Majda Sebbani1,2*†
Anas Alami Idrissi2†
Ouassim Mansoury2Latifa Adarmouch2Mohamed Amine2Marie-Claude Audétat1- 1Unit of Research and Development in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- 2Laboratory of Epidemiology, Laboratory Biosciences and Health, Department of Public Health and Community Medicine, Faculty of Medicine and Pharmacy, University Cadi Ayyad, Marrakech, Morocco
Introduction: In the context of Moroccan medical education reforms toward a competency-based approach (CBA), the integration of non-technical skills (NTS) is imperative. The Faculty of Medicine and Pharmacy of Marrakech initiated a project to develop its competency framework. This study aimed to identify and prioritize NTS for undergraduate medical training from the students' perspective and to submit these results to experts' judgment.
Methods: A mixed-methods study was conducted. A qualitative phase identified NTS through semi-structured interviews with 10 medical students selected via purposive and snowball sampling; data were analyzed using thematic content analysis. A quantitative phase prioritized the identified NTS using the Analytical Hierarchy Process (AHP) technique with 10 faculty professors.
Results: The qualitative analysis revealed 22 NTS categorized into four domains: Communication, Management and Teamwork, Intrapersonal Skills, and Ethics and Professional Values. In the quantitative phase, the AHP prioritization by an expert group ranked Ethics and Professional Values as the most important domain (relative weight: 0.481), followed by Intrapersonal Skills (0.223), Communication (0.165), and Management and Teamwork (0.131). Key sub-competencies included ethics, empathy, and communication with the patient.
Discussion: This study produces a consensus-based, prioritized framework of non-technical skills that emphasizes the paramount importance of adherence to ethics and professional values and of intrapersonal skills. The findings offer a concrete foundation for educational engineering toward implementing the competency-based approach and for adapting professional situations within the local competency framework at the Faculty of Medicine and Pharmacy of Marrakech. They also provide actionable, context-sensitive guidance relevant to integrating NTS into medical curricula in comparable low- and middle-income settings.
1 Introduction
To meet the growing demand for training competent physicians and to respond to the quality care requirements, the medical education sector in Morocco has been undergoing reforms and profound transformations since 2015. The project includes both theoretical medical training in Medical Schools and clerkship in hospitals and primary care facilities. Aligning with international standards in medical education is imperative for the accreditation of the curriculum and the mobility of Moroccan doctors and students. In this context, the Faculty of Medicine and Pharmacy of Marrakech (FMPM), which was accredited in 2020, has begun to consider adopting a competency-based approach (CBA) and training a doctor capable of meeting the population's needs. By the end of their curriculum, the future doctor is expected to have acquired non-technical skills (NTS) in addition to technical skills (TS).
According to Jacques Tardif, the competency-based approach (CBA) is defined as a “complex know-how” that effectively mobilizes and combines various internal resources (knowledge, skills, attitudes) and external resources (tools, documents, and people) in a range of situations (Poumay et al., 2017). Non-technical skills (NTS) are inseparable from the competency-based approach. They consist of internal cognitive, social, and personal resources that complement technical skills and contribute to the safe and effective execution of tasks (Flin and O'Connor, 2008). Thus, the CBA offers an educational framework that recognizes the importance of these skills and proposes methods to develop and assess them in an integrated manner (Poumay et al., 2017). Classified into intrapersonal and interpersonal skills, they represent important indicators for providing quality care. Indeed, the NTSs improve physicians' clinical skills, the safety of provided care, and patients' satisfaction with the received care (Brunckhorst et al., 2015; Cha et al., 2019; Prineas et al., 2021; Goodrich and Lazenby, 2023). Many medical schools have recognized the crucial role of competencies during training and have developed competency frameworks, such as CanMed (Canadian Medical Educational Directives for Specialists) in Canada (Neufeld et al., 1998; Frank and Langer, 2003; van der Lee et al., 2013), the competency daisy in France, and PROFILES (Principal Relevant Objectives and Framework for Integrated Learning and Education in Switzerland) in Switzerland (Michaud et al., 2016; Sohrmann et al., 2020; Verte, n.d.).
In Morocco, like in other countries, the development of NTS is an area of growing interest (Scott et al., 2016; Siraj, 2022; Zerouali, 2023). The CBA represents a strategic goal of medical education, supported by reforms and growing institutional commitment from local pedagogical leaders. However, despite faculty members positive openness, widespread implementation faces concrete obstacles, primarily due to a lack of trainers' preparation and structural constraints, necessitating ongoing efforts in training, support, and adaptation (Sebbani et al., 2019).
