The compass project: comprehensive overview of European perceptions of non-technical skills in surgery

Non-Technical Skills for Surgeons (NOTSS) are essential for safe operative practice, yet integration into European training remains inconsistent . This study assessed surgeons' perceptions of NOTSS by career stage and prior training.

A 5-point Likert survey based on the NOTSS framework was distributed to European surgeons from February 15 to April 15, 2025. Responses were analyzed using Mann-Whitney U and Kruskal-Wallis tests, including subgroup analysis by training status and NOTSS exposure.

A total of 512 surgeons from 31 countries responded: 262 trainees and 250 attending surgeons. Only 108 (21.1%) participants had formal NOTSS training, though 95% expressed interest. Attending surgeons more often endorsed awareness of patient condition (53.2% vs. 45.4%), anticipation of complications (87.2% vs. 64.9%), and trainee decision-making autonomy in intraoperative and pre-procedure decision making. In leadership, they more strongly agreed with managing stress (62.4% vs. 28.6%), addressing mistakes privately, and promoting respectful dialogue. They also emphasized preoperative discussions (42.0% vs. 30.9%) and postoperative debriefing. Trainees perceived greater benefit from NOTSS training in general, and more often rated its promotion as essential for safe surgery.

European surgeons recognize NOTSS as critical, yet structured training remains limited. Attending surgeons show greater confidence, reflecting experiential acquisition, while trainees demonstrate strong enthusiasm for formal education. Standardized approaches to NOTSS training could address generational differences and enhance operative safety and team performance.