Daniel A Hashimoto1, C Gustaf Axelsson2, Cara B Jones3, Roy Phitayakorn4, Emil Petrusa4, Sophia K McKinley4, Denise Gee4, Carla Pugh5. 1. Department of Surgery, Massachusetts General Hospital, United States; Harvard Medical School, United States. Electronic address: dahashimoto@mgh.harvard.edu. 2. Harvard Medical School, United States. 3. Department of Surgery, Massachusetts General Hospital, United States. 4. Department of Surgery, Massachusetts General Hospital, United States; Harvard Medical School, United States. 5. Department of Surgery, Stanford University, United States.
Abstract
INTRODUCTION: The objective of this study was to determine whether decision-based procedural mapping demonstrates differences in attendings versus residents. METHODS: Attendings and residents were interviewed about operative decision-making in laparoscopic cholecystectomy (LC) using a cognitive task analysis framework. Interviews were converted into procedural maps. Operative steps, patient factors, and surgeon factors noted by attendings and residents were compared. Two scoring methods were used to compare map structures of attendings versus residents. RESULTS: Six attendings and six residents were interviewed. There were no significant differences in the number of patient or surgeon factors identified. Attendings had significantly more operative steps (29.67 ± 1.9 vs. 23.3 ± 1.9, p = 0.04) and crosslinks (3.2 ± 0.5 vs. 1 ± 0.4, p = 0.005) in their maps and a higher total score (90.2 ± 8.4 vs. 63.2 ± 3.8, p = 0.015) than residents. CONCLUSION: LC procedural map scoring for attendings and residents demonstrated significant differences in structural complexity and may provide a useful framework for assessing decision making.
INTRODUCTION: The objective of this study was to determine whether decision-based procedural mapping demonstrates differences in attendings versus residents. METHODS: Attendings and residents were interviewed about operative decision-making in laparoscopic cholecystectomy (LC) using a cognitive task analysis framework. Interviews were converted into procedural maps. Operative steps, patient factors, and surgeon factors noted by attendings and residents were compared. Two scoring methods were used to compare map structures of attendings versus residents. RESULTS: Six attendings and six residents were interviewed. There were no significant differences in the number of patient or surgeon factors identified. Attendings had significantly more operative steps (29.67 ± 1.9 vs. 23.3 ± 1.9, p = 0.04) and crosslinks (3.2 ± 0.5 vs. 1 ± 0.4, p = 0.005) in their maps and a higher total score (90.2 ± 8.4 vs. 63.2 ± 3.8, p = 0.015) than residents. CONCLUSION: LC procedural map scoring for attendings and residents demonstrated significant differences in structural complexity and may provide a useful framework for assessing decision making.
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