connor, SJ, Fine, DJ. Building an understanding of the competencies needed for health administration practice. J Healthc Manag. 2005;50(1):32-48.Google ScholarPubMed
Birnbaum, ML. Structure and science. Prehosp Disaster Med. 2006;21(06):369-371.CrossRefGoogle ScholarPubMed
Westera, W. Competences in education: a confusion of tongues. J Curric Stud. 2001;33(1):75-88.CrossRefGoogle Scholar
Reznek, M, Smith-Coggins, R, Howard, S, et al. Emergency medicine crisis resource management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine. Acad Emerg Med. 2003;10(4):386-389.CrossRefGoogle ScholarPubMed
Neira, VM, Bould, MD, Nakajima, A, et al. “GIOSAT”: a tool to assess CanMEDS competencies during simulated crises. Can J Anesth. 2013;60(3):280-289.CrossRefGoogle ScholarPubMed
Cooper, S, Cant, R, Connell, C, et al. Measuring teamwork performance: validity testing of the Team Emergency Assessment Measure (TEAM) with clinical resuscitation teams. Resuscitation. 2016;101:97-101.CrossRefGoogle Scholar
Endacott, R, Bogossian, FE, Cooper, SJ, et al. Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios. J Clin Nurs. 2015;24(1-2):90-100.CrossRefGoogle ScholarPubMed
Cooper, S, Cant, R, Porter, J, et al. Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM). Resuscitation. 2010;81(4):446-452.CrossRefGoogle Scholar
Cant, RP, Porter, JE, Cooper, SJ, et al. Improving the non-technical skills of hospital medical emergency teams: the Team Emergency Assessment Measure (TEAM). Emerg Med Australas. 2016;28(6):641-646.CrossRefGoogle Scholar
Deitchman, S. Enhancing crisis leadership in public health emergencies. Disaster Med Public Health Prep. 2013;7(5):534-540.CrossRefGoogle ScholarPubMed
Georgino, MM, Kress, T, Alexander, S, et al. Emergency preparedness education for nurses: core competency familiarity measured utilizing an adapted emergency preparedness information questionnaire. J Trauma Nurs. 2015;22(5):240-248, E1-E2.CrossRefGoogle ScholarPubMed
Wisniewski, R, Dennik-Champion, G, Peltier, JW. Emergency preparedness competencies: assessing nurses’ educational needs. J Nurs Adm. 2004;34(10):475-480.CrossRefGoogle ScholarPubMed
Smith, S, Farra, S, Dempsey, A, et al. Preparing nursing students for leadership using a disaster-related simulation. Nurse Educ. 2015;40(4):212-216.CrossRefGoogle ScholarPubMed
Davis, B, Welch, K, Walsh-Hart, S, et al. Effective teamwork and communication mitigate task saturation in simulated critical care air transport team missions. Mil Med. 2014;179(8 Suppl):19-23.CrossRefGoogle ScholarPubMed
Marin, SM, Witt, RR. Hospital nurses’ competencies in disaster situations: a qualitative study in the south of Brazil. Prehosp Disaster Med. 2015;30(6):548-552.CrossRefGoogle ScholarPubMed
Pryor, E, Heck, E, Norman, L, et al. Integrated decision-making in response to weapons of mass destruction incidents: development and initial evaluation of a course for healthcare professionals. Prehosp Disaster Med. 2006;21(1):24-30.CrossRefGoogle ScholarPubMed
Barbera, JA, Macintyre, AG, Shaw, G, et al. Healthcare emergency management competencies: competency framework final report. 2007. https://www.va.gov/VHAEMERGENCYMANAGEMENT/Documents/Education_Training/Healthcare_System_Emergency_Management_Competency_Framework_2007.pdf. (Accessed December 24, 2019).Google Scholar
Leenstra, NF, Jung, OC, Johnson, A, et al. Taxonomy of trauma leadership skills: a framework for leadership training and assessment. Acad Med. 2016;91(2):272-281.CrossRefGoogle ScholarPubMed
ICN. WPRO | ICN Framework of Disaster Nursing Competencies. 2009. https://asprtracie.hhs.gov/technical-resources/resource/4830/icn-framework-of-disaster-nursing-competencies. (Accessed December 24, 2019).Google Scholar
Lambden, S, DeMunter, C, Dowson, A, et al. The Imperial Paediatric Emergency Training Toolkit (IPETT) for use in paediatric emergency training: development and evaluation of feasibility and validity. Resuscitation. 2013;84(6):831-836.CrossRefGoogle ScholarPubMed
Veenema, TG, Deruggiero, K, Losinski, S, et al. Hospital administration and nursing leadership in disasters. Nurs Admin Q. 2017;41(2):151-163.CrossRefGoogle ScholarPubMed
von Wyl, T, Zuercher, M, Amsler, F, et al. Technical and non-technical skills can be reliably assessed during paramedic simulation training. Acta Anaesthesiol Scand. 2009;53(1):121-127.CrossRefGoogle ScholarPubMed
Steinemann, S, Berg, B, DiTullio, A, et al. Assessing teamwork in the trauma bay: introduction of a modified “NOTECHS” scale for trauma. Am J Surg. 2012;203(1):69-75.CrossRefGoogle ScholarPubMed
Wang, C, Wei, S, Xiang, H, et al. Development and evaluation of a leadership training program for public health emergency response: results from a Chinese study. BMC Public Health. 2008;8:377.CrossRefGoogle ScholarPubMed
Hsu, EB, Thomas, TL, Bass, EB, et al. Healthcare worker competencies for disaster training. BMC Med Educ. 2006;6:19.CrossRefGoogle ScholarPubMed
