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Annual Meeting 2018 Presentations

C1 - 01: PREPARATION FOR CHALLENGING CASES: WHAT DIFFERENTIATES EXPERT SURGEONS FROM NOVICES?
Amlish Gondal, MD1, Lev Korovin1, McKenna White1, Timothy Farrell, MD2, Iman Ghaderi, MD, MSc1; 1University of Arizona, 2University of North Carolina

 

Introduction: The field of expert performance has largely remained unexplored in surgical literature. This study aimed to examine the difference between expert and novice surgeons in their preparation for challenging cases.

Methods and procedures: Two groups of expert (attending) and novice (Postgraduate Year 2) surgeons were provided with two cases of complicated cholecystitis, and they were asked how they prepare for a difficult case, what they anticipate to encounter intraoperatively, and how they would deal with these challenges. Their responses were recorded, transcribed verbatim and analyzed using thematic analysis.

Results: Nine experts and twelve novices from two academic centers participated. In preparation for challenging cholecystectomy, the majority of novices focused on patient history, work-up, preoperative optimization, anatomy, and anticipation of intra-operative challenges/complications. In addition to patient’s presentation and preoperative optimization, most of experts’ thoughts were directed toward preparation for surgery (level of urgency, required skills in surgical team, case difficulty and risk of conversion to open). Experts would involve the patient in the decision-making process and more likely to communicate with the OR team.

Novices attempted to predict challenges depending on gallbladder condition and intra-abdominal adhesions. Experts highlighted the importance of various elements of operative field, the detail of their technique and possible challenges and their troubleshooting plans. Regarding operative planning to address the anticipated challenges, the novices would tailor their plan to patient’s characteristics and verbalized an analytical “if-then” approach for all possibilities they may encounter. Experts would start with their standard laparoscopic cholecystectomy technique regardless of case complexity and would deal with contingencies as they arise. Safety was a critical part of an expert surgeons’ plan.

Conclusions: This study demonstrates a difference between expert and novice surgeons in their approach to challenging cases. Novices mostly conveyed descriptive knowledge based presented facts while experts demonstrated an ability to paint a richer mental image of possible future events by creating comprehensive situational awareness of the operative field. Further study is needed to validate the results of this study, which can be used for educating surgical trainees. 

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