Nature des compétences non techniques du leader médical à la prise en charge d’afflux massif de victimes : une étude à partir du point de vue des formateurs

Abstract : The high-risk dynamic environments management (transports, nuclear industry, medicine etc.) increases every day in our societies. A good management of these environments requires the reliability of technical and organization systems. It also requires the training of operators in non-technical skills. This thesis is focused on this last point. In the literature, the non-technical skills concept stays unclear.This works examines this concept, based on the training situations of medical leaders from the Army Health Service to wounded people massive influx in theatre operation. We adopt the point of view from trainers when they are analyzing activity of leaders.In a first part (Chap. I, II & III), we describe the training of the French army physicians and the current stakes and tools of the wounded people massive influx management training. This part also describes current non-technical skills training and trainer roles. The theoretical part describes works around non-technical skills, from its origins to its diffusion in various areas (Chap. IV & V). We describe the current NTS taxonomies which are mainly based on a divided into seven NTS categories: leadership, teamworking, communication, situation awareness, decision making, coping with fatigue and managing stress. Then, we characterize the activity of medical leader (Chap. VI). This theoretical part lead us to consider non-technical skills as technical or non-technical abilities (Chap. VII) and is conclude with the formulation of our research questions (Chap. VIII).The empirical part of this thesis starts with the elaboration of a corpus (Chap. IX) listing all the abilities linked to the leader performance. The construction of this corpus is based on twenty individual alloconfrontation interviews conducted with physician-trainers. Ten of them classified the abilities into three classes: technical (T), non-technical (NT), technical and non-technical (T-NT).The first study (Chap. X) analyses trainer classification. It shows the importance of NT class and identify the existence of five “representational styles” among trainers. The second study (Chap. XI) examines the meaning assigned by each participant to ability and highlight gaps between trainer representations. Then we identified five ability families with a two main families: slightly-divergent (45%) and NT (41%). We notice that there is a core of thirty abilities which are unanimously classified as non-technical only.The following studies (Chap. XII and XIII) are based on the classification of the 30 NT-only abilities by CRM trainers and MED trainers. The third study highlight that all trainers associate more than once NTS category to each ability. That shows NTS categories are not exclusive. In a descendant order leadership, communication, teamworking and situation awareness are the most used by trainers without difference between groups. The CRM group used more the leadership category. The MED group used more stress managing and coping with fatigue. The fourth study examines if it possible to gather, even to merge, some NTS categories based on the classification of NT-ONLY abilities. Our results show the proximities between the categories of leadership, teamwork and communication, then between situation awareness and decision making, and finally between managing stress and coping with stress. The last part of this thesis (Chap. XIV) discuss about the methodology used, results and questions they raise.
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Renaud Delmas. Nature des compétences non techniques du leader médical à la prise en charge d’afflux massif de victimes : une étude à partir du point de vue des formateurs. Psychologie. Université Paris-Saclay, 2019. Français. ⟨NNT : 2019SACLS024⟩. ⟨tel-02107648⟩

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