The success of urologic surgeries may be related to the success of the surgeon's technical skills as well as non-technical skills such as managing the team, interpersonal skills, cognitive skills and the environment of the urologist. Limited use of non-technical skills can be the underlying cause of adverse events in urologic surgeries. Urologists need to control their level of stress, organization and management skills during the surgery. But limited number of urology residents or urologists interested in these kind of management technics which can increase the patient safety, quality of the operation and technical skills proficiency during surgery. Changes in perspective and current developments in the field of rehabilitation and psychology increased the surgeons interest in the main subjects such as activity, adaptation, cognitive skills, self-management, teamwork, time management, leadership and behavior change, which is one of the main branches of rehabilitation. It is thought that the rehabilitation perspective has an important role in the development of the non-technical skills of the surgeon and surgical team. According to these given background the aim of the present study is to develop an activity based non-technical skills education (A-NTSE) module from rehabilitation perspective for urologists/urology residents and assess its effectiveness.

The study is a cross-sectional study including urologists and urology residents. First a need analysis including urologists, urology residents, urologic surgery team members such as nurses, technicians, and rehabilitation professional including psychologists, psychiatrists, occupational therapists, physiotherapists and flight simulation instructors was done and according to the results the content of the A-NTSE module has been prepared with an interdisciplinary perspective for urologists who receive surgical training on 3D printed physical urologic surgery stimulation education. A-NTSE syllabus was based the result of need analysis,   taxonomy of surgeons' non-technical skills which has four principal categories: situation awareness, decision-making, communication, teamwork, leadership and activity based mental health and management skills adult education perspective of rehabilitation professionals. Totally 45 urology residents and urologists attended 2-day training course developed by an interdisciplinary team including psychologist, occupational therapist, physical therapist, drama therapist and a flight simulation instructor educated in mental health to rise surgeons’ awareness and use of non-technical skills during surgery on 3D printed physical urology stimulators. Participants were evaluated before and after the A-NTSE module during various 3D printed physical urologic surgery stimulators by raters to analyze the utility/validity and the reliability of the education. Participants' use of non-technical skills during simulated surgeries were evaluated pre and post A-NTSE module by Non-Technical Skills for Surgeons (NOTSS) which is a behaviour rating system and participants satisfaction level from the A-NTSE, their opinions and suggestions about A-NTSE were evaluated. The results were evaluated with quantitative and qualitative statistical analysis.

Scores of category and elements of situation awareness, decision-making, communication, teamwork and leadership were statistically higher after A-NTSE (p<0.05) module. All the participants declared that A-NTSE module  improved their awareness on non-technical skills and their satisfaction from the education were high. The content of the discussions and the activity-based exercises were enjoyable. Majority of the participants reported that they want to make some behavioral changes during surgery. The validity coefficient value (0.81) and the reliability coefficient value (0.87) levels of the education were good.

This study showed that improving the non-technical skills of urologists can benefit from activity based non technical skill education module in order to produce more effective solutions to the risks they could face during surgery. Limited studies in the field support our results.

It was concluded that activity based non-technical skills education (A-NTSE) module could increase the success of urologic surgery trainings and can be used to enhance the non-technical skills, behavioral change and management skills of urology residents and urologists.