There is growing evidence that non-technical skills (NTS) are related to surgical outcomes and patient safety. The aim of this study was to further evaluate a behaviour rating system (NOTSS: Non-Technical Skills for Surgeons) which can be used for workplace assessment of the cognitive and social skills which are essential components of NTS. A novice group composed of consultant surgeons (n = 44) from five Scottish hospitals attended one of six experimental sessions and were trained to use the NOTSS system. They then used NOTSS to rate surgeons' behaviors in six simulated scenarios filmed in the operating room. The behaviours demonstrated in each scenario were compared to expert ratings to determine accuracy. The mode rating from the novice group (who received a short training session in behaviour assessment) was the same as the expert group in 50% of ratings. Where there was disagreement, novice raters tended to provide lower ratings than the experts. Novice raters require significant training in this emerging area of competence in order to accurately rate non-technical skills.
Medical students are not inherently equipped to manage common ward-based distractions to mitigate error. These skills can be taught-with simulation and feedback conferring the greatest benefit. Curricular integration of simulated ward round experiences is recommended.
THE BRITISH MDICAL JOURNAL. [jamsO.188G reommended " from the acroion to the pubes." As, in Mr. Tait's first ase of cholecystotomy, the tumour had crosed the middle line, and in my own case it was on the verge of crossing, I do not think this can be so reliable as the one I have given. Both, however, would eliminate the class of tumoura just referred to. Case No. 9 is, of course, a very exceptional one. In this case, if the gall-bladder could have been felt, it must necesarily have been altogether to the right of the line which I have described and I should wish to be distinctly understood as claiming for my "line" nothing beyond a good indication of the direction in which a distended gallbladder will " naturally " lie. Neither this nor any other extraabdominal sign can be more than an aid to diagnosis. In any very doubtful case, the diagnosis should be intra.abdominal. The liver and kidney may be so displaced, and adhesions may so alter the relations of important viscera, that the expectation of the most careful and experienced may often (and occasionally most fortunately) be found wido of the mark.
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