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Background: The purpose of the study was to determine knowledge, attitudes, and practices toward the prevention of typhoid fever among patients aged 15-50 years in Adjumani General Hospital, Adjumani District. Methodology: The study employed a cross-sectional study design with both quantitative approaches. Simple random sampling was used. Data were analyzed manually by use of tally sheets and were entered in the Excel computer program to generate tables, graphs, and pie charts. Results: The study findings revealed that the overall knowledge of the prevention of typhoid fever among the respondents was generally poor, as most (60%) of the respondents did not know anything about typhoid fever. Regarding attitude, the majority (70%) of the respondents agreed washing hands with soap helped in preventing typhoid fever, most (60%) agreed that boiling water also helped in preventing typhoid fever, and the majority (84%) were willing to prevent typhoid fever. In regards to practices half (50%) of the respondents did not know any of the practices that helped in the prevention of typhoid fever, more than half (56%) agreed washing hands with soap helped to minimize typhoid fever infection, the majority (70%) of the agreed on using pit latrine as a fecal disposal facility to minimize typhoid fever infection. Conclusion: The general knowledge, attitude, and practices of the respondents towards the prevention of typhoid fever were generally poor which in the end could lead to an increase in the spread of typhoid fever within the district. Recommendation: Health workers in Adjumani General Hospital should promote community health-based programs to teach the community the best practices to curb the increasing typhoid fever.

Background: The purpose of the study was to determine the knowledge, attitude, and practices towards hepatitis B vaccination among patients aged 16- 40 years attending Buwasa health center IV Sironko District. Methodology: The study involved a descriptive cross-sectional study design to address the specific objectives of the study, on a sample of sixty (60) respondents using a simple random technique as the sampling technique. A semi-structured questionnaire was designed and used as a data collection tool. Results: Regarding the practices, the majority (90%) of the respondents reported that they had ever been screened against hepatitis B infection, the majority (87%) of those who reported having been screened negative were initiated on vaccination, and more than half (59%) of them had completed the three doses, among the unvaccinated, the most (47%) frequently mentioned reason for non-vaccination was fear of side effects, more than half (55%) had ever been sensitized about the importance of hepatitis B vaccination. Conclusion: the knowledge of hepatitis B vaccination was poor since most of the respondents did not know the complete hepatitis B vaccination schedule, and the intervals between the doses; with a relatively good attitude and fair practices towards hepatitis B vaccination, and this consequently called for the need to raise patient’s awareness about hepatitis B vaccination to improve on the knowledge, attitude, and practices towards hepatitis B vaccination. Recommendation: The researcher finally recommended that the government of Uganda through the ministry of health should supply adequate vaccine stock to the facility to ensure consistent availability of the vaccine.

Background: Oral hygiene is maintaining the cleanliness of the mouth and taking care of teeth and gum. The purpose of the study was to assess the knowledge, attitude, and practices toward oral hygiene among patients aged 18-45 years in Lira Regional Referral Hospital, Lira district. Methodology: The study employed a cross-section design to address the specific objectives of the study on a sample of 50 respondents using the simple random technique. A semi-structured questionnaire was designed and used as a data collection tool. Results: From the study findings, the majority (86%) of the respondents knew about oral health, most (40%) of the respondents reported dentists as their source of information about oral hygiene, and the majority (92%) went for dental checkups to dentists, the majority (86%) knew about dental caries and most (68.9%) gave the correct response about what dental caries are, the majority (92%) reported that they knew the causes of dental caries and more than half (60%) gave the correct response about the cause of dental caries. Conclusion: Even though the respondents had good knowledge and positive attitudes toward oral hygiene, surprisingly they were at risk of contracting dental caries and other periodontal conditions because their oral hygiene practices were below the global recommendations and most of them used only toothbrushes to clean their teeth. Recommendation: The ministry of health should emphasize oral and dental care health education in health facilities and hospitals or carry out health camps and community outreaches. This would at least ensure that the general public gets access to basic knowledge about oral health and hygiene practices and can identify the signs and symptoms of oral health conditions as well as prevent them.

