Misunderstandings in robotic surgical instruction: An exploratory discourse analysis

INTRODUCTION: When communication breaks down, misunderstandings ensue and may result in a communication process called repair. We aimed to characterize misunderstandings in robotic surgical instruction by appraising repairs. METHODS: We recorded learners and instructors working through simulated robotic surgical procedures. Using tools from discourse analysis, we categorized different aspects of repair: the trouble source (cause of confusion), initiation of repair (marker of the trouble source as confusing), repair proper (attempted resolution of confusion), and response to repair (signal of repair proper as adequate or inadequate). RESULTS: We reviewed 2596 min of video and audio data from 33 simulated cases. Using transcripts, we defined categories of trouble source, initiation of repair, repair proper, and response to repair. CONCLUSIONS: Our findings suggest methods by which instructors can avoid common trouble sources to reduce reasons for misunderstanding and through which both learners and instructors can more effectively address misunderstandings when they do occur.