Steven Yule

In order to better understand the role of non-technical skills in surgery, Steven Yule, PhD, and colleagues developed a Non-Technical Skills for Surgeons (NOTSS) behavior rating tool at the University of Aberdeen, Scotland, in 2006. Since then, the tool has been widely implemented and adapted for use in settings ranging from Japan to rural Rwanda. Now, development of a similar tool is underway for use in an even more high-risk environment: deep space, during long-duration exploration missions.

Yule is the director of Education & Research at BWH’s STRATUS Center for Medical Simulation and is an academic psychologist and expert in assessing NOTSS for improving patient safety in surgery. He is the principal investigator for a carefully assembled, multi-institutional, interdisciplinary team of researchers who were recently awarded a $400,000 one-year grant from NASA’s National Space Biomedical Research Institute to develop and assess a non-technical skill-based training program for astronauts to effectively manage medical emergencies on deep-space human-exploration missions such as missions to Mars, near-earth asteroids or the moon.

The team is composed of experts in training and simulation, human factors, emergency medicine and surgery. Several of the experts on the team are affiliated with BWH and BWH’s Center for Surgery and Public Health, including Stuart Lipsitz, ScD; Chuck Pozner, MD; Douglas Smink, MD, MPH; Jamie Robertson, MPH, PhD; Roger Dias, MD, MBA, PhD; and Avni Gupta, BDS, MPH. Team members also include David Musson, MD, PhD, of Northern Ontario School of Medicine, and Thomas Doyle, PhD, PEng, of McMaster University.

Developing a Non-Technical Skills Measurement Tool for Astronauts

Experts participated in a two-day meeting at Lunar and Planetary Institute, Houston.

The first task ahead for the team is to establish which non-technical skills are relevant for effective management of medical emergencies during deep-space missions by astronauts (space-flight crew).

“These are skills like leadership, communication, teamwork and situational awareness—the kind of skills that are really important for team function and dynamic in high-risk situations, but aren’t formally taught to medical teams, nor are they being assessed,” said Yule.

The researchers have gathered an international expert advisory panel of astronauts, NASA officials, scientists in various disciplines such as human factors and simulation, and clinicians to determine the key non-technical skills astronauts need to respond to in-flight medical emergencies effectively. Earlier this month, these experts participated in a two-day meeting at Lunar and Planetary Institute, Houston where they brainstormed on key non-technical skills, possible medical emergencies to train and the challenges of space context through an iterative process that included rating exercises, group discussions and sorting activities. The outcome of the meeting was a consensus on space context-specific skills and emergencies, as well as on the features of the medical bay simulator to be developed at STRATUS that can best reproduce in-flight situations and challenges during medical emergencies. With this information, researchers will now begin to home in on the particular skills or set of behaviors for astronaut crews that will help to maximize safety and minimize errors in the face of medical events in space.

Testing the NOTSS Measurement Tool with Simulated Medical Emergency Scenarios

The second part of the project is to create a simulated spacecraft medical bay and run a series of filmed simulation scenarios to fine-tune the assessment tool and gauge its accuracy in measuring improvement.

“We want to recreate what the medical situation is really like in that environment so we can start to run training courses and evaluate competence of performance in simulation,” explained Yule. “The only thing the simulated bay will not have that the real medical bay does have is zero-gravity. It will be using a lot of the same equipment, sensors and technology.”

One reason that this proposal was selected from a very competitive pool of applicants was the STRATUS Center’s long-standing reputation for simulation excellence. “We have a simulated operating room that is almost identical to the operating rooms in the hospital. It has the same equipment so people are familiar with the tools, room layout and connectivity,” said Yule.

Does this mean that BWHers should be on the lookout for astronauts around the hospital? Not quite. The simulated medical bay will be housed here, but for now, the team will recruit emergency medical technicians (EMTs) to pilot test their simulation. “EMTs are similar to most astronauts in that they have some training in managing medical emergencies, but they are not trained clinicians,” said Yule. “The aim for this project is to develop an assessment tool; then, the next stage will be to run some training for the astronauts and see if we can take it to the end users.”

Improving Responses to Medical Emergencies, on Earth and in Space

Earth and space may be vastly different settings, but teams in both environments must master non-technical skills in order to succeed when it comes to responding to medical emergencies. Yule is optimistic that this project will help identify and assess which skills are essential for astronaut crews for medical event management in space so that they can enhance proficiency, reduce performance errors and realize optimal patient outcomes during space missions to maximize mission success.