Background: The purpose of the study was to assess; the knowledge, attitude, and practices toward the prevention of dental caries among youths aged 15-25 years in Soroti Regional Referral Hospital, Soroti district. The specific objectives of the study were to assess; the knowledge towards prevention of dental caries among youths aged15-25 years, attitudes towards prevention of dental caries among youths aged 15-25 years, and practices towards prevention of dental caries among youths aged 15-25 years. Methodology: A cross-section study design was employed with sampling technique as a sampling technique. Data was collected from a sample of 50 respondents using a semi-structured questionnaire written in the English language; later analyzed manually; using a scientific calculator, and systematically computed into frequency and percentages using Microsoft excel to generate tables and figures for easy presentations. Results: About practices towards prevention of dental caries among youths aged 15-25 years; results showed that (70%) of the respondents were using fluoridated toothpaste, (90%) commonly used toothpaste and toothbrush, (60%) used to take sugar-containing snacks, and (40%) were eating them daily, (60%) reported a brush and paste as oral cleaning habit that they normally used and (80%) reported cleaning their teeth once daily. Conclusion: The researcher generally concluded that; even though study participants exhibited fair knowledge about the prevention of dental caries but their attitude and practices were not worthy agreeable since almost all respondents had an average attitude towards the prevention of dental caries and also doing some practices that are not in line with the prevention of dental caries. Recommendation; the government together with the ministry of health should improve on the sensitization of people about oral health and put up restrictions that can reduce the accessibility of sugar-containing products like snacks hence preventing dental caries among youths of Soroti district.

Background: The purpose of the study was to determine the factors contributing to the increased use of herbal medicine among pregnant women aged 18-45 years attending Buwambo Health Centre IV, Wakiso District. The specific objectives were to determine the: Maternal, Socioeconomic, and health facility-related factors contributing to the increased use of herbal medicine among pregnant women aged 18-45 years. Methodology: The study design was descriptive and cross-sectional and the researcher employed the simple random sampling technique. The study instrument was a questionnaire and a sample of 50 respondents was used. Medicine because they were readily available. Results: Regarding the health facility-related factors contributing to increased use of herbal medicine, the majority (74%) of the respondents reputed that the health workers took a lot of time to work on them, and most (40%) had their homes more than 10km away from the health facility and more than half (52%) waited over 2hrs to be seen by the doctor. Conclusion: Maternal factors contributing to increased use of herbal medicine included having information about herbal medicine from family members (70%), being in the first trimester (76%), and the pregnancy-related complications such as nausea and vomiting (40%), socio-economic factors were; encouragement by their culture and religion (60%), availability of herbal medicine (56%), health facility-related factors were; long waiting hours (74%), and long-distance from the health facility (40%). Recommendation: The researcher recommended the Ministry of Health put up more health facilities to reduce the distance moved by the pregnant women while looking for the antenatal care services and that Buwambo Health Centre IV should intensify health education the pregnant women on the importance of antenatal care visits and the implications of the use of herbal medicine during pregnancy.

Abstract Background The introduction of the National Health Service (NHS) Breast Screening Programme has led to a considerable increase in the detection of impalpable breast cancer. Patients with impalpable breast cancer typically undergo oncological resection facilitated either by the insertion of guide wires placed stereo-tactically or through ultra-sound guided skin markings to delineate the extent of a lesion. The need for radiological interventions on the day of surgery adds complexity and introduces the risk that a patient may accidentally transferred to the operating room directly without the image guidance procedure. Case report A case is described of a patient who required a pre-operative ultrasound scan in order to localise an impalpable breast cancer but who was accidentally taken directly to the operating theatre (OR) and anaesthetised without pre-operative intervention. The radiologist was called to the OR and an on-table ultrasound was performed without further consequence. Conclusion It is evident that breast cancer patients undergoing image-guided resection are exposed to an additional layer of clinical risks. These risks are not offset by the World Health Organisation surgical safety checklist in its present guise. Here, we review a number of simple and inexpensive changes to the system that may improve the safety of the breast cancer patient undergoing surgery.

