Expert Intraoperative Judgment and Decision-Making: Defining the Cognitive Competencies for Safe Laparoscopic...

Area of Science:

• Surgical Education
• Patient Safety
• Cognitive Science in Medicine

Background:

• Bile duct injuries are a significant complication of laparoscopic cholecystectomy, often stemming from intraoperative errors.
• This study addresses the need to define higher-order cognitive competencies for safe surgical performance.

Purpose of the Study:

• To define and characterize the cognitive competencies crucial for safely performing laparoscopic cholecystectomy.
• To establish a critical view of safety during the procedure.

Main Methods:

• Qualitative study employing hierarchical and cognitive task analyses.
• Semi-structured interviews and field observations with experienced surgeons (≥5 years, ≥100 procedures).
• Thematic analysis of transcribed data and literature using grounded theory by two independent reviewers.

Main Results:

• A conceptual framework identified 108 cognitive elements and 75 potential errors.
• Cognitive elements included situation awareness (32%), decision-making (44%), and action-oriented subtasks (24%).
• Root causes of errors were primarily linked to decision-making (65%) and situation awareness (32%).

Conclusions:

• Essential competencies for establishing a critical view of safety and preventing bile duct injuries during laparoscopic cholecystectomy have been defined.
• The developed framework can inform instructional design, assessment tools, and quality improvement initiatives.
• Promoting a culture of patient safety is a key outcome of understanding these cognitive requirements.