Health sciences education is complex and unique. Health providers must learn vast amounts of knowledge and technical procedures and essential non-technical skills – including leadership, situational awareness, decision-making, good communication, and teamwork. Despite the essential nature of communication skills, they are rarely taught formally in educational programs.
This blog will highlight key points to help educators and students learn more about team communication and essential non-technical skills.

Team Member Communication Skills

For the team to work harmoniously, all members need to be:

• Engaged – with a clear focus on the current situation;
• Efficient – reporting their actions and anticipating further action;
• Able to translate their knowledge into action;
• Respectful of the team, patients, and family.

Team Leader Communication Skills

The team leader directs an orchestra. As a conductor, if the team leader performs well, the final music is pleasant, even if one musician makes a mistake. However, the opposite is not true – if the leader fails, the team is more likely to fail. To communicate precisely, the leader needs to:

• Have a closed-loop, direct, and clear communication;
• Assume their role as a leader and assign tasks to each team member;
• Be aware of the situation.

Assessing Communication Skills

There are several strategies to assess non-technical skills, such as communication. The most common are behavioral markers systems. These are assessment tools used to score a student, a health provider, or the entire team based on their attitudes. Currently, the most common behavioral markers systems used for a surgical environment are the NOTECHS (Non-technical Skills) and the NOTSS (Non-technical Skills for Surgeons). NOTECHS is an assessment tool focusing on team performance.
In contrast, NOTSS focuses on the team’s leader or the primary surgeon. Both tools have level II recommendations, and despite having a different focus, they show good inter-reliability scores. It means that if the leader does not perform well and does not get a good NOTSS score in a given scenario, the whole team will probably not have a good NOTECHS score.

Improving Communication Skills

The first thing is to assure a safer environment, where health providers can feel comfortable working on their skills. In a safer place, they will not suffer harassment or will feel embarrassed. If possible, surgical educators should be there to facilitate their training. That is one of the reasons why simulation is considered a gold-standard for improving communication skills. Besides removing the pressure of a real case, surgical educators can set different immersion levels to attend to each team’s or individual’s learning goals.

To improve and master these skills, health professionals should practice them deliberately, preferably in simulated scenarios, and include debriefings after each case.

Take-Home Messages

1. Communication skills are essential for healthcare. Improving them can prevent errors.
2. Simulation is ideal for learning and practicing communication skills.
3. To improve communication skills, evaluate each member and the entire team with appropriate assessment tools and promote frequent debriefing sections with your team.

Suggested Reading

Bajaj, Komal, Michael Meguerdichian, Brent Thoma, Simon Huang, Walter Eppich, and Adam Cheng. 2018. “The PEARLS Healthcare Debriefing Tool.” Academic Medicine: Journal of the Association of American Medical Colleges 93 (2): 336.

Flin, Rhona, George Youngson, Steven Yule, Simon Paterson-Brown, and Nikki Maran. 2012. The Non-technical Skills for Surgeons (NOTSS) System Handbook. Vol. 1.2. Aberdeen: University of Aberdeen.
Garden, A. L., D. M. Le Fevre, H. L. Waddington, and J. M. Weller. 2015. “Debriefing after Simulation-Based Non-technical Skill Training in Healthcare: A Systematic Review of Effective Practice.” Anaesthesia and Intensive Care 43 (3): 300–308.

Kassam, Farah, Alexander R. Cheong, David Evans, and Ash Singhal. 2019. “What Attributes Define Excellence in a Trauma Team? A Qualitative Study.” Canadian Journal of Surgery. Journal Canadien de Chirurgie 62 (6): 450–53.

Lee, Alex, Alexandra Finstad, Nada Gawad, Sylvain Boet, Isabelle Raiche, and Fady Balaa. 2020. “Non-technical Skills (NTS) in the Undergraduate Surgical and Anesthesiology Curricula: Are We Adequately Preparing Medical Students?” Journal of Surgical Education, August. https://doi.org/10.1016/j.jsurg.2020.08.001.

Ounounou, Esther, Abdullatif Aydin, Oliver Brunckhorst, M. Shamim Khan, Prokar Dasgupta, and Kamran Ahmed. 2019. “Non-technical Skills in Surgery: A Systematic Review of Current Training Modalities.” Journal of Surgical Education 76 (1): 14–24.

Paige, John T. 2019. “Developing Surgical Teams: Theory.” In Advancing Surgical Education: Theory, Evidence and Practice, edited by Debra Nestel, Kirsten Dalrymple, John T. Paige, and Rajesh Aggarwal, 279–88. Singapore: Springer Singapore.

Roberts, Nicole K., Reed G. Williams, Cathy J. Schwind, John A. Sutyak, Christopher McDowell, David Griffen, Jarrod Wall, et al. 2014. “The Impact of Brief Team Communication, Leadership and Team Behavior Training on Ad Hoc Team Performance in Trauma Care Settings.” American Journal of Surgery 207 (2): 170–78.

Sevdalis, Nick, Rachel Davis, Mary Koutantji, Shabnam Undre, Ara Darzi, and Charles A. Vincent. 2008. “Reliability of a Revised NOTECHS Scale for Use in Surgical Teams.” American Journal of Surgery 196 (2): 184–90.

Youngson, George G. 2016. “Non-technical Skills in Pediatric Surgery: Factors Influencing Operative Performance.” Journal of Pediatric Surgery 51 (2): 226–30.