title: Planning to avoid trouble in the operating room: experts' formulation of the preoperative plan.
abstract: OBJECTIVE
  The purpose of this study was to capture the preoperative plans of expert hepato-pancreato-biliary (HPB) surgeons with the goal of finding consistent aspects of the preoperative planning process.
  
  
  METHODS
  HPB surgeons were asked to think aloud when reviewing 4 preoperative computed tomography scans of patients with distal pancreatic tumors. The imaging features they identified and the planned actions they proposed were tabulated. Surgeons viewed the tabulated list of imaging features for each case and rated the relevance of each feature for their subsequent preoperative plan. Average rater intraclass correlation coefficients were calculated for each type of data collected (imaging features detected, planned actions reported, and relevance of each feature) to establish whether the surgeons were consistent with one another in their responses. Average rater intraclass correlation coefficient values greater than 0.7 were considered indicative of consistency.
  
  
  METHODS
  Division of General Surgery, University of Toronto.
  
  
  METHODS
  HPB surgeons affiliated with the University of Toronto.
  
  
  RESULTS
  A total of 11 HPB surgeons thought aloud when reviewing 4 computed tomography scans. Surgeons were consistent in the imaging features they detected but inconsistent in the planned actions they reported. Of the HPB surgeons, 8 completed the assessment of feature relevance. For 3 of the 4 cases, the surgeons were consistent in rating the relevance of specific imaging features on their preoperative plans.
  
  
  CONCLUSIONS
  These results suggest that HPB surgeons are consistent in some aspects of the preoperative planning process but not others. The findings further our understanding of the preoperative planning process and will guide future research on the best ways to incorporate the teaching and evaluation of preoperative planning into surgical training.
authors.affiliation: The Wilson Centre, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: nathan.zilbert@utoronto.ca.
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Zilbert
authors.affiliation: The Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: St-Martin
authors.affiliation: Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Glenn
authors.initials: G
authors.lastname: Regehr
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.affiliation: The Wilson Centre, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Carol-Anne
authors.initials: CA
authors.lastname: Moulton
mesh_terms: D000328:Adult; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D000066491:Clinical Decision-Making; D013505:Digestive System Surgical Procedures / Q000193:education*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D009864:Ontario; D009873:Operating Rooms / Q000458:organization & administration; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D010347:Patient Care Planning / Q000458:organization & administration*; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D018794:Problem-Based Learning / Q000379:methods; D011786:Quality Control; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; expertise; preoperative planning; surgical decision making; surgical judgment