Non-Technical Skills for Surgeons (NOTSS)

RCSEd is committed to the global health priority of patient safety

The non-technical skills of surgeons (NOTSS) play a significant role in patient safety. RCSEd is at the epicentre of an initiative to build a taxonomy and training system and raise awareness of the importance of NOTSS. This demonstrates our commitment to patient safety and why we support the World Health Organisation’s World Patient Safety Day.

A behaviour rating system based on a skills taxonomy

The aim of the NOTSS project was to develop and test an educational system for assessment and training of non-technical skills in the intra-operative phase of surgery. NOTSS is a behaviour rating system based on a skills taxonomy that allows valid and reliable observation and assessment of four categories of surgeons' non-technical skill: situation awareness, decision making, communication & teamwork, and leadership.

These are the essential non-technical skills surgeons need to perform safely in the operating room and NOTSS allows measurement of several ACGME (Accreditation Council for Graduate Medical Education) competencies, including professionalism, interpersonal and communication skills, and systems-based practice. The skills taxonomy can be used to structure training and assessment in this important area of surgical competence.

The Royal College of Surgeons of Edinburgh has been successfully running a NOTSS Masterclass in observing and rating behaviour for both consultant/attending and trainee surgeons since 2006. Faculty development has also occurred for groups in North America, East Africa, Japan, Australasia and Malaysia, all of whom now run their own NOTSS courses. NOTSS has been adopted by the Royal Australasian College of Surgeons as part of their competence assessment and recommended by the ACGME (Accreditation Council for General Medical Education) for workplace assessment in the UK.

NOTSS Introductory Videos

These videos introduce the principles behind the NOTSS system, and although they were made to accompany the ChM in Clinical Ophthalmology, they are suitable for all surgical specialties.

NOTSS Masterclass

The NOTSS Masterclass is a one-day course designed to equip consultants and senior trainees across all surgical specialties with essential non-technical skills for safe patient care. These skills encompass cognitive and interpersonal aspects of surgery that are pivotal for enhancing individual and team performance.

The course offers participants the opportunity to observe and rate non-technical behaviours in a practical setting. The learning experience is enriched through small group work and simulated scenarios drawn from both the operating theatre and other industries.

Upon completion of the course, participants will gain a deep understanding of the theories and research associated with adverse events in surgery and other high-risk industries. They will also be proficient in using the NOTSS system to observe, rate, and provide feedback on behaviour in the operating theatre."

NOTSS Handbook

This handbook provides details on the non-technical skills taxonomy for surgeons and how these skills may be observed and rated.

NOTSS for Trainees

This eLearning resource aims to fill the knowledge gap in undergraduate and postgraduate education of surgical trainees in behavioural aspects of surgical performance, so that surgeons of the future are available to identify, classify and acquire non-technical skills. Intended for those in the early stages of surgical training, it consists of an introductory video and 6 short eLearning modules.

NOTSS References and Publications List

Please find NOTSS references, reading lists and publications here.

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