Introduction: Emergency general surgery (EGS) is responsible for 80-90% of surgical in-hospital deaths and the early management of these unwell patients is critical to improving outcomes. Unfortunately care for EGS patients is often fragmented and important care processes are frequently omitted.Methods: This study aimed to define a group of important processes during EGS admission and assess their reliability. Literature review and semi-structured interviews were used to define a draft list of processes, which was refined and validated using the Delphi consensus methodology. A prospective cohort study of the 22 included processes was performed in 315 patients across 5 acute hospitals.Results: Prospective study of the 22 selected processes demonstrated omission of 1130/5668 (19.9%) processes. Only 6 (1.9%) patients had all relevant processes performed correctly. Administration of oxygen to hypoxic patients (82/129, 64%), consultant review (202/313, 65%) and administration of antibiotics within 3 h for patients with severe sepsis (41/60, 68%) were performed particularly poorly. There were significant differences in the mean number of omissions per patient between hospitals (Anova: F = 11.008, p < 0.001) and this was strongly correlated with hospitals' median length of stay (Spearman's rho = 0.975, p = 0.005).Conclusions: Reliability of admissions processes in this study was poor, with significant variability between hospitals. It is likely that improvements in process reliability would enhance EGS patients' outcomes. This will require engagement of the entire surgical team and the implementation of multiple interventions to improve the effectiveness of the admission phase of care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate impact of WHO checklist compliance on riskadjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. Background: There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. Methods: Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. Results: Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affectmortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio=0.57, 95% confidence interval: 0.37-0.87, P<0.01). Calculated population-attributable fractions showed that 14% (95% confidence interval: 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. Conclusions: Checklist implementation was associated with reduced casemix- adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care. [ABSTRACT FROM AUTHOR]

Abstract: Background: Clinical handover (handoff, sign out) is frequently implicated as a cause of adverse events in hospitalised patients. Complex social interactions such as handover are subject to the teamwork skills of the participants and there is increasing evidence that the quality of teamwork in handover affects outcome. Teamwork skills have been assessed in one-to-one handovers but the applicability of these measurement tools to healthcare team shift handovers remains unproven. This study aimed to assess the feasibility of measurement of teamwork skills in shift handover and the applicability of adapted teamwork skills rating scales to a shift handover environment. Methods: Morning surgical shift handovers were assessed for completeness of information transfer, duration, interruptions and handover attendance. Handover teamwork skills were evaluated using two validated rating scales, adapted from one-to-one handovers and intra-operative teamwork skill measurement. Results: 50 handovers, including 306 patients were observed. Communication checklist completion was 97% but the quality of teamwork skills varied widely between handovers. There was very good concurrent validity between the two teamwork skill rating scales (Spearman''s rho = 0.67, p < 0.001). There was no significant correlation between content completion, duration, interruptions or attendance and teamwork skill ratings. Conclusions: Teamwork skills vary widely between handovers and can be consistently scored using both rating scales. It is feasible to use adapted teamwork skill rating scales in shift handover and they appear to measure different constructs to traditional handover measures such as interruptions and communication checklist completion. The assessment of teamwork skills is a necessary complement to the assessment of completeness of information transfer when evaluating the overall quality of handover. [Copyright &y& Elsevier]

In an attempt to reduce the negative sequelae of cardiopulmonary bypass (CPB), a variety of new technologies have been created. This study investigates variations in the application of these technologies throughout Great Britain and Ireland (GB & I). All perfusion departments within GB & I were surveyed about equipment and technologies used in CPB. Eighty-five percent of units use a standard arterial line filter in all cases. Forty percent of units occasionally use leukocyte-depleting filters in various sites within the circuit. Sixteen percent always use some element of heparin-bonded circuit, but 62% never use them. Twenty-five percent use solely rotary pumps, 18% use solely centrifugal pumps, and 56% use both. Finally, 20% are now using minimal extracorporeal circulation in certain clinical scenarios. These decisions are most frequently affected by clinician preference and cost. This survey has highlighted significant variation in the utilization of various technologies used in CPB. While some variation between centers is to be expected, as innovative technologies are adopted at varying rates, surveys such as this are useful for alerting clinicians to gaps between evidence-based knowledge and clinical practice. [ABSTRACT FROM AUTHOR]

The study, first published in 2006, looks at patient safety from the perspective of surgery, looking at surgeons' technical skills, surgical team performance in the operating theatre, the team's views of their performance, interruptions and distractions, and multidisciplinary team training in surgery using simulated training scenarios. [ABSTRACT FROM AUTHOR]

