Bulstra, Sjoerd

Cnossen, Fokeltje

Jaarsma, Debbie

Nieboer, Patrick

Stevens, Martin

English

Background: Success of surgical procedures largely depends on good judgment and decision making and these skills are mostly taught implicitly in the OR. Cognitive task analysis (CTA) has been used successful to elicit tacit expert knowledge to determine the decision points in a medical procedure and then use this in medical skill instructions. For instructions to be effective, it is also important that they are timed properly, that is, during low mental workload in the resident. Aim(s): As a start for further research, we therefore asked residents to indicate their mental workload during the steps of an orthopaedic procedure. Because in the OR, residents are commonly guided by supervisors, we also investigated which steps supervisors find mentally demanding. Methods: A task analysis of a total hip replacement procedure was constructed. Subsequently we asked both 17 orthopedic surgeons (supervisors) and 21 residents to rate (5-point scale) how much mental effort they invest in each subtask. They were asked to explain ratings above average (&gt;3). Results: Although there were subtasks where supervisors and residents disagreed on the level of attention required, overall, supervisors and residents agreed for most subtasks. High attention was related to subtasks that require decision making skills. However, the reasons were different. In residents, high ratings were associated with subtasks that they found difficult, or where they were anxious about doing it accurately. Supervisors’ ratings were more correlated with the evaluation of crucial, i.e., point-of-no-return steps where quality of execution has important consequences for later steps, end result or complications. Discussion/Conclusion: Supervisors pay more attention to steps that will become important later in the procedure, whereas residents are more anxious about their own performance in crucial steps. It may be useful for supervisors and residents to be aware of this difference in interpretation of “important steps”

ARTS repository - University of Groningen

   University of GroningenCan I handle the scalpel?Nieboer, Patrick; Cnossen, Fokeltje; Bulstra, Sjoerd; Stevens, Martin ; Jaarsma, DebbieIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2016Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Nieboer, P., Cnossen, F., Bulstra, S., Stevens, M., & Jaarsma, D. (2016). Can I handle the scalpel?Different views on critical subtask assessment between residents and expert surgeons. Poster sessionpresented at International Meeting for Behavioural Sciences Applied to Surgery and Acute Care Settings,Aberdeen, United Kingdom.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 13-02-2023  Conclusion and discussion:   • Experts’ high attention for subtasks was different from residents’:    Experts: effects on patient outcome and complications.   Residents: more anxious about their own task performance.   • Critical subtasks are characterised by judgment and decision making as key competences.    • Experts and residents might both benefit when they identify and discuss critical and complex subtasks before going into  the operation theatre, because:     A. Experts as teachers can adapt their guiding strategies to the residents’ needs.    B. Residents as learners need to appreciate when the focus of experts shifts towards patient outome  rather than to teaching.   Can I handle the scalpel? Different views on critical subtask assessment between residents and expert surgeons   University Medical Center Groningen, Department of Orthopedics Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, the Netherlands Tel: +31 (0)50 361 12 21 E-mail: w.rienstra@umcg.nl   Methods  •  56 subtasks were identified in an uncemented total hip replacement procedure for osteoarthritis. •  21 residents and 17 experts rated how much attention they need for every subtask of the procedure on a 5-point Likert scale. •  High attention sub tasks were defined as a median attention score of 4 or more. •  We asked the participants to provide arguments for high attention scores.     Results •  Both experts and residents expected to need normal attention for the majority of the subtasks.  •  Experts had:  a. High attention scores on 12 subtasks (table).  b. Frequent Arguments: ‘Crucial for end result’, ‘Essential for outcome’, ‘Prevention of complications such as luxation’.   •  Residents had:  a. High attention scores on 8 subtasks (table).  b. Frequent Arguments: ‘Little room for error', 'Is difficult’, ‘Must be perfect’.  •  The majority of these critical tasks can be characterised as ‘point of no return’ judgment and decision making (table). Introduction  •  Experts have two roles once they entrust residents to ‘handle the scalpel’ in the operation theatre:  As a teacher:  Allowing the resident to progress to autonomous task performance.  As an expert:  Striving for the best possible outcome for the patient.    •  Residents have two goals as learners in the operation theatre:  a. ‘Handle the scalpel’ as long as possible.   b. Elicit expert information when their expertise becomes insufficient.   •  Complex or critical subtasks execution has an effect on :  a. Experts: outcome becomes more important than teaching.  b. Residents: they need teachers even more to ‘keep the scalpel’ themselves.  Objective What is the complexity of all the different subtask of a single orthopaedic surgical procedure:    a. According to the experts?  b. According to the residents? Subtask	 Skill	(predominantly)	 Experts	High	a:en;on	Residents	High	a:en;on		1	 Assessing	angle	and	height	of	collum	osteotomy	femur	Judgement	/	Decision	making		Yes	 Yes	2	 Exposing	acetabulum	with	homan	retractors	/	pins	Motor		 Yes	3	 Reaming	acetabulum	in	right	angle	and	volume	Motor	+	Judgement	/	Decision	making	Yes	 Yes	4	 TesFng	trial	cup	acetabulum	and	assess	definite	size	Judgement	/	Decision	making	Yes	 Yes	5	 Insert	cup	acetabulum	 Motor	 Yes	 Yes	6	 Assessing	cup	posiFon	acetabulum	 Judgement	/	Decision	making	Yes	 Yes	7	 Assessing	direcFon	of	broaching	femur	 Judgement	/	Decision	making	Yes	8	 Assess	posiFon	trial	prosthesis	and	determine	off	set	femur	Judgement	/	Decision	making	Yes	 Yes	9	 Assessing	definiFve	stem	size	femur	 Judgement	/	Decision	making	Yes	10	 DefiniFve	stem	placement	femur	 Motor	 Yes	11	 Assessing	definiFve	stem	posiFon	and	anteversion	angle	Judgement	/	Decision	making	Yes	 Yes	12	 Assessing	definiFve	posiFon,	stability	and	lenght		uncemented	Judgement	/	Decision	making	Yes	 Yes	Total	 		 12	 8	p.nieboer01@umcg.nl   table: High attention subtasks of experts and residents    Patrick Nieboer, MD Sjoerd Bulstra, MD, PhD Martin Stevens, PhD University medical Centre Groningen, Dep. of orthopeadic surgery   Debbie Jaarsma, PhD University medical Centre Groningen, Dep. of medical education   Fokie Cnossen, PhD University of Groningen, Center of artificial intelligence and cognitive engineering.  f.cnossen@rug.nl  

Can I handle the scalpel?:Different views on critical subtask assessment between residents and expert surgeons

https://pure.rug.nl/ws/files/37559766/BSAS16_PNFC.pdf

Can I handle the scalpel?:Different views on critical subtask assessment between residents and expert surgeons

Abstract

Similar works

Full text

Available Versions

ARTS repository - University of Groningen