Scenario Analysis: This scenario presents a professional challenge centered on ensuring patient safety and maintaining the integrity of surgical training and practice within the specialized field of neonatal surgery. The core difficulty lies in balancing the need for experienced surgical supervision with the developmental progression of a trainee surgeon. Misjudging the readiness for independent assessment or the appropriate level of supervision can lead to suboptimal patient outcomes, compromise the trainee’s learning experience, and potentially violate professional standards and regulatory expectations for competency assessment. Careful judgment is required to accurately gauge the trainee’s skills against established criteria. Correct Approach Analysis: The best professional practice involves a structured and objective assessment process that aligns with the stated purpose and eligibility criteria for the Applied Neonatal Surgery Competency Assessment. This approach prioritizes patient safety by ensuring that the trainee surgeon has met all prerequisite requirements and demonstrated the necessary skills and knowledge under supervised conditions before being deemed eligible for independent assessment. The purpose of such an assessment is to confirm a surgeon’s readiness to perform complex neonatal procedures with a defined level of autonomy, thereby safeguarding patients and upholding the standards of the specialty. Eligibility is typically defined by the successful completion of specific training modules, documented experience in a range of procedures, and positive evaluations from supervising consultants. This methodical approach ensures that the assessment is fair, valid, and serves its intended function of certifying competence. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the competency assessment without the trainee having fulfilled all documented eligibility criteria, such as insufficient supervised operative experience or incomplete prerequisite training modules. This failure directly contravenes the purpose of the assessment, which is to evaluate a surgeon who has already achieved a certain level of proficiency. It risks exposing patients to unnecessary risk and undermines the credibility of the assessment process. Another incorrect approach is to base eligibility for assessment solely on the subjective perception of the supervising consultant, without adherence to objective, pre-defined competency benchmarks. While consultant opinion is valuable, it must be grounded in measurable outcomes and documented performance. Relying solely on subjective judgment can lead to bias and may not accurately reflect the trainee’s ability to consistently perform safely and effectively across a range of scenarios, thus failing to meet the rigorous standards expected for neonatal surgery. A further incorrect approach is to interpret the “applied” nature of the assessment as a license to bypass formal eligibility checks, assuming that the assessment itself will reveal any deficiencies. The “applied” aspect refers to the practical demonstration of skills in a real-world setting, but this demonstration is predicated on the trainee meeting the established eligibility criteria beforehand. This misunderstanding can lead to premature assessment, potentially before the trainee has acquired the necessary foundational experience and skills, thereby compromising both patient safety and the validity of the assessment. Professional Reasoning: Professionals should approach competency assessment by first thoroughly understanding the established purpose and eligibility requirements for the specific assessment. This involves consulting official guidelines, training program curricula, and regulatory body pronouncements. The decision-making process should then involve a systematic review of the trainee’s documented progress against these criteria. Objective evidence, such as operative logs, case reviews, and formal feedback, should be prioritized. Any deviation from the established pathway should be carefully considered and justified, with patient safety and the integrity of the assessment process always being paramount. When in doubt, seeking clarification from training program directors or relevant professional bodies is advisable.

