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Observer-based tools for non-technical skills assessment in simulated and real clinical environments in healthcare: a systematic review
  1. Helen Higham1,
  2. Paul R Greig1,
  3. John Rutherford2,
  4. Laura Vincent1,
  5. Duncan Young1,
  6. Charles Vincent3
  1. 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  2. 2 Department of Anaesthetics, Dumfries and Galloway Royal Infirmary, Dumfries, UK
  3. 3 Department of Experimental Psychology, University of Oxford, Oxford, UK
  1. Correspondence to Dr Helen Higham, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK; helen.higham{at}


Background Over the past three decades multiple tools have been developed for the assessment of non-technical skills (NTS) in healthcare. This study was designed primarily to analyse how they have been designed and tested but also to consider guidance on how to select them.

Objectives To analyse the context of use, method of development, evidence of validity (including reliability) and usability of tools for the observer-based assessment of NTS in healthcare.

Design Systematic review.

Data sources Search of electronic resources, including PubMed, Embase, CINAHL, ERIC, PsycNet, Scopus, Google Scholar and Web of Science. Additional records identified through searching grey literature (OpenGrey, ProQuest, AHRQ, King’s Fund, Health Foundation).

Study selection Studies of observer-based tools for NTS assessment in healthcare professionals (or undergraduates) were included if they: were available in English; published between January 1990 and March 2018; assessed two or more NTS; were designed for simulated or real clinical settings and had provided evidence of validity plus or minus usability. 11,101 articles were identified. After limits were applied, 576 were retrieved for evaluation and 118 articles included in this review.

Results One hundred and eighteen studies describing 76 tools for assessment of NTS in healthcare met the eligibility criteria. There was substantial variation in the method of design of the tools and the extent of validity, and usability testing. There was considerable overlap in the skills assessed, and the contexts of use of the tools.

Conclusion This study suggests a need for rationalisation and standardisation of the way we assess NTS in healthcare and greater consistency in how tools are developed and deployed.

  • team training
  • performance measures
  • medical education

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  • Contributors HH was responsible for the study concept and drafting the initial review manuscript. HH, PRG, JR, LV, DY and CV were responsible for design, analysis, interpretation and preparation of the completed manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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