title: Descriptive operative reports: teaching, learning, and milestones to safe surgery.
abstract: OBJECTIVE
  Few tasks are more ingrained within the minds of practicing surgeons than the dictation of the narrative report of an operation. However, the construct of these reports varies widely among surgeons and is rarely formally taught and not tested formally during surgical training or board certification.
  
  
  METHODS
  A cohort of patients undergoing incisional hernia repair (IHR) over a 5-year period from 16 academically affiliated Veterans' Administration (VA) hospitals was identified. Technical details of the operative approach were obtained only from operative notes. Frequency of missing elements was analyzed by postgraduate year of the resident.
  
  
  RESULTS
  Overall, 1367 IHR operative reports were analyzed, comprising 456 (33%) suture repairs, 802 (59%) open mesh repairs, 97 (7%) laparoscopic repairs, and 12 (1%) where repair type could not be determined. Hernia size in any dimension was absent in 63.5% of dictations and was similar regardless of PGY, (54%, 56%, 71%, 67%, and 66% for PGY 1-5, respectively). Among the 906 mesh repairs, 65% failed to mention the mesh size. This absence was similar across PGY (64%, 69%, 65%, 66%, and 68% for PGY 1-5, respectively), and attending reports were only marginally better, with mesh size absent in 57% of reports. In the 456 cases repaired by suture alone, 76% did not record the type of suture used with significant variation by PGY (78%, 59%, 87%, 89%, and 69% for PGY 1-5, attending - 86%).
  
  
  CONCLUSIONS
  Resident dictation of the operative report represents an opportunity to understand current cognitive deficits regarding the procedure and to allow for intervention. Future studies to validate that internalization of the cognitive aspects of operations can be measured by audit of operative notes are needed. These endeavors will ensure that not only the technical but also the mental guides to safe surgery are acquired.
authors: Center for Surgical, Medical Acute Care Research and Transitions, Veterans Affairs Medical Center, Birmingham, Alabama, USA. john.porterfield@ccc.uab.edu
authors: John R
authors: JR
authors: Porterfield
authors: Laura K
authors: LK
authors: Altom
authors: Laura A
authors: LA
authors: Graham
authors: Stephen H
authors: SH
authors: Gray
authors: Marshall M
authors: MM
authors: Urist
authors: Mary T
authors: MT
authors: Hawn
mesh_terms: D013502:General Surgery / Q000193:education*; D006555:Hernia, Ventral / Q000601:surgery; D006801:Humans; D007396:Internship and Residency; D008499:Medical Records / Q000592:standards*; D012189:Retrospective Studies