This implementation challenge is not unique to Morocco but is frequently encountered in other Low- and Middle-Income Countries (LMICs), where contextual factors such as overburdened healthcare systems, lack of provider empowerment, and deficiencies in formal provider training complicate the integration of new pedagogical approaches (Scott et al., 2016).
The FMPM, concerned about its social responsibility in health and the importance of the participation of all stakeholders, has launched a project to develop its competency framework for undergraduate training in collaboration with the University of Montreal (as part of the skills for employment project) and involving institutional partners, representatives from the Ministry of Health, and representatives of medical students in a participatory approach (Maroc/Liban - Fin du projet ≪ Compétences pour l'emploi ≫, 2023). The stakeholders' perspectives were considered during the situation diagnosis (Sebbani et al., 2019, 2020). The inherent subjectivity of non-technical skills (NTS) presents a central challenge for curriculum designers: determining how to effectively teach, integrate, and objectively assess these competencies. Given the literature gap on NTS in the Moroccan healthcare sector and in LMICs compared to high income countries, research efforts to document this paradigm shift in training would provide considerable scientific contributions for implementation, monitoring, and evaluation, both locally and in similar contexts.
The primary objective of this research was to identify and prioritize the NTS for the future medical practice from the students' perspective. The secondary objective was to submit the results to the faculty members' judgment and to develop action-oriented recommendations for the ongoing reform of medical education at the faculty.
2 Participants and methods
We conducted a mixed-methods study that included a qualitative phase in which NTS were explored and identified through individual interviews with medical students in the second and third cycles of their medical studies at FMPM. A quantitative phase followed, where the identified NTS were prioritized by the faculty members using the “Analytical Hierarchy Process (AHP)” technique. The AHP uses objective calculations to process subjective and personal preferences of an individual or group when making a decision (Saaty, 2008).
2.1 Qualitative phase
The NTS were identified through semi-structured interviews with students in the second and third cycles of medical studies at the FMPM. These students were selected using purposive sampling and the snowball method (Coleman, 1958; Heckathorn, 2011). Inclusion was based on the student's involvement and leadership in the development of NTS (local committee of IFMSA—International Federation of Medical Students' Associations) and knowledge of the research field (prior training in NTS in Morocco or abroad). The interviews were conducted face-to-face or via phone calls using an interview guide. Two test interviews were conducted before the study began. Interviews were conducted until saturation was attained. After the 8th interview, no further new NTS were identified, two additional interviews were completed to confirm this, resulting in a total of 10 interviews. The interviews were recorded in their entirety and transcribed verbatim by (AAI). A summary of the transcriptions was then sent to the participants for validity verification. The thematic content analysis was then carried out separately by two researchers (AAI) and (OM) through coding and categorization using a coding grid following the steps of the content analysis methodology (Krippendorff, 2004). First, to ensure complete immersion, each interview transcript was meticulously read several times by two independent researchers (AAI and OM). Subsequently, a line-by-line coding process was conducted separately by the two researchers using an inductive approach to allow NTS themes to emerge from the data. Finally, to ensure the reliability and rigor of the analysis, the coding results and categorizations were compared during a consensus meeting attended by a third senior researcher (MS). This meeting served to discuss interpretations, resolve any discrepancies in coding, and validate the final grid of NTS categories.
2.2 Quantitative phase
The identified NTS were prioritized using the AHP technique. The targeted participants were full professors and associate professors at the FMPM, considered the expert group. It is generally accepted that AHP does not require a large sample (Schmidt et al., 2015). Ten professors were selected by reasoned choice. They all had at least 4 years of teaching experience, and they represented different medical specialties. Furthermore, all participants were members of faculty bodies.
This phase was carried out in several steps:
1. Explain the objective to the participants: prioritize the essential NTS for medical students based on the qualitative results.
2. Structure the elements into criteria and sub-criteria: create and organize a hierarchical tree of NTS into categories and sub-categories previously identified in the qualitative phase. At the highest level of the tree, we find the previously mentioned objective. In the second category (or criteria), we find the components of the NTS, and in the third category, the sub-components of each NTS.
