Non-Technical Skills for Surgeons (NOTSS) 

There is an established evidence base for the importance of non-technical skills in surgical performance. Developed by surgeons, NOTSS is a behaviour assessment tool and training system for evaluation and improvement in four categories of non-technical skills.

The NOTSS PROJECT

NOTSS was developed using Human Factors methodologies (critical incident interviews, observations, surgery, systematic review, adverse event analysis) from 2003-2007. Since then it has been implemented widely in real and simulated operative environments. Many adaptations have been developed specific to surgical contexts in North America, Europe, Africa, Asia and Australia. NOTSS has even influenced the development of a similar system for astronaut crews funded by NASA. There is a popular NOTSS Masterclass series run by the Royal College of Surgeons of Edinburgh with courses for established surgeons and trainees in the UK and around the world.

The NOTSS system

The NOTSS taxonomy is broken down into four distinct categories of non-technical skill: Situation Awareness, Decision Making, Communication and Teamwork, and Leadership, each with associated elements. Exemplar good and poor behaviours were carefully written for each element. Surgical language is evident throughout for trained surgeons to observe, rate, and provide feedback on non-technical skills in a structured manner

NOTSS Training courses

NOTSS has found a natural home at the Royal College of Surgeons of Edinburgh (RCSEd) who have been successfully running NOTSS Masterclasses in observing and rating behaviour since 2006. Faculty development has also occurred for groups in the United States, Japan, Australia, Malaysia, Sri Lanka, and in Europe. The first of many NOTSS workshops in the USA was held in May 2011 at the Annual meeting of the American Association of Thoracic Surgeons. Over 100 cardiothoracic surgeons attended this 3-hour program. In 2013, NOTSS was incorporated to the ACSS Weekly Curriculum and in 2014 became part of the SCORE (Surgical Council on Resident Education) national curriculum for surgical training. For practicing surgeons, a one-day NOTSS workshop was held at the American College of Surgeons Annual Clinical Congress several years from 2013-2020, and technical skills courses are commonly held at major simulation and education conferences.