Cross-cultural adaptation and validation of the Spanish version of the Anesthetists' Non-Technical Skills (ANTS) assessment tool

Abstract

Study objective: Establish the transcultural validity of Anesthetists Non-Technical Skills (ANTS) in a Spanish-speaking country.

Design: Prospective cohort.

Setting: Clinical simulation center.

Subjects: Forty-two Anesthesia PY2 and PY3 residents participated in the study.

Interventions: Four clinical scenarios simulating anesthesia crises were assessed with a Spanish version of ANTS. Every simulated scenario was run twice with a time span of 3 to 4 months between them.

Measurements: Two anesthesiologists independently assessed all simulated sessions using ANTS. The ANTS indicators of construct validity were obtained by confirmatory factor analysis. Various goodness-of-fit indices of the factorial model were calculated: Comparative Fit Index (CFI); Tucker-Lewis Adjustment Index (TLI) and Root Mean Square Error of Approximation (RMSEA). The standardized factor loadings and the determination coefficient (R2) was also estimated.

Main results: A total of 212 clinical scenarios were analyzed. The specified factorial model had the same grouping of elements in four domains as the original version of ANTS. The CFI index and the TLI were 0.99 and the RMSEA reached 0.07 (95% CI 0.06-0.08). All the standardized factor loadings were found to be >0.4. Also, the elements obtained an R2 value that fluctuated between 0.54 and 0.92.

Conclusions: The Spanish version of ANTS is a valid, reliable and a useful tool to assess non-technical skills in Spanish-speaking countries. The applicability of the instrument was comparable to the original setting. The high reliability of ANTS in our setting allows us to propose its use not just in an educational and research setting; it can be used as an assessment tool of non-technical skills.

Keywords: Anesthetic non-technical skills; Assessment; Feedback; Reliability; Validity.