A SHERPA approach to surgical training in parotidectomy

Aim: Systematic Human Error Reduction and Prediction Approach (SHERPA) is a Human Factors error analysis method. In this pilot study, we investigated its use as a tool to visualise surgical procedures, identify perioperative errors and assess differing trainer/trainee perceptions of task difficulty.Method: The identification of the facial nerve during parotidectomy was considered by the consultant in our team as a common but difficult task to train for. A Hierarchical Task Analysis was initially performed based on the literature followed by revisions with the consultant to ensure clinical relevance. A focus group involving consultants and trainees was then held to compare trainer/trainee views.Results: Literature review of the task yielded a total of 55 steps. Following revision, this was modified to 37 steps, of which 2 steps were considered difficult for trainees. During the focus group, trainers and trainees identified 4 steps and 8 steps difficult respectively and expressed variations in surgical practice.Conclusions: SHERPA is a concrete platform in identifying perioperative errors and conceptualising both technical and non-technical skills, which can be assessed and monitored. This opens the path for future applications in its use as a reliable self-assessment tool that allows learning through objective feedback, self-reflection and recognition of competencie