Non-technical skills training is becoming increasingly emphasised in training curricula [8, 32], as appropriate use of these skills has been recognised as a key factor in the prevention of surgical errors [30]. Non-technical skills include social skills (communication, teamwork and leadership) as well as cognitive skills (decision-making and situational awareness). Other skills include personal resource factors such as ability to cope with stress and fatigue. Training for these skills is particularly hard in the real operative environment for several reasons. For example, teaching skills that are more abstract in nature than technical skills is even harder for mentors and proctors to teach while focusing on the procedure itself. Non-technical skills training can also utilise simulation to increase competence outside the operating theatre while preserving patient safety. This can be achieved by human performance simulation.

Human performance simulation may take place in real operating theatres with the whole surgical team. This can provide to be very useful for team training but is associated with significant costs and is dependent on availability of such facilities [2]. A cheaper and more feasible alternative is full immersion simulation (see Fig. 28.3), which is a blow-up simulated environment with theatre staff and equipment to replicate the operating theatre as a whole [11]. Simulated procedures can be carried out under specific scenarios to help trainees develop their non-technical skills in an observed and safe environment, where detailed feedback can be given afterwards. Full immersion simulation has been shown to be a feasible, valid and cost-effective means of training for non-technical skills [21, 22, 23].