Defining Cognitive Competencies for Breast Augmentation Surgery

BACKGROUND: Breast augmentation is the most per-formed aesthetic procedure in the United States yet one that surgical trainees have limited exposure to. This cre-ates a lack of confidence in performing this key proce-dure among graduates. It is imperative to develop novel curricula and objective measures to standardize acquir-ing competency.OBJECTIVE: This qualitative study establishes various cognitive competencies and pitfalls in augmentation mammoplasty. METHODS: Using a priori established task analysis, liter-ary sources and operative observations, a total of 20 cog-nitive vignettes were developed to conduct cognitive task analyses (CTA) for breast augmentation through semistructured interviews of experts. Interviews were itemized, and verbal data were recorded, transcribed ver-batim, and thematically analyzed by reviewers.RESULTS: Eight experts were interviewed (median age 39 years, 87.5% males, with a median of 7 years in prac-tice). A conceptual framework for breast augmentation was developed and divided into 5 operative stages con-taining 208 competencies and 41 pitfalls. Pitfalls were mapped to deficits in shared decision making, proper informed consent, prospective hemostasis, and aware-ness of anatomical landmarks and markings.CONCLUSIONS: This work provided an inclusive frame-work of cognitive competencies in breast augmentation surgery to facilitate their assessment. This model guides the analysis of other procedures to transfer cognitive competencies to learners. In a transition toward compe-tency-based education, this provides a primer to assessments that include all aspects of a surgeon's skill set. (J Surg Ed 80:873-883. (c) 2023 Association of Pro-gram Directors in Surgery. Published by Elsevier Inc. All rights reserved.)