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. 2026 Feb;108(2):132-136.
doi: 10.1308/rcsann.2025.0040. Epub 2025 Jun 17.

Theatre etiquette Delphi: the development of a guide on professional conduct and best practices in operating environments

M El Boghdady  1 , J Hardie  2 , P A Brennan  3 ; TED Collaborative Group
Affiliations

Theatre etiquette Delphi: the development of a guide on professional conduct and best practices in operating environments

M El Boghdady et al. Ann R Coll Surg Engl. 2026 Feb.

Abstract

Introduction: The importance of non-technical skills (NTS) to surgical performance and patient safety has been increasingly recognised by surgical teams. Inductions for new surgical team members in theatre often provide insufficient, non-standard and 'ad hoc' training in theatre behaviour and etiquette. We conducted a Delphi consensus study among senior surgeons to develop standardised guidance on theatre etiquette for those unfamiliar with the theatre environment, including resident surgical trainees and medical students.

Methods: An international Delphi process of two rounds was conducted. An electronic survey was distributed among senior surgeons, anaesthetists and senior scrub nurses/practitioners, with participants recruited via surgical societies. Participants were asked to rank each statement on a Likert scale of 1 to 5. Consensus was considered if achieved for any statement for which 75% or more indicated agreement. The study was registered with the Open Science Framework.

Results: A total of 261 participants completed the Delphi process; 239 valid responses were included in round 1, with a 23% dropout in round 2. Participants were from 23 countries, 66% were from the UK, 58.2% were male, 51% were from the 30 to 40-year age group, 39% were consultant surgeons and 49% were senior trainees. General surgeons made up 68.6% of respondents, trauma and orthopaedic surgeons 13.4%, healthcare practitioners 2.1% and anaesthetists 1.3%. Thirteen statements were excluded, and 29 reached agreement and were included in the final guidance.

Conclusion: There was agreement among a large international group of surgeons to develop a standardised guidance for theatre etiquette, addressing most of the key aspects of professional conduct and team dynamics. We anticipate that this guidance will serve as a valuable resource for orienting new members of the surgical team, providing a clear framework for maintaining professionalism and fostering effective communication within the theatre environment.

Keywords: Behaviour; Etiquette; Operating theatre; Respect.

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Figures

Figure 1
Figure 1
Worldwide distribution (blue) of participants who completed the Delphi process
Figure 2
Figure 2
Theatre etiquette guidance
See this image and copyright information in PMC

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