1 Department of Ergonomics, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Occupational Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Anatomy, School of medicine, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Biostatistics and Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Non-technical skills are interpersonal and cognitive skills involved in safe performance and preventing
adverse events during surgery. it is necessary to dominate the non-technical skills to ensure patient safety. This study
has aimed to assess the validity and reliability of Oxford Non-technical skills 2 system (Oxford NOTECHS 2) in Iran and
to evaluate surgical teams’ non-technical skills in orthopedic surgery wards.
Methods: This cross-sectional study was conducted in Tehran, Iran during 2015. The level of evidence is III based on
Canadian Task Force on the Periodic Health Examination. We followed the Beaton’s guideline for Persian translation
and cross-cultural adaptation of the checklist. In this study, 60 orthopedic surgical team members working in two
selected public hospitals were selected by cluster random sampling method.Oxford NOTECHS 2 system which is
consisted of four subscales including leadership and management, teamwork and collaboration, decision-making
and problem-solving, and situational awareness was used to collect the data.
Results: The overall mean score of non-technical skills was 69.52±6.64. The mean score for surgery, anesthesia, and
nursing sub-teams were 24.98±3.71, 21.12±4.29, and 23.42±3.60, respectively. The teams’ scores in total, leadership
and management, teamwork and collaboration, problem solving and decision making, and situational awareness at
the standard level were 74.70%, 76.95%, 73.75%, 66.87%, and 74.70% of maximum score, respectively.
Conclusion: The validity and reliability of the Persian version of Oxford NOTECHS 2 scale in Iran was confirmed. The
results of this study showed that surgical teams’ non-technical skills were at a moderate level in orthopedic surgery
wards. The minimum score of the surgical teams’ non-technical skills belonged to anesthesia and maximum to surgery
sub-team. Using the training programs and setup workshop is recommended to improve the surgical teams’ nontechnical
skills, especially surgery-nursing sub-team.
Level of evidence: III


Main Subjects

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