title: Introduction of the non-technical skills for surgeons (NOTSS) system in a Japanese cancer center.
abstract: OBJECTIVE
  Non-technical skills rating systems, which are designed to support surgical performance, have been introduced worldwide, but not officially in Japan. We performed a pilot study to evaluate the "non-technical skills for surgeons" (NOTSS) rating system in a major Japanese cancer center.
  
  
  METHODS
  Upper gastrointestinal surgeons were selected as trainers or trainees. The trainers attended a master-class on NOTSS, which included simulated demo-videos, to promote consistency across the assessments. The trainers thereafter commenced observing the trainees and whole teams, utilizing the NOTSS and "observational teamwork assessment for surgery" (OTAS) rating systems, before and after their education.
  
  
  RESULTS
  Four trainers and six trainees were involved in this study. Test scores for understanding human factors and the NOTSS system were 5.89 ± 1.69 and 8.00 ± 1.32 before and after the e-learning, respectively (mean ± SD, p = 0.010). The OTAS scores for the whole team improved significantly after the trainees' education in five out of nine stages (p < 0.05). There were no differences in the NOTSS scores before and after education, with a small improvement in the total scores for the "teamwork and communication" and "leadership" categories.
  
  
  CONCLUSIONS
  These findings demonstrate that implementing the NOTSS system is feasible in Japan. Education of both surgical trainers and trainees would contribute to better team performance.
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 2320024, Japan. tuburayaa@gmail.com.
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuburaya
authors.affiliation: Sakakibara Memorial Hospital, 3-16-1 Asahi-cho, Fuchu, Tokyo, 1830003, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Soma
authors.affiliation: Kanagawa Cancer Center, 2-2-2, Nakao, Asahi-ku, Yokohama, 2418515, Japan.
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
authors.affiliation: Kanagawa Cancer Center, 2-2-2, Nakao, Asahi-ku, Yokohama, 2418515, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Cho
authors.affiliation: University of Shizuoka, 52-1, Yada, Suruga-ku, Shizuoka, 4228526, Japan.
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Miki
authors.affiliation: University of Shizuoka, 52-1, Yada, Suruga-ku, Shizuoka, 4228526, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Uramatsu
authors.affiliation: Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Fujisawa
authors.affiliation: University of Aberdeen, Aberdeen, AB24 3UB, UK.
authors.forename: George
authors.initials: G
authors.lastname: Youngson
authors.affiliation: STRATUS Center for Medical Simulation, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Yule
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education*; D006268:Health Facilities; D006801:Humans; D007564:Japan; D009369:Neoplasms / Q000628:therapy*; D010348:Patient Care Team; D010865:Pilot Projects; D066231:Surgeons / Q000193:education*; D000066477:Work Performance
keywords: Human factors; Non-technical skills; Operating room; Surgery