Highlights
- •This study examined how intraoperative errors affect surgical outcomes.
- •Surgery residents performed the final steps of a simulated hernia repair.
- •Neither the number nor types of errors committed predicted outcomes.
- •Differences in error management did correlate significantly with outcomes.
Abstract
Background
This paper explores a method for assessing intraoperative performance by modeling
how surgeons integrate psychomotor, procedural, and cognitive skills to manage errors.
Methods
Audio-video data were collected from general surgery residents (N = 45) performing a simulated laparoscopic ventral hernia repair. Errors were identified
using a standard checklist, and speech was coded for elements related to error recognition
and management. Epistemic network analysis (ENA) was used to model the integration
of error management skills.
Results
There was no correlation between number or type of errors committed and operative
outcome. However, ENA models showed significant differences in the integration of
error management skills between high-performing and low-performing residents.
Conclusion
These results suggest that error checklists and surgeons' speech can be used to model
the integration of psychomotor, procedural, and cognitive aspects of intraoperative
performance. Moreover, ENA can identify and quantify this integration, providing insight
on performance gaps in both individuals and populations.
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Article info
Publication history
Published online: November 30, 2017
Accepted:
November 16,
2017
Received:
November 7,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
