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Title: Exploring the role of tactical decision games as a novel method of developing medical students' non-technical skills
Author: Drummond, Iain Donald
ISNI:       0000 0004 7223 8739
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2017
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Introduction Clinical decision-making, situation awareness, task management, and teamwork are key non-technical skills (NTS) required by junior doctors. However, research has demonstrated that new doctors have difficulty demonstrating effective NTS behaviours. Tactical decision games (TDGs) are low-fidelity classroom-based activities designed to develop proficiency in NTS. They have been used in other safety-critical industries to develop NTS but their use in undergraduate medical education has been very limited. This aim of this thesis was to explore the potential role of TDGs as a novel method of developing final year medical students’ NTS. Methods Throughout this thesis a qualitative approach was taken, underpinned by constructivist epistemology. In the first instance the feasibility and acceptability of using generic (non-medical) TDGs with groups of final year medical students was explored. Thereafter, the use of non-medical TDGs and acute care simulation scenarios to develop NTS was investigated. Acute medical TDGs were developed with support and guidance from an expert panel. The potential role of medical TDGs to develop final year medical students’ NTS was then explored. Medical TDGs were then implemented into the core undergraduate curriculum in the clinical assistantship programme. Results In the feasibility study six key themes emerged from the data: ‘‘the value of non-medical games’’; ‘‘giving and receiving feedback’’; ‘‘observing and reflecting’’; ‘‘recognizing and understanding NTS’’; ‘‘dealing with uncertainty and ambiguity’’, and ‘‘introducing TDGs into the curriculum’’. Exploring the use of non-medical TDGs and acute care simulation to develop NTS, five key themes emerged from the data: “situation awareness and fixation”; “expectations influencing behaviour”; “being uncomfortable with uncertainty”; “transmitting and receiving information” and “working with peers and seniors”. Using acute medical TDGs to develop NTS, five key themes emerged from the data: “understanding capabilities and responsibilities of team members”; “prioritising in a busy clinical environment”; “developing a workable solution”; “relating medical TDGs to clinical experience” and “introducing medical TDGs into the undergraduate curriculum”. A team of facilitators were trained and medical TDGs delivered to the full final year cohort in the clinical assistantship programme. Discussion and conclusions This thesis has found that generic and acute medical TDGs represent an exciting potential method of teaching medical students NTS. TDGs appear to be versatile activities that can be adapted to meet the needs of participants in different contexts. As such, the full potential of TDGs in the undergraduate curriculum and beyond remains to be explored.
Supervisor: Wood, Morwenna ; Skinner, Janet Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: non-technical skills ; clinical decisions ; tactical decision games ; TDGs ; medical students ; teaching