Nontechnical skills for the surgery clerkship in the operating room based on adult learning principles in Taiwan

Medical education has traditionally been rooted in the teaching of medical knowledge and surgical technique in the operating room, with little attention to the nontechnical skills (NTS) that include situational awareness, decision-making, teamwork and communication, and leadership. Under the guidance of adult learning principles, the aim of this study is to evaluate the learning outcomes of the NTS program for the surgery clerkship in the operation room in Taiwan. Self-directed learning principles were practiced during this 2-week subspecialty rotation. The learners were randomly divided into two groups: the control group (the learners and teachers deciding together what should be learnt) and the intervention group (the same as the control group and the formal NTS program implemented during the second week). A 12-item quantitative questionnaire including both the 6-item Accreditation Council for Graduate Medical Education (ACGME) Core Competencies and the 6-item adult learning characteristics was completed twice: before and after rotation. From Oct 2020 to May 2021, 16 medical students received NTS training and 16 were training-naive. For those undergoing NTS training, six core competencies significantly improved on a 6-point scale. Moreover, total score differences (post-training - pre-training) in core competency had significant correlations to the differences in adult learning characteristics (r = 0.648, p = 0.007). The NTS program could be feasibly integrated into core objectives of the basic surgical clerkships, with the improvement in adult learning motivation in the learners helping to facilitate NTS training under the competency-based surgical training program.