Rating Anaesthetists' Non-Technical Skills — The Ants System

Non-technical skills are the cognitive and social skills required in any operational task involving decision making and team work, such as aviation or surgical medicine. This study identified the key non-technical skills required in anaesthesia, and developed a behavioural marker system (Anaesthetists' Non-Technical Skills (ANTS)) for their assessment in theatre, in the simulator or from video recordings. It comprises four skill categories (task management, team working, situation awareness and decision making) divided into fifteen elements, each with example behaviours. A first stage evaluation was conducted by asking 50 consultant anaesthetists to rate the behaviour of a target anaesthetist using the prototype ANTS system in eight videos of simulated anaesthetic scenarios. The system appeared to be complete, and the skills were observable, and could be rated with acceptable levels of agreement and accuracy. The second stage evaluation is now testing the usability of the behavioural rating system in the operating theatre environment.