Journal of the American College of Surgeons
Volume 214, Issue 2 , Pages 214-230 , February 2012

The Impact of Nontechnical Skills on Technical Performance in Surgery: A Systematic Review

Received 13 September 2011 ,Revised 27 October 2011 ,Accepted 31 October 2011.

References 

  1. Kohn LT , Corrigan JM , Donaldson MS . To err is human . Washington, DC: National Academies Press; 1999;
  2. Gawande AA , Zinner MJ , Studdert DM , et al.   Analysis of errors reported by surgeons at three teaching hospitals . Surgery . 2003;133:614–621
  3. Rogers SO , Gawande AA , Kwann M , et al.   Analysis of surgical errors in closed malpractice claims at 4 liability insurers . Surgery . 2006;140:25–33
  4. Greenberg CC , Regenbogen SE , Studdert DM , et al.   Patterns of communication breakdowns resulting in injury to surgical patients . J Am Coll Surg . 2007;204:533–540
  5. Lingard L , Espin S , Whyte S , et al.   Communication failures in the operating room: an observational classification of recurrent types and effects . Qual Saf Health Care . 2004;13:330–334
  6. Flin R , O'Connor P , Crichton M . Safety at the Sharp End: A Guide to Non-Technical Skills . Aldershot: Ashgate; 2008;
  7. Yule S , Flin R , Paterson-Brown S , et al.   Non-technical skills for surgeons in the operating room: a review of the literature . Surgery . 2006;139:140–149
  8. Yule S , Flin R , Paterson-Brown S , et al.   Development of a rating system for surgeons' non-technical skills . Med Educ . 2006;40:1098–1104
  9. Hull L , Arora S , Kassab E , et al.   Observational teamwork assessment for surgery: content validation and tool refinement . J Am Coll Surg . 2011;212: 234–243.e1–5
  10. Fletcher G , Flin R , McGeorge P , et al.   Anaesthetists' Non-Technical Skills (ANTS): evaluation of a behavioural marker system . Br J Anaesth . 2003;90:580–588
  11. Hull L , Arora S , Kassab E , et al.   Assessment of stress and teamwork in the operating room: an exploratory study . Am J Surg . 2011;201:24–30
  12. van Hove P , Tuijthof G , Verdaasdonk E , et al.   Objective assessment of technical surgical skills . Br J Surg . 2010;97:972–987
  13. Scott DJ , Dunnington GL . The New ACS/APDS skills curriculum: moving the learning curve out of the operating room . J Gastrointest Surg . 2008;12:213–221
  14. King HB , Battles J , Baker DP , et al.   TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety .  Henriksen K ,  Battles JB ,  Keyes MA ,  Grady ML editor. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools) . Rockville (MD): Agency for Healthcare Research and Quality (US); 2008;
  15. Backstein D , Agnidis Z , Sadhu R , et al.   Effectiveness of repeated video feedback in the acquisition of a surgical technical skill . Can J Surg . 2005;48:195–200
  16. Rogers DA , Regehr G , Howdieshell TR , et al.   The impact of external feedback on computer-assisted learning for surgical technical skill training . Am J Surg . 2000;179:341–343
  17. Rogers DA , Regehr G , Yeh KA , et al.   Computer-assisted learning versus a lecture and feedback seminar for teaching a basic surgical technical skill . Am J Surg . 1998;175:508–510
  18. Porte MC , Xeroulis G , Reznick RK , et al.   Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills . Am J Surg . 2007;193:105–110
  19. O'Connor A , Schwaitzberg SD , Cao CG . How much feedback is necessary for learning to suture? . Surg Endosc . 2008;22:1614–1619
  20. Zheng B , Denk PM , Martinec DV , et al.   Building an efficient surgical team using a bench model simulation: construct validity of the Legacy Inanimate System for Endoscopic Team Training (LISETT) . Surg Endosc . 2008;22:930–937
  21. Xeroulis GJ , Park J , Moulton CA , et al.   Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback . Surgery . 2007;141:442–449
  22. LeBlanc V , Woodrow SI , Sidhu R , et al.   Examination stress leads to improvements on fundamental technical skills for surgery . Am J Surg . 2008;196:114–119
  23. Backstein D , Agnidis Z , Regehr G , et al.   The effectiveness of video feedback in the acquisition of orthopedic technical skills . Am J Surg . 2004;187:427–432
