Integrating Non-technical Skills in Endoscopy into Gastroenterology Training: A National Framework for Saudi Arabia

The practice of gastroenterology has evolved rapidly over the past two decades, driven by advances in endoscopic technology, expanding therapeutic indications, and increasing expectations of patient safety and quality of care. While technical competence in endoscopy remains a cornerstone of gastroenterology training, there is growing recognition that non-technical skills in endoscopy (NTSE) are also critical determinants of procedural success and patient outcomes. NTSE encompasses cognitive, interpersonal, and behavioral competencies, including communication, situational awareness, decision-making, leadership, teamwork, professionalism, and ethical practice within the endoscopy unit. However, their incorporation into gastroenterology training remains variable, particularly in the Middle East. In Saudi Arabia, gastroenterology training programs have made substantial progress in standardizing technical endoscopic training, yet formal curricula addressing non-technical skills are limited. This narrative review examines the rationale for integrating NTSE into gastroenterology training programs in Saudi Arabia, reviews relevant international evidence, and proposes a contextually appropriate framework for curriculum development, implementation, and assessment. Embedding non-technical skills training within existing gastroenterology curricula will enhance patient safety, improve trainee performance, and align Saudi training programs with international best practices. We outline practical strategies for faculty development, assessment methods, and future research priorities to support sustainable implementation.