Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;37(5):3921-3925.
doi: 10.1007/s00464-023-09970-3. Epub 2023 Apr 10.

Uncovering patient safety considerations in laparoscopic cholecystectomy using cognitive task analysis

Michael E Villarreal  1 , Clayton Rothwell  2 , Emily Huang  2
Affiliations

Uncovering patient safety considerations in laparoscopic cholecystectomy using cognitive task analysis

Michael E Villarreal et al. Surg Endosc. 2023 May.

Abstract

Introduction: Educating residents on laparoscopic operations requires direct teaching and deliberate practice. Attending surgeons are often systematic when performing surgery, which creates a challenge when instructing surgery residents. The aim of this study was to use cognitive task analysis to expand laparoscopic cholecystectomy into microsteps reflecting expert surgeon cognition (perceptions, assessments, decisions, etc.) throughout the operation such that these could be better formalized and conveyed to residents in educational materials or assessments and to attending surgeons as teaching scripts.

Materials and methods: One surgeon, a surgical resident, and a human factors specialist conducted cognitive task analyses with three expert general surgeons and one hepatobiliary surgeon using semi-structured interviews. These interviews expanded an existing task model of laparoscopic cholecystectomy to specifically add patient safety aspects including injury prevention, risk management, and complication detection for each step. Interview analysis resulted in an expanded task diagram.

Results: Cognitive task analysis expanded the current laparoscopic cholecystectomy task model from 19 to 97 microsteps. In addition to microsteps, an additional major step was identified, the planning step or step zero. Steps with the greatest number of microsteps included dissection with 15 microsteps and intraoperative cholangiogram with 10 microsteps.

Discussion: Laparoscopic cholecystectomies are complex operations with multiple microsteps. Identification of these steps can lead to explicit strategies that can improve training of surgeons, with an end towards efficacy and safety. The identification of a planning step prior to beginning the operation is a significant finding that should arguably be included in all future cognitive task analyses regardless of operation or procedure, to emphasize to trainees what senior surgeons have learned through experience. These findings inform the development of interventions for surgical training and evaluation of competency.

Keywords: Cholecystectomy; Cognitive task analysis; Learner; Patient safety; Task model; Trainee.

PubMed Disclaimer

References

    1. Bell RH (2009) Why Johnny cannot operate. Surgery 146(4):533–542. https://doi.org/10.1016/j.surg.2009.06.044 - DOI - PubMed
    1. Kenton K (2006) How to teach and evaluate learners in the operating room. Obstet Gynecol Clin North Am 33(2):325–332. https://doi.org/10.1016/j.ogc.2006.02.003 - DOI - PubMed
    1. Pugh CM, Santacaterina S, DaRosa DA, Clark RE (2011) Intra-operative decision making: more than meets the eye. J Biomed Inform 44(3):486–496. https://doi.org/10.1016/j.jbi.2010.01.001 - DOI - PubMed
    1. Sullivan ME, Yates KA, Inaba K, Lam L, Clark RE (2014) The use of cognitive task analysis to reveal the instructional limitations of experts in the teaching of procedural skills. Acad Med 89(5):811–816. https://doi.org/10.1097/ACM.0000000000000224 - DOI - PubMed
    1. Klein GA, Hoffman RR (2020) Seeing the invisible: perceptual-cognitive aspects of expertise. In Cognitive science foundations of instruction. Routledge, Mahwah, NJ

Publication types

LinkOut - more resources