Non-Technical Skills for Surgery in African Perioperative Curricula: A Scoping Review

Every surgery involves more than just the surgeon's hands. While technical skill—the ability to cut, stitch, and repair—is the foundation of the operation, a safe outcome also depends on how the team thinks and works together. These invisible abilities are called non-technical skills. They include knowing what is happening around you in the operating room, making quick decisions when things change, communicating clearly with nurses and anesthesiologists, and leading the team through a crisis. When these skills are missing, even the most skilled surgeon can make mistakes that harm patients. In Africa, where surgical care is expanding rapidly, understanding whether doctors and nurses are being taught these vital human skills is a matter of life and death.

Researchers set out to find out exactly how these skills are being taught in medical schools and training programs across the African continent. They did not look at individual doctors or specific hospitals, but rather at the official training documents themselves. These documents are the blueprints for education, outlining what a student must learn to become a surgeon, an anesthesiologist, an obstetrician, or a midwife. The team gathered these blueprints from universities and medical colleges in eleven different countries, searching through public records, online databases, and direct requests to training institutions. They focused on materials published from 2015 onward to ensure they were looking at current standards. Their goal was simple: to see if these training plans explicitly included lessons on teamwork, leadership, and decision-making, or if they left these skills to chance.

The search revealed a mixed picture. The researchers found thirty-one distinct training curricula from eighteen institutions. These programs covered surgery, anesthesia, and women's health, with the majority coming from West Africa, followed by East Africa. Curricula from Central Africa were notably absent, and only a few were found in North and Southern Africa. When the team examined the content of these documents, they found that most of them did mention non-technical skills. In fact, nearly all of the programs included at least one reference to these skills. However, the way these skills were presented varied widely. In almost half of the documents, the skills were mentioned explicitly, meaning the text clearly stated that a student needed to learn them. In another significant portion, the skills were mentioned only implicitly, using vague language like "work well with others" rather than defining specific competencies like "leadership" or "situation awareness."

The specific skills that were taught also showed a clear pattern. Leadership and teamwork were the most common topics, appearing in the majority of the documents. Communication was also frequently included. However, the more complex mental skills were largely missing. Concepts like situation awareness—knowing exactly what is happening in the room at all times—and critical thinking were mentioned in only a tiny fraction of the curricula. This suggests that while training programs acknowledge that doctors need to be good team members, they often fail to teach the specific mental habits required to prevent errors during a crisis. Furthermore, the study found that very few programs actually included a structured course dedicated to these skills. Most programs simply listed the skills as something a student should have, without providing a class or a specific method to teach them. Even rarer was the inclusion of a formal test to see if a student had actually learned these skills. Only two of the thirty-one curricula combined a clear lesson on these skills with a specific way to assess whether the student had mastered them.

The researchers concluded that while the idea of non-technical skills is present in African surgical education, the actual teaching of these skills is inconsistent and often incomplete. The training documents often treat these skills as something a student will naturally pick up while learning to operate, rather than as a distinct set of abilities that require their own lessons and tests. This gap is most pronounced in Central, Northern, and Southern Africa, where few training documents were even available to review. The study suggests that to improve patient safety, medical schools need to move beyond simply listing these skills. They must create structured courses that teach leadership, decision-making, and situation awareness just as rigorously as they teach anatomy and surgery techniques. Without this shift, the vital human elements of safe surgery may remain an untaught hope rather than a guaranteed skill.