Impact of Educational Intervention on Confidence and Competence in the Performance of a Simple Surgical Task

Leopold, Seth S.; Morgan, Hannah D.; Kadel, Nancy J.; Gardner, Gregory; Schaad, Douglas C.; Wolf, Fredric M.

doi:10.2106/00004623-200505000-00014

Cited by 63 publications

(61 citation statements)

References 17 publications

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“…Surgical skill instructors have attempted to do this. Expert instruction enhances performance of simple surgical procedures, specifically joint injection and knot-tying [8,9,12]. Evidence also suggests that the use of computer-based video instruction can be effective in teaching learners surgical skills such as knot-tying [11,21].…”

Section: Discussionmentioning

confidence: 99%

Is Teaching Simple Surgical Skills Using an Operant Learning Program More Effective Than Teaching by Demonstration?

Levy

McKeon²

2016

Clinical Orthopaedics &Amp; Related Research

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Background A surgical procedure is a complex behavior that can be constructed from foundation or component behaviors. Both the component and the composite behaviors built from them are much more likely to recur if it they are reinforced (operant learning). Behaviors in humans have been successfully reinforced using the acoustic stimulus from a mechanical clicker, where the clicker serves as a conditioned reinforcer that communicates in a way that is language-and judgment-free; however, to our knowledge, the use of operant-learning principles has not been formally evaluated for acquisition of surgical skills. Questions/purposes Two surgical tasks were taught and compared using two teaching strategies: (1) an operant learning methodology using a conditioned, acoustic reinforcer (a clicker) for positive reinforcement; and (2) a more classical approach using demonstration alone. Our goal was to determine whether a group that is taught a surgical skill using an operant learning procedure would more precisely perform that skill than a group that is taught by demonstration alone. Methods Two specific behaviors, ''tying the locking, sliding knot'' and ''making a low-angle drill hole,'' were taught to the 2014 Postgraduate Year (PGY)-1 class and first-and second-year medical students, using an operant learning procedure incorporating precise scripts along with acoustic feedback. The control groups, composed of PGY-1 and -2 nonorthopaedic surgical residents and first-and second-year medical students, were taught using demonstration alone. The precision and speed of each behavior was recorded for each individual by a single experienced surgeon, skilled in operant learning. The groups were then compared. Results The operant learning group achieved better precision tying the locking, sliding knot than did the control group. Twelve of the 12 test group learners tied the knot and precisely performed all six component steps, whereas only four of the 12 control group learners tied the knot and correctly performed all six component steps (the test group median was 10 [range, 10-10], the control group median was 0 [range, 0-10], p = 0.004). However, the median ''time to tie the first knot'' for the test group was longer than for the control group (test group median 271 seconds [range, 184-626 Conclusions Operant learning occurs as the behavior is constructed and is highly reinforced with the result measured, not in the time saved, but in the ultimate outcome of an accurately built complex behavior. Level of Evidence Level II, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Is Teaching Simple Surgical Skills Using an Operant Learning Program More Effective Than Teaching by Demonstration?

Levy

McKeon²

2016

Clinical Orthopaedics &Amp; Related Research

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“…Dr. Ring: The answer to a survey question about trust in the evidence base may be measuring faith and confidence in authority more so than it measures whether or not a surgeon does or does not use treatments that are unsupported by evidence (such as corticosteroid injection for tennis elbow). And while there likely are some variations by race, gender, and culture-such as those that you and others [9,10] have observed-I believe it is safe to assume that the associations we observed represent basic human traits that would remain relatively consistent in other settings.…”

Section: Dr Leopoldmentioning

confidence: 67%

Editor's Spotlight/Take 5: Do Orthopaedic Surgeons Acknowledge Uncertainty?

Leopold

2016

Clinical Orthopaedics &Amp; Related Research

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“…7,9 Our residents' self-reported confidence levels declined in correspondence with the lack of experience in performing actual procedures. For example, confidence to perform shoulder injections (specifically, the subacromial bursa) decreased more than the confidence to perform knee injections, reflecting the fewer opportunities for residents to perform shoulder injections as compared with knee injections.…”

Section: Discussionmentioning

confidence: 96%

“…4 Simulation-based learning provides a low risk, predictable, and reproducible environment that has been embraced as a solution to teach learners new procedures without compromising patient safety. 5,6 Many studies, [7][8][9][10][11] including a few that specifically examined teaching arthrocentesis and intra-articular injection techniques, report preintervention to postintervention increases in…”

Section: Introductionmentioning

confidence: 99%

Impact of Web-Based Review on Long-Term Retention of Simulation-Acquired Knee and Shoulder Aspiration and Injection Skills

Preisner¹,

Jasti²,

Elnicki³

et al. 2012

Journal of Graduate Medical Education

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Background Musculoskeletal problems are the reason for one-quarter of primary care visits. Opportunities for internal medicine residents to perform joint aspirations and injections have declined. Simulation has been shown to improve procedure skills post completion of simulation courses, yet controversy exists about the durability of simulation-acquired skills. Objective To investigate whether web-based review preserves residents' joint procedure skills 6 to 30 months after a simulation course. Methods Postgraduate year–1 internal medicine residents participated in a simulation-based Joint Aspiration Injection Course consisting of web-based instructional material, guided practice on joint models, and a multiple-choice test. Procedure proficiency was scored by using a 3-component skills checklist. Six to 30 months later, residents who had participated in the simulation were randomly assigned to review or not to review the original web-based instructional material before retesting. The groups were compared by using Wilcoxon rank sum and matched pairs signed rank tests. Results Compared to the performance at the end of the simulation course, scores of all 3 procedure components declined (informed consent, 64.7–43.0 versus 30.6–23.8, P < .001; procedure proficiency, 63.4–61.7 versus 46.4–44.3, P < .001; and postprocedure instructions, 58.0–54.1 versus 29.9–29.4, P < .001). However, the review group outperformed the nonreview group on informed consent (shoulder: 37.1 versus 24.6, P = .01) and postprocedure instructions (shoulder: 34.0 versus 25.2, P = .01; knee: 35.5 versus 24.8, P < .001). Residents who reported doing actual procedures maintained a higher confidence level, compared with those reporting none (6.8–5.1 versus 4.1–3.6, P < .001). Conclusion Shoulder and knee simulation-acquired skills declined 6 to 30 months after a simulation course. However, rereview of web-based instructional material improved proficiency in informed consent, shoulder, and postprocedure instructions, shoulder and knee.

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Impact of Educational Intervention on Confidence and Competence in the Performance of a Simple Surgical Task

Cited by 63 publications

References 17 publications

Is Teaching Simple Surgical Skills Using an Operant Learning Program More Effective Than Teaching by Demonstration?

Is Teaching Simple Surgical Skills Using an Operant Learning Program More Effective Than Teaching by Demonstration?

Editor's Spotlight/Take 5: Do Orthopaedic Surgeons Acknowledge Uncertainty?

Impact of Web-Based Review on Long-Term Retention of Simulation-Acquired Knee and Shoulder Aspiration and Injection Skills

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