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Non-technical skills for urological surgeons (NoTSUS): development and evaluation of curriculum and assessment scale

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Abdullatif Aydın, Cora M Griffin, Oliver Brunckhorst, Ahmed Al-Jabir, Nicholas Raison, Haleema Aya, Craig McIlhenny, James Brewin, Majid Shabbir, Joan Palou Redorta, Muhammad Shamim Khan, Prokar Dasgupta, Kamran Ahmed

Original languageEnglish
Pages (from-to)2231-2237
JournalWorld Journal of Urology
Issue number6
Early online date18 Aug 2020
E-pub ahead of print18 Aug 2020
PublishedJun 2021



    NoTSUS_WJU.pdf, 845 KB, application/pdf

    Uploaded date:20 Aug 2020

    Version:Final published version

    Licence:CC BY

King's Authors


OBJECTIVE: In the last decade non-technical skills (NTS) have emerged as a vital area for improvement within surgery. This study aims to develop and evaluate a Non-technical Skills for Urological Surgeons (NoTSUS) training curriculum and assessment scale.

METHODS: This international, longitudinal and observational study began with a 3-round Delphi methodology to refine curriculum contents and rating scale. Sessions with up to four participants were delivered where each candidate undertook an independent scenario within the validated full immersion simulation environment. Candidates were assessed using both the NoTSS (Non-technical Skills for Surgeons) and NoTSUS rating scales by NTS-trained and non-trained experts. A post-training evaluation survey was distributed.

RESULTS: 62 participants comprising trainees (n = 43) and specialists (n = 19) undertook the NoTSUS course. The NoTSS and NoTSUS scales correlated well, with a mean difference of 3.3 in the overall total (p = 0.10, r = 0.53). However, there was significant differences in scores between the NoTSS-trained and non-trained raters (n = 28, p = 0.03). A one-way ANOVA test revealed significant improvement throughout the four simulation scenarios in each session (p = 0.02). The NoTSUS curriculum received positive feedback from participants and demonstrated educational value and acceptability.

CONCLUSIONS: The NoTSUS curriculum has demonstrated high educational value for NTS training aimed at urologists, with marked improvement throughout sessions. Correlation of NoTSUS and NoTSS scales proves its suitability for evaluating NTS in future training. Demonstration of inter-rater reliability indicates that the scale is reliable for use in assessment by expert faculty members. Furthermore, qualitative feedback from participants suggests gain of transferrable skills over the course.

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