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The Complexity of the Retropubic Midurethral Sling: A Cognitive Task Analysis
Mary F Ackenbom, Eliza B Littleton1, Fizza Mahmud2
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Female Pelvic Medicine & Reconstructive Surgery
|May 15, 2019
Summary
Cognitive task analysis broke down the retropubic midurethral sling surgery into 197 detailed microsteps. This detailed breakdown can improve surgical training and patient safety.
Area of Science:
- Urogynecology
- Surgical Education
- Cognitive Psychology
Background:
- The retropubic midurethral sling procedure is a complex surgical intervention.
- Understanding the detailed steps and cognitive demands is crucial for surgical proficiency.
Purpose of the Study:
- To apply cognitive task analysis to deconstruct the retropubic midurethral sling procedure into granular microsteps.
- To map the surgeon's thought processes and information needs during the surgery.
Main Methods:
- Collaboration between surgeons, a cognitive psychologist, and expert urogynecologic surgeons.
- Iterative interviews and structured discussions to define surgical steps and microsteps.
- External review by expert surgeons to ensure comprehensive detail and accuracy.
Main Results:
- The retropubic midurethral sling procedure was expanded from 23 steps to 197 detailed microsteps.
- Key steps with high microstep counts included trocar advancement during retropubic and ventral procedures.
- Exploration of the relationship between microsteps and surgical cognitive load was initiated.
Conclusions:
- The retropubic midurethral sling involves numerous microsteps, highlighting its complexity.
- Identifying these microsteps can inform strategies to reduce cognitive load, enhancing surgical efficacy and safety.
- The detailed microstep analysis provides a foundation for developing targeted surgical training and competency assessments.
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