Formulation of cognitive non-technical skill in laparoscopic cholecystectomy learning module: a Delphi consensus

Background. The laparoscopic cholecystectomy training currently being conducted in Indonesia focuses mainly on technical aspects, leaving many doctors lacking in laparoscopic cholecystectomy cognitive non-technical skills. As a result, there is a potential that laparoscopic cholecystectomy will continue to cause an increase in bile duct damage. Non-technical skills proficiency is essential for a surgeon. However, there is little evidence to support this claim, particularly in Indonesia. We conducted a Delphi study to formulate a learning module for a safe laparoscopic cholecystectomy cognitive non-technical skill. Methods. A two-round Delphi consensus was carried out from January to February 2023. The experts gathered are 25 digestive surgeons with teaching experiences in general surgery training programs across Indonesia with high laparoscopic cholecystectomy experience. Results. The agreed-upon learning content for the first Delphi round focuses on building situational awareness skills, which include perceiving warning signs, analyzing the information, and projecting the appropriate amount of work to be done in the future. Perception is supported by anatomical knowledge, an assessment of how difficult the operation is to achieve a Critical View of Safety (CVS), an understanding that uses a checklist and pauses to quickly and accurately analyze objective information, and projections that consider alternative follow-up actions, like bail-out attempts. After that, decisions must be made to complete the procedure securely. Further information on the operation's difficulty level assessment and the importance of CVS as a part of situational awareness skills is provided in the second Delphi round. Conclusion. Our Delphi consensus successfully created a safe laparoscopic cholecystectomy cognitive non-technical skill learning module that emphasizes situational awareness and debiasing skills through case-based discussions and is assessed using a concordance test.