3. Compare each level of the hierarchical tree in pairs: the pairwise comparisons were conducted sequentially at two hierarchical levels. First, participants compared the four main NTS domains against each other (e.g., “Is Communication more important than Ethics?”). Second, they performed comparisons between the sub-categories within each specific domain. The pairwise comparison questionnaire was designed based on degrees of importance, ranging from not important to extremely important. On this scale, the number 1 represents unimportant or equal, 2 represents unimportant to slightly important, 3 slightly important, 4 slightly important to important, 5 important, 6 important to very important, 7 is very important, 8 very important to extremely important, and 9 extremely important.
4. Calculate the weight of each NTS using mathematical calculations developed by Saaty (2008) with the help of a comparison matrix. The inconsistency ratio was also calculated. This tool measures the consistency of the pairwise comparison matrix and shows the degree of confidence that can be obtained from the comparative priorities. According to Saaty, if the judgments are stable, the rate should be less than < 0.1. During this stage, the researchers used the open-access tool, “AHP Online System” (Goepel, 2018) was used to perform these complex calculations.
5. Prioritize the different NTS according to the calculated relative weight.
2.3 Ethics
Ethical approval was granted by the Marrakech University Hospital Ethics Committee (Ref: 63/2023).
At the start of each interview, the investigator (AAI) systematically introduced himself and obtained informed consent from all participants. Professors provided written consent. For student participants, two modalities were used: those interviewed face-to-face provided written consent which was also recorded orally, while others provided verbal informed consent only, recorded at the start of the session. All data were anonymized and treated confidentially.
3 Results
3.1 Qualitative phase
Ten students participated, including six males and four females. The median age of the participants was 24 years, with range of 22–28 years. Four second-year students participated in the interviews. Two interns at the university hospitals participated, as well as two students in the process of completing their theses. In the case of interns outside the university hospital and residents, there was one participant from each category. All interviewed students had participated in Non-Technical Skills (NTS) training and/or had held positions of responsibility at the local, national, or international level in IFMSA.
Analysis of the data from the interviews with the participants enabled us to extract 22 NTS in four categories. (1) communication with six sub-categories; (2) management and teamwork with seven sub-categories; (3) intrapersonal skills with six sub-categories; and (4) ethics and professional values with three sub-categories (Figure 1 and Table 1).
Figure 1. Hierarchical tree of essential NTS identified for a future physician.
Table 1. Ranking and mentions of NTS.
On the other hand, all the students interviewed expressed a lack of emphasis on soft skills during training (n = 10). Three participants mentioned the FMPM's pioneering efforts at the national level. From the participants' perspective, professors' involvement in NTS training remains highly variable, depending on the discipline (n = 8). They also point out that some professors, particularly those on teaching committees, place particular emphasis on these skills. Other professors, however, don't attach much importance, either because of a lack of awareness or because of their workload. Most students (n = 8) emphasized the crucial role of student associations in the development of NTS. The training courses, workshops and extracurricular activities organized by these associations seem to play a significant role in building students' capacity for NTS (Table 2).
Table 2. NTS Identified in the qualitative phase.
3.2 Quantitative phase
Ten professors participated in this phase of the research, all of whom were members of committees and governance bodies at the FMPM and/or the University Hospital Mohammed VI. In this study, the inconsistency ratio for the main criteria and sub-criteria was < 0.1, indicating acceptable consistency in the pairwise comparisons and confirming the stability of the participants' judgments. Female participants represented 40% (n = 4) of the sample, yielding to a male-to-female sex ratio of 1.5. The median age was 53 years, ranging from 35 to 55 years. The median length of experience in higher medical education was 19 years (ranging from 4 to 30 years). Among these professors, nine were full professors and one was an associate professor. Regarding their specialties, 80% (n = 8) specialized in medicine and 20% (n = 2) in surgery.
The prioritization results of the NTS necessary for medical students and their future practice, based on the Analytical Hierarchy Process (AHP), showed that adherence to ethics and professional values (relative weight of 0.481) was considered the most important NTS by the experts, followed by intrapersonal skills (relative weight of 0.223), then communication (relative weight of 0.165), and finally Management and Teamwork (relative weight of 0.131; Table 3).
Table 3. Relative importance of NTS.
