There is substantial lack of guidance when it comes to the implementation of non-technical skills (NTS) in undergraduate medical education. This review aimed to identify and critically evaluate published literature on learning strategies for NTS in undergraduate medical education and to derive a training framework targeted towards standardizing future training interventions. A systematic review of the MEDLINE database was performed using a prospective protocol following PRISMA guidelines. Studies evaluating undergraduate medical students exposed to NTS interventions, which measured subjective or objective outcomes in selected attributes, were included. Initial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria. A total of 24 NTS were identified, with communication skills being the most commonly reported skill evaluated (n = 37). A variety of educational tools were used (n = 32), noteworthy being the use of simulated patients. Great heterogeneity was also observed in measured outcomes and methods of assessment. A 'triad of outcomes' in NTS training was devised (knowledge, skill performance and attitude towards skills) and used for classification of all reported outcomes. Extracted data were used to design a non-technical skill training framework. The existing literature describes a plethora of NTS interventions in undergraduate medical education, with varied outcomes and assessments. We hereby propose the 'NTS Training Framework', in an attempt to coordinate future research and catalyze the identification of an ideal NTS course structure to form tomorrow's physicians.

The aim of this study is to evaluate a simulation-based team performance course for medical students and compare its low- and high-fidelity components. This is a prospective crossover observational study. Groups participated in one low- and one high-fidelity session twice. Low-fidelity scenarios included management of an emergency case on a simulated-patient, whereas high-fidelity scenarios constituted of multiple-trauma cases where simulated-patients wore a hyper-realistic suit. Team performance was assessed objectively, using the TEAM™ tool, and subjectively using questionnaires. Questionnaires were also used to assess presence levels, stress levels and evaluate the course. Participants' team performance was higher in the low-fidelity intervention as assessed by the TEAM™ tool. An overall mean increase in self-assessed confidence towards non-technical skills attitudes was noted after the course, however there was no difference in self-assessed performance between the two interventions. Both reported mean stress and presence levels were higher for the high-fidelity module. Evaluation scores for all individual items of the questionnaire were ≥4.60 in both NTS modules. Students have assessed the high-fidelity module higher (4.88 out of 5, SD = 0.29) compared to low-fidelity module (4.74 out of 5, SD = 0.67). Both the low- and high-fidelity interventions demonstrated an improvement in team performance of the attending medical students. The high-fidelity intervention was more realistic, yet more stressful. Furthermore, it proved to be superior in harvesting leadership, teamwork and task management skills. Both modules were evaluated highly by the students, however, future research should address retention of the taught skills and adaptability of such interventions.

Minimally invasive interventional approaches are gaining wider acceptance with several specialities incorporating such principles. Awareness and understanding of interventional principles require efficacious education and training methodologies. We performed a systematic review to identify all available interventional speciality learning modules or training opportunities available for undergraduate medical students. We also propose a standardised framework for relevant modules. We searched PubMed and all Ovid databases with no language restriction for studies that report and evaluate interventional speciality educational modules or similar training initiatives. We followed a prospective protocol (PROSPERO registration: CRD42018110006). Internal and external validity of the included studies was assessed. Qualitative synthesis of data was performed to define performance improvement and/or motivation towards a career in an interventional speciality. Out of 6081 records, 17 studies met the inclusion criteria, 15 of which were focused on interventional radiology. More than half of studies (9/17) were surveys where student knowledge and interest were reported as poor. 5 out of 6 studies which assessed the effect of educational interventions concluded to improved knowledge or performance. Most surveys concluded that early exposure can increase interest towards such specialities, improve knowledge and relevant motivation. Few studies report teaching initiatives in interventional radiology and other interventional specialities, reflecting the poor relevant motivation and knowledge amongst medical students. Simple interventions e.g. introductory lectures and simulation sessions spark interest in students and also improve knowledge as proven in the case of interventional radiology. Standardisation of such efforts via a suggested framework, Strategy Development Framework for Interventional Radiology, can further optimise such outcomes.

Introduction Physiological hand tremor occurs naturally, due to oscillations of the upper extremities. Tremor can be exacerbated by stress and anxiety, interfering with fine motor tasks and potentially impact on surgical performance, particularly in microsurgery. We investigated the link between tremor, anxiety and performance in a neurosurgical module as part of an international surgical course. Methods Essential Skills in the Management of Surgical Cases (ESMSC) course recruits medical students from European Union (EU) medical schools. Students are asked to suture the dura mater in an ex vivo swine model, of which the first suture completed was assessed. Questionnaires were distributed before and after the module, eliciting tremor risk factors, self-perception of tremor and anxiety. Johnson O’Connor dexterity pad was used to objectively measure dexterity. Direct Observation of Procedural Skills (DOPS) was used to assess skills-based performance. Anxiety was assessed using the Westside Test Anxiety Scale (WTAS). Tremor was evaluated by four qualified neurosurgeons. Results Forty delegates participated in the study. Overall performance decreased with greater subjective perception of anxiety (p = 0.032, rho = − 0.392). Although increasing scores for tremor at rest and overall WTAS score were associated with decreased performance, this was not statistically significant (p > 0.05). Tremor at rest did not affect dexterity (p = 0.876, rho = − 0.027). Conclusions Physiological tremor did not affect student performance and microsurgical dexterity in a simulation-based environment. Self-perception of anxiety affected performance in this module, suggesting that more confident students perform better in a simulated neurosurgical setting.