News from the North – an update on progress in Human Factors Education in Scotland from Prof George Youngson

“In its report, ‘NHS Workforce Planning: limitation and possibilities’, The King’s Fund recommended a shift from the current emphasis on “new recruits”, to the development of skills for those who are already employed in delivering services….. enabling the current workforce to evolve and adapt to the inherently unpredictable health care environment.”

Liberating the NHS: developing the healthcare workforce – a consultation on proposals – DH 20 December 2010

This extract from a document published by the Department of Health in England has strong resonance with some of the items under active consideration in Scotland. Whilst most of the Scottish medical schools have integrated patient safety and human factors education into their senior years teaching, the curricula of postgraduate specialities still have gaps in these areas. The “novices” are up to speed (or are getting their) while the “masters” have some way to go to catch up and that missing link needs filled. Similarly continuous professional development (CPD) for the trained workforce has little or no content in human factors training – yet these are skills and attributes that are essential for us all to treat patients and colleagues effectively.

The Academy of Medical Royal Colleges commissioned a project jointly from the Royal College of Surgeons of Edinburgh and the NHS Institute which is trying to fill this gap in the postgraduate curriculum by allowing each medical specialty to build its bespoke curriculum in patient safety and human factors training. The Curriculum Creator tool extracted keywords and high-level domains from all international patient safety curricula published to date (including the WHO patient safety curriculum for medical schools); this online tool allows educational leads from every specialty in medicine to scroll through the important keywords and from that list they can drag-and-drop into their own specialty specific curriculum with the assistance of an intelligent cursor which explains the meaning of each keyword-thus building a bespoke curriculum for their own type of medicine (http://www.institute.nhs.uk/safer_care/safer_care/patient_safety_and_improvement_guidance_for_postgraduate_medical_education.html ).

The Royal College of Surgeons of Edinburgh is also running a project funded through the Joint Committee of Surgical Training (JCST) and NHS Education Scotland, to try and make non-technical skills an essential part of workplace-based assessment and is working with colleagues in Sheffield to develop a procedure-based assessment (PBA) for that task. There is no great problem in designing an assessment tool but there is a much bigger problem in making sure that it is valid and that the assessors themselves understand human factors and know how to use the assessment tool effectively. In that regard the most major challenge will be delivering a learning package that will inform both trainers and trainees alike.

High-level training in non-technical skills continues to attract national and international interest from Surgeons with RCSEd running master classes in Non-Technical Skills for Surgeons (NOTSS master classes). The last course in December 2010 attracted delegates from the Royal Australasian College of Surgeons and from Japan. Both these countries have exhibited significant interest in the 3 non-technical tools (NOTSS, ANTS -anaesthetic non-technical skills, and SPLINTS -surgical practitioners list of intraoperative non-technical skills )-developed jointly by Aberdeen University (Prof Rhona Flin, Dr Steven Yule ), Royal College of Surgeons of Edinburgh Patient Safety Board, (www.patientsafetyboard.org) Scottish Simulation Centre and funded by NHS Education Scotland. The faculty from the patient safety board in the college will be delivering workshops in Philadelphia in May 2011 at the annual meeting of the American Association of Thoracic Surgeons and this denotes an increased awareness of the value of non-technical skills throughout the surgical community. It looks as though an awareness of non-technical skills is beginning to “tip” in the surgical sector leaving us with a significant challenge of rollout and faculty development-a nice problem to have. It does mean that non-technical skills and human factors are beginning to appear in the consciousness of surgeons when reflecting on their CPD needs.

The Scottish Patient Safety Program (http://www.patientsafetyalliance.scot.nhs.uk/programme) has now reached its 3rd year and is making sure progress in integration of improvement science into clinical practice in the acute sector of Scottish hospitals but its failure to integrate human factors training is a void soon to be filled through Quality Improvement Scotland (QIS). This group is about to establish a working party which will be scoping out the needs of different groups of health care workers in the workforce. Delivering to meet that need will be a significant task but again one that is welcome by those who aspire to integrate human factors training into the day-to-day practice of anyone with a responsibility for looking after patients.

Prof George G Youngson CBE, MBChB, PhD, FRCSEd

About the author
George is Emeritus Professor of Paediatric Surgery at Aberdeen University and Vice President of the Royal College of Surgeons of Edinburgh