To determine the relative weights within each NTS domain, the results showed that in the domain of ethics and professional values, ethics was considered the most important NTS (relative weight of 0.499), followed by professionalism (relative weight of 0.349), and finally intercultural competencies (relative weight of 0.152). Within intrapersonal skills, empathy emerged as the most important NTS (relative weight of 0.212). For the communication domain, communication with the patient and his family was identified as the most important skill (relative weight of 0.284). Finally, in team management and leadership, teamwork and collaborative work (networking) were regarded as the most important competencies by the experts (relative weight of 0.196; Table 4).
Table 4. Relative importance within each NTS domain.
4 Discussion
The objective of this study was to identify and prioritize the NTS necessary for a medical student. From the students' perspective, four areas of NTS were identified, including ethics and the demonstration of professional values, intrapersonal skills, communication, and team management and leadership.
The cross-analysis of the data highlighted a significant priority gap between the perception of learners and that of curriculum experts' priorities.
From the experts' perspective, adherence to ethics is the most important competence for a medical student. However, this NTS only accounted for 7.9% of student mentions, placing it last in their perceived importance. These results are consistent with those of Park et al. (2023) indicating that doctors consider professionalism and reliability as the most important factors. These results can be explained by the experiences of professors in contact with medical students in the 2nd and 3rd cycles and the perception of the importance of professionalism in medical practice. Indeed, according to Harch et al., the knowledge of the definition of ethics, its fundamental principles, and its main guidelines was weak among Moroccan interns and residents (Harch et al., 2024). This gap can be explained by the fact that professors have noted a lack of training in this area, as well as by the fact that students have not yet fully integrated the importance of these values into their daily clinical practice.
Intrapersonal skills come in second place in terms of importance with a relative weight of 22.3%, and represent the third most mentioned domain by students (26.7%). In this area, empathy comes first. Empathetic medical care is associated with numerous benefits, including an improved patients' experience, adherence to treatment recommendations, better clinical outcomes, fewer medical errors, and reduced malpractice claims (Riess et al., 2012). However, several studies have shown that medical students rate themselves less empathetic over the course of their studies (Nunes et al., 2011). Emotional intelligence is emerging as an essential skill for medical students and their future practice. Various studies have shown that emotional intelligence is linked to better academic results, more effective stress management, better mental health and greater empathy (Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka et al., 2022). Intrapersonal skills are an intrinsic and essential component of the very definition of medical competency, particularly emphasized by roles such as “Professional” and “Scholar” within the CanMEDS framework. Their development and evaluation, although sometimes complex, are crucial for training competent and “human” physicians (Sebbani et al., 2019).
In the prioritization of skills based on the AHP, communication comes third in the ranking of NTS to be developed by a medical student. In this area, communication with the patient and the family is the most important, followed by active listening, then announcement. Cross-referencing the results with the competency frameworks, communication occupies a central place among the CanMEDS 2015 key roles. Indeed, the link between poor communication and poor patient outcomes has been widely documented (The Joint Commission Perspectives, 2016). It was found that most of these assessments were developed in high-income countries and applied without modification to contexts in low- and middle-income countries. This highlights the need to adapt or develop tools that are sensitive to local challenges (Scott et al., 2016). The competency palm developed at the FMPM would help highlight the importance of developing communication skills in various professional situations throughout local medical training.
Management and teamwork received the lowest ratings during the quantitative assessment phase. In this area, several skills are highlighted by the students, such as networking and collaboration, decision-making, and problem-solving. These professional situations call for the physician's leadership skills, who must be a leader and a manager, with the primary motivation being the patients' wellbeing and safety of the patients (Institute of Medicine (US) Committee on Quality of Health Care in America, 2000; Flin and O'Connor, 2008; Abbas et al., 2011; Prineas et al., 2021). This skill should be strengthened to address the gaps described among “accidental leaders” in the medical profession (Collins-Nakai, 2006). Leadership competence has long been minimized in the healthcare setting, whereas it is fundamental for the development of the professional identity of a physician leader (Lüchinger et al., 2024). We are renewing the call to action for the deployment of leadership training programs during the medical curriculum from the early years (Stoller, 2009; Lüchinger et al., 2023; Huikko-Tarvainen et al., 2024).
The domains of Communication and Management/Teamwork were most frequently identified by students, each representing 32.7% of all mentions. This gap between learner and expert perceptions suggests that students feel an urgent need to develop these organizational skills to function within the hospital setting. This priority is likely shaped by contextual factors typical of LMICs, including overburdened health systems and gaps in formal clinical training, which push learners to focus intensely on direct patient care.
