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Updated: Feb 14, 2026

Principles of Rodent Surgery for the New Surgeon
Published on: January 6, 2011
Non-Technical Skills for Surgeons (NOTSS): Critical appraisal of its measurement properties
James J Jung1, Cornelia M Borkhoff2, Peter Jüni3
1International Centre for Surgical Safety, Keenan Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Background:
To critically appraise the development and measurement properties, including sensibility, reliability, and validity of the Non-Technical Skills of Surgeons (NOTSS) system.
Data Sources:
Articles that described development process of the NOTSS system were identified. Relevant primary studies that presented evidence of reliability and validity were identified through a comprehensive literature review.
Results:
NOTSS was developed through robust item generation and reduction strategies. It was shown to have good content validity, acceptability, and feasibility. Inter-rater reliability increased with greater expertise and number of assessors. Studies demonstrated evidence of cross-sectional construct validity, in that the tool was able to differentiate known groups of varied non-technical skill levels. Evidence of longitudinal construct validity also existed to demonstrate that NOTSS detected changes in non-technical skills before and after targeted training.
Conclusion:
In populations and settings presented in our critical appraisal, NOTSS provided reliable and valid measurements of intraoperative non-technical skills of surgeons.
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