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Non-technical skills and gastrointestinal endoscopy: a review of the literature
  1. Charlotte R Hitchins1,2,
  2. Magdalena Metzner2,3,
  3. Judy Edworthy4,
  4. Catherine Ward2,5
  1. 1Department of General Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
  2. 2Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
  3. 3Department of Gastroenterology, Plymouth Hospitals NHS Trust, Plymouth, UK
  4. 4Cognition Institute, Plymouth University, Plymouth, UK
  5. 5Department of Anaesthesia, Plymouth Hospitals NHS Trust, Plymouth, UK
  1. Correspondence to Charlotte R Hitchins, Department of General Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, UK; Charlotte.hitchins{at}


Background Non-technical skills (NTS) have gained increasing recognition in recent years for their role in safe, effective team performance in healthcare. Gastrointestinal endoscopy is a procedure-based specialty with rapidly advancing technology, significant operational pressures and rapidly changing ‘teams of experts’. However, to date there has been little focus on the effect of NTS in this field.

Objectives This review aims to examine the existing literature on NTS in gastrointestinal endoscopy and identify areas for further research.

Method A systematic search of MEDLINE, Embase, Cochrane Library, PsychINFO, CINAHL Plus and PubMed databases was performed using search terms Non-Technical Skills, Team Performance or Team Skills, and Endoscopy, Colonoscopy, OGD, Gastroscopy, Endoscopic Retrograde Cholangio-Pancreatography or Endoscopic Ultrasound.

Results Eighteen relevant publications were found. NTS are deemed an essential component of practice, but so far there is little evidence of their integration into training or competency assessment. Those studies examining the effects of NTS and team training in endoscopy are small and have variable outcome measures with limited evidence of improvement in skills or clinical outcomes. NTS assessment in endoscopy is in its early phases with a few tools in development.

Conclusions The current literature on NTS in gastrointestinal endoscopy is limited. NTS, however, are deemed an essential component of practice, with potential positive effects on team performance and clinical outcomes. A validated reliable tool would enable evaluation of training and investigation into the effects of NTS on outcomes. There is a clear need for further research in this field.


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  • Correction notice This article has been corrected since it published Online First. The order of authors has been corrected.

  • Contributors CRH: design, literature search, drafting, revision and final approval of the manuscript. CW, JE and MM: revision of manuscript for important intellectual content. Final approval of the version published.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.