title: Customization of a tool to assess Danish surgeons´ non-technical skills in the operating room.
abstract: BACKGROUND
  Errors in surgery often stem from failure related to non-technical skills such as communication and teamwork. Tools for training and assessment of non-technical skills are needed to ensure safe surgery. The aim of this study was to customize the Non-Technical Skills for Surgeons (NOTSS) rating system for Danish general surgeons.
  
  
  METHODS
  Eight group interviews were conducted at two hospitals with consultant general surgeons, trainee surgeons, scrub nurses and anaesthesia staff (n = 72). Interviews were transcribed and analysed by two coders identifying surgeons´ non-technical skills. Skills were sorted according to NOTSS and behavioural examples were written. The prototype of NOTSSdk was discussed with a panel of surgeons (n = 12) to ensure face validity.
  
  
  RESULTS
  The skills identified in a Danish context fitted NOTSS's four categories: situation awareness, decision making, leadership, communication and teamwork and the 12 underlying elements. Only one element was added to the NOTSSdk; "monitoring own performance." A total of 3-8 good and 3-6 poor behavioural examples were written for each element. Respecting team members, creating a good working atmosphere and discussing options in the surgical team were distinct themes.
  
  
  CONCLUSIONS
  The tool, which was customized for Danish surgeons, comprises four categories, 13 elements and numerous behavioural examples. The distinct themes regarding respect, discussing options and creating a good working atmosphere are more prominent than in the Scottish NOTSS, which may be explained by cultural differences or the fact that the present study included the perspectives of the entire surgical team.
  
  
  CONCLUSIONS
  NOTSSdk holds potential as a tool for the guiding of assessment and feedback on surgeons´ non-technical performance.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  The study was registered with clinicaltrials.gov (NCT01334411).
authors.affiliation: Dansk Institut for Medicinsk Simulation, Herlev Hospital, Herlev, Denmark. lene.spanager@regionh.dk
authors.forename: Lene
authors.initials: L
authors.lastname: Spanager
authors.forename: Helle Teglgaard
authors.initials: HT
authors.lastname: Lyk-Jensen
authors.forename: Peter
authors.initials: P
authors.lastname: Dieckmann
authors.forename: André
authors.initials: A
authors.lastname: Wettergren
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Doris
authors.initials: D
authors.lastname: Ostergaard
mesh_terms: D000328:Adult; D003657:Decision Making; D003718:Denmark; D056348:Emotional Intelligence; D005260:Female; D013502:General Surgery / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic / Q000379:methods*; D007857:Leadership; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008505:Medical Staff, Hospital / Q000523:psychology / Q000592:standards*; D009873:Operating Rooms / Q000458:organization & administration / Q000592:standards; D010348:Patient Care Team / Q000592:standards; D017064:Process Assessment, Health Care / Q000379:methods; D011795:Surveys and Questionnaires