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Safer Surgery part 21. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | This page has been left blank intentionally Chapter 11 Integrating Non-Technical Skills into Anaesthetists Workplace-based Assessment Tools Ronnie Glavin and Rona Patey Introduction In this chapter the authors will provide a brief account of the development of the Anaesthetists Non-Technical Skills ANTS system and then consider how this system may find a suitable home in the UK anaesthetic curriculum Anaesthetists Non-Technical Skills System Handbook . But first what are non-technical skills NTS Within the context of anaesthesia they have been defined as behaviours in the operating theatre environment which are not directly related to the use of medical expertise drugs or equipment Fletcher et al. 2003 . They encompass both interpersonal skills e.g. communication team working and leadership and also cognitive skills e.g. situation awareness and decision making Anaesthetists Non-Technical Skills System Handbook . NTS are important because we need them to function effectively in our professional lives. As with many important aspects of living we really only notice them when they are absent or poorly performed. Then our practice is not so effective and may become dangerous. In anaesthesia and many other professions studies of adverse incidents consistently suggest that the underlying factors are more likely to be due to difficulties with the application of NTS rather than a lack of basic knowledge or practical skill Flin et al. 2008 . Is it then reasonable to ask If NTS are so important why have they not featured prominently in anaesthetic training One might reply that they might have done had we known what they were exactly in the context of anaesthesia. Until now NTS have been elusive and difficult to describe or pin down. This inability to accurately define or describe NTS has resulted in them generally only being considered under a broad umbrella category of soft skills . However there is nothing soft about these skills. The platform they provide along with the .