Development of workplace‐based assessments of non‐technical skills in anaesthesia

Summary Non‐technical skills are recognised as crucial to good anaesthetic practice. We designed and evaluated a specialty‐specific tool to assess non‐technical aspects of trainee performance in theatre, based on a system previously found reliable in a recruitment setting. We compared inter‐rater agreement (multir‐ater kappa) for live assessments in theatre with that in a selection centre and a video‐based rater training exercise. Twenty‐seven trainees participated in the first in‐theatre assessment round and 40 in the second. Round‐ 1 scores had poor inter‐rater agreement (mean kappa = 0.20) and low reliability (generalisability coefficient G = 0.50). A subsequent assessor training exercise showed good inter‐rater agreement, (mean kappa = 0.79) but did not improve performance of the assessment tool when used in round 2 (mean kappa = 0.14, G = 0.42). Inter‐rater agreement in two selection centres (mean kappa = 0.61 and 0.69) exceeded that found in theatre. Assessment tools that perform reliably in controlled settings may not do so in the workplace.