Recent studies have investigated disruptions to surgical process via observation. We developed the Disruptions in Surgery Index (DiSI) to assess operating room professionals’ self-perceptions of disruptions that affect surgical processes. The DiSI assesses individual issues, operating room environment, communication, coordination/situational awareness, patient-related disruptions, team cohesion, and organizational issues. Sixteen surgeons, 26 nurses, and 20 anesthetists/operating departmental practitioners participated. Participants judged for themselves and for their colleagues how often each disruption occurs, its contribution to error, and obstruction of surgical goals. We combined the team cohesion and organizational disruptions to improve reliability. All participants judged that individual issues, operating room environment, and communication issues affect others more often and more severely than one’s self. Surgeons reported significantly fewer disruptions than nurses or anesthetists. Although operating room professionals acknowledged disruptions and their impact, they attributed disruptions related to individual performance and attitudes more to their colleagues than to themselves. The cross-professional discrepancy in perceived disruptions (surgeons perceiving fewer than the other two groups) suggests that attempts to improve the surgical environment should always start with thorough assessment of the views of all its users. DiSI is useful in that it differentiates between the frequency and the severity of disruptions. Further research should explore correlations of DiSI-assessed perceptions and other observable measures. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Correct decision making is pivotal and an integral part of surgical competency. To date there has not been an attempt to assess surgeons making decisions whilst operating. In our present study we aim to assess operative decision making by trainee and expert surgeons by using hierarchical task analysis (HTA) as a method to map out decision making in surgery. Methods: One hundred and forty live laparoscopic operations were prospectively analyzed, independently and blindly. The operations were compared to an operative HTA, and individual case reasons for deviations noted. Factors in the operating theatre which may influence the surgeons'' decisions whilst operating were assessed using a checklist. Results: One hundred and nineteen elective and 21 emergency laparoscopic operations performed by 12 consultants and 14 registrars were analysed. Factors from the HTA and theatre environment checklists were categorised. Inter-rater reliability was k =0.95, k =1.00 for sub-tasks and tasks, respectively, and 0.98 between the surgeon and independent observer for the operating theatre checklist. From these data sets a psychomotor surgical decision making model was constructed. Face and content validities of the model were verified by experts in surgery and decision making. Conclusions: Dynamic surgical decision making is a multi-faceted and intricate process. We have used HTA to map this process and we present a model in surgical decision making. By understanding the mechanisms and factors which influence this process we may use it for effective, focused surgical training. We aim to use and test our model also on open major complex surgery. [Copyright &y& Elsevier]

High-reliability organizations have stressed the importance of nontechnical skills for safety and of regularly providing such training to their teams. Recently safety skills training has been applied in the practice of medicine. In this study, we developed and piloted a module using multidisciplinary crisis scenarios in a simulated operating theatre to train entire surgical teams. Twenty teams participated ( n = 80); each consisted of a trainee surgeon, anesthetist, operating department practitioner (ODP), and scrub nurse. Crisis scenarios such as difficult intubation, hemorrhage, or cardiac arrest were simulated. Technical and nontechnical skills (leadership, communication, team skills, decision making, and vigilance), were assessed by clinical experts and by two psychologists using relevant technical and human factors rating scales. Participants received technical and nontechnical feedback, and the whole team received feedback on teamwork. Trainees assessed the training favorably. For technical skills there were no differences between surgical trainees’ assessment scores and the assessment scores of the trainers. However, nurses overrated their technical skill. Regarding nontechnical skills, leadership and decision making were scored lower than the other three nontechnical skills (communication, team skills, and vigilance). Surgeons scored lower than nurses on communication and teamwork skills. Surgeons and anesthetists scored lower than nurses on leadership. Multidisciplinary simulation-based team training is feasible and well received by surgical teams. Nontechnical skills can be assessed alongside technical skills, and differences in performance indicate where there is a need for further training. Future work should focus on developing team performance measures for training and on the development and evaluation of systematic training for technical and nontechnical skills to enhance team performance and safety in surgery. [ABSTRACT FROM AUTHOR]