Scenario Analysis: This scenario is professionally challenging because it involves balancing the need for a standardized, objective assessment of competency with the inherent variability in individual learning curves and the potential for external factors to impact performance. The program director must make a critical decision that affects a trainee’s progression and the safety of future patients, requiring careful consideration of established policies and ethical obligations. The pressure to maintain high standards while also supporting a trainee necessitates a nuanced approach to retake policies. Correct Approach Analysis: The best professional practice involves a thorough review of the trainee’s performance data, including their initial assessment scores, any documented remediation efforts, and feedback from supervisors. This approach aligns with the principles of fair and transparent assessment, ensuring that decisions are evidence-based and not arbitrary. Adhering strictly to the established blueprint weighting and scoring criteria, as well as the documented retake policy, provides a clear and objective framework for evaluation. This ensures consistency and equity for all trainees, upholding the integrity of the assessment process and ultimately protecting patient safety by ensuring only demonstrably competent surgeons progress. The CISI guidelines emphasize the importance of clear, pre-defined assessment criteria and fair procedures for trainees. Incorrect Approaches Analysis: One incorrect approach would be to immediately grant a retake without a comprehensive review of the initial performance and remediation. This fails to uphold the integrity of the assessment process and the established retake policy. It bypasses the structured evaluation designed to identify specific areas of weakness and ensure adequate improvement, potentially allowing a less-than-competent surgeon to proceed, which is a significant ethical and patient safety concern. Another incorrect approach would be to deny a retake solely based on the initial failure, without considering the trainee’s overall progress, effort in remediation, or any extenuating circumstances that may have contributed to the performance. This approach lacks compassion and can be seen as punitive rather than developmental, potentially hindering a trainee’s ability to demonstrate their acquired competencies. It also deviates from the spirit of a competency assessment, which aims to ensure mastery, not simply to penalize initial shortcomings. Finally, an incorrect approach would be to arbitrarily change the scoring or weighting of the assessment for this specific trainee to allow them to pass. This undermines the entire assessment framework, rendering the blueprint weighting and scoring criteria meaningless. It introduces bias and unfairness, eroding trust in the assessment process and potentially compromising patient safety by lowering the bar for competency. Professional Reasoning: Professionals should approach such situations by first consulting the established program policies and guidelines, specifically the assessment blueprint, scoring rubrics, and retake procedures. They should then gather all relevant data pertaining to the trainee’s performance. A structured review process, involving objective evaluation against pre-defined criteria, is paramount. If the policy allows for discretion, this discretion should be exercised within the ethical boundaries of ensuring patient safety and maintaining professional standards, always prioritizing evidence-based decision-making and transparent communication with the trainee.

This scenario is professionally challenging because it requires a surgeon to balance the immediate need for effective surgical intervention with the paramount importance of patient safety, particularly in the delicate field of neonatal surgery. The choice of instrumentation and energy device directly impacts tissue handling, bleeding control, and the potential for iatrogenic injury, all of which are amplified in neonates due to their small size and immature physiology. Careful judgment is required to select the safest and most effective tools for the specific operative context. The best professional practice involves a meticulous pre-operative assessment of the neonate’s condition and the planned procedure to select instrumentation and energy devices that minimize tissue trauma and thermal spread. This includes utilizing specialized micro-instrumentation designed for neonatal anatomy and employing energy devices with precise control settings and appropriate safety features, such as bipolar electrocautery with integrated cutting capabilities or ultrasonic scalpels, to achieve hemostasis and dissection with minimal collateral damage. This approach aligns with the fundamental ethical principle of non-maleficence (do no harm) and the regulatory imperative to adhere to best practices in surgical care, ensuring that all available technological advancements are employed judiciously to optimize patient outcomes and minimize risks. Employing standard adult-sized instrumentation without appropriate modification or consideration for neonatal anatomy risks significant tissue damage, increased bleeding, and prolonged operative times, potentially leading to adverse outcomes. This approach fails to meet the standard of care expected in neonatal surgery and violates the principle of providing individualized, appropriate care. Using an energy device with excessive power settings or inadequate insulation, or one not designed for delicate tissue dissection, can lead to thermal injury to surrounding vital structures, such as nerves or blood vessels, resulting in severe complications. This constitutes a failure to exercise due diligence in device selection and application, directly contravening the duty of care owed to the patient. Opting for a technique that relies solely on mechanical division of tissues without adequate hemostasis, or using blunt dissection in areas where precise cutting is required, can lead to uncontrolled bleeding and increased operative time. This demonstrates a lack of understanding of the principles of surgical technique and hemostasis, potentially compromising patient stability and recovery. The professional decision-making process for similar situations should involve a systematic evaluation of the patient’s specific needs, the planned surgical intervention, and the available instrumentation and energy devices. This includes consulting relevant surgical literature, seeking advice from experienced colleagues, and prioritizing patient safety through the selection of the most appropriate and least invasive techniques and technologies. A thorough understanding of the biomechanical properties of neonatal tissues and the thermal characteristics of energy devices is crucial for making informed choices that optimize surgical outcomes.

