The NOTSS system: Non-Technical Skills for Surgeons

NOTSS is a behaviour rating system for surgeons. The system was developed using task analysis with subject matter experts and evaluated in trials using standardized video scenarios and real operations. It allows consultant (attending) surgeons to give feedback to colleagues and trainees based on structured observations of non-technical aspects of performance during intraoperative surgery. Ratings and feedback�are given on four categories of non-technical skills:

Situation Awareness
Decision Making
Communication & Teamwork
Leadership

Training in NOTSS is�offered by The Royal College of Surgeons of Edinburgh. Click here for latest course details

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NOTSS handbook v1.2: email Steven Yule for a copy�

NOTSS Publications & Downloads

Yule, S., Rowley, D., Flin, R., Maran, N., Youngson, G.G., Duncan, J., Paterson-Brown, S. (in press). Experience matters: Comparing novice and expert ratings of non-technical skills using the NOTSS system. Australian Journal of Surgery.

Yule, S., Flin, R., Maran, N., Rowley, D. R., Youngson, G.G. and Paterson-Brown, S. (2008). Surgeons' non-technical skills in the operating room: Reliability testing of the NOTSS behaviour rating system. World Journal of Surgery, 32, 548-556

Yule, S., Flin, R., Rowley, D., Mitchell, A., Youngson, G.G., Maran, N. and Paterson-Brown, S. (2008). Debriefing surgical trainees on non-technical skills (NOTSS). Cognition, Technology & Work, 10, 265 -274

Flin, R., Youngson, G. G., & Yule, S. (2007). How do surgeons make intraoperative decisions? Quality and Safety in Healthcare 16, 235-239

Flin, R., Yule, S., Paterson-Brown, S., Maran, N., Rowley, D. R., & Youngson, G. G. (2007). Teaching surgeons about non-technical skills. The Surgeon 5, 86-89

Yule, S., Flin, R., Paterson-Brown, S., Maran, N., & Rowley D. (2006). Development of a rating system for surgeons' non-technical skills. Medical Education, 40, 1098-1104�Download article (in press) (177kb)

Flin, R., Yule, S., McKenzie, L., Paterson-Brown, S., Maran, N. (2006). Attitudes to teamwork and safety in the operating theatre. The Surgeon, 4:3; 145-151 Download article (359kb): Download additional tables (114kb): Download ORMAQ questionnaire (120kb)

Yule, S., Flin, R., Paterson-Brown, S. & Maran, N. (2006). Non-technical skills for surgeons: A review of the literature. Surgery, 139: 140-149 Download pdf article (141kb)

Surgeons' News Articles

Lessons from the aviation industry. Download pdf article (92kb)

Advances in patient safety: non-technical skills in surgery. Download pdf article (121kb)

Critical thinking: Non-technical skills in surgery. Download pdf article (98kb)

Scientific Meetings

NOTSS research has been presented at several conferences from 2003-2008, including HFES, ASME, AMEE, ASGBI, IAAP, IMMS, AAvP. Please email Steven Yule for a complete list of conference papers in proceedings.