• Nicolas J Dedy, Peter Szasz, Marisa Louridas, Esther M Bonrath, Heinrich Husslein, and Teodor P Grantcharov.
• Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada. Electronic address: dedyn@smh.ca.
• Surgery. 2015 Jun 1;157(6):1002-13.

BackgroundNontechnical skills are critical for patient safety in the operating room (OR). As a result, regulatory bodies for accreditation and certification have mandated the integration of these competencies into postgraduate education. A generally accepted approach to the in-training assessment of nontechnical skills, however, is lacking. The goal of the present study was to develop an evidence-based and reliable tool for the in-training assessment of residents' nontechnical performance in the OR.MethodsThe Objective Structured Assessment of Nontechnical Skills tool was designed as a 5-point global rating scale with descriptive anchors for each item, based on existing evidence-based frameworks of nontechnical skills, as well as resident training requirements. The tool was piloted on scripted videos and refined in an iterative process. The final version was used to rate residents' performance in recorded OR crisis simulations and during live observations in the OR.ResultsA total of 37 simulations and 10 live procedures were rated. Interrater agreement was good for total mean scores, both in simulation and in the real OR, with intraclass correlation coefficients >0.90 in all settings for average and single measures. Internal consistency of the scale was high (Cronbach's alpha = 0.80).ConclusionThe Objective Structured Assessment of Nontechnical Skills global rating scale was developed as an evidence-based tool for the in-training assessment of residents' nontechnical performance in the OR. Unique descriptive anchors allow for a criterion-referenced assessment of performance. Good reliability was demonstrated in different settings, supporting applications in research and education.Copyright © 2015 Elsevier Inc. All rights reserved.

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