Using 360-degree feedback to identify actionable strategies to improve surgeon intraoperative non-technical skills - 11/08/25

Doi : 10.1016/j.amjsurg.2025.116277

Stefanie J. Soelling ^a,^c, Emily Cummins ^c, Robert D. Sinyard ^b,^c, Max Riley ^a,^c, Yves Sonnay ^c, Steven Yule ^d, Steven J. Fishman ^e, Douglas S. Smink ^a,^c,^⁎
^a Brigham & Women's Hospital, Department of Surgery, Boston, MA, USA
^b Massachusetts General Hospital, Department of Surgery, Boston, MA, USA
^c Ariadne Labs, Boston, MA, USA
^d The University of Edinburgh, College of Medicine and Veterinary Sciences, Edinburgh, UK
^e Boston Children's Hospital, Department of Surgery, Boston, MA, USA

^⁎Corresponding author. Brigham and Women's Hospital, 75Francis St. Boston, MA, 02115, USA.Brigham and Women's Hospital75Francis St. BostonMA02115USA

Abstract

Background

This study aimed to evaluate comments received by surgeons on an intraoperative 360-degree evaluation (i360) and their alignment with Non-Technical Skills for Surgeons (NOTSS).

Methods

The i360 assesses surgeons’ intraoperative skills via feedback from perioperative staff. 88 academic surgeons underwent i360s. Inductive thematic analysis identified feedback themes and their alignment with NOTSS categories (leadership, communication and teamwork, decision-making, situation awareness).

Results

699 evaluations had qualitative comments and 589 (84.3 %) included NOTSS-related concepts. Most fell within leadership (n = 371, 53.1 %) and communication and teamwork (n = 275, 39.3 %). Notable leadership themes included mentorship, professionalism, and respect for colleagues. Communication and teamwork themes were communicating case needs, intraoperative bedside manner, and team collaboration. Themes surrounding decision-making (n = 157, 22.5 %) were case bookings and patient care judgements, while situation awareness (n = 117, 16.7 %) included patience, rushing, and stress response.

Conclusions

i360 surgeon feedback aligned with non-technical skills, indicating that perioperative staff are a valuable source of actionable insights.

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Graphical abstract

Image 1

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Highlights

•	An intraoperative 360-degree feedback tool provides non-technical skill feedback.
•	Most feedback themes related to leadership and communication and teamwork.
•	Perioperative staff can provide actionable non-technical skill feedback to surgeons.

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Keywords : 360-Degree feedback, Non-technical skills, Communication, Leadership, Intraoperative feedback, NOTSS