title: Surgeons' non-technical skills in the operating room: reliability testing of the NOTSS behavior rating system.
abstract: BACKGROUND
  Previous research has shown that surgeons' intraoperative non-technical skills are related to surgical outcomes. The aim of this study was to evaluate the reliability of the NOTSS (Non-technical Skills for Surgeons) behavior rating system. Based on task analysis, the system incorporates five categories of skills for safe surgical practice (Situation Awareness, Decision Making, Task Management, Communication & Teamwork, and Leadership).
  
  
  METHODS
  Consultant (attending) surgeons (n = 44) from five Scottish hospitals attended one of six experimental sessions and were trained to use the NOTSS system. They then used the system to rate consultant surgeons' behaviors in six simulated operating room scenarios that were presented using video. Surgeons' ratings of the behaviors demonstrated in each scenario were compared to expert ratings ("accuracy"), and assessed for inter-rater reliability and internal consistency.
  
  
  RESULTS
  The NOTSS system had a consistent internal structure. Although raters had minimal training, rating "accuracy" for acceptable/unacceptable behavior was above 60% for all categories, with mean of 0.67 scale points difference from reference (expert) ratings (on 4-point scale). For inter-rater reliability, the mean values of within-group agreement (r (wg)) were acceptable for the categories Communication & Teamwork (.70), and Leadership (.72), but below a priori criteria for other categories. Intra-class correlation coefficients (ICC) indicated high agreement using average measures (values were .95-.99).
  
  
  CONCLUSIONS
  With the requisite training, the prototype NOTSS system could be used reliably by surgeons to observe and rate surgeons' behaviors. The instrument should now be tested for usability in the operating room.
authors.affiliation: School of Psychology, University of Aberdeen, Aberdeen AB24 2UB, Scotland, United Kingdom. s.j.yule@abdn.ac.uk
authors.forename: Steven
authors.initials: S
authors.lastname: Yule
authors.forename: Rhona
authors.initials: R
authors.lastname: Flin
authors.forename: Nicola
authors.initials: N
authors.lastname: Maran
authors.forename: David
authors.initials: D
authors.lastname: Rowley
authors.forename: George
authors.initials: G
authors.lastname: Youngson
authors.forename: Simon
authors.initials: S
authors.lastname: Paterson-Brown
mesh_terms: D001364:Awareness; D003142:Communication; D003657:Decision Making; D013502:General Surgery / Q000193:education / Q000592:standards*; D006801:Humans; D007857:Leadership; D011364:Professional Practice / Q000592:standards*; D012107:Research Design; D012680:Sensitivity and Specificity; D013647:Task Performance and Analysis