Role and educational implications of cognitive surgical skills.

Surgical skills have traditionally been classified as technical and non-technical skills. Technical skills—also called psychomotor skills—constitute a core component of surgical skills. They have been the focus of surgical skill training for several decades. However, the cognitive component has not been evaluated as applied in surgical practice and training. The integration of cognitive and motor components and the resulting sequence of steps involved in the psychomotor skills have not been adequately explained. Bloom and colleagues described the psychomotor skill domain of learning in 1956. In 1972, Simpson proposed various domains (perception, set, guided response, mechanism, complex overt response, adaptation and origination).1 Even though these categories describe cognitive and kinetic skills, they focus on certain aspects such as responses to actions and performance levels. Since then, multiple publications have described training and evaluation models, such as the Zwisch model, the famous ‘see one, do one, teach one’ model, and the global assessment scales. Nonetheless, they describe technical skills as one part rather than multiple integrated components and steps. Miller’s well-known hierarchical triangle describes the levels of performance (knows, knows how, shows how, then does) rather than the steps involved. The aim of this article is to describe a new perspective of the surgical skills components that focus on the cognitive aspect. The concept can improve surgical training and evaluation through specially prepared, competency-based2 activities that do not consume the valuable operative room time or the resident 80-hour work limit. It also fosters building expertise in surgical skills for junior or international practitioners. Operative procedures and tasks are performed after adequate and appropriate evaluation and planning. The motor program …