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"Human factors" is an influential rationale in the UK national health service to understand mistakes, risk and safety. Although there have been studies examining its implications in workplaces, there has been little investigation of how it is taught, as a form of professional morality. This article draws on an observational study of human factors teaching in four hospital simulation centres in London, UK. Its main argument is that the teaching of human factors is realised through an identification and positive evaluation of "non-technical skills" and the espousal of "non-judgemental" pedagogy, both of which mean that mistakes cannot be made. Professional solidarity is then maintained on the absence of mistakes. We raise questions about the ethics of this teaching. The study is situated within a history of ethnographic accounts of medical mistakes, to explore the relationship between claims to professional knowledge and claims about failure.

Competency based surgical training uses proficiency of technical skills to quantify surgical competency. We believe this is an over simplification of what is required to be a competent surgeon. This work aims to illuminate the attributes of a mature, competent, thinking surgeon. A bespoke (or custom) tailor is highly trained craftsman who produces unique items of clothing to the customers' requirements. This paper uses the practice of expert bespoke tailoring as a metaphor for illuminating surgical training and practice. A sustained and evolving dialogue with a single eminent tailor identified a number of emergent themes. A three-year iterative process included wide reading, interviews, observation, discussion and reflection. These emergent themes have produced a provisional working framework for exploring non-technical domains of surgical competence. Surgical practice is a complex process, which interweaves non-technical and technical elements in a seamless harmonious marriage of physical and mental processes. These processes need to be more clearly defined to allow the most effective training of future surgeons in the limited time now available. We discuss the benefits of illuminating these hidden facets of surgical practice, pointing out the limitations of defining competency in terms of knowledge acquisition and technical skills. If we are to train balanced, thinking surgeons for future surgical practice, and the training of future surgeons, has to be viewed as a complex integrated process rather than a collection of isolated domains.

Assessment of clinical skills is a critical element of undergraduate medical education. We compare a traditional approach to procedural skills assessment--the Objective Structured Clinical Examination (OSCE) with the Integrated Performance Procedural Instrument (IPPI). In both approaches, students work through "stations" or "scenarios" undertaking defined tasks. In the IPPI, all tasks are contextualised, requiring students to integrate technical, communication and other professional skills. The aim of this study was to explore students' responses to these two assessments. Third-year medical students participated in formative OSCE and IPPI sessions on consecutive days. Although performance data were collected in both assessments, quantitative data are not presented here. Group interviews with students were conducted by independent researchers. Data were analysed thematically. The OSCE and the IPPI were both valued, but for different reasons. Preference for the OSCE reflected the format of the summative assessment. The IPPI was valued for the opportunity to practise patient-centred care in a simulated setting which integrated technical, communication and other professional skills. We posit that scenario-based assessments such as the IPPI reflect real-world issues of patient-centred care. Although the limitations of this study prevent wide extrapolation, we encourage curriculum developers to consider the influence of assessments on what and how their students learn. (Contains 3 tables, 3 figures, and 1 note.)