title: Re-validating the Observational Teamwork Assessment for Surgery tool (OTAS-D): cultural adaptation, refinement, and psychometric evaluation.
abstract: BACKGROUND
  The nontechnical and team skills of surgical teams are critical for safety and efficiency in the operating room. Assessment of nontechnical and team skills can facilitate improvement by encouraging both self-reflection and team reflection, identifying training needs, and informing operating room (OR) team training approaches. The observational teamwork assessment for surgery (OTAS) tool is a well-validated and robust tool for capturing teamwork in the operating room. The aims of the present study were to systematically adapt and refine the OTAS for German-speaking OR staff and to test the adapted assessment tool (OTAS-D) for psychometric properties and metric equivalence.
  
  
  METHODS
  The study was carried out in three stages: at stage 1, OTAS was translated into German. At stage 2, experienced German OR experts (surgeons, OR nurses, anesthetists) were interviewed. At stage 3, two blinded assessors observed 11 general surgical operations (general surgical and vascular procedures) and interrater reliability was tested for refined OTAS-D behavioral exemplars and scorings.
  
  
  RESULTS
  The German OR experts confirmed the applicability and content validity of the vast majority of translated behavioral exemplars. After their evaluation, 32 items were changed slightly, six were changed substantially, and one item was added. During observations, perfect and substantial interobserver agreement was found for 77 behavioral exemplars (67.1 % of the items, kappa coefficient >0.60). Rating at all OTAS behaviors showed acceptable levels of reliability (intraclass correlation coefficients >0.72).
  
  
  CONCLUSIONS
  The OTAS-D is a tool for valid and reliable assessment of nontechnical skills that contribute to safe and effective surgical performance in ORs staffed by German-speaking professionals. Furthermore, our study serves as an example for systematically adapting and customizing well-established observational tools across different healthcare environments.
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Ziemssentr. 1, 80336, Munich, Germany, stefanie.passauerbaierl@med.uni-muenchen.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Passauer-Baierl
authors.forename: Louise
authors.initials: L
authors.lastname: Hull
authors.forename: Danilo
authors.initials: D
authors.lastname: Miskovic
authors.forename: Stephanie
authors.initials: S
authors.lastname: Russ
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.forename: Matthias
authors.initials: M
authors.lastname: Weigl
mesh_terms: D000776:Anesthesiology; D003299:Cooperative Behavior; D005260:Female; D005858:Germany; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009872:Operating Room Technicians / Q000592:standards; D009873:Operating Rooms / Q000592:standards; D010348:Patient Care Team / Q000592:standards*; D011594:Psychometrics; D013514:Surgical Procedures, Operative