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

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. (Surgery 2006;139:140-9.)