Wallin, CJ, Meurling, L, Hedman, L, et al. Target-focused medical emergency team training using a human patient simulator: effects on behaviour and attitude. Med Educ. 2007;41(2):173-180.CrossRefGoogle ScholarPubMed
Ranse, J, Shaban, RZ, Considine, J, et al. Disaster content in Australian tertiary postgraduate emergency nursing courses: a survey. Australas Emerg Nurs J. 2013;16(2):58-63.CrossRefGoogle ScholarPubMed
Atack, L, Parker, K, Rocchi, M, et al. The impact of an online interprofessional course in disaster management competency and attitude towards interprofessional learning. J Interprof Care. 2009;23(6):586-598.CrossRefGoogle ScholarPubMed
Al Thobaity, A, Williams, B, Plummer, V. A new scale for disaster nursing core competencies: development and psychometric testing. Australas Emerg Nurs J. 2016;19(1):11-19.CrossRefGoogle ScholarPubMed
Bristowe, K, Siassakos, D, Hambly, H, et al. Teamwork for clinical emergencies. Qual Health Res. 2012;22(10):1383-1394.CrossRefGoogle ScholarPubMed
Hart, PL, Spiva, L, Baio, P, et al. Medical-surgical nurses’ perceived self-confidence and leadership abilities as first responders in acute patient deterioration events. J Clin Nurs. 2014;23(19-20):2769-2778.CrossRefGoogle ScholarPubMed
Meeker, J, Perry, A, Dolan, C, et al. Development of a competency framework for the nutrition in emergencies sector. Public Health Nutr. 2014;17(03):689-699.CrossRefGoogle ScholarPubMed
Subbarao, I, Lyznicki, JM, Hsu, EB, et al. A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness. Disaster Med Public Health Prep. 2008;2(1):57-68.CrossRefGoogle ScholarPubMed
Gebbie, KM, Qureshi, K. Emergency and disaster preparedness: core competencies for nurses. Am J Nurs. 2002;102(1):46-51.CrossRefGoogle ScholarPubMed
Yeager, V, Cooper, GJ, Burkle, FJ, et al. Twitter as a potential disaster risk reduction tool. Part IV: competency-based education and training guidelines to promote community resiliency. PLoS Curr. 2015;7. doi: 10.1371/currents.dis.ce3fad537bd666770a649a076ee71ba4.Google ScholarPubMed
Gebbie, KM, Weist, EM, McElligott, JE, et al. Implications of preparedness and response core competencies for public health. J Public Health Manag Pract. 2013;19(3):224-230.CrossRefGoogle ScholarPubMed
Bahrami, M, Aliakbari, F, Aein, F. Iranian nurses’ perception of essential competences in disaster response: a qualitative study. J Educ Health Promot. 2014;3:81.Google ScholarPubMed
Saleh, SS, Williams, D, Balougan, M. Evaluating the effectiveness of public health leadership training: the NEPHLI experience. Am J Public Health. 2004;94(7):1245-1249.CrossRefGoogle ScholarPubMed
Luo, Y, Liu, L, Huang, WQ, et al. A disaster response and management competency mapping of community nurses in China. Iran J Public Health. 2013;42(9):941-949.Google ScholarPubMed
Daniel, C, Nick, S, Vishal, P, et al. Tactical and operational response to major incidents_ feasibility and reliability of skills assessment using novel virtual environment. Resuscitation. 2013;84:992-998.Google Scholar
Weller, J, Frengley, R, Torrie, J, et al. Evaluation of an instrument to measure teamwork in multidisciplinary critical care teams. BMJ Qual Saf. 2011;20(3):216-222.CrossRefGoogle ScholarPubMed
Poremski, D, Lim, XY, Kunjithapatham, G, et al. Which skills boost service provider confidence when managing people presenting with psychiatric emergencies? Int J Ment Health Nurs. 2016;25(6):566-573.CrossRefGoogle ScholarPubMed
Cooper, S, Wakelam, A. Leadership of resuscitation teams: “Lighthouse Leadership”. Resuscitation. 1999;42(1):27-45.CrossRefGoogle Scholar
Al Khalaileh, MA, Bond, E, Alasad, JA. Jordanian nurses’ perceptions of their preparedness for disaster management. Int Emerg Nurs. 2012;20(1):14-23.CrossRefGoogle ScholarPubMed
Ahayalimudin, N, Osman, NN. Disaster management: emergency nursing and medical personnel’s knowledge, attitude and practices of the East Coast region hospitals of Malaysia. Australas Emerg Nurs J. 2016;19(4):203-209.CrossRefGoogle ScholarPubMed
Garbutt, SJ, Peltier, JW, Fitzpatrick, JJ. Evaluation of an instrument to measure nurses’ familiarity with emergency preparedness. Mil Med. 2008;173(11):1073-1077.CrossRefGoogle ScholarPubMed
Figure 0

FIGURE 1 Selection Process Used in A Systematic Review of Non-Technical Competency Frameworks for Health Professionals in All-Hazard Emergency Environment Published through March 2018.

Figure 1

TABLE 1 Inclusion and Exclusion Criterion for Studies

Figure 2

TABLE 2 Characteristics of 94 Studies Included in a Systematic Review of Frameworks Used to Describe Nontechnical Competencies for Health Profession Workers in Emergency Environment Published Through August 2018

Figure 3

TABLE 3 Characteristics of 65 Frameworks Used to Describe Nontechnical Competencies for Health Profession Workers in Emergency Environment Published Through August 2018

Figure 4

TABLE 4 Domains, Descriptions, and Frequency of Competencies Included in 65 Frameworks Used to Describe Nontechnical Skills for All Health Professionals in Emergence Response

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