Non-Technical Skills for Surgeons (NOTSS)

Non-Technical Skills for Surgeons (NOTSS) is a tool allowing trainers to give feedback to colleagues and trainees based on structured observations of non-technical aspects of performance.

What are non-technical skills?

Non-technical skills are the cognitive and interpersonal skills that complement practical and technical competences, such as decision making, leadership and team working. In surgical specialties, these behavioural or non-technical aspects of performance (e.g. communication failures) are often the underlying causes of adverse events, rather than a lack of technical expertise. Traditionally, these aspects of performances have been largely developed informally rather than explicitly addressed in training.

What is NOTSS?

The NOTSS system provides a framework and common terminology for rating and giving feedback ton non-technical skills. Used in conjunction with medical knowledge and clinical skills, NOTSS is a tool to observe and rate behaviour in theatre in a structured manner. This enables clear and transparent assessment of training needs.

NOTSS describes the main observable non-technical skills associated with good surgical practice, under the following headings:

Situation awareness
Decision making
Communication and teamwork
Leadership

The RCOG has adapted the NOTSS system for use on the labour ward and in the gynaecological operating room. We have removed the rating system to focus on providing constructive and timely feedback. The system includes only those behaviours that are directly observable or that can be inferred through communication. NOTSS covers a wide range of non-technical skills in as few categories as possible.

How many NOTSS do I need to perform?

NOTSS are encouraged as a method to provide evidence for CiPs. The aim is for quality over quantity. Useful WBAs will challenge, act as a stimulus and mechanism for reflection, uncover learning needs and provide an opportunity for developmental feedback.