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Prospective observational study to evaluate NOTSS (Non-Technical Skills for Surgeons) for assessing trainees'
J Crossley1, J Marriott, H Purdie
1Academic Unit of Medical Education, University of Sheffield, Sheffield, UK.
The British Journal of Surgery
|April 12, 2011
Summary
The Non-Technical Skills for Surgeons (NOTSS) assessment is feasible and reliable for evaluating trainee surgeons. Minimally trained operating theatre staff can provide consistent judgments on non-technical skills.
Area of Science:
- Surgical Education
- Patient Safety
- Healthcare Professional Assessment
Background:
- Traditional surgical assessment focuses on technical skills, neglecting non-technical skills crucial for patient safety and clinical outcomes.
- The Non-Technical Skills for Surgeons (NOTSS) instrument was developed to evaluate individual surgeons' non-technical skills in the operating theatre.
- This study assessed the real-world feasibility, validity, and psychometric reliability of the NOTSS instrument using minimally trained assessors.
Purpose of the Study:
- To evaluate the feasibility, validity, and psychometric reliability of the NOTSS assessment instrument in a real-world setting.
- To determine if minimally trained assessors can reliably evaluate surgeons' non-technical skills.
- To explore the applicability of NOTSS across different surgical specialties and trainee levels.
Main Methods:
- A total of 715 assessments were conducted on 404 surgical cases across 15 index procedures in six specialties.
- Assessments were performed by a mixed group of 56 anaesthetists, 39 scrub nurses, two surgical care practitioners, and three independent assessors.
- The study involved 85 surgical trainees, with each case assessed by multiple minimally trained observers.
Main Results:
- The NOTSS assessment was found to be feasible, though implementation challenges were identified.
- Respondents largely considered the method valid, with some reservations regarding the assessment of cognition.
- The factor structure and positive correlations with experience supported the validity of NOTSS scores, which demonstrated good reliability (generalizability coefficient ≥ 0.8) with 6-8 assessors per case.
Conclusions:
- Minimally trained operating theatre personnel can effectively discriminate and provide consistent judgments on trainee surgeons' non-technical skills.
- Reliable NOTSS scores can be obtained with an achievable number of observations by typically present staff.
- The findings support the use of NOTSS with minimally trained assessors to enhance surgical training and patient safety.