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Response to: ‘Lack of standardisation between specialties for human factors content in postgraduate surgical training: an analysis of specialty curricula in the UK’ by Greig et al
  1. George Youngson,
  2. Simon Paterson-Brown,
  3. Stephanie Russ
  1. Patient Safety Board, Royal College of Surgeons of Edinburgh, Edinburgh, Scotland
  1. Correspondence to Professor George Youngson, Patient Safety Board, Royal College of Surgeons of Edinburgh, Nicolson Street, Edinburgh, EH8 9DG, Scotland; ggyrach{at}

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We were very interested to read the article by Greig et al,1 which has identified how poorly non-technical skills appear in a review of 46 postgraduate curricula from all medical specialties. This is similar to work sponsored by the Academy of Medical Royal Colleges and carried out by the Royal College of Surgeons of Edinburgh (RCSEd) in conjunction with the NHS Institute of Innovation and Improvement2 which also demonstrated significant deficiency in identifying patient safety in general and non-technical skills in particular, as part of the requirement for any educational portfolio. This project also provided an online curriculum builder that could be customised for each medical specialty. There was, however, little uptake by medical educationalists in any specialty. We are, therefore, in complete agreement with the authors in their view that non-technical skills need to be explicitly taught within all medical curricula, along with much more formal and specific assessment.

We are, however, surprised that the authors review did not acknowledge the recent literature on non-technical skills for surgeons (NOTSS), a joint research project which has been running between the RCSEd and the School of Psychology of Aberdeen University since 2002 and which has identified the NOTSS. The NOTSS project identified the skills which underpin good operative performance and developed a taxonomy and rating form which has now been incorporated into the Intercollegiate Surgical Curriculum Project for the assessment of surgical trainees in the UK.3 The RCSEd has been running NOTSS Masterclasses since 2006 throughout the UK and overseas ( to identify these non-technical skills to surgeons and enhance the understanding of their importance in surgical performance. The undergraduate curriculum in many medical schools now contains teaching in a variety of areas concerning patient safety in general, including human factors and non-technical skills. Therefore, with all the evidence demonstrating the importance of these skills in all areas of medical practice, the time is right, as the authors say, for a combined and concerted approach to establish them firmly within all postgraduate specialty curricula so that they are taught and assessed. This effort must include all Specialty Associations, the Medical Royal Colleges and the General Medical Council.



  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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