Constructing hierarchical task analysis in surgery

Background: 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. Methods: 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. Results: 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. Conclusions: 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.