Beyond technical proficiency: An Italian survey on perception and training of nontechnical skills in surgical practice

Introduction: Nontechnical skills (NTS) are cognitive and social resources critical for safe and efficient surgical performance, yet they are often overlooked in formal curricula. This study evaluates NTS awareness, knowledge levels, and training gaps among Italian surgeons to identify areas for institutional intervention. Materials and methods: A cross-sectional survey involving 331 surgeons was conducted via a 35-item questionnaire (nine NTS domains). Inclusion criteria targeted board-certified consultants and residents active in Italian surgical departments. Data were collected between January and March 2025 and analyzed using RStudio. Results: Of the 331 participants (79% consultants, 18% residents, 2% employed residents), 91% recognized the importance of NTS, but only 30.2% had received formal university training. Consultants demonstrated significantly higher NTS familiarity (94%) than residents (80%; P < 0.005). Seniority positively correlated with emotional awareness and stress regulation ( P < 0.01). However, residents reported significantly higher levels of ethical strain compared with seniors. Although mentorship was deemed essential by nearly all respondents, 35% reported a total absence of a dedicated mentor, highlighting a critical gap in professional development. Conclusions: While awareness is high, NTS acquisition in Italy remains largely informal and experience-dependent. To mitigate the “hidden curriculum” effect and reduce ethical strain among trainees, we recommend the mandatory integration of NTS modules into residency programs, the implementation of structured mentorship protocols, and the use of high-fidelity simulation to standardize these essential competencies across all career stages.