The New ACS/APDS Skills Curriculum: Moving the Learning Curve Out of the Operating Room

Scott, Daniel J.; Dunnington, Gary L.

doi:10.1007/s11605-007-0357-y

Cited by 286 publications

(161 citation statements)

References 45 publications

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“…Time constraints from work-hour regulations, time pressures on surgeon teachers, and the limited experience with using tools that many residents bring to orthopaedic programs make learning these skills more challenging [16,18]. Accomplishing this, with both time and financial sensitivity, is a challenge that requires creative solutions, including efficient teaching models, creative and inexpensive skills modules, and motivating performance criteria [10].…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…The findings are important to faculty members looking to start a simulation program. The article 26 summarized recent changes in surgical education that have led to greater emphasis on simulation, including limited trainee work hours, real or perceived decreases in case volumes, and broader and more structured educational objectives. A 3-phase curriculum development plan was created: basic and core skills first, followed by advanced skills, and finally a set of team-based skills.…”

Section: The Authorsmentioning

confidence: 99%

Review of Influential Articles in Surgical Education: 2002–2012

Wohlauer¹,

George²,

Lawrence³

et al. 2013

Journal of Graduate Medical Education

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Background Exploring the trends in surgical education research offers insight into concerns, developments, and questions researchers are exploring that are relevant to teaching and learning in surgical specialties. Objective We conducted a review of the surgical education literature published between 2002 and 2012. The purpose was 2-fold: to provide an overview of the most frequently cited articles in the field of surgical education during the last decade and to describe the study designs and themes featured in these articles. Methods Articles were identified through Web of Science by using “surgical education” and “English language” as search terms. Using a feature in Web of Science, we tracked the number of citations of any publication. Of the 800 articles produced by the initial search, we initially selected 23 articles with 45 or more citations, and ultimately chose the 20 articles that were most frequently cited for our analysis. Results Analysis of the most frequently cited articles published in US journals between the years 2002–2012 identified 7 research themes and presented them in order of frequency with which they appear: use of simulation, issues in student/resident assessment, specialty choice, patient safety, team training, clinical competence assessment, and teaching the clinical sciences, with surgical simulation being the central theme. Researchers primarily used descriptive methods. Conclusions Popular themes in surgical education research illuminate the information needs of surgical educators as well as topics of high interest to the surgical community.

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“…[