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Area of Science:

  • Cognitive science
  • Surgical education
  • Human factors in medicine

Background:

  • Nontechnical skills are critical for surgical team performance.
  • Understanding intraoperative cognitive processes is key to enhancing patient safety.
  • Existing research lacks a comprehensive compilation of these processes across different roles.

Purpose of the Study:

  • To elucidate cognitive processes during surgical procedures from the perspectives of surgeons, anesthesiologists, and perfusionists.
  • To create a comprehensive compilation of intraoperative cognitive processes.
  • To improve patient safety by understanding team cognition in the operating room.

Main Methods:

  • A mixed-methods approach using semistructured interviews with 9 experts.
  • Cognitive task analysis based on hierarchical segmentation of coronary artery bypass grafting procedures.
  • Cued-recall protocol utilizing video vignettes.

Main Results:

  • Identified 137 unique surgical cognitive processes, including decision points, critical communications, pitfalls, and strategies.
  • Observed substantial variation in self-reported cognitive workload based on team role and surgical step.
  • Developed a web-based interactive dashboard to visualize team cognitive processes in the operating room.

Conclusions:

  • This study explicitly details cognitive processes during cardiac surgery for multiple operating room team members.
  • An interactive dashboard offers an innovative way to present findings for enhanced trainee learning.
  • The methodology can be applied to understand cognitive factors contributing to surgical errors and adverse events.