INTRODUCTION
Minimally invasive spine surgery (MISS) has transformed the management of various spinal pathologies by minimizing tissue trauma and reducing recovery time while preserving much of the spinal stability [
1]. Among all the MISS, the unilateral biportal endoscopy (UBE) represents a cutting-edge innovation in spine surgery. However, mastering this technique poses significant challenges for novice surgeons due to its steep learning curve. This curve is typically assessed through metrics such as operative time, clinical outcomes, and complication rates [
1,
2]. Most studies indicate that achieving proficiency for UBE requires performing approximately 30–50 cases, and all the assessed parameters will be gradually decreased [
2]. Therefore, accelerating this learning process while maintaining efficiency and safety requires adopting frameworks that truly expedite learning and performance. Surgeons aiming to adopt UBE or even any other surgical procedures should consider involving comprehensive and structured training programs, for instance, the Competency Task Analysis (CTA). Performing the CTA provides a framework and a mechanism to uncover, extract, and collate knowledge from “Subject Matter Experts” so as to build educational programs that promote knowledge, know-how, and skills acquisition, retention, and application while minimizing the cognitive load of learners. This editorial article aims to highlight the potential benefits of using the CTA to facilitate UBE learning.
WHAT IS THE CTA?
CTA aligns with Cognitive Load Theory and Cognitive Processing, which highlights the limitations of working memory and the importance of designing learning experiences that expedite the translation of knowledge from working- to long-term memory. Overloading working memory or failing to build a schema to help the efficient translation, storage, and recollection of information can hinder learning. The Herman Ebbinghaus’ Forgetting Curve demonstrates how 50% of newly acquired knowledge is forgotten within a day and 90% within a week [
3] (
Fig. 1). Thus, transferring information to long-term memory is critical for effective learning. CTA enhances this process by structuring knowledge into manageable components that facilitate retention and application. CTA is a qualitative “backward planning” method for studying expert cognition, emphasizing task-specific knowledge, problem-solving strategies, and practical application [
4-
6]. Its implementation in medical fields, including MISS, has demonstrated improved efficiency in learning curves and enhanced patient safety [
7,
8]. Despite its rising popularity, there are no current reports applying CTA specifically to UBE, a rapidly growing field with significant technical advancements shared over recent decades.
The CTA framework consists of 5 essential steps that systematically guide skill acquisition and procedural mastery: (1) identifying the critical procedural tasks and defining their optimal outcomes; (2) recognizing specific challenges or obstacles encountered during the procedure; (3) determining the requisite knowledge, skills, or strategies needed to overcome these challenges; (4) developing structured and targeted learning approaches tailored to address these needs; and (5) validating the effectiveness of the framework through iterative feedback and outcomes evaluation. When applied to UBE, this framework serves as a comprehensive roadmap for novice surgeons, offering a stepby-step approach to acquiring the necessary skills efficiently while minimizing the risk of errors. By deconstructing the UBE procedure into manageable components, the CTA process facilitates focused learning and enhances procedural confidence. A practical application of this framework to a specific step in the UBE technique is illustrated in
Fig. 2, highlighting how CTA principles can address real-world challenges in surgical education.
Building on our theoretical exposition of CTA, this manuscript is intended as an invitation to the surgical education community to undertake further research that bridges theory with practice. While we have detailed the framework and potential benefits of the CTA for UBE training, we recognize that practical validation is essential. Future studies should aim to implement CTA-based curricula, assess training outcomes, and compare these results with established methods, such as those highlighted in recent e-learning and simulation-based studies [
9]. By doing so, researchers can elucidate how the CTA not only enhances the learning process for novice surgeons but also translates into measurable improvements in procedural competence and overall patient care.
CONCLUSION
CTA presents a structured framework that may facilitate skill acquisition and enhance learning outcomes in UBE. By supporting cognitive and technical skill development, this approach could have the potential to help new adopters navigate the learning curve more effectively and safely. However, further research is needed to validate these potential benefits and determine its role in UBE education. Investigating the application of CTA in this context could provide valuable insights for standardizing training, improving surgeon competence, and ultimately optimizing patient care.
NOTES
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Conflict of Interest
The authors have nothing to disclose.
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Funding/Support
This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Author Contribution
Conceptualization: MP; Data curation: PC, MP; Formal analysis: PC; Methodology: SS, PC, WB; isualization: SS, WB; Writing – original draft: SS, PC; Writing – review & editing: SS, WB, BS, MP, JSK.
Fig. 1.The Ebbinghaus Forgetting Curve illustrates that approximately half of newly acquired knowledge is typically forgotten within 1 day, with up to 90% forgotten within 1 week.
Fig. 2.An example demonstrates the application of the Cognitive Task Analysis concept using the 5 core principles to a specific step in the unilateral biportal endoscopy procedure.
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