Effectiveness of non-technical skills training for healthcare professionals in emergency departments: a systematic review.

objectivesThis systematic review evaluated the effectiveness of non-technical skills (NTS) training for healthcare professionals working in emergency departments (EDs) and assessed the certainty of the evidence.

methodsPeer-reviewed studies of NTS training for ED staff, including physicians, nurses, and allied health professionals, were systematically identified from PubMed, Scopus, Web of Science, the Cochrane Library, CINAHL, EMBASE, and PsycINFO, with supplementary searches of Google Scholar and reference lists (search date: 19 August 2025). Eligible studies reported learning outcomes, observed behavioural performance, and/or patient- or process-level outcomes in ED settings. Two reviewers independently screened records, extracted data, and assessed risk of bias using RoB 2 for randomised controlled trials, ROBINS-I for non-randomised comparative studies, and the NIH/NHLBI tool for before-and-after studies. Owing to methodological heterogeneity, findings were synthesised narratively, and certainty of evidence was assessed using the GRADE approach (PROSPERO: CRD420251181995).

resultsOf 6,359 records identified, 15 studies met inclusion criteria, comprising two randomised controlled trials, one quasi-experimental study with a control group, and twelve before-and-after studies, predominantly from single-centre adult EDs in North America, Europe, and Asia. NTS training was commonly delivered through simulation-based courses with structured debriefing and was associated with consistent pre- to post-training improvements in knowledge, teamwork attitudes, and self-confidence, with low to moderate certainty of evidence. Behavioural performance improved across study designs, including more frequent closed-loop communication, clearer role allocation and prioritisation, improved situational awareness, and higher teamwork ratings measured using validated instruments such as the Team Emergency Assessment Measure (TEAM) and the Trauma Non-Technical Skills scale (T-NOTECHS) (moderate certainty). Evidence for clinical or process outcomes was limited but generally favourable in single-centre studies, including shorter resuscitation times and improved protocol adherence; no study reported effects on mortality or complication rates, and the certainty of evidence for these outcomes was rated as low to very low.

conclusionNTS training for ED teams improves learning outcomes and observable team performance, particularly when simulation is combined with high-quality debriefing and brief in-situ refreshers. Evidence for effects on patient outcomes remains limited. Future research should prioritise pragmatic multi-site designs with blinded video-based assessment and pre-specified process and patient endpoints.