Elsevier

Surgery

Volume 139, Issue 2, February 2006, Pages 140-149
Surgery

Clinical review
Non-technical skills for surgeons in the operating room: A review of the literature

https://doi.org/10.1016/j.surg.2005.06.017Get rights and content

Background

This review examines the surgical and psychological literature on surgeons' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons' non-technical skills.

Methods

A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect.

Results

A number of “core” categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons.

Conclusions

Further work is required to develop a valid taxonomy of individual surgeons' non-technical skills for training and feedback.

Section snippets

Material and methods

The literature search was carried out by consulting a number of different sources:

  • Databases and University library catalogues, including BioMed Central, Medline, Web-of-Knowledge, EDINA BIOSIS, PsychLit, and ScienceDirect.

  • Proceedings from recent applied health care, psychology, and human factors conferences.

  • The Library of the Royal College of Surgeons of Edinburgh.

  • Bibliographies from relevant research articles and book chapters.

  • Previous research on non-technical skills in aviation, nuclear

The Surgical Team Assessment Record (STAR)

The STAR questionnaire was designed to study the role of human factors in surgical outcomes18 and measure the organizational, situational, team, and personal factors thought to contribute to surgical performance. Questions on team factors cover dealing with unexpected events, communication between theater teams, preoperative briefings, confidence in other team members' abilities, and the level of harmony or disharmony among team members. Personal factors include technical skill, mental

Discussion

This review attempted to identify surgeons' non-technical skills from the surgical and psychological literature and then establish whether there was a valid and reliable taxonomy and associated behavioral marker system available for the assessment of surgeons' non-technical skills.

Conclusions and strategy for further research

The current state of assessment of surgeons' non-technical skills is in its infancy. Although imperfect, the studies reviewed here have sought to identify, develop, and rate surgeons' non-technical skills and established important groundwork in this field. Because the systems assessed in this review do not conform to the suggested criteria for behavioral marker systems, a project sponsored by the Royal College of Surgeons of Edinburgh and NHS Education for Scotland (NES) is now underway to

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    Funded by the Royal College of Surgeons of Edinburgh and NHS Education for Scotland (NES).

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