Resident Physicians Improve Nontechnical Skills When on Operating Room Management and Leadership Rotation

Anesth Analg. 2017 Jan;124(1):300-307. doi: 10.1213/ANE.0000000000001687.


Background: Anesthesiology residency primarily emphasizes the development of medical knowledge and technical skills. Yet, nontechnical skills (NTS) are also vital to successful clinical practice. Elements of NTS are communication, teamwork, situational awareness, and decision making.

Methods: The first 10 consecutive senior residents who chose to participate in this 2-week elective rotation of operating room (OR) management and leadership training were enrolled in this study, which spanned from March 2013 to March 2015. Each resident served as the anesthesiology officer of the day (AOD) and was tasked with coordinating OR assignments, managing care for 2 to 4 ORs, and being on call for the trauma OR; all residents were supervised by an attending AOD. Leadership and NTS techniques were taught via a standardized curriculum consisting of leadership and team training articles, crisis management text, and daily debriefings. Resident self-ratings and attending AOD and charge nurse raters used the Anaesthetists' Non-Technical Skills (ANTS) scoring system, which involved task management, situational awareness, teamwork, and decision making. For each of the 10 residents in their third year of clinical anesthesiology training (CA-3) who participated in this elective rotation, there were 14 items that required feedback from resident self-assessment and OR raters, including the daily attending AOD and charge nurse. Results for each of the items on the questionnaire were compared between the beginning and the end of the rotation with the Wilcoxon signed-rank test for matched samples. Comparisons were run separately for attending AOD and charge nurse assessments and resident self-assessments. Scaled rankings were analyzed for the Kendall coefficient of concordance (ω) for rater agreement with associated χ and P value.

Results: Common themes identified by the residents during debriefings were recurrence of challenging situations and the skills residents needed to instruct and manage clinical teams. For attending AOD and charge nurse assessments, resident performance of NTS improved from the beginning to the end of the rotation on 12 of the 14 NTS items (P < .05), whereas resident self-assessment improved on 3 NTS items (P < .05). Interrater reliability (across the charge nurse, resident, and AOD raters) ranged from ω = .36 to .61 at the beginning of the rotation and ω = .27 to .70 at the end of the rotation.

Conclusions: This rotation allowed for teaching and resident assessment to occur in a way that facilitated resident education in several of the skills required to meet specific milestones. Resident physicians are able to foster NTS and build a framework for clinical leadership when completing a 2-week senior elective as an OR manager.

Publication types

  • Observational Study

MeSH terms

  • Anesthesiologists / education
  • Anesthesiologists / organization & administration*
  • Anesthesiologists / psychology
  • Anesthesiology / education*
  • Attitude of Health Personnel
  • Awareness
  • Clinical Competence
  • Clinical Decision-Making
  • Cooperative Behavior
  • Curriculum
  • Education, Medical, Graduate / organization & administration*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Interdisciplinary Communication
  • Internship and Residency / organization & administration*
  • Leadership*
  • Learning
  • Operating Room Information Systems / organization & administration*
  • Operating Rooms / organization & administration*
  • Patient Care Team / organization & administration
  • Personnel Staffing and Scheduling / organization & administration*
  • Personnel Staffing and Scheduling Information Systems / organization & administration*
  • Surveys and Questionnaires
  • Task Performance and Analysis
  • Workplace