Non-Technical Skills for Surgery in African Perioperative Curricula: A Scoping Review

Introduction : Non-technical skills (NTS) such as situation-awareness, decision-making, communication, and leadership among surgical healthcare providers are vital to safe surgical care. Studies have associated poor NTS with errors in the operating room. The extent to which African training curricula address NTS is unclear. We mapped the presence and absence of NTS content in surgery, obstetrics and gynecology, anesthesia, and nursing/midwifery training curricula across Africa. Methods : Using the Arksey and O'Malley methodological framework, we conducted a scoping review on PubMed, AJOL, and Google Scholar databases, followed by a grey literature search to identify published perioperative training curricula from African institutions. Data on NTS were abstracted and were categorized as explicitly teaching, explicitly mentioning, implicitly mentioning, or making no mention of NTS. Results : From 55 screened documents, 31 specialty curricula from 18 institutions across 11 countries met inclusion criteria. West Africa was represented at 45.2%, followed by East Africa at 29.0%, and North and South Africa at 6.5% each. Curricula from the College of Surgeons of East, Central and Southern Africa, the College of Anesthesiologists of East, Central and Southern Africa, the East, Central and Southern African College of Obstetrics and Gynecology, and the WHO Africa Prototype Competency-Based Curriculum accounted for 12.9%. No single-country NTS curriculum was identified from Central Africa. NTS were mentioned implicitly (38.7%), explicitly (48.4%), both implicitly and explicitly (6.5%), or not at all (6.5%). Most curricula (93.5%) mentioned at least one NTS. Among NTS domains, leadership was most frequently mentioned (67.7%), followed by teamwork (61.3%), communication (45.2%), professionalism (35.5%), decision-making (32.3%), and problem-solving (29.0%). Critical thinking and situation awareness (6.5%) were the least represented domains. Conclusion : While several African perioperative curricula mention NTS, gaps exist in the incorporation of formalized NTS training in existing courses and assessments, especially in Central Africa. Targeted curriculum reform is needed to transition NTS from implicit expectations to explicitly taught and assessed competencies in African perioperative training. Structured coursework, such as the Non-Technical Skills for Surgeons in Variable Resource Contexts (NOTSS-VRC) may help fill these gaps.