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J Surg Educ. 2015 Nov-Dec;72(6):1124-30. doi: 10.1016/j.jsurg.2015.06.012.

Coaching Non-technical Skills Improves Surgical Residents' Performance in a Simulated Operating Room.

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STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Psychology, University of Aberdeen, Aberdeen, Scotland. Electronic address:
Department of Psychology, University of Aberdeen, Aberdeen, Scotland; National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia.
Department of Psychology, University of Aberdeen, Aberdeen, Scotland.
Department of Surgery, University of Aberdeen, Aberdeen, Scotland.
Department of Surgery, Southern Trust, Northern Ireland.
Department of Surgery, University of Aberdeen, Aberdeen, Scotland; Department of Surgery, Belfast City Hospital, Belfast, Northern Ireland.



To investigate the effect of coaching on non-technical skills and performance during laparoscopic cholecystectomy in a simulated operating room (OR).


Non-technical skills (situation awareness, decision making, teamwork, and leadership) underpin technical ability and are critical to the success of operations and the safety of patients in the OR. The rate of developing assessment tools in this area has outpaced development of workable interventions to improve non-technical skills in surgical training and beyond.


A randomized trial was conducted with senior surgical residents (n = 16). Participants were randomized to receive either non-technical skills coaching (intervention) or to self-reflect (control) after each of 5 simulated operations. Coaching was based on the Non-Technical Skills For Surgeons (NOTSS) behavior observation system. Surgeon-coaches trained in this method coached participants in the intervention group for 10 minutes after each simulation. Primary outcome measure was non-technical skills, assessed from video by a surgeon using the NOTSS system. Secondary outcomes were time to call for help during bleeding, operative time, and path length of laparoscopic instruments.


Non-technical skills improved in the intervention group from scenario 1 to scenario 5 compared with those in the control group (p = 0.04). The intervention group was faster to call for help when faced with unstoppable bleeding in the final scenario (no. 5; p = 0.03).


Coaching improved residents' non-technical skills in the simulated OR compared with those in the control group. Important next steps are to implement non-technical skills coaching in the real OR and assess effect on clinically important process measures and patient outcomes.


Interpersonal and Communication Skills; Non-technical skills; Practice-Based Learning and Improvement; Professionalism; assessment; coaching; education; simulation

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