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Observational Tools That Quantify Nontechnical Skills in the Operating Room: A Systematic Review
Ryan D McMullan1, Rachel Urwin1, Neroli Sunderland1
1Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
The Journal of Surgical Research
|November 11, 2019
Summary
Operating room errors stem from technical and nontechnical skills (NTSs). This review identifies and evaluates NTS assessment tools, highlighting the NOn-Technical Skills for Surgeons for individuals and Oxford NOn-TECHnical Skills for teams.
Area of Science:
- Medical Education
- Patient Safety
- Surgical Performance
Background:
- Operating room errors are linked to technical performance and nontechnical skills (NTSs).
- Numerous tools exist to assess NTS in the operating room.
- A systematic review is needed to evaluate these tools for selection and use.
Purpose of the Study:
- To systematically review observational tools for assessing NTS in the OR.
- To report on the implementation and psychometric properties of these tools.
- To guide healthcare professionals, educators, and researchers in tool selection.
Main Methods:
- Systematic literature search from 1990 to 2019 across major databases.
- Independent screening, quality assessment, and data extraction by reviewers.
- Analysis of identified tools, study settings, and assessment focus (individual, subteam, team).
Main Results:
- Thirty-one NTS assessment tools were identified across 88 studies.
- NOn-Technical Skills for Surgeons (NOTSS) showed strong validity (content, concurrent, predictive, face).
- Oxford NOn-TECHnical Skills demonstrated good validity and reliability (inter-rater, test-retest).
Conclusions:
- NOTSS is the most validated tool for individual NTS assessment.
- Oxford NOn-TECHnical Skills is the most robust for team NTS evaluation.
- Further research on feasibility, reproducibility, observer training, and recording technologies is recommended.
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