While the technical skills of surgeons and surgical teams are of critical importance, until relatively recently the non-technical skills for surgeons (NOTSS) have generally tended to slip under the radar. Thanks largely to the efforts of The Royal College of Surgeons of Edinburgh (RCSEd) who have driven an initiative to build a taxonomy and training system and raise global awareness among practitioners of the importance of NOTSS, these skills have now been thrust into the spotlight.
At the most recent meeting of the NOTSS project team and faculty, surgeons from across the UK, USA and Sub-Saharan Africa came together to discuss the current position of NOTSS training, how it is being delivered and what actions could be implemented in the future to improve it.
This year, attendees included a team from Harvard Medical School in the USA, where NOTSS has already been incorporated into simulation training for surgical teams. Representing the team at the meeting were Dr Doug Smink and Associate Professor Steven Yule.
Non-technical skills include teamwork, leadership and communication, in addition to cognitive skills such as situational awareness. Steven described this as: “Your ability to gather information from the operating theatre or the operating room, to understand what it means to think ahead in the future, to make decisions under stress, to change the plan, to review things, to keep other members of the team in the loop – so other members of the team know what’s happening and so people are not working in silos.”
This, he explained, is linked to cognitive and social psychology, about how people work in groups and how they interact, and he and Doug are currently developing ways to train and improve the abilities of surgeons and surgical teams in those areas.
Doug said: “We have come to realise that how we communicate with our team members, how we lead in the operating room, has a great impact on how the team functions and ultimately as a result, how the patient does. We also know that there are important decisions that you have to make as a surgeon or as a surgical team in the operating room that impact directly the patient’s outcome.”
Steven explained how the training has been effectively introduced at the STRATUS Center for Medical Simulation at Boston’s Brigham and Women’s Hospital and outlined the team’s ongoing work with the American College of Surgeons to spread and scale the learnings and successes. With at least half of the errors that occur in an operating theatre apparently down to non-technical skill failures, the importance of cultivating these skills is clear. Doug further paid tribute to the role of RCSEd, who he asserted were, “at the epicentre of non-technical skills development and dissemination.”
The benefits of effective implementation are extensive. As Doug and Steven concluded, if non-technical skills are well implemented: “Surgery would be done more efficiently and more precisely, the communication would be clear, the team would be in perfect harmony and every member of the team would feel like they were an important contributor.”
The risks of burn-out would be mitigated, people would feel more engaged and the work environment would be one that they would want to be a part of. The benefits are clear to see.
To find out more and get involved, RCSEd is currently running a series of one-day Non-Technical Skills for Surgeons courses aimed at consultant surgeons and post-CCT trainees from all surgical specialities across the UK and in Nepal.
RCSEd also provide a range of NOTSS resources including a handbook, introductory videos and e-Learning resources.