title: Teaching nontechnical skills in surgical residency: a systematic review of current approaches and outcomes.
abstract: BACKGROUND
  A growing body of evidence suggests that nontechnical skills (NTS) of surgeons play an important role in patient safety in the operating room and can be improved through specific training interventions. The need to address communication and interpersonal skills in postgraduate medical education has been emphasized by the respective regulatory bodies for accreditation and certification. The present review had 2 purposes: To provide an overview of current approaches to training and assessment of NTS in surgery and to critically appraise the strength of the evidence supporting their effectiveness.
  
  
  METHODS
  A systematic search of the literature (Ovid MEDLINE; PsycINFO; Embase) was conducted using predefined inclusion criteria. The evidence for the main outcome themes was appraised using the GRADE approach.
  
  
  RESULTS
  Of the 2,831 identified records, 23 were selected for qualitative synthesis. Four randomized, controlled trials and 19 observational pre-post studies were reviewed. Significant effects of training were shown for the identified outcome themes (patient-centered communication, teamwork, decision making, coping with stress, patient safety and error management). The overall strength of evidence supporting training effects on outcome measures was graded as "moderate" (teamwork), "low" (patient-centered communication, decision making, and coping with stress), and "very low" (patient safety and error management), respectively.
  
  
  CONCLUSIONS
  Training interventions can have positive effects on residents' nontechnical knowledge, skills, and attitudes. Although the overall strength of evidence is moderate at best, recent interventions provide valuable information regarding instructional strategies and methods for training and assessment of NTS in modern surgical curricula.
authors.affiliation: Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: dedyn@smh.ca.
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Dedy
authors.forename: Esther M
authors.initials: EM
authors.lastname: Bonrath
authors.forename: Boris
authors.initials: B
authors.lastname: Zevin
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003657:Decision Making; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007398:Interpersonal Relations; D010348:Patient Care Team; D018802:Patient-Centered Care