Roger D Dias1,2, Marco A Zenati3,4, Heather M Conboy5, Lori A Clarke5, Leon J Osterweil5, George S Avrunin5, Steven J Yule1,4,6. 1. STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA. 2. Department of Emergency Medicine, Harvard Medical School, Boston, MA. 3. Medical Robotics and Computer Assisted Surgery (MRCAS) Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA. 4. Department of Surgery, Harvard Medical School, Boston, MA. 5. College of Information and Computer Sciences, University of Massachusetts, Amherst, MA. 6. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
Abstract
OBJECTIVE: The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes. SUMMARY BACKGROUND DATA: Nontechnical skills play a crucial role in surgical team performance and understanding the cognitive processes underlying the intraoperative phase of surgery is essential to improve patient safety in the operating room (OR). METHODS: A mixed-methods approach encompassing semistructured interviews with 9 subject-matter experts. A cognitive task analysis was built upon a hierarchical segmentation of coronary artery bypass grafting procedures and a cued-recall protocol using video vignettes was used. RESULTS: A total of 137 unique surgical cognitive processes were identified, including 33 decision points, 23 critical communications, 43 pitfalls, and 38 strategies. Self-report cognitive workload varied substantially, depending on team role and surgical step. A web-based dashboard was developed, providing an integrated visualization of team cognitive processes in the OR that allows readers to intuitively interact with the study findings. CONCLUSIONS: This study advances the current body of knowledge by making explicit relevant cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple OR team members. By displaying the research findings in an interactive dashboard, we provide trainees with new knowledge in an innovative fashion that could be used to enhance learning outcomes. In addition, the approach used in the present study can be used to deeply understand the cognitive factors underlying surgical adverse events and errors in the OR.
OBJECTIVE: The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes. SUMMARY BACKGROUND DATA: Nontechnical skills play a crucial role in surgical team performance and understanding the cognitive processes underlying the intraoperative phase of surgery is essential to improve patient safety in the operating room (OR). METHODS: A mixed-methods approach encompassing semistructured interviews with 9 subject-matter experts. A cognitive task analysis was built upon a hierarchical segmentation of coronary artery bypass grafting procedures and a cued-recall protocol using video vignettes was used. RESULTS: A total of 137 unique surgical cognitive processes were identified, including 33 decision points, 23 critical communications, 43 pitfalls, and 38 strategies. Self-report cognitive workload varied substantially, depending on team role and surgical step. A web-based dashboard was developed, providing an integrated visualization of team cognitive processes in the OR that allows readers to intuitively interact with the study findings. CONCLUSIONS: This study advances the current body of knowledge by making explicit relevant cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple OR team members. By displaying the research findings in an interactive dashboard, we provide trainees with new knowledge in an innovative fashion that could be used to enhance learning outcomes. In addition, the approach used in the present study can be used to deeply understand the cognitive factors underlying surgical adverse events and errors in the OR.
Authors: Richard E Clark; Carla M Pugh; Kenneth A Yates; Kenji Inaba; Donald J Green; Maura E Sullivan Journal: J Surg Res Date: 2011-10-02 Impact factor: 2.192
Authors: Tara N Cohen; Sarah E Francis; Douglas A Wiegmann; Scott A Shappell; Bruce L Gewertz Journal: Am J Med Qual Date: 2018-03-21 Impact factor: 1.852
Authors: Christopher L Tarola; Sameer Hirji; Steven J Yule; Jennifer M Gabany; Alessandro Zenati; Roger D Dias; Marco A Zenati Journal: IEEE Conf Cogn Comput Asp Situat Manag Date: 2018-08-02
Authors: R D Dias; M A Zenati; G Rance; Rithy Srey; D Arney; L Chen; R Paleja; L R Kennedy-Metz; M Gombolay Journal: Comput Methods Biomech Biomed Eng Imaging Vis Date: 2021-12-03
Authors: Lauren R Kennedy-Metz; Maria Arshanskiy; Sandra Keller; David Arney; Roger D Dias; Marco A Zenati Journal: IEEE Conf Cogn Comput Asp Situat Manag Date: 2022-07-22
Authors: Sangwon Seo; Lauren R Kennedy-Metz; Marco A Zenati; Julie A Shah; Roger D Dias; Vaibhav V Unhelkar Journal: IEEE Conf Cogn Comput Asp Situat Manag Date: 2021-07-09
Authors: Roger D Dias; William Riley; Kenneth Shann; Donald S Likosky; David Fitzgerald; Steven Yule Journal: J Thorac Cardiovasc Surg Date: 2021-07-02 Impact factor: 5.209
Authors: Lauren R Kennedy-Metz; Pietro Mascagni; Antonio Torralba; Roger D Dias; Pietro Perona; Julie A Shah; Nicolas Padoy; Marco A Zenati Journal: IEEE Trans Med Robot Bionics Date: 2020-11-24
Authors: Lauren R Kennedy-Metz; Roger D Dias; Rithy Srey; Geoffrey C Rance; Heather M Conboy; Miguel E Haime; Jacquelyn A Quin; Steven J Yule; Marco A Zenati Journal: Hum Factors Date: 2020-12-16 Impact factor: 2.888