81 Citations (Scopus)


OBJECTIVE: Development of nontechnical skills for surgeons has been recognized as an important factor in surgical care. Training tools for this specific domain are being created and validated to maximize the surgeon's nontechnical ability. This systematic review aims to outline, address, and recommend these training tools.

DESIGN: A full and comprehensive literature search, using a systematic format, was performed on ScienceDirect and PubMed, with data extraction occurring in line with specified inclusion criteria.

SETTING: Systematic review was performed fully at King's College London.

RESULTS: A total of 84 heterogeneous articles were used in this review. Further, 23 training tools including scoring systems, training programs, and mixtures of the two for a range of specialities were identified in the literature. Most can be applied to surgery overall, although some tools target specific specialities (such as neurosurgery). Interrater reliability, construct, content, and face validation statuses were variable according to the specific tool in question.

CONCLUSIONS: Study results pertaining to nontechnical skill training tools have thus far been universally positive, but further studies are required for those more recently developed and less extensively used tools. Recommendations can be made for individual training tools based on their level of validation and for their target audience. Based on the number of studies performed and their status of validity, NOTSS and Oxford NOTECHS II can be considered the gold standard for individual- and team-based nontechnical skills training, respectively, especially when used in conjunction with a training program.

Original languageEnglish
Pages (from-to)548-578
Number of pages31
JournalJournal of Surgical Education
Issue number4
Early online date21 Dec 2016
Publication statusPublished - 2017


  • Clinical Competence
  • Curriculum
  • Education, Medical, Graduate
  • Educational Measurement
  • Humans
  • Surgeons/education


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