Non-technical skills for surgeons in the operating room: a review of the literature

Surgery. 2006 Feb;139(2):140-9. doi: 10.1016/j.surg.2005.06.017.


Background: This review examines the surgical and psychological literature on surgeons' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons' non-technical skills.

Methods: A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect.

Results: A number of "core" categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons.

Conclusions: Further work is required to develop a valid taxonomy of individual surgeons' non-technical skills for training and feedback.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cognition*
  • Communication
  • Decision Making
  • General Surgery / education
  • Humans
  • Interpersonal Relations*
  • Leadership
  • Patient Care Team
  • Professional Competence*
  • Surgical Procedures, Operative / standards*