This scenario presents a significant professional challenge due to the inherent instability of a neonate experiencing severe trauma and requiring immediate resuscitation. The critical nature of the situation, coupled with the need for rapid, coordinated action, demands a high level of clinical judgment and adherence to established protocols. The pressure to act quickly must be balanced with the imperative to ensure patient safety and ethical care. The best approach involves immediate initiation of the Neonatal Resuscitation Program (NRP) guidelines, focusing on the ABCs (Airway, Breathing, Circulation) and addressing any identifiable sources of shock or hypoperfusion. This includes prompt assessment of vital signs, establishment of intravenous access, administration of appropriate fluids and, if indicated, blood products, and consideration of vasopressors based on clinical response. This systematic, evidence-based approach ensures that the most life-threatening issues are addressed first in a structured manner, aligning with best practices in neonatal critical care and resuscitation. The ethical imperative to provide the highest standard of care in an emergency dictates adherence to established, validated protocols designed to maximize the chances of survival and minimize morbidity. An incorrect approach would be to prioritize the administration of broad-spectrum antibiotics before stabilizing the airway and circulation. While infection is a concern in trauma, immediate life threats like airway obstruction or profound hypovolemic shock take precedence. Delaying essential resuscitation measures to administer antibiotics would violate the principle of immediate life-saving intervention and could lead to irreversible organ damage or death. Another incorrect approach would be to delay definitive airway management in favor of obtaining detailed imaging studies. While diagnostic imaging is important, a compromised airway is an immediate threat that requires prompt intervention. Postponing intubation or other airway support to obtain X-rays or ultrasounds would be a failure to address the most critical physiological derangement first, potentially leading to hypoxia and further deterioration. Finally, an approach that involves administering a large bolus of crystalloid solution without reassessing the patient’s response or considering other potential causes of shock, such as hemorrhage, would be professionally unsound. While fluid resuscitation is a cornerstone of shock management, it must be guided by ongoing assessment and tailored to the specific etiology of the shock. Over-resuscitation with crystalloids can lead to complications like pulmonary edema and coagulopathy, and failing to consider blood products in a trauma setting where hemorrhage is likely is a significant oversight. Professionals should employ a structured decision-making process that prioritizes immediate life threats, follows established resuscitation algorithms (like NRP), and involves continuous reassessment of the patient’s condition. This process should also include clear communication within the resuscitation team and a willingness to adapt the plan based on the patient’s evolving status.

Scenario Analysis: This scenario presents a significant challenge due to the inherent complexity of neonatal surgical cases, the potential for rapid deterioration, and the critical need for timely, evidence-based decision-making. The pressure to act swiftly, coupled with the ethical imperative to involve the family in all aspects of care, creates a delicate balance. Misjudging the urgency or failing to adequately communicate with the family can lead to suboptimal outcomes and erode trust. Correct Approach Analysis: The best professional practice involves a structured, multi-disciplinary approach that prioritizes patient safety and family-centered care. This includes a thorough pre-operative assessment, clear communication of risks and benefits to the parents, and a collaborative decision-making process. The surgical team must be prepared to adapt their plan based on intra-operative findings and post-operative monitoring. This approach aligns with ethical principles of beneficence, non-maleficence, and respect for patient autonomy (exercised through parental consent). Regulatory frameworks in neonatal surgery emphasize the importance of informed consent and the involvement of a multidisciplinary team in complex cases. Incorrect Approaches Analysis: Proceeding with surgery without a comprehensive pre-operative assessment and clear parental understanding of the risks and benefits is ethically unsound and potentially violates informed consent regulations. This approach prioritizes intervention over patient safety and parental rights. Delaying surgery indefinitely due to parental hesitation without a thorough exploration of their concerns and providing comprehensive information about the necessity and potential consequences of delay is also professionally unacceptable. This fails to adequately address the child’s medical needs and can lead to preventable harm. Making unilateral decisions about the surgical plan without consulting the entire multidisciplinary team, including nursing staff and anaesthetists, increases the risk of overlooking critical factors and can lead to communication breakdowns and errors. This approach disregards the collaborative nature of safe surgical practice. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a comprehensive assessment of the patient’s condition. This should be followed by open and honest communication with the family, ensuring they understand the diagnosis, proposed treatment, potential risks, benefits, and alternatives. A multidisciplinary team meeting should then be convened to discuss the case, formulate a consensus plan, and identify potential challenges. Throughout the process, documentation of all discussions, decisions, and plans is crucial for accountability and continuity of care.

