• Kitty Y Wu, Stephanie Kim, Kevin Fung, and Kathryn Roth.
• Division of Plastic and Reconstructive Surgery, Department of Surgery, London, Ontario, Canada.
• Laryngoscope. 2018 Oct 1; 128 (10): 2301-2306.

ObjectiveNontechnical skills (NTS) are essential to emergency crisis management. Due to the rarity of true emergencies, they are challenging to teach and assess within a competency-based curriculum. Our purpose is to evaluate the utility of the Non-Technical Skills in Surgery (NOTSS) scale in NTS assessment in simulated otolaryngology and head and neck surgery (OTO-HNS) emergencies and identify common challenges that residents encounter.MethodsMixed methods analysis of 15 junior OTO-HNS resident teams in four simulated emergency scenarios. Six raters rated resident NTS performance using the NOTSS score. Constructivist-grounded theory was used to analyze scenario video transcripts to identify areas of learner difficulty to guide future simulation development.ResultsResidents scored highest in situational awareness and lowest in leadership domains. Raters showed good consistency and reliability overall (Cronbach's alpha = 0.885). There was no statistical difference in ratings between surgical experts and nonexperts. Qualitative analysis demonstrated challenges with closed-loop communication and handling transitions of leadership with the scenarios.ConclusionSimulation-based training is an effective modality to teach NTS in crisis resource management. The NOTSS rating scale is a reliable instrument for assessing NTS in simulated OTO-HNS emergencies. Incorporating the NOTSS scale for NTS assessment within a competency-based curriculum is recommended.Level Of EvidenceNA. Laryngoscope, 128:2301-2306, 2018.© 2018 The American Laryngological, Rhinological and Otological Society, Inc.

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