complications is essential for any MBS surgeon. As the research in this thesis focuses on the technical part of training, the NOTSS and knowledge will only be glanced at. Skills Acquisition Research of Nieboer et al. has shown that one of the differences between the supervisor (expert or master) and most trainees is the ability to ‘see and act ahead’ during surgical procedures.4 Trainees must master skills, procedures, and obtain non-technical skills, all adding to the mental workload. The mental workload of a (surgical) task is reduced by training.5 Training will help recollection and recognition of previous similar events, so one ‘knows what to do’. It changes decision making from ‘when A happens do B’ into intuitive responses. Simulation studies using eye movement tracking show that experts have a more rapid search of the operative field (absorbed awareness), so monitoring the surroundings of this field takes less mental capacity.6 Historically, based on studies of Dreyfus, the four domains of mental activities are recollection, recognition, decision making and awareness. Dreyfus describes 5 levels of competence defined by these four domains, i.e. novice, competent, proficient, expert and master (Table 1).7 In the research of this thesis, three levels of expertise -novice, intermediate and expert- are used, either combining ‘competent’ and ‘proficient’ (both still not experts) and ‘expert’ and ‘master’. When determining validity of assessments, it is eminent to take the definitions of these expertise levels into account, as these may differ between different studies. Table 1: Expertise Levels and Functions During Training Exper&se levels Dreyfus et al. Novice Competent Proficient Expert Master This thesis Novice Intermediate Expert Func&ons RecollecSon Non-situa~onal Situa~onal Situa~onal Situa~onal Situa~onal RecogniSon Decomposed Decomposed Holis~c Holis~c Holis~c Decision Analy~cal Analy~cal Analy~cal Intui~ve Intui~ve Awareness Monitoring Monitoring Monitoring Monitoring Absorbed Functions and expertise levels by Dreyfus et al., compared to expertise levels in this thesis 7 8 149 General discussion and future perspectives
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