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 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 Masterclass

This is a one day course is for consultant surgeons and higher surgical trainees from all specialties who already have some basic knowledge of the role of Human Factors in surgical performance, such as completing the NOTSS in a Box training modules and who have an ongoing interest in surgical training and assessment. The non-technical skills which underpin safer operative surgery will be examined in detail with short talks, video simulated scenarios and small group discussions. At the end of the course participants will be able to understand the theories and research relating to adverse events in surgery and other high risk industries. They will be able to use 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. Please download by clicking on the icon on the right.

NOTSS References

Please find references and a relevant reading lists here.

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