The Development of an Online Standalone Cognitive Hazard Training for Laparoscopic Cholecystectomy: A Feasibility Study

Abstract

Introduction: In the UK, surgical training is under pressure due to reductions in training time and training opportunities, which pose patient safety risks. Cognitive, nontechnical, training has been suggested as a possible solution inspired by the identified benefits in aviation industry. A recent review article highlighted the need for such training despite its high cost and the need for expert trainers.

Aim: This study aimed to design and test the feasibility of an online standalone module to address the current gap in cognitive surgical training.

Method: An online standalone, Cognitive Hazard Training module for laparoscopic cholecystectomy was created. It combined multiple choice questions, extended matching items, and single-line free text questions. It contained relevant sketch images and real life hazards video clips, highlighting potential mistakes to enhance: Safety knowledge, reduce bias, and improve self-limitation awareness. Two experts were invited to validate the prototype before testing its feasibility in one English Deanery training environment.

Results: In total 93 candidates signed up to review the training. However only 47 (50%) later participated and 33 completed the Module. Those included 3 juniors, 20 higher trainees, and 10 consultants. Candidates' answers were quantitatively analysed. Qualitative feedback was also collected from 27 candidates, via semi-structured interviews. The overall feedback from the feasibility study was positive. Results supported this online resource value in enhancing knowledge and awareness. Interview data also suggested the module's potential to change trainees' practice by being more cautious and adhering to the safety steps of dissection.

Discussion: This new training module overcomes some of the previously reported problems in surgical cognitive training. It is a stand-alone online resource with low running cost and does not require expert trainers. The feasibility study supported the aim to enhance hazard awareness and create an attitude shift towards adherence to safety steps during the procedure.

Keywords: Nontechnical skills for surgeons; Patient safety; Practice-Based Learning and Improvement; Student cognition; Surgery simulation; Surgical competency; e-Learning resource.