Developing an objective framework for scrub nurse training: A Japanese pilot study

Background: Scrub nurses play a critical role in maintaining safety and efficiency in the operating room, requiring both advanced technical precision and non-technical competencies such as communication and situational awareness. In Japan, however, scrub nurse education is often apprenticeship-based and lacks standardised, objective assessments or structured feedback. To address this, we developed the Scrub Nurse Competency and Performance Evaluation (SCOPE), a concise tool designed to evaluate both technical and non-technical skills, that is integrated within the ‘briefing, intraoperative teaching, debriefing’ (BID) educational model. Methods: A preliminary needs assessment, involving interviews, direct observations and a survey of nine scrub nurses with one to three years’ experience, identified deficits in structured feedback and non-technical skills – particularly situational awareness and prediction. Based on these findings, SCOPE was designed with five domains (instrument handling, safety management, situational awareness, situational prediction and communication) and anchored behavioural criteria. Two novice scrub nurses participated in a pilot study involving 26 surgical procedures, during which real-time intra-operative instruction and post-procedure feedback were delivered using SCOPE. Assessments were performed by trained instructors, attending surgeons and the participants themselves. Results: Gradual improvement in novice scores was observed over time. Inter-rater reliability between instructors and the primary researcher was high (ICC = 0.9078). Instructor scores correlated with case experience, particularly for Novice B (r = 0.88). Novices tended to rate themselves lower than instructors, though this difference was not statistically significant (p = 0.056). Survey data emphasised the need for more regular, structured feedback and highlighted variability in skill acquisition. Conclusion: Integrating SCOPE with the BID model enhances both technical and cognitive competencies in novice scrub nurses. The framework is feasible and well received in clinical settings. Further multicentre studies are warranted to assess long-term skill retention and validate broader applicability for standardised perioperative nursing education.