Teaching and Assessing Cognitive Competencies in Aesthetic and Plastic Surgery

Background: Cognition, part of surgical competence, employs forward planning, error prevention, and orchestration of technical skills. Thus, an understanding of mental processes used by experts throughout patient care is essential to teaching such competencies. The authors' study aimed to analyze and compare mental models of two distinct procedures in plastic surgery-breast augmentation and flexor tendon repair-to develop a framework to define cognitive competencies in plastic surgery aided by a review of the literature. Methods: Based on data from a priori cognitive task analyses, literary sources, and field observations of breast augmentation surgery and flexor tendon repair, task lists were produced for each procedure. Two mental models were developed using fuzzy logic cognitive maps to visually illustrate and analyze cognitive processes used in either procedure. A comparison of the models aided by literature was used to define the cognitive competencies employed, identify differences in the decision-making process, and provide a guiding framework for understanding cognitive competencies. Results: Five distinct cognitive competency domains were identified from the literature applicable to plastic surgery: situation awareness, decision-making, task management, leadership, and communication and teamwork. Differences in processes of decision-making utilized between an elective and a trauma setting were identified. A framework to map cognitive competencies within a generic mental model in surgical care was synthesized, and methods were suggested for training on such competencies. Conclusion: Cognitive competencies in different settings in plastic surgery are introduced using a comparative study of two mental models of distinct procedures to guide the teaching and assessment of such competencies.