Endoscopic non-technical skills team training: The next step in quality assurance of endoscopy training

Table 1 Participants’ demographics

Participant specialty	n
Bowel Cancer Screening endoscopist	6
Specialist screening practitioner	6
Endoscopy nurse	8
Administrative staffs	3

Table 2 Participants (n = 23) patient safety knowledge assessment: Multiple Choice Question scores pre and post training

Knowledge assessment	Pre-training mean ± SD	Post-training mean ± SD	Change mean (95%CI)	P value
Correct Multiple Choice Question responses	43% ± 16%	55% ± 16%	+12% (6-18)	< 0.001

Table 3 Participants (n = 23) patient safety attitudes pre and post training on a 5-point Likert scale (1: strongly disagree, 5: strongly agree)

Patient safety attitude	Pre-course mean ± SD	Post-course mean ± SD	P value
A. Perceived patient safety knowledge
Different types of medical error	3.3 ± 1.2	4.2 ± 0.6	< 0.001
Factors contributing to error	3.5 ± 1.0	4.5 ± 0.5	< 0.001
Factors influencing patient safety	4.0 ± 1.0	4.5 ± 0.5	0.04
Ways of speaking up about error	3.5 ± 1.1	4.3 ± 0.6	0.009
What should happen if an error occurs	3.6 ± 1.2	4.3 ± 0.7	0.01
How to report an error1	3.8 ± 1.3	4.3 ± 0.7	0.11
B. Perceived patient safety awareness
Able to identify situations leading to error	3.9 ± 0.6	4.3 ± 0.5	0.03
Able to take steps to ensure patient safety1	4.0 ± 0.5	4.1 ± 0.5	0.45
Able to investigate errors to prevent re-occurrence	3.5 ± 0.8	4.1 ± 0.6	0.006
Understand the role of human factors in error prevention	4.0 ± 0.8	4.5 ± 0.6	0.01
Able to see potential for error and rectify it1	3.8 ± 0.6	4.0 ± 0.6	0.09
Understand factors resulting in wrong site procedure	3.8 ± 0.8	4.7 ± 0.5	< 0.001
Able to prevent wrong site procedures	4.0 ± 0.7	4.5 ± 0.6	0.004
Understand factors behind drug errors	3.9 ± 0.8	4.4 ± 0.6	0.004
Able to prevent drug errors	3.9 ± 0.8	4.4 ± 0.6	0.002
C. Perceived influence on patient safety
Easier to find someone to blame following an error	2.5 ± 1.2	2.4 ± 1.0	0.79
Confident addressing a colleague disregarding patient safety	3.9 ± 0.8	4.3 ± 0.6	0.07
Able to talk to a colleague who has made an error1	3.7 ± 0.7	4.0 ± 0.7	0.06
Able to ensure safety is not compromised	3.5 ± 0.8	3.9 ± 0.8	0.10
Incident forms improve patient safety	4.0 ± 1.0	4.0 ± 0.8	0.59
Able to talk about my own errors	4.1 ± 0.5	4.3 ± 0.5	0.16
D. Attitudes towards error management
Identifying incident causation contributes to patient safety	4.3 ± 0.6	4.5 ± 0.5	0.13
Learning from my mistakes will prevent medical error	4.2 ± 0.8	4.4 ± 0.6	0.45
Dealing with errors is an important part of my job	4.5 ± 0.5	4.5 ± 0.5	1.00
Able to challenge practices that compromise patient safety	4.5 ± 0.5	4.6 ± 0.6	0.65
It is acceptable to be honest about mistakes in my work-place	4.5 ± 0.6	4.4 ± 0.6	0.48
Admitting error would lead to fair treatment by management	4.0 ± 0.7	4.1 ± 0.6	0.32
E. Error management actions
I report errors in my workplace	4.4 ± 0.7	4.5 ± 0.6	0.76
I challenge patient safety complacency	4.2 ± 0.7	4.4 ± 0.5	0.24
I communicate safety expectations to my team	4.3 ± 0.6	4.4 ± 0.5	0.39
I support team members involved in an incident	4.5 ± 0.6	4.7 ± 0.5	0.10
I inform colleagues about errors they make	4.2 ± 0.6	4.1 ± 0.6	0.71
I intervene if a patient is exposed to harm	4.4 ± 0.7	4.6 ± 0.5	0.23
I actively learn from others’ mistakes	4.4 ± 0.6	4.5 ± 0.5	0.41
F. Personal views following an error
Following an error I would feel afraid	3.1 ± 0.9	3.1 ± 0.8	1.00
Following an error I would feel ashamed	3.6 ± 0.9	3.6 ± 1.0	1.00
Following an error I would feel guilty	4.1 ± 0.7	3.9 ± 0.8	0.15
Following an error I would feel upset	4.5 ± 0.5	4.3 ± 0.6	0.24
I know whom to inform following an error	4.4 ± 0.7	4.5 ± 0.6	0.24
I know whom to escalate a problem to arising during a list	4.5 ± 0.7	4.4 ± 0.7	0.56
Able to request a debrief +/- support following a mistake I have made	4.1 ± 1.1	4.2 ± 0.9	0.94

