PS2 - 02: SURGICAL PROCEDURAL MAP SCORING FOR LAPAROSCOPIC CHOLECYSTECTOMY
Daniel A Hashimoto, MD, MS¹, C. Gustaf Axelsson, MD², Cara B Jones¹, Roy Phitayakorn, MD, MHPE¹, Emil Petrusa, PhD¹, Sophia K McKinley, MD, EDM¹, Denise W Gee, MD¹, Carla M Pugh, MD, PhD³; ¹Massachusetts General Hospital, ²Harvard Medical School, ³University of Wisconsin

Introduction: Concept maps are tools that allow users to visually organize complex knowledge in a hierarchical manner. Procedural maps are modified concept maps that represent non-linear decision-making in surgery, including the effects of patient and surgeon factors on operative steps. Scoring of concept maps has demonstrated that more experienced individuals create more structurally complex maps. The objective of this study was to determine whether scoring of procedural maps can detect differences in attendings versus residents.

Methods: Attendings and residents were interviewed about operative decision-making in laparoscopic cholecystectomy (LC) using a cognitive task analysis framework. Interviews were transcribed and converted into individual procedural maps using a standardized protocol. Respective maps were approved by each individual. Operative steps, patient factors, and surgeon factors between attendings and residents were compared. The Novak and Gowin scoring method for concept maps was used to compare structures of attending versus resident procedural maps.

Results: Six attendings and six residents (PGY2: 2, PGY3: 3, PGY5: 1) were interviewed. Attending specialties included general (n=3), acute care (n=1), and hepatobiliary (n=2) surgery. There were no significant differences between groups in the number patient or surgeon factors identified. Attending surgeons had significantly more operative steps and crosslinks in their maps as well as a higher total score (Table 1).

Conclusion: Procedural maps for LC of attending and resident surgeons are different in a number of facets. Attending surgeons have more structural complexity in their procedural maps than residents. Further research is needed to determine whether trainees would benefit from a curriculum that incorporates procedural mapping.