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Non-Technical Skills for Surgeons (NOTSS)

The aim of the NOTSS project was to develop and test an educational system for assessment and training of non-technical skills in the intraoperative 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 emerging area of surgical competence. 

The Royal College of Surgeons of Edinburgh has been successfully running a NOTSS Masterclass in observing and rating behaviour for attending surgeons since 2006. Faculty development has also occurred for groups in North America, East Africa, Japan and Australia. 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, it is proposed that all surgical trainees will be assessed using NOTSS; two online training resources NOTSS in a Box (for senior trainees and consultants) and NOTSS for Trainees (for early stage trainees) have been developed by RCSEd and discussions regarding implementation methods are ongoing.

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 aquire 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 in a Box

This eLearning resource, aimed at Senior Trainees and Consultants, contains an introduction into human factors and the language of NOTSS. It highlights the classification and rating system used for assessment of non-technical skills as well as providing an introduction into the basic concepts of the NOTSS categories. It is intended as a preliminary learning resource for those involved in the teaching and assessment of surgical trainees, identifying examples of the cognitive and social behaviours involved in NOTSS. This resource, available free-of-charge to RCSEd Fellows and Members, provides suitable background information for those wishing to attend a full NOTSS Masterclass. Please use your RCSEd website username and password to access this site here.

NOTSS Masterclass

This course is for consultant surgeons and higher surgical trainees from all specialties who have already have some basic knowledge on the role of Human Factors in surgical performance, such as completing the NOTSS in a Box 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 below.


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