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Related Experiment Video

Updated: Feb 27, 2026

Intraoperative Video Consultation Following Bile Duct Transection Facilitates Direct OR Transfer for Robotic Hepaticojejunostomy at Tertiary Center
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How can surgeons facilitate resident intraoperative decision-making?

Katherine A Hill1, Mohini Dasari2, Eliza B Littleton2

  • 1Department of Surgery, University of Pittsburgh Medical Center, F600 Presbyterian Hospital, Pittsburgh, PA, USA.

American Journal of Surgery
|July 8, 2017
PubMed
Summary

Resident decision-making during surgery is improved by dialogue and safe struggle. Unanticipated findings and time pressures create barriers, highlighting the need for pre-operative discussions to enhance surgical training.

Keywords:
Intraoperative decision-makingOperative autonomySurgical educationSurgical residency

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Area of Science:

  • Surgical Education
  • Medical Simulation
  • Cognitive Science in Medicine

Background:

  • Decision-making is crucial for surgical autonomy.
  • Resident decision-making during laparoscopic cholecystectomy was explored.

Purpose of the Study:

  • To investigate factors influencing resident decision-making in the operating room.
  • To understand the role of attending surgeons in resident skill development.

Main Methods:

  • Semi-structured interviews with attending surgeons and residents post-procedure.
  • Analysis of 30 interviews from 15 laparoscopic cholecystectomy cases.
  • Inductive thematic analysis of interview data.

Main Results:

  • Facilitators included dialogue, safe struggle, and appreciation for retraction.
  • Barriers comprised aberrant cases, anatomic uncertainty, and time pressure.
  • Attending-resident dynamics revealed issues in transferring operative control.

Conclusions:

  • Concept-driven feedback and reciprocal dialogue enhance intraoperative teaching.
  • Unanticipated findings hinder resident decision-making.
  • Pre-operative discussions are suggested to improve surgical training and decision-making.