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Intraoperative non-technical skills: a critical target for improving surgical outcomes
  1. Kara Vande Walle,
  2. Caprice Greenberg
  1. Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
  1. Correspondence to Dr Caprice Greenberg, Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, USA; greenberg{at}

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Surgical performance is a function of technical and non-technical skills, the latter of which encompasses both cognitive and interpersonal skills.1 The important role of intraoperative non-technical skills in determining surgical safety and outcomes has been increasingly recognised in recent years. To that end, in this issue, Sexton et al 2 evaluate the non-technical skills of teamwork and situation awareness. Specifically, they examine the effect of team anticipation on operative time and cognitive load in the environment of robotic surgery. Through analysis of video and audio from 12 robot-assisted radical prostatectomies, they were able to calculate anticipation ratios (per cent of requests that were non-verbal) and investigate the impact on surgical performance. While increased anticipation led to decreased operating room time, it also increased the assistant surgeon’s cognitive workload.2 Prior work has shown that increased cognitive load is associated with errors and poorer performance, which demonstrates the complexity of this important domain of intraoperative performance.3 While increased anticipation may improve overall efficiency, these data suggest it may also increase system and team vulnerability to adverse events if not carefully managed.

It is postulated that the ability to anticipate a team member’s needs reflects a shared mental model. Shared mental models are common or overlapping cognitive representations of task requirements, procedures and role responsibilities.4 Mental models help team members describe, explain and predict …

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