Non-technical skill

The concept of non-technical skills was first introduced in aviation to describe team behaviour, and later adapted for anesthetic and surgical practice. Non-technical skills in the OR are defined as observable behaviours of the surgical team, and can be measured on 3 dimensions: cognitive (e.g., situational awareness, decision-making), interpersonal (e.g., teamwork, communication, cooperation), and personal resource skills (e.g., stress and fatigue management). Evidence suggests that deficiencies in non-technical skills can contribute to adverse outcomes, presenting the need for non-technical skills assessment in the OR. The current method for evaluating non-technical skills uses a global rating scale (GRS) to assess performance at the individual and team level. Evaluation using GRS has shown high reliability and validity, but relies on the constant presence of an expert rater in the OR to infer non-technical performance from subtle cues. Furthermore, GRS represents the overall quality of a surgery and does not reflect the performance during specific phases of a surgery. To overcome the limitations of evaluation by direct observation, alternative methods of non-technical evaluation include post-operative observation via video recordings, and surrogate measures such as stress level and fatigue.