Performance Improvement With Implementation of a Surgical Skills Curriculum

Abstract

Objective To assess the efficacy of an intern surgical skills curriculum involving a boot camp for core open and laparoscopic skills, self-guided practice with positive and negative incentives, and semiannual performance evaluations. Design Longitudinal cohort study. Setting Academic tertiary care center. Participants Intervention group ( n = 15): residents who completed the intern surgical skills curriculum and had performance evaluations in fall of intern year, spring of intern year, and fall of second year. Control group ( n = 8): second-year residents who were 1 year ahead of the intervention group in the same residency program, did not participate in the curriculum, and had performance evaluations in fall of second year. Results In fall of second year of residency, the intervention group had better performance (presented as median values with interquartile ranges) than the control group on one-hand ties (left hand: 9.1 [6.3-10.1] vs 14.6 [13.5-15.4] seconds, p = 0.007; right hand: 8.7 [8.5-9.6] vs 11.5 [9.9-16.8] seconds, p = 0.039). The intervention group also had better performance on all open suturing skills, including mattress suturing (vertical: 33.4 [30.0-40.0] vs 55.8 [50.0-67.6] seconds, p = 0.001; horizontal: 28.7 [27.3-39.9] vs 52.7 [40.7-57.8] seconds, p = 0.003), and a water-filled glove clamp, divide, and ligate task (28.0 [25.0-31.0] vs 59.1 [53.0-93.0] seconds, p < 0.001). Finally, the intervention group had better performance on all laparoscopic skills, including peg transfer (66.0 [59.0-82.0] vs 95.2 [87.5-101.5] seconds, p = 0.018), circle cut (82.0 [69.0-124.0] seconds vs 191.8 [155.5-231.5] seconds, p = 0.002), and intracorporeal suturing (195.0 [117.0-200.0] seconds vs 359.5 [269.0-450.0] seconds, p = 0.002). Conclusions Implementation of a comprehensive surgical skills curriculum was associated with improved performance on core open and laparoscopic skills. Further research is needed to understand and optimize motivational factors for deliberate practice and surgical skill acquisition.

Laparoscopic simulation training for residents in obstetrics and gynecology over 12 months

“…[ 14 ] Previous research with non-FLS simulator box training reports mixed findings for simulation training performance for precision cutting where some report improved performance[ 13 ] while others do not report improved performance. [ 14 ] Our findings for FLS simulator box training are similar to those reporting decreased time[ 12 13 ] and improved performance. [ 13 ] We suggest that FLS simulator box training is helpful to residents with time decreases occurring over 6 months, while the higher level of improved performance passing rates needs more practice over 12 months.…”

“…However, performance of passing did not change over time. Previous research for non-FLS simulator box training reports reduced time for peg transfer[ 12 ] and improved performance for peg transfer. [ 13 ] Our findings for FLS simulator box training are similar to the time findings but are not similar to the performance findings.…”

“…Performance of passing also increased from baseline to 12 months. Previous research with non-FLS simulator box training reports mixed findings for simulation training time for precision cutting where some report a decrease[ 12 13 ] while others only report decreased time for certain types of residents. [ 14 ] Previous research with non-FLS simulator box training reports mixed findings for simulation training performance for precision cutting where some report improved performance[ 13 ] while others do not report improved performance.…”

“…Simulation training is reported as useful for obstetrics and gynecology residents where simulation training improved knowledge,[ 10 ] surgical skills assessed by virtual reality,[ 11 ] and surgical skills assessed in the operating room. [ 10 ] Simulation training reduced time for peg transfer[ 12 ] and intracorporeal suturing,[ 12 ] while some reported reduced time for circle cut,[ 12 13 ] and others only reported reduced time for circle cut for certain types of residents. [ 14 ] Simulation training improved performance for peg transfer[ 13 ] and single stitch/knot,[ 13 ] while some reported improved performance for circle cut[ 13 ] and others did not report any improved performance for circle cut.…”

“…We are aware of only one simulation study that has a follow-up over 1 year. [ 12 ] However, this was studied with general surgery residents and not obstetrics and gynecology residents. The FLS simulation studies[ 6 15 ] report better overall performance but do not specify performance for each of the tasks.…”