Rationale and aims Research suggests that there are problems of communication effectiveness in surgery. Here we describe the content, initiators and recipients of communications that intrude or interfere with individual surgical cases. We also consider the level at which the surgical team and its team members are distracted by these case-irrelevant communications (CICs). Methods Two psychologist observers sampled 48 general surgery procedures and they recorded the initiator and the recipient of CIC events, their content and the level of observable distraction that they caused. Results Irrelevant comments and queries (i.e. ‘small-talk’) accounted for half of the observed CICs. From the remaining CICs that we observed, most were related to the organization and administration of the case-list, to operating theatre provisions and to teaching junior staff. Surgeons initiated a third of the observed CICs, while receiving two thirds of them . External staff visiting the operating theatre initiated the most distracting communications. The CICs addressed to surgeons introduced significantly less distraction to the operating theatre than those addressed to anaesthetists and nurses. Conclusions Some of the observed CICs contributed to the administration of the operating theatre case-list. Nonetheless, this communication can interfere with highly sensitive work. More effectively co-ordinated communication could reduce this interference. More research should assess the communication effectiveness and the impact of CICs on task performance in the operating theatre. [ABSTRACT FROM AUTHOR]

Background: Teamwork is fundamental to effective surgery, yet there are currently no measures of teamwork to guide training, evaluate team interventions or assess the impact of teamwork on outcomes. We report the first steps in the development of an observational assessment of teamwork and preliminary findings. Method: We observed 50 operations in general surgery from a single operating theater using a measure of teamwork specifically developed for use in the operating theater. The OTAS(Observational Teamwork Assessment for Surgery) comprises a procedural task checklist centered on the patient, equipment and communications tasks and ratings on team behavior constructs, namely: communication, co-operation, co-ordination, shared-leadership and monitoring. Results: Ratings of overall team performance were reasonably high, though variable, but there was evidence that clinically significant steps were being missed which at the very least eroded safety margins. There was, for instance, a frequent failure to check both surgical and anesthetic equipment and a failure to confirm the procedure verbally, patient notes were missing in about one-eighth of the cases and delays or changes occurred in over two-thirds of the cases. Conclusions:This study takes an initial step towards developing measures of team performance in surgery that are defined in relation to tasks and behaviors of the team. The observational method of assessment is feasible and can provide a wealth of potentially valuable research data. However,for these measures to be used for formal assessment, more research is needed to make them robust and standardized. [ABSTRACT FROM AUTHOR]

Surgery depends on interprofessional teamwork, which is becoming increasingly specialized. If surgery is to become a highly reliable system, it must adapt and professionals must learn from, and share, tested models of interprofessional teamwork. Trainers also need valid measures of teamwork to assess individual and team performance. However, measurement and assessment of interprofessional teamwork is lacking and interprofessional team training is scarce in the surgical domain. This paper addresses the complexity of measuring interprofessional teamwork in the operating theatre. It focuses mainly on the design and properties of observational assessment tools. The report and analysis serves to inform the researcher or clinician of the issues to consider when designing or choosing from alternative measures of team performance for training or assessment. [ABSTRACT FROM AUTHOR]

The article deals with issues related to patient safety in surgery. An operating theater is an extraordinarily complex system. The complexity is manifested not only in the patient as well as their condition however, due to the sophistication of instrumentation, the high volume of information that must be processed, the nature of communication and team coordination, and the urgency and occasional uncertainty with which decision and interventions must be created.

Abstract: Making errors is part of normal human behaviour. However when errors have significant consequences or occur in high risk industries they become of paramount importance. There has been little research in why and how errors occur in the healthcare industry. Errors occur throughout healthcare, but in particular, surgery as a high risk speciality. Surgery is a dynamic speciality with a milieu of possible mishaps waiting to happen. So to understand and prevent errors in surgery we must explore this intricate multi-cogwheel process. This article will summarise the epidemiology of surgical errors, factors which influence them in the patient pathway, explain concepts and models of why errors occur, technical skill error assessment and possible strategies to prevent or reduce surgical errors. Practicing surgery in the new millennium will embrace new innovations, medications, technologies, equipment, operations, all which aim to improve the treatment and care of patients. However we must remember with this constant evolution in healthcare the error goalposts are forever moving, so we must be vigilant not to take our eye off the error ball. [Copyright &y& Elsevier]

Background: There is a lack of structured instruments to assess how technical skills are taught. We aimed to develop a practical assessment tool that is easy to use and will assess the teaching of technical skills. Methods: A 5-point Likert global rating scale was constructed. An experienced surgeon independently assessed each surgery using the assessment tool. Trainees also used the assessment tool after the surgery. Results: Forty-two surgeries were assessed: 26 open and 16 laparoscopic surgeries. Interrater reliability between the independent assessor and trainees was performed using a kappa coefficient of .77 and a P value of less than .05. Conclusions: Our study shows that our assessment instrument has a potential ability to assess any taught technical task. We will continue and expand the study in surgery, and we aim to expand it further to medical specialties (eg, internal medicine, and so forth) that also teach technical tasks (eg, chest drain insertion, and so forth). [ABSTRACT FROM AUTHOR]

