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Uncovering patient safety considerations in laparoscopic cholecystectomy using cognitive task analysis
Michael E Villarreal1, Clayton Rothwell2, Emily Huang2
1Department of Surgery, The Ohio State University Wexner Medical Center, 395 W 12th, Suite 600, Columbus, OH, 43210, USA. Michael.Villarreal@osumc.edu.
Surgical Endoscopy
|April 10, 2023
Summary
Cognitive task analysis detailed laparoscopic cholecystectomy into 97 microsteps, including a crucial planning step. This enhances surgical resident training and patient safety through explicit strategies.
Area of Science:
- Surgical Education
- Human Factors Engineering
- Medical Simulation
Background:
- Laparoscopic surgery training relies on direct teaching and practice.
- Expert surgeons' systematic approaches pose challenges for resident instruction.
- Cognitive task analysis (CTA) can bridge this gap by deconstructing complex procedures.
Purpose of the Study:
- To expand the laparoscopic cholecystectomy task model using CTA.
- To identify microsteps reflecting expert surgeon cognition.
- To formalize and convey expert knowledge for resident education and assessment.
Main Methods:
- Conducted semi-structured interviews with expert surgeons and a resident.
- Utilized a human factors specialist for CTA.
- Expanded an existing task model incorporating patient safety aspects.
Main Results:
- The laparoscopic cholecystectomy model expanded from 19 to 97 microsteps.
- A distinct 'planning step' (step zero) was identified.
- Dissection (15 microsteps) and intraoperative cholangiogram (10 microsteps) had the most microsteps.
Conclusions:
- Detailed microsteps improve surgical training efficacy and safety.
- The identified planning step is critical for comprehensive surgical training.
- Findings support developing targeted interventions for surgical competency evaluation.
