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Enhancing surgical education for resource-limited settings: open appendectomy cognitive task analysis

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Global Surgical Education - Journal of the Association for Surgical Education Aims and scope Submit manuscript

Abstract

Purpose

Open appendectomy is one of the most common procedures performed globally, especially in low- and middle-income countries (LMICs). In many LMICs, surgical education is limited by personnel shortages. Developing effective teaching methods for resource-limited environments may enhance the availability of a trained workforce. Cognitive task analysis (CTA) is an effective method to obtain expert input to define operative steps and cognitive processes in complex procedures. The aim of this study was to perform the first CTA for open appendectomy in an effort to develop a teaching module for practitioners in LMICs.

Methods

Twelve expert general surgeons completed semi-structured interviews which were recorded via Zoom. Each expert had previously performed > 100 open appendectomies. Each interviewee described the entire procedure and then answered specific questions to inform surgical decision making, anatomic landmarks, and error recognition/avoidance. The responses were collated by two independent reviewers into a CTA model which then underwent review through a multi-disciplinary surgical education team. Final steps were presented back to the experts for feedback and modifications and tested on a simulator. Completeness of each expert’s interview was determined by two metrics: time and percentage of steps on the compiled model that the expert surgeon described.

Results

The CTA identified five main steps: preoperative patient preparation, safe entry into the abdomen, identify the appendix, appendectomy, and abdominal closure. Each step had additional sub-steps for a total of 24 procedural steps. Available equipment/supplies and critical decision point descriptions provided the most variability. The median completeness score for the unstructured portion of the interview was 76% (IQR 68–80).

Conclusions

Using CTA, we defined the essential operative steps, decision points, and areas of potential error with performing an open appendectomy. These results provide a framework that can guide intraoperative instruction and the development of a teaching module for open appendectomy that can be implemented in LMIC to enhance surgical education.

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Acknowledgements

The authors would like to acknowledge the entire AMPATH Surgical App team for the mentorship and guidance throughout all stages of this project. The project was funded through the Global Surgical Training Challenge (GSTC) hosted by the Intuitive Foundation and Nesta Challenges.

Funding

Intuitive Foundation.

Author information

Authors and Affiliations

  1. Department of Surgery, Indiana University, 545 Barnhill Drive, 125 EmersonHall, Indianapolis, IN, 46222, USA

    Manisha B. Bhatia, Amelia T. Collings, Anna Gillio, Jeffry Levy, Dimitrios Stefanidis & JoAnna L. Hunter-Squires

  2. Case Network, Philadelphia, PA, USA

    Jeffry Levy

  3. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390-9169, USA

    Ganesh Sankaranarayanan

  4. Moi Teaching and Referral Hospital, Eldoret, Kenya

    Seno I. Saruni

  5. Moi University, Eldoret, Kenya

    JoAnna L. Hunter-Squires

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  1. Manisha B. Bhatia
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MB and Amelia Collings. The first draft of the manuscript was written by MB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Manisha B. Bhatia.

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The authors have no other relevant financial or non-financial interests to disclose.

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Bhatia, M.B., Collings, A.T., Gillio, A. et al. Enhancing surgical education for resource-limited settings: open appendectomy cognitive task analysis. Global Surg Educ 1, 61 (2022). https://doi.org/10.1007/s44186-022-00064-7

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  • DOI: https://doi.org/10.1007/s44186-022-00064-7

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