Filming an NOTSS training video in Rwanda

All physicians want to provide the best possible care to their patients, but clinicians in parts of the world where resources are limited can face many challenges in doing so.

Recognizing this challenge, John Scott, MD, MPH, a general surgery resident and research fellow at the Center for Surgery and Public Health, teamed up with surgeons in Rwanda to improve surgical care for patients through the Non-Technical Skills for Surgeons (NOTSS) training program. This program—originally designed in Scotland by a team of psychologists, surgeons and anesthesiologists—was created to assess and improve surgeons’ non-technical skills, such as situation awareness, decision-making, communication, teamwork and leadership.

With the help of his mentors Robert Riviello, MD, MPH, of Trauma, Burns and Critical Care, and Steven Yule, PhD, of the STRATUS Center for Medical Simulation, Scott redesigned the NOTSS program to be used in a resource-limited setting for the first time. Additionally, they collaborated with students at the KWETU Film Institute in Kigali, Rwanda, to produce an on-location video series to complement the curriculum.

“Surgery is very technical, but expert performance takes more than just cutting and stitching,” said Scott. “Before the NOTSS program, we didn’t have a reliable way to teach these critically important non-technical skills.”

Having training in skills like situation awareness, leadership and decision-making makes it easier for doctors in resource-limited settings to resolve problems that may be specific to their operating rooms, Scott says. For instance, surgeons in Rwanda see variability in the equipment they use, the personnel and assistance they receive, and the support systems they work within. This makes it difficult for surgeons to plan ahead, and they must think creatively and deal with changes very rapidly, as their access to these medical resources can change quickly.

“The long-term goal is to improve the surgical service in Rwanda so that resource variability is no longer an issue,” said Scott. “But NOTSS enables us to improve patient safety and surgical performance here and now, without waiting around for more money and technology.”

For more information about BWH’s global health initiatives, visit BWHGlobalHealthHub.org.