Nieboer Patrick, Cnossen Fokie, Stevens Martin, Huiskes Mike, Bulstra Sjoerd K, Jaarsma Debbie Adc
Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands.
J Surg Educ. 2021 Jan-Feb;78(1):104-112. doi: 10.1016/j.jsurg.2020.06.010. Epub 2020 Jul 2.
Progressive autonomous task performance is the cornerstone of teaching residents in the operating room, where they are entrusted with autonomy when they meet their supervisors' preferences. To optimize the teaching, supervisors need to be aware of how residents experience parts of the procedure. This study provides insight into how supervisors and residents perceive different tasks of a single surgical procedure.
In this qualitative survey study a cognitive task analysis (CTA) of supervisors and residents for the 47 tasks of an uncemented total hip arthroplasty was executed. Both groups rated the level of attention they would assign to each task and were asked to explain attention scores of 4 or 5.
University Medical Centre Groningen (the Netherlands) and its 5 affiliated teaching hospitals.
Seventeen supervising surgeons and 21 residents.
Normal attention (median attention score 3) was assigned by supervisors to 34 tasks (72.3%) and by residents to 35 tasks (74.5 %). Supervisors rated 12 tasks (25.6%) and residents 9 tasks (19.1%) with a median attention score of 4. In general, supervisors associated high attention with patient outcome and prevention of complications, while residents associated high attention with "effort."
Supervisors and residents assigned attention to tasks for different reasons. Supervisors think ahead and emphasize patient outcome and prevention of complications when they indicate high attention, while residents think in the "now" and raise attention to execute the tasks themselves. The results of this study allow residents and supervisors to anticipate preferences: residents are able to appreciate why supervisors increase attention to specific tasks, and supervisors obtain information on which tasks require individual guidance of residents. This information can contribute to improve the learning climate in the operating room and task-specific procedural training.
逐步实现自主任务执行是手术室住院医师教学的基石，在手术室中，当住院医师符合上级医师的偏好时，他们会被赋予自主权。为了优化教学，上级医师需要了解住院医师对手术过程各部分的体验。本研究深入探讨了上级医师和住院医师如何看待单一外科手术的不同任务。
在这项定性调查研究中，对非骨水泥型全髋关节置换术的47项任务进行了上级医师和住院医师的认知任务分析（CTA）。两组都对他们会分配给每项任务的注意力水平进行了评分，并被要求解释4分或5分的注意力得分。
荷兰格罗宁根大学医学中心及其5家附属教学医院。
17名指导外科医生和21名住院医师。
上级医师将正常注意力（注意力得分中位数为3）分配给34项任务（72.3%），住院医师将其分配给35项任务（74.5%）。上级医师将12项任务（25.6%）评为注意力得分中位数为4，住院医师将9项任务（19.1%）评为注意力得分中位数为4。总体而言，上级医师将高注意力与患者预后和并发症预防相关联，而住院医师将高注意力与“努力”相关联。
上级医师和住院医师因不同原因对任务给予关注。上级医师在表示高度关注时会提前思考并强调患者预后和并发症预防，而住院医师则着眼于“当下”，并提高对自行执行任务的关注度。本研究结果使住院医师和上级医师能够预判偏好：住院医师能够理解上级医师为何对特定任务增加关注，上级医师则获得关于哪些任务需要对住院医师进行个别指导的信息。这些信息有助于改善手术室的学习氛围和特定任务的操作培训。
