Assessing non-technical skills in the operating room

The assessment of clinical skills is ingrained in all areas of medical practice, irrespective of the subspecialty, from medical students through specialist training and culminating in a summative assessment before obtaining a completion certificate to practise independently. Each medical specialty has developed their own methods of assessment, but all share the aim of using techniques that are fair, reproducible and reliable. They must of course be reliable between assessors, specific and have construct validity" in other words, test what they are supposed to test. In this chapter, we will review the criteria for assessment tools in surgery, focus on how to assess non-technical skills with behaviour marker tools, consider how behaviour assessment fits with current models of assessment in surgery and then attempt to give advice on possible courses of action when ratings are less than acceptable in the form of remediation and retraining.