  24. LeBlanc VR , Tabak D , Kneebone R , et al.   Psychometric properties of an integrated assessment of technical and communication skills . Am J Surg . 2009;197:96–101
  25. Moulton CA , Tabak D , Kneebone R , et al.   Teaching communication skills using the integrated procedural performance instrument (IPPI): a randomized controlled trial . Am J Surg . 2009;197:113–118
  26. Black SA , Nestel DF , Kneebone RL , et al.   Assessment of surgical competence at carotid endarterectomy under local anaesthesia in a simulated operating theatre . Br J Surg . 2010;97:511–516
  27. DeMaria EJ , McBride CL , Broderick TJ , et al.   Night call does not impair learning of laparoscopic skills . Surg Innov . 2005;12:145–149
  28. Kahol K , Leyba MJ , Deka M , et al.   Effect of fatigue on psychomotor and cognitive skills . Am J Surg . 2008;195:195–204
  29. Hassan I , Weyers P , Maschuw K , et al.   Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance . Br J Surg . 2006;93:1554–1559
  30. Gerdes J , Kahol K , Smith M , et al.   Jack Barney award: the effect of fatigue on cognitive and psychomotor skills of trauma residents and attending surgeons . Am J Surg . 2008;96:813–820
  31. Eastridge BJ , Hamilton EC , O'Keefe GE , et al.   Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill . Am J Surg . 2003;186:169–174
  32. Arora S , Sevdalis N , Aggarwal R , et al.   Stress impairs psychomotor performance in novice laparoscopic surgeons . Surg Endosc . 2010;24:2588–2593
  33. Moorthy K , Munz Y , Adams S , et al.   A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre . Ann Surg . 2005;242:631–639
  34. Wetzel CM , Black SA , Hanna GB , et al.   The effects of stress and coping on surgical performance during simulations . Ann Surg . 2010;251:171–176
  35. Catchpole K , Mishra A , Handa A , et al.   Teamwork and error in the operating room: analysis of skills and roles . Ann Surg . 2008;247:699–706
  36. McCulloch P , Mishra A , Handa A , et al.   The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre . Qual Saf Health Care . 2009;18:109–115
  37. Mishra A , Catchpole K , Dale T , et al.   The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy . Surg Endosc . 2008;22:68–73
  38. Mishra A , Catchpole K , McCulloch P . The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre . Qual Saf Health Care . 2009;18:104–108
  39. ElBardissi AW , Wiegmann DA , Henrickson S , et al.   Identifying methods to improve heart surgery: an operative approach and strategy for implementation on an organizational level . Eur J Cardiothorac Surg . 2008;34:1027–1033
  40. Wiegmann DA , ElBardissi AW , Dearani JA , et al.   Disruptions in surgical flow and their relationship to surgical errors: An exploratory study . Surgery . 2007;142:658–665
  41. Zausig YA , Grube C , Boeker-Blum T , et al.   Inefficacy of simulator-based training on anaesthesiologists' non-technical skills . Acta Anaesthesiol Scand . 2009;53:611–619
  42. Jensen AR , Wright AS , Levy AE , et al.   Acquiring basic surgical skills: is a faculty mentor really needed? . Am J Surg . 2009;197:82–88
  43. Driskell JE , Salas E . Stress and Human Performance . Mahwah, NJ: Lawrence Erlbaum Associate; 1996;
  44. Arora S , Sevdalis N , Nestel D , et al.   The impact of stress on surgical performance: a systematic review of the literature . Surgery . 2010;147: 318–330.e1–6
  45. Sevdalis N , Davis R , Koutantji M , et al.   Reliability of a revised NOTECHS scale for use in surgical teams . Am J Surg . 2008;196:184–190
  46. Vincent C , Moorthy K , Sarker SK , et al.   Systems approaches to surgical quality and safety: from concept to measurement . Ann Surg . 2004;239:475–482
  47. Undre S , Koutantji M , Sevdalis N , et al.   Multi-disciplinary crisis simulations: The way forward for training surgical teams . World J Surg . 2007;31:1843–1853
  48. Martin JA , Regehr G , Reznick R , et al.   Objective structured assessment of technical skill (OSATS) for surgical residents . Br J Surg . 1997;84:273–278
