Assessment is a fundamental component of surgical education, offering essential feedback that identifies areas of strength and highlights domains that require targeted improvement among novice surgeons. Since the introduction of the Objective Structured Assessment of Technical Skill (OSATS),1 numerous instruments have emerged to objectively evaluate technical proficiency. Although some such as OSATS, can be used to assess any surgical procedure, many have been developed to assess specific surgical procedures. The GOALS-GH2 and the TAPP checklist3 for laparoscopic inguinal hernia repair (LIHR) were systematically developed and validated. These instruments contribute significantly to defining precise educational objectives and enhancing structured training methodologies within surgical training programs.2,3 Nonetheless, existing assessment frameworks predominantly emphasize technical performance and often overlook critical nontechnical dimensions of surgical competence.

The essential role of nontechnical skills such as effective communication, situational awareness, and clinical decision-making is widely recognized as integral to overall surgical success.4 Spencer et al.5 notably reported that while technical skills constitute approximately 25% of surgical effectiveness, nontechnical competencies account for the remaining 75%. In response to this critical insight, NOTSS6 framework was introduced in 2006 to systematically assess surgeon behavior intraoperatively to enhance patient safety and improve team efficiency. Despite this advancement, the NOTSS primarily assesses general nontechnical skills and requires an expert rater within the operating room (OR) to conduct the assessment. This presents methodological limitations, particularly when evaluating specific competencies such as communication, teamwork, and leadership, through video-based assessments that lack direct expert involvement within the OR.7,8 Amin et al.9 through their work on laparoscopic cholecystectomy, further emphasized the critical need for developing procedure-specific tools to assess nontechnical skills. Existing general nontechnical skills assessment frameworks, such as NOTSS, may not fully capture the procedure-specific decision-making processes critical to particular surgical techniques. However, procedure-specific assessment instruments have not been developed for this purpose.

To address this gap, there is a need for a nontechnical skill assessment tool tailored to specific surgical procedures. Additionally, using recorded performances for assessment presents a promising alternative for trainees in institutions without expert raters, allowing them to receive structured evaluation and feedback on their nontechnical skills. This study aimed to develop a dedicated assessment tool specifically designed to evaluate nontechnical skills in the TAPP procedure and to gather valid evidence for its use in assessing recorded performance.