¹Areas that did not significantly change after training and would be addressed in future training sessions.

Table 4 Summary of quantitative course evaluation for 23 participants following the training intervention on a 5-point Likert scale (1: strongly disagree, 5: strongly agree)

Course evaluation	Statement	Mean ± SD
Content	Improved my understanding of patient safety, human factors and the systems approach to error	3.95 ± 0.72
	Improved my understanding of how to analyse an adverse event and learn from error	4.14 ± 0.77
	Improved my understanding of solutions to prevent error	4.18 ± 0.66
	Enhanced my understanding of non-technical skills	4.32 ± 0.57
	Will enable me to use the Endoscopic Non-Technical Skills framework to reflect upon patient safety issues	4.23 ± 0.53
	Provided me with a set of strategies to enhance safety in the endoscopy suite	4.09 ± 0.43
Implementation	Will change my practice in endoscopy to enhance patient safety	4.14 ± 0.83
	The learning objectives were met and the take-home message was clear	4.32 ± 0.57
	Teaching and learning materials were of an appropriate quality	4.27 ± 0.55
	This course should be mandatory for all members of the Bowel Cancer Screening team	3.91 ± 1.11
	This course should be offered to non-Bowel Cancer Screening endoscopy teams	4.36 ± 0.79
Satisfaction	This course was well delivered and engaging	4.23 ± 0.53
	Overall, I was satisfied with the course	4.18 ± 0.73
	I would recommend this course to a colleague	4.18 ± 0.80

Table 5 Summary of qualitative course evaluation

Free text comments

Highly relevant to day-to-day endoscopy practice

ENTS is no-brainer need to educate others' on the topic

Video cases were really interesting and good interactive discussion

Excellent faculty, and well organised with high quality handbook

Highly important topic, training should be mandatory for all endoscopy teams

Suggested improvements

More clinical cases

More adverse event analysis

More time for video analysis

Practical ENTS sessions in real teams

Table 6 Summary of patient safety training intervention studies

Ref.	Number of participants	Target audience	Duration of training	Patient safety outcome measures	Long term evaluation
Matharoo et al[24]	23	English BCS teams from training centres	Full day	Knowledge	No
				Attitude
Arora et al[26]	27	Surgical residents in North West London training region	Half day	Knowledge	Yes
				Attitude
				PSI observations
Ahmed et al[27]	216	Senior clinicians from 20 hospitals in the North Western Deanery	Half day	Knowledge	Yes
				Attitude
				Error analysis
				Uptake of training role
Hull et al[33]	30	Postgraduate students (clinical and non-clinical specialties) in Colombia	Full day	Knowledge	No
				Attitude
				Observations of theatre teams using OTAS

BCS: Bowel cancer screening; OTAS: Observational teamwork assessment for surgery; PSI: Patient safety incident.