![]() bleeding, extensive fibrosis, bowel injury) can lead to multiple decision points that require more complex, non-linear representations of decision making. anatomic variation, equipment malfunction) or even expected events (e.g. 7, 8 CTAs currently available in the literature are limited to decision structures that are largely linear. 1, 3, 6, 7ĬTA has provided a wealth of information on key decision trees and relevant cues necessary to successfully complete procedures ranging from appendectomy to colonoscopy and have resulted in curricula to teach technical skills and decision points or checklists to ensure learners have demonstrated an understanding of the technical skills and decisions necessary to complete a task. 5 Therefore, rigorous, standardized processes such as such as cognitive task analysis (CTA) are necessary to generate procedural and decision-making models of experienced surgeons. However, such automaticity can lead experienced surgeons to unintentionally omit upwards of 50–75% of their own knowledge when interacting with trainees. 3, 4 As experience increases, surgeons are able to begin to automate decisions based on recognition of intraoperative patterns. Novice surgeons are more likely to have higher cognitive load and mental demand due to a need to be more highly engaged in task completion while technical skills, cognitive understanding, and stress management are put to the test in the operating room. Both novice and experienced surgeons can omit key steps or decision points of an operation from their conscious recall 1, 2 however, differences underlying those omissions are due to differences in cognitive processing at different levels of experience. 63.2 ± 3.8, p = 0.015) than residents.ConclusionLC procedural map scoring for attendings and residents demonstrated significant differences in structural complexity and may provide a useful framework for assessing decision making.ĭecision-making in surgery is a complex phenomenon that provides the foundation for the more visibly apparent technical skills required to successfully perform an operation. Attendings had significantly more operative steps (29.67 ± 1.9 vs. ![]() There were no significant differences in the number of patient or surgeon factors identified. Two scoring methods were used to compare map structures of attendings versus residents.ResultsSix attendings and six residents were interviewed. Operative steps, patient factors, and surgeon factors noted by attendings and residents were compared. Interviews were converted into procedural maps. IntroductionThe objective of this study was to determine whether decision-based procedural mapping demonstrates differences in attendings versus residents.MethodsAttendings and residents were interviewed about operative decision-making in laparoscopic cholecystectomy (LC) using a cognitive task analysis framework. ![]()
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