This scenario presents a significant professional challenge due to the inherent risks associated with complex neonatal surgical procedures and the critical need for timely, accurate management of unforeseen complications. The attending neonatologist faces a situation demanding immediate, expert decision-making under pressure, where patient outcomes are directly contingent on the chosen course of action. The challenge is amplified by the need to balance immediate patient needs with established protocols, ethical considerations, and the potential for long-term consequences. The best professional approach involves immediate, direct communication with the senior neonatologist and the surgical team, while simultaneously initiating evidence-based supportive care for the infant. This approach is correct because it prioritizes patient safety by ensuring that the most experienced clinicians are immediately involved in managing a critical situation. It aligns with ethical principles of beneficence and non-maleficence by seeking expert consultation to guide treatment and minimize harm. Furthermore, it adheres to professional guidelines that mandate clear communication and collaboration among healthcare providers in complex cases. This ensures that all available expertise is leveraged to make informed decisions regarding further diagnostic steps and therapeutic interventions, thereby optimizing the infant’s chances of a positive outcome. An incorrect approach would be to delay informing the senior neonatologist and surgical team while attempting to manage the complication independently. This fails to acknowledge the limits of one’s immediate expertise in a subspecialty context and risks delaying crucial interventions or misinterpreting critical signs, potentially leading to patient harm. Ethically, this could be seen as a breach of duty of care by not seeking the most appropriate expertise promptly. Another incorrect approach would be to immediately escalate to a more invasive or experimental intervention without thorough assessment and consultation. This disregards the principle of proportionality in medical treatment and could expose the infant to unnecessary risks and complications without a clear indication or established benefit. It bypasses the essential step of collaborative decision-making based on a comprehensive understanding of the situation. A further incorrect approach would be to focus solely on documenting the event without actively managing the infant’s immediate clinical status. While documentation is vital, it must not supersede the urgent need for clinical intervention and management in a life-threatening situation. This prioritizes administrative tasks over immediate patient care, which is ethically unacceptable. Professionals should employ a decision-making framework that begins with rapid assessment of the patient’s status, followed by immediate consultation with relevant specialists (senior neonatologists, surgeons). This framework emphasizes clear, concise communication, adherence to established protocols for managing known complications, and a commitment to evidence-based practice. It also requires a continuous re-evaluation of the patient’s condition and a willingness to adapt the management plan based on new information and expert consensus.

This scenario presents a significant professional challenge due to the inherent complexities and potential for adverse outcomes in neonatal surgery. The critical need for structured operative planning with robust risk mitigation stems from the vulnerability of neonates, the limited physiological reserve, and the potential for long-term sequelae. Careful judgment is paramount to ensure patient safety and optimize surgical outcomes. The best approach involves a comprehensive, multidisciplinary pre-operative assessment and planning session that explicitly identifies potential intra-operative and post-operative complications. This session should involve the entire surgical team, including surgeons, anesthesiologists, neonatologists, and nursing staff. The plan should detail contingency strategies for anticipated risks, such as specific equipment needs, alternative surgical approaches, and immediate management protocols for identified complications. This aligns with the ethical imperative of beneficence and non-maleficence, ensuring that all reasonable steps are taken to maximize benefit and minimize harm. Furthermore, it reflects the professional standards of care that mandate thorough preparation and anticipation of foreseeable risks in complex surgical procedures, as often underscored by professional bodies and institutional guidelines that emphasize patient safety and quality improvement. An approach that relies solely on the lead surgeon’s experience without formal team input or documented contingency plans is professionally unacceptable. This fails to leverage the collective expertise of the multidisciplinary team, increasing the risk of overlooking critical considerations or failing to adequately prepare for emergent situations. Ethically, it can be seen as a breach of the duty of care by not ensuring all available resources and knowledge are utilized for the patient’s benefit. Another unacceptable approach is to focus exclusively on the technical aspects of the primary surgical procedure while neglecting the detailed planning for potential complications and their management. This oversight can lead to delays and suboptimal responses when unforeseen events occur, potentially compromising patient safety and outcomes. It demonstrates a failure to adhere to the principles of comprehensive risk management, which is a cornerstone of safe surgical practice. Finally, an approach that delegates risk mitigation solely to junior team members without adequate oversight or integration into the overall operative plan is also professionally deficient. While fostering learning is important, critical risk assessment and mitigation strategies require the experience and authority of senior clinicians to be effectively implemented and integrated into the patient’s care pathway. This approach risks fragmenting responsibility and potentially missing crucial elements of the risk mitigation strategy. Professionals should employ a structured decision-making process that prioritizes patient safety through comprehensive, collaborative, and documented pre-operative planning. This involves actively seeking input from all relevant disciplines, systematically identifying potential risks, developing clear contingency plans, and ensuring that all team members understand their roles in managing these risks. Regular review and adaptation of these plans based on new information or evolving patient status are also essential components of this process.

