1. Non-technical competencies for
surgeons in disaster response: a
qualitative study
Anneliese Willems
Bruce Waxman
Andrew Bacon
Simon Kitto
Department of Surgery
Outline
1. Rationale
2. Research Questions
3. Qualitative Design
4. Research Outcomes
5. Implications for IPE
6. Summary
7. Questions
Rationale
 Natural disasters are increasing in
frequency
 Prompting calls for rigorous research
in Disaster Medicine
 Health professionals need to be
equipped with appropriate skills
 Non-technical competencies and
interprofessionalism associated with
best-practice in mainstream surgery
Rationale
How do non-technical core competencies
and interprofessionalism apply to disaster
environments?
Research Questions
1. What are the perceptions of
health professionals of the
required non-technical core
competencies of Australian
surgeons in disaster
response?
2. What are the facilitators of
effective interprofessional
practice in disaster response?
3. What elements should be
addressed in training
surgeons to work in disaster
response?
Qualitative Design and Sampling
 Thematic Content Analysis
 Including matrix analysis
 Purposeful sampling strategy
comprising:
 Snowball sampling
 Maximum variation sampling
 Inclusion Criteria:
 Australian health professionals
with disaster
response/education
experience

2. Data Collection & Analysis
 Semi-structured interviews (n=20)
 45mins-2hrs duration
 Face-to-face or telephone interviews
 Digitally recorded and transcribed
 Themes explored were disaster
experiences, perceptions on non-technical
skills for surgeons, effective team structures
and potential training strategies
Data Collection & Analysis
 Qualitative Analysis
 Field notes
 Coding
 Memos
 Matrix analysis – Conceptual
Clustered Matrices
Health
Professions
Interviewed
• Surgeons (6)
• Physicians (6)
• Nurses &
Paramedics (5)
• Public Health
Specialists (3)
Results (1) Newly identified non-technical
attributes for Australian surgeons in disaster
response
Results (1) Newly identified non-technical
attributes for Australian surgeons in disaster
response
Cognitive
Strategies
• ‘Big Picture’
thinking
• Situational
Awareness
• Critical Thinking
• Problem Solving
• Creativity
Results (1) Newly identified non-technical
attributes for Australian surgeons in disaster
response
Austere
Environment Skills
• Physical Self-
Care/Survival Skills
• Psychological Self-
Care
• Flexibility
• Adaptability
• Innovation
• Improvisation
Results (2). Interprofessional Practice was
identified as important in Disaster Teams
Interprofessionalism
in
Disaster Teams

3. Results - Effective Teamwork
 Learning to work with unfamiliar professionals
 ‘I’ve never really worked with paramedics…and our firemen that
came as well, I’d never really worked alongside them either‘
 Blurred personal and professional boundaries
 ‘You are going to live with them, you are going to sleep and eat
with them’
 Permissive environment essential
 ‘You have to allow a permissive environment where people feel
free to say look I don’t think this is right, or that is not right, should
we do this….’
 Mutual respect between professions
 ‘Respect for each other and acknowledgement of each other’s
skills that are brought to the environment are very important.’
Results - Good Leadership
 Leadership should be designated based on the
situation and personal experience
 ‘People who are used to being bosses need to
become [team players] on occasions’
 Not necessarily a surgeon or doctor
 Psychological leadership
 ‘responsible for setting the tone for all the other team
member’s interactions….responsible for role modelling
being calm’
 Appropriate leadership styles vary
 Authoritarian, Participative, Transformational,
Transactional
Results - Professional Role Adjustment
 Procedural and status changes to roles
 ‘Role extension’
 ‘Complete change of professional role’
 ‘Inclusion of less glamorous tasks’
 Precipitant to role changes was a chaotic,
fluctuating and austere environment
 Emphasis for professionals to work within
their capabilities to promote safe practice
Results - Conflict Resolution
 Most frequent causes were ‘individual factors’
and ‘resource allocation’
 ‘We found out we had four suture kits, I mean they
were literally in a zip lock bag and I had trouble
containing myself at that point’
 Conflict resolution methods
 'Negotiation and discussion’
 ‘Removing or relocating individuals’
 ‘Humour’
Results (3)- Training Surgeons for Disaster
Response
 Perceived Need:
 Training surgeons in non-technical core competencies for
disaster response recommended
 Multi-disciplinary format with a focus on interprofessional
interactions
 Form:
 Introductory elements in the RACS competency curriculum
 Full training could be incorporated into existent disaster
programmes (e.g. EMST, DCST)
 Educational Styles:
 Lectures, simulations/exercises, group work, tabletop exercises,
mentoring and ‘expectations training’
Results (4) Implications for
Interprofessional education (IPE)
 IPE is essential in disaster
education
 Understanding of other
professions and potential role
adjustment
 Exploration of non-traditional
leaders and leadership styles
 Understanding of appropriate
conflict management methods
in an austere environment
 Effective training strategies
include simulation training

4. Summary
 16 non-technical attributes
for surgeons in disaster
response identified in this
research
 Interprofessionalism
identified as a facilitator of
team best practice in
disaster environments
 Surgeons’ disaster training
should potentially
incorporate non-technical
core competencies and an
interprofessional focus
Recommendation
RACS/ADF develop a multidisciplinary Disaster
Response Course incorporating
 non-technical attributes for
a surgeon
 components of interprofessional
education
 multiple educational styles and
simulation
Acknowledgements
Anneliese Willems
BMed Science
Monash University
Andrew Bacon
Anaesthetist and Displan Medical Coordinator
Victoria
Simon Kitto
Postdoctoral Fellow, Qualitative Research
Department of Surgery, Monash University
Bruce Waxman
Director, Academic Surgical Unit
Monash University, Southern Health
RAAF Specialist Reserve