5 Strengths
The present study is part of a larger research project aimed at the implementation of the CBA at the faculty. To our knowledge, this is the first time a study has attempted to identify and prioritize the NTS from the perspective of medical students' in our context. The mixed methodology allowed for the intersection of the perspectives of student leaders and expert teachers, two essential stakeholders for the success of the project. The results will be inspiring for other contexts. In Morocco, the Faculty of Medicine of Marrakech stands out as a pioneer in the implementation of the Competency-Based Approach, and the findings of this study are expected to have a national impact.
6 Limitations
However, some limitations must be acknowledged. The single-institution design limits the generalizability of the findings in Morocco and in LMICs. The authors acknowledge that the results are not generalizable, but they remain inspiring for other contexts. Indeed, generalization is not the aim of qualitative methods, which primarily seek to deepen understanding in order to foster pedagogical innovation. Although the study is limited by institutional homogeneity, we mitigated the risk of a narrow perspective by deliberately sampling participants with high internal heterogeneity, including students from the Second Cycle up to interns and residents, thereby covering the full spectrum of clinical responsibility and NTS needs. Also, the cross-analysis compared distinct constructs (student-identified salience vs. professor-prioritized weight) representing a confrontation of different perspectives rather than a direct comparison of the same variable.
7 Recommendations and outcomes
We recommend relying on the results of this research for educational engineering aimed at the implementation of the CBA and the adaptation of professional situations within the framework of consolidating the local competency framework. Furthermore, our study will contribute to encouraging more research in similar contexts, enriching the literature on leadership in educational transformation projects, and promoting the integration of non-technical skills into medical training curricula in low and middle-income countries.
8 Conclusion
In conclusion, this mixed-methods study successfully identified and prioritized the essential NTS for future medical practice from the dual perspectives of students and professors at the FMPM. The research underscores a clear consensus on the critical importance of NTS, while also revealing a strategic hierarchy: ethics and professional values were deemed paramount by the expert group, followed by intrapersonal skills like empathy, communication, and finally management and teamwork.
These findings provide a crucial, evidence-based foundation for the ongoing curricular reform at FMPM. They highlight a necessary alignment with international competency frameworks while simultaneously advocating for a context-sensitive approach that addresses local challenges and opportunities. The study exposes a gap in formal NTS training, currently supplemented by variable extracurricular activities led by student associations.
Therefore, the path forward necessitates a deliberate and structured integration of these prioritized NTS into the medical curriculum. This calls for concerted action in faculty development, the design of authentic professional situations for learning and assessment, and the formal recognition of NTS as core physician competencies. This work serves as a catalyst for further research and a model for similar medical education reforms in comparable contexts. To fully validate the clinical relevance of these NTS, future research must expand beyond the academic perspective to integrate the viewpoints of external stakeholders, specifically patients and non-physician healthcare professionals.
Data availability statement
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
Author contributions
MS: Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing. AAI: Conceptualization, Data curation, Formal analysis, Investigation, Writing – original draft. OM: Data curation, Formal analysis, Writing – review & editing. LA: Writing – review & editing. MA: Methodology, Supervision, Writing – review & editing. M-CA: Validation, Writing – review & editing.
Funding
The author(s) declared that financial support was not received for this work and/or its publication.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Keywords: competency-based approach, medical education, non-technical skills, perspectives, qualitative quantitative method, soft skills
Citation: Sebbani M, Alami Idrissi A, Mansoury O, Adarmouch L, Amine M and Audétat M-C (2026) Non-technical skills for Moroccan physicians: a cross-analysis of student and professor perspectives in Marrakech. Front. Educ. 11:1695272. doi: 10.3389/feduc.2026.1695272
Received: 29 August 2025; Revised: 23 December 2025;
Accepted: 12 January 2026; Published: 05 February 2026.
Edited by:
Chenguang Zhang, Sanofi Genzyme, United StatesReviewed by:
Richard Beuttler, Chapman University, United StatesAli Mansoor Al-Ameri, University of Kerbala, Iraq
Copyright © 2026 Sebbani, Alami Idrissi, Mansoury, Adarmouch, Amine and Audétat. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Majda Sebbani, TWFqZGEuU2ViYmFuaUBldHUudW5pZ2UuY2g=; ZHIuc2ViYmFuaUBnbWFpbC5jb20=
†These authors have contributed equally to this work and share first authorship