Technical competence is an essential aspect of intraoperative performance but is in itself insufficient to ensure an optimal surgical outcome. A list of other skills complement technical ability and these relate, among others, to surgical judgment and intraoperative decision-making processes as well as the role of the operating surgeon as leader of the surgical team. This article outlines the composite set of nontechnical skills (NTS) and the factors which influence surgical performance by virtue of this skill set. A framework has been developed to allow identification, teaching, and assessment of NTS known as Nontechnical Skills for Surgeons (NOTSS), and the relevance and influence of NOTSS during the intraoperative performance of pediatric surgery is presented.
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