Abstract: Background: Decision-making is an essential skill for surgeons, but systematic objective feedback is lacking. Cognitive feedback provides information about how risk factors relate to outcomes, and how individual surgeons mentally synthesize these relationships. Methods: Pre-feedback, we assessed accuracy and reliability of 105 trainee surgeons''/medical students'' estimates of operative mortality for major surgery for 28 patient vignettes with varying risk factors, using a published risk model as a gold standard. Post-feedback, participants were retested on a second case set. Results: Post-feedback, both groups'' estimates became more reliable. Pre-feedback, medical students were less accurate than trainee surgeons; post-feedback, their accuracy improved to match that of trainee surgeons, who did not improve further. Conclusions: Cognitive feedback improved risk estimate reliability in both groups and accuracy in the medical students group. Lack of improvement in the surgical group implies a ceiling effect. These findings have implications for training and assessment of surgical decision-making. [Copyright &y& Elsevier]

Abstract: Background: Recent developments in the surgical literature highlight the need for assessment of nontechnical skills in surgery. We report a revision of the NOn-TECHnical Skills (NOTECHS) scale of the aviation industry for use in surgery and detailed analysis on its reliability. Methods: The original NOTECHS scale assesses (1) Cooperation, (2) Leadership and Managerial Skills, (3) Situation Awareness and Vigilance, and (4) Decision Making. We added a Communication and Interaction dimension and adapted all subscales for use in surgical context. Reliability was assessed in simulation-based training for trainee clinicians. Results: Satisfactory reliability (Cronbach''s α) was obtained (1) across professional groups and trainers and trainees, (2) in separate analyses for trainers and trainees, (3) in successive administrations of the scale, and (4) in surgical, anaesthetic and nursing groups analyzed separately. In the operating department practitioners group, Situation Awareness and Vigilance and Cooperation and Team Skills exhibited lower reliability. Conclusions: Assessment of surgical nontechnical skills is becoming a training priority. The present evidence suggests that the revised NOTECHS scale exhibits good reliability. Further empirical research should assess the validity of the scale. [Copyright &y& Elsevier]

Abstract: Background: Training surgeons in vital decision-making skills remains unstructured. We aimed to map a process of care from the perspective of surgical decision making and test whether it could be deconstructed into an accessible format for trainees. Methods: Semistructured interviews were conducted with 10 experienced surgeons by using symptomatic gallstones as a clinical exemplar. Data were analyzed by 2 independent reviewers to identify decisions, cues, and decision rules, with further thematic analysis of selected decisions. Results: Eighteen specific decisions were identified in 6 or more transcripts, with significant interreviewer reliability (Spearman''s ρ = .65, P = .004, n = 17, 1 outlier excluded). These were arranged to form a “decision map.” Two main decision strategies were described. Conclusions: We identified and mapped the decisions made in the care of patients with symptomatic gallstone disease. The interpretation of competency at any procedure should include the surgeon''s ability to make appropriate decisions at all stages of patient care. [Copyright &y& Elsevier]

Abstract: Background: Surgical judgment and decision making require valid methods of assessment. The aim of this study was to evaluate the use of judgment analysis as a technique for quantitative evaluation of surgeons’ risk estimates. Methods: Thirty trainee surgeons’ estimates of conversion risk in laparoscopic cholecystectomy were investigated using judgment analysis. Hypothetical cases were created, differing in relevant risk factors. Twenty repeat cases were incorporated to test for reliability. Surgeons’ estimates were compared with an outcome-derived gold standard from the published literature. Results: The mean reliability was .77 (range, .47–.98), and regression models indicating the weighting of variables had a mean adjusted R2 value of .53 (range, .12–.76). Variables were subject to wide variation in weighting. The mean correlation to the gold standard model was .48 (range, .08–.72). Conclusions: Judgment analysis allows detailed quantitative evaluation of the consistency of surgeons’ risk estimates and the influence of different variables on them. Comparison with a gold standard model enables accuracy to be measured. [Copyright &y& Elsevier]