title: Assessing trainee surgeons' nontechnical skills: five cases are sufficient for reliable assessments.
abstract: BACKGROUND
  Trainee surgeons would benefit from regular, formative assessments to ensure they learn the nontechnical aspects of surgical performance. Non-Technical Skills for Surgeons in Denmark (NOTSSdk) is a tool to assess surgeons' nontechnical skills (NTS) during an operation. The aims of this study were to explore which parts of NOTSSdk supervisors use to assess trainee surgeons' NTS, to determine the internal consistency reliability of NOTSSdk, and to estimate how many operations were needed to obtain reliable ratings of a trainee surgeon's NTS.
  
  
  METHODS
  A total of 12 supervisors from 2 hospitals assessed 13 trainees in 48 procedures including laparoscopic cholecystectomies, inguinal hernia repairs, and laparoscopic appendectomies.
  
  
  RESULTS
  NOTSSdk showed good internal consistency reliability (R(2) = 0.95). Supervisors used both categories and elements of the tool to provide assessments, although 2 elements of leadership ("supporting others" and "coping with pressure") were considered irrelevant in 27% to 31% of the cases. Assessments of 5 procedures were sufficient to gain reliable ratings (Generalizability coefficient > 0.80) of a trainee surgeon's NTS.
  
  
  CONCLUSIONS
  As supervisors used the full tool, the internal consistency reliability was high and assessment of 5 procedures could be achieved in clinical practice, we suggest that NOTSSdk could be implemented as a formative assessment tool to facilitate the training of surgeons' NTS.
authors.affiliation: Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark. Electronic address: lene.spanager@regionh.dk.
authors.forename: Lene
authors.initials: L
authors.lastname: Spanager
authors.affiliation: Centre for Clinical Education, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
authors.affiliation: Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Dieckmann
authors.affiliation: Department of Surgery, Hilleroed Hospital, Hilleroed, Denmark.
authors.forename: Randi
authors.initials: R
authors.lastname: Beier-Holgersen
authors.affiliation: Department of Surgery, Herlev Hospital and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
authors.affiliation: Danish Institute for Medical Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Doris
authors.initials: D
authors.lastname: Oestergaard
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000193:education; D017081:Cholecystectomy, Laparoscopic / Q000193:education; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D003162:Competency-Based Education; D003657:Decision Making; D004521:Educational Measurement; D013502:General Surgery / Q000193:education*; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D011446:Prospective Studies; D011594:Psychometrics; D015203:Reproducibility of Results
keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; assessment; nontechnical skills; operating room; surgery