Adopt cluster-randomised or stepped-wedge trial designs with blinded, video-based assessment and pre-defined process and patient endpoints in future NTS training research.¶

Strategy · All strategies
Evidence · 6 claims (6 for) · 1 study (1 review), q2 · 0 of 1 report an effect size · 6 claims rest on one study

Description¶

The review recommends that future research "adopt cluster-randomised or stepped-wedge trials that balance internal validity with feasibility in dynamic ED environments" and ensure allocation concealment, fidelity assessment, and transparent attrition reporting. For measurement, it recommends "blinded, video-based assessment with predefined competency anchors, rater training, and reporting of inter-rater reliability". For outcomes, it recommends predefining mechanism-linked process endpoints and powering for patient-centred outcomes with longitudinal follow-up to examine decay and booster effects.

Design Implications¶

Context¶

Requirements¶

• Multi-site pragmatic designs
• Blinded video-based assessment with predefined competency anchors and rater training
• Pre-specified process and patient endpoints

Constraints¶

• Cluster-randomised or stepped-wedge designs must balance internal validity with feasibility in dynamic ED environments.

Target Learners¶

• Healthcare professionals working in emergency departments

Target Learning Goals¶

• Rigorous evaluation of NTS training effects on team performance and patient-centred outcomes

Claims¶

• Similar behavioural domains improved across diverse organisational cultures in North America, Europe, and Asia, suggesting core NTS constructs are portable and adaptable locally. [+W]
• Evidence that NTS training improves clinical or process outcomes in EDs is limited but generally favourable in single-centre studies, including shorter resuscitation times and improved protocol adherence (low to very low certainty). [+W]
• NTS training for emergency department professionals is associated with consistent pre- to post-training improvements in knowledge, teamwork attitudes, and self-confidence (low to moderate certainty). [+W]
• NTS training improves observable team behavioural performance in EDs, including more frequent closed-loop communication, clearer role allocation and prioritisation, improved situational awareness, and higher teamwork ratings (moderate certainty). [+W]
• In one included study, simulation-based team training in a trauma bay was followed by a 16 percent reduction in total resuscitation time and faster completion of primary surveys. [+W]
• Interventions combining core simulation with in-situ refreshers, visual prompts, and structured micro-debriefs more often reported larger or more durable behavioural improvements. [+W]

Related Strategies¶

• Incorporate quality control measures with standardized photographic or video-based assessments using predefined anatomic landmarks
• Future active-learning research should use randomised controlled designs with larger samples and standardised outcome measures
• Use cluster randomized clinical trials and blinded simulation-based behavior assessment to strengthen NTS training evidence
• Future simulation research should use rigorous designs, standardized tools, and transparent reporting

Examples¶

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Key Sources¶

• Zhang YuKun, Wang YuWei, Jiang ManYu, Sun XiHui, Tang LiYoong. (2026). Effectiveness of non-technical skills training for healthcare professionals in emergency departments: a systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. https://doi.org/10.1186/s13049-026-01574-9