Introduction

The Problem: The Critical View of Safety (CVS) is the gold standard for safe laparoscopic cholecystectomy, but trainee conceptualization and assessment variability remain unstudied.

Objectives: 

1. Improve the accuracy and consistency of CVS knowledge across all postgraduate levels. 

2. Standardize the evaluation of intraoperative CVS images.

The "Shared Mental Model": Aligning operative 

expectations across the program to promote safer surgery.

Methods

Design: Prospective educational quality-improvement (QI) initiative at a single academic military medical center.

Implementation: Weekly academic sessions utilizing QR code–based surveys for data collection (began July 2025).

Conceptual Component: Respondents provide free-text descriptions of the definition of the CVS, scored by independent raters on a 3-point scale.

Applied Component: Participants (Medical Students, Residents, and Staff) review intraoperative video and answer binary (Yes/No) questions regarding the achievement of the three CVS elements.

Results

Knowledge Gaps: Out of 63 conceptual responses, the greatest variability concerned the clearance of fibrofatty tissue from the hepatocystic triangle.

Training Disconnect: Resident accuracy for triangle clearance (0%–80%) did not correlate with higher training levels (p=0.15).

Staff Findings: Only 22.2% of staff correctly identified that the hepatocystic triangle must be cleared of both fatty and fibrous tissue.

Applied Variability: When staff noted a complete CVS, scores were more homogeneous among all groups.  When staff scored the CVS lower, there was greater variability among scores of trainees (93 responses).