A Cognitive Task Analysis of How to Teach the Retropubic Midurethral Sling Surgery

Area of Science:

• Urology
• Surgical Education
• Medical Simulation

Background:

• Retropubic midurethral sling (RP-MUS) surgery presents significant training challenges due to the complexity and risks associated with blind trocar passage.
• A structured approach to teaching these high-risk surgical steps is crucial for improving trainee proficiency and ensuring patient safety.

Purpose of the Study:

• To systematically catalog expert-level teaching techniques for the RP-MUS procedure.
• To identify strategies that facilitate novice surgeons' understanding and execution of critical surgical steps.

Main Methods:

• Cognitive Task Analysis (CTA) interviews with 11 expert RP-MUS surgeons.
• Analysis of intraoperative teaching videos from 4 surgeons.
• Extraction and mapping of 458 teaching microsteps to operative steps.

Main Results:

• A comprehensive catalog of 458 teaching microsteps was generated.
• Identified categories include technical advice, demonstrations, complication awareness, ergonomic guidance, and safety-focused assist steps.
• Many strategies addressed the cognitive challenges of visualizing the retropubic space and instrument orientation.

Conclusions:

• This study innovatively applied CTA to characterize expert RP-MUS surgical teaching.
• The findings provide a foundation for refining surgical education and future research on instructional strategies.
• This work supports improved trainee performance, surgeon confidence, and patient safety in RP-MUS procedures.