The impact of nontechnical skills on technical performance in surgery: a systematic review.
BACKGROUND
Failures in nontechnical and teamwork skills frequently lie at the heart of harm and near-misses in the operating room (OR). The purpose of this systematic review was to assess the impact of nontechnical skills on technical performance in surgery.


METHODS
MEDLINE, EMBASE, PsycINFO databases were searched, and 2,041 articles were identified. After limits were applied, 341 articles were retrieved for evaluation. Of these, 28 articles were accepted for this review. Data were extracted from the articles regarding sample population, study design and setting, measures of nontechnical skills and technical performance, study findings, and limitations.


RESULTS
Of the 28 articles that met inclusion criteria, 21 articles assessed the impact of surgeons' nontechnical skills on their technical performance. The evidence suggests that receiving feedback and effectively coping with stressful events in the OR has a beneficial impact on certain aspects of technical performance. Conversely, increased levels of fatigue are associated with detriments to surgical skill. One article assessed the impact of anesthesiologists' nontechnical skills on anesthetic technical performance, finding a strong positive correlation between the 2 skill sets. Finally, 6 articles assessed the impact of multiple nontechnical skills of the entire OR team on surgical performance. A strong relationship between teamwork failure and technical error was empirically demonstrated in these studies.


CONCLUSIONS
Evidence suggests that certain nontechnical aspects of performance can enhance or, if lacking, contribute to deterioration of surgeons' technical performance. The precise extent of this effect remains to be elucidated.
Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Louise
L
Hull
Sonal
S
Arora
Rajesh
R
Aggarwal
Ara
A
Darzi
Charles
C
Vincent
Nick
N
Sevdalis
D000223:Adaptation, Psychological; D006801:Humans; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000592:standards; D011361:Professional Competence; D011787:Quality of Health Care; D013514:Surgical Procedures, Operative / Q000592:standards*