  49. Abell N , Springer DW , Kamata A . Developing and validating rapid assessment instruments . New York: Oxford University Press; 2009;
  50. Sevdalis N , Lyons M , Healey AN , et al.   Observational teamwork assessment for surgery: construct validation with expert versus novice raters . Ann Surg . 2009;249:1047–1051
  51. Yule S , Flin R , Maran N , et al.   Surgeons' non-technical skills in the operating room: Reliability testing of the NOTSS behavior rating system . World J Surg . 2008;32:548–556
  52. Sharma B , Mishra A , Aggarwal R , et al.   Non-technical skills assessment in surgery . Surg Oncol . 2011;20:169–177
  53. Arora S , Miskovic D , Hull L , et al.   Self vs expert assessment of technical and non-technical performance in high fidelity simulation . Am J Surg . 2011;202:500–506
  54. Russ S, Hull L, Rout S, et al. Observational teamwork assessment for surgery:Feasibility of clinical and non-clinical assessor calibration with short-term training. Ann Surg (in press).
  55. Nagpal K , Vats A , Lamb B , et al.   Information transfer and communication in surgery: a systematic review . Ann Surg . 2010;252:225–239
  56. Moorthy K , Munz Y , Sarker SK , et al.   Objective assessment of technical skills in surgery . BMJ . 2003;327:1032–1037
  57. Catchpole KR , Dale TJ , Hirst DG , et al.   A multicenter trial of aviation-style training for surgical teams . J Patient Saf . 2010;6:180–186
  58. McCulloch P , Kreckler S , New S , et al.   Effect of a “Lean” intervention to improve safety processes and outcomes on a surgical emergency unit . BMJ . 2010;341:c5469
  59. National Patient Safety Agency . WHO surgical safety checklist: patient safety alert update (reference number 0861) . http://www.nrls.npsa.nhs.uk/resources/clinical-specialty/surgery/?entryid45=59860 Accessed March 31, 2011
  60. ACGME Program Requirements for Fellowship Education in Surgical Critical Care (Surgery) . http://www.acgme.org/acWebsite/downloads/RRC_progReq/442_critical_care_surgery_01012009.pdf Accessed May 19, 2011
  61. Marteau TM , Bekker H . The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI) . Br J Clin Psychol . 1992;31:301–306
  62. Tomaka J , Blascovich J , Kelsey RM , et al.   Subjective, physiological, and behavioral effects of threat and challenge appraisal . J Pers Soc Psychol . 1993;65:248–260
  63. Tomaka J , Blascovich J , Kibler J , et al.   Cognitive and physiological antecedents of threat and challenge appraisal . J Pers Soc Psychol . 1997;73:63–72
  64. Chatterton RT , Vogelsong KM , Lu Y , et al.   Hormonal responses to psychological stress in men preparing for skydiving . J Clin Endocrinol Metab . 1997;82:2503–2509
  65. Arora S , Tierney T , Sevdalis N , et al.   The Imperial Stress Assessment Tool (ISAT): a feasible, reliable and valid approach to measuring stress in the operating room . World J Surg . 2010;34:1756–1763
  66. Ising M , Weyers P , Reuter M , et al.   Comparing two approaches for the assessment of coping Part II (Differences in stability in time) . J Individual Differences . 2006;27:15–19
  67. Ising M , Weyers P , Janke W , et al.   The psychometric properties of the SVF78 by Janke and Erdmann, a short version of the SVF120 . Zeitschrift fuer Differentielle und Diagnostische Psychologie . 2001;22:279–289
  68. Hodges B , McIlroy JH . Analytic global OSCE ratings are sensitive to level of training . Med Educ . 2003;37:1012–1016

 Disclosure Information: Nothing to disclose.

 This research was funded by the UK's National Institute for Health Research (NIHR), and a joint Economic and Social Research Council/Medical Research Council grant (UK). Rajesh Aggarwal is funded by a Clinician Scientist Award from the National Institute for Health Research, UK. Miss Hull and Drs Sevdalis and Arora are affiliated with the Imperial Centre for Patient Safety and Service Quality, which is funded by the National Institute for Health Research, UK.

PII: S1072-7515(11)01228-2

doi: 10.1016/j.jamcollsurg.2011.10.016

Journal of the American College of Surgeons
Volume 214, Issue 2 , Pages 214-230 , February 2012

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