Surgical Endoscopy

, Volume 22, Issue 1, pp 107–111 | Cite as

Constructing hierarchical task analysis in surgery

  • Sudip K. SarkerEmail author
  • Avril Chang
  • Tark Albrani
  • Charles Vincent



Generic technical skills are required by a surgeon to perform a complete operation or procedure. They alone do not form a task or subtask but allow the surgeon to perform so. Specific technical skills are required to complete a task or subtask, which can be depicted by hierarchical task analysis (HTA). In this study we aim to demonstrate a reliable and valid method to construct a surgical HTA.


One hundred thirty video recordings of operations and procedures (30 laparoscopic cholecystectomies, 20 open inguinal hernia repairs, 20 saphenofemoral junction ligations, 20 upper GI and 40 lower GI endoscopies) from 37 different expert surgeons were assessed in view of constructing a HTA. Three research surgeons with more than eight years of postgraduate surgical experience assessed each operation or procedure blindly and independently and constructed a HTA. Each consultant surgeon assessed the HTA constructed by the researchers and modified it according to his/her own technical style.


For tasks there was a 100% correlation between the researchers and individual expert surgeons. Mean interrater reliability for subtasks was k = 0.89 (range = 0.81–0.95), p < 0.05. Content and face validities of the HTA were confirmed by the expert surgeons.


This study outlines a valid and reliable method of constructing a surgical task analysis and HTA for any operation or procedure, which could be used to assess and evaluate trainees’ and expert surgeons’ specific technical skills.


Assessment Analysis Hierarchical Surgery Task 



The authors thank the surgical, anesthetic, and nursing staff at the Imperial and Queen Mary’s College network of hospitals in West and East London for their help.


  1. 1.
    Pickersgill T (2001) The European working time directive for doctors in training. BMJ 323:1266PubMedCrossRefGoogle Scholar
  2. 2.
    Sarker SK (2003) Courses, counsellors and cadavers: reducing errors in the operating theatre. BMJ 327:s109PubMedCrossRefGoogle Scholar
  3. 3.
    Hance J, Moorthy K, Aggarwal R, Undre S, Munz Y, Darzi A (2004) Objective measurement of the acquisition of psychomotor skills on laparoscopic cholecystectomy courses. Surg Endosc 18:s179 Google Scholar
  4. 4.
    Moorthy K, Muntz Y, Sarker SK, Darzi A (2003) Objective assessment of technical skills in surgery. BMJ 327:1032–1037PubMedCrossRefGoogle Scholar
  5. 5.
    Faulkner H, Regehr G, Martin J, Reznick R (1996) Validation of an objective structured assessment of technical skill for surgical residents. Acad Med 71(12):1363–1365PubMedCrossRefGoogle Scholar
  6. 6.
    Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, Brown M (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84(2):273–278PubMedCrossRefGoogle Scholar
  7. 7.
    Anastakis DJ, Regehr G, Reznick RK, Cusimano M, Murnaghan J, Brown M, Hutchison C (1999) Assessment of technical skills transfer from the bench training model to the human model. Am J Surg 177(2):167–170PubMedCrossRefGoogle Scholar
  8. 8.
    Kirwan B (1994) A Guide to Practical Human Reliability Assessment, 1st ed. Taylor and Francis, LondonGoogle Scholar
  9. 9.
    Johnson P (1992) Human–computer interaction: psychology, task analysis and software engineering, 1st ed. McGraw-Hill, New YorkGoogle Scholar
  10. 10.
    Shepherd A (1989) Analysis and training in information technology tasks. In: Diaper D (ed) Task Analysis for Human–Computer Interaction, 1st ed. Ellis Horwood, Chichester, West SussexGoogle Scholar
  11. 11.
    Cuschieri A (2000) Human reliability analysis in surgery – a new approach for improving surgical performance and clinical outcome. Ann R Coll Surg 82: 83–87Google Scholar
  12. 12.
    Kirwan B, Ainsworth LK (1992) A Guide to Task Analysis. Taylor & Francis, London.Google Scholar
  13. 13.
    Sarker SK, Hutchinson R, Chang A, Vincent C, Darzi AW (2006) Self-appraisal hierarchical task analysis of expert surgeons performing laparoscopic surgery. Surg Endosc 20(4):636–640PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Sudip K. Sarker
    • 1
    Email author
  • Avril Chang
    • 2
  • Tark Albrani
    • 3
  • Charles Vincent
    • 4
  1. 1.Academic Surgery UnitRoyal Free HospitalLondonUnited Kingdom
  2. 2.Academic Surgery UnitKing’s College HospitalLondonUnited Kingdom
  3. 3.Academic Surgery UnitQueen Mary’s College LondonLondonUnited Kingdom
  4. 4.Academic Surgery UnitImperial College LondonLondonUnited Kingdom

Personalised recommendations