Scenario Analysis: This scenario presents a professional challenge because the candidate is seeking guidance on preparing for a high-stakes competency assessment in a specialized surgical field. The challenge lies in balancing the candidate’s desire for efficient and effective preparation with the ethical and professional obligations to ensure their preparation is comprehensive, evidence-based, and aligns with established professional standards. Misguided preparation could lead to a failure to demonstrate competency, potentially impacting patient care and the candidate’s career progression. Careful judgment is required to steer the candidate towards resources and timelines that are both realistic and robust. Correct Approach Analysis: The best professional approach involves guiding the candidate to identify and utilize a structured, evidence-based preparation plan that incorporates a variety of learning modalities and allows for sufficient time for mastery. This includes consulting official assessment guidelines, engaging with peer-reviewed literature, seeking mentorship from experienced neonatologists and surgeons, and practicing with simulated scenarios. The timeline should be realistic, allowing for deep learning and skill consolidation rather than superficial review. This approach is correct because it directly addresses the requirements of the competency assessment by focusing on validated knowledge and skills, promotes a deep understanding of the subject matter, and aligns with the ethical imperative to ensure practitioners are adequately prepared to provide safe and effective patient care. It respects the rigor of the assessment process and the responsibility to the patient population. Incorrect Approaches Analysis: One incorrect approach involves recommending a highly condensed, last-minute cramming strategy based solely on anecdotal advice from colleagues who have previously passed the assessment. This is professionally unacceptable because it bypasses the need for systematic learning and evidence-based preparation. It risks superficial knowledge acquisition and fails to address potential gaps in the candidate’s understanding or skill set. Ethically, it compromises the commitment to patient safety by potentially allowing an inadequately prepared individual to pass an assessment. Another incorrect approach is to suggest that the candidate rely exclusively on a single, outdated textbook without supplementing it with current research or practical experience. This is professionally unsound as it limits the candidate’s exposure to the most up-to-date practices and evidence in neonatal surgery, which is a rapidly evolving field. It fails to acknowledge the dynamic nature of medical knowledge and the importance of continuous learning. This approach is ethically problematic as it may lead to the candidate being assessed on outdated information, which is detrimental to patient care. A further incorrect approach is to recommend that the candidate focus solely on memorizing potential exam questions from unofficial sources without understanding the underlying principles. This is a flawed strategy that prioritizes test-taking tactics over genuine competency. It does not foster the deep understanding and critical thinking skills necessary for effective neonatal surgical practice. Ethically, this approach undermines the integrity of the assessment process and poses a risk to patient safety by promoting a superficial grasp of complex surgical concepts. Professional Reasoning: Professionals should approach guiding candidates for competency assessments by first understanding the official requirements and scope of the assessment. They should then advocate for a preparation strategy that is systematic, evidence-based, and incorporates diverse learning methods. This involves encouraging the candidate to seek out official study guides, relevant literature, and opportunities for hands-on practice or simulation. A realistic timeline that allows for mastery, not just memorization, is crucial. Mentorship and peer discussion can be valuable, but should supplement, not replace, a structured, evidence-informed approach. The ultimate goal is to ensure the candidate develops genuine competency, which is paramount for patient safety and professional integrity.

This scenario presents a professionally challenging situation due to the inherent risks associated with neonatal surgery, particularly when dealing with complex congenital anomalies. The critical need for precise anatomical knowledge, understanding of immature physiological systems, and meticulous perioperative management places immense pressure on the surgical team. The challenge lies in balancing the urgency of intervention with the fragility of the neonate, requiring a highly coordinated and evidence-based approach. Careful judgment is paramount to minimize morbidity and mortality. The approach that represents best professional practice involves a comprehensive pre-operative assessment that meticulously reviews all available imaging and clinical data to precisely delineate the anatomical defect and assess the neonate’s physiological status. This includes a thorough understanding of the specific embryological origins of the anomaly and its potential impact on surrounding structures. This approach is correct because it aligns with the fundamental principles of patient safety and evidence-based medicine, emphasizing thorough preparation and risk mitigation. Ethically, it upholds the principle of beneficence by ensuring that the surgical plan is tailored to the individual neonate’s needs, minimizing unnecessary risks. Regulatory frameworks, such as those governing surgical practice and patient care standards, mandate such comprehensive pre-operative evaluations to ensure competence and safety. An approach that relies solely on intraoperative findings to guide the surgical strategy without adequate pre-operative anatomical mapping is professionally unacceptable. This failure constitutes a significant ethical lapse, potentially violating the principle of non-maleficence by exposing the neonate to unforeseen risks due to a lack of preparedness. It also falls short of regulatory expectations for due diligence and patient safety. Another professionally unacceptable approach would be to proceed with surgery based on a generalized understanding of the anomaly without considering the specific physiological limitations of the neonate, such as immature thermoregulation, cardiovascular instability, or altered pharmacokinetics. This demonstrates a lack of applied physiological understanding and a failure to adhere to best practices in perioperative care, potentially leading to adverse outcomes and contravening ethical obligations to provide individualized care. Finally, an approach that neglects to involve a multidisciplinary team, including neonatologists, anesthesiologists, and specialized nurses, in the pre-operative planning and perioperative management is also professionally unsound. This isolation of the surgical decision-making process undermines the collaborative nature of modern neonatal care and can lead to fragmented care, increased risk of errors, and a failure to optimize the neonate’s overall well-being, which is a cornerstone of ethical and regulatory compliance in complex pediatric surgery. The professional reasoning framework for similar situations should involve a systematic process: 1) Thoroughly review all available diagnostic information. 2) Integrate anatomical and physiological knowledge specific to the neonate and the anomaly. 3) Consult with the multidisciplinary team to formulate a comprehensive, individualized surgical plan. 4) Continuously reassess the neonate’s status throughout the perioperative period. 5) Document all decisions and rationale meticulously.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for process improvement with the sensitive nature of reviewing adverse events. The surgical team must foster an environment of open reporting and learning without creating a culture of blame, which is crucial for effective quality assurance and morbidity and mortality review in neonatal surgery. Human factors are paramount, as errors in this high-stakes environment can have devastating consequences. Correct Approach Analysis: The best professional practice involves a systematic, multidisciplinary approach to morbidity and mortality review that prioritizes identifying systemic issues and human factors contributing to adverse events. This includes a thorough, non-punitive investigation of each case, utilizing structured tools and frameworks to analyze the sequence of events, decision-making processes, and environmental influences. The focus is on learning from each event to implement targeted improvements in protocols, training, and system design, thereby enhancing patient safety and reducing future morbidity and mortality. This aligns with the ethical imperative to provide the highest standard of care and the professional responsibility to continuously improve practice. Incorrect Approaches Analysis: One incorrect approach involves focusing solely on individual performance and assigning blame to specific team members. This fails to acknowledge the complex interplay of human factors, system design, and organizational culture that often contribute to adverse events. Such an approach can lead to a culture of fear, discouraging open reporting and hindering the identification of systemic vulnerabilities, thereby undermining the goals of quality assurance and morbidity and mortality review. It also violates ethical principles of fairness and due process. Another incorrect approach is to dismiss adverse events as isolated incidents without conducting a thorough review. This neglects the opportunity to learn from mistakes and implement preventative measures. It demonstrates a lack of commitment to quality assurance and patient safety, potentially leading to repeated errors and increased patient harm. Ethically, this represents a failure to uphold the duty of care. A third incorrect approach is to rely solely on anecdotal evidence or informal discussions to identify areas for improvement. While valuable for initial awareness, this lacks the rigor required for effective quality assurance. Without systematic data collection and analysis, potential root causes may be missed, and interventions may not be evidence-based or effective. This approach fails to meet the standards of professional accountability and evidence-based practice. Professional Reasoning: Professionals should approach morbidity and mortality reviews with a commitment to continuous learning and patient safety. This involves adopting a structured, multidisciplinary process that emphasizes identifying systemic and human factors. When reviewing adverse events, professionals should ask: What happened? Why did it happen? What can we learn from this? How can we prevent it from happening again? This iterative process, grounded in a culture of psychological safety and a commitment to evidence-based practice, is essential for optimizing care in neonatal surgery.