Development of a rating system for surgeons' non-technical skills

Area of Science:

• Surgical Education
• Patient Safety
• Human Factors in Medicine

Background:

• Surgical adverse events frequently result from behavioral factors like communication failures, not solely technical errors.
• Non-technical skills (cognitive and interpersonal) are crucial for surgeons but are not explicitly part of current surgical training.
• Developing these skills is essential for maximizing patient safety in the operating theatre.

Purpose of the Study:

• To identify surgeons' non-technical skills.
• To develop a skills taxonomy and a behavioral rating system for surgical training.
• To structure observation and feedback for enhancing surgical performance.

Main Methods:

• Cognitive task analyses, including critical incident interviews with 27 consultant surgeons across various specialties.
• Iterative development of a skills taxonomy by a multidisciplinary team of surgeons and psychologists.
• Data triangulation using attitude surveys, literature reviews, mortality report analysis, and direct theatre observations.

Main Results:

• Identification of five key non-technical skill categories: situation awareness, decision making, task management, leadership, and communication/teamwork.
• Development of a prototype skills taxonomy (v1.1) with 14 distinct non-technical skill elements.
• Creation of a prototype behavior rating system with observable markers for good and poor performance, defined by 16 consultant surgeons.

Conclusions:

• The developed prototype skills taxonomy and behavior rating system are empirically validated within surgical practice.
• Ongoing reliability testing using standardized scenarios is underway.
• Successful validation could lead to the system's implementation for structured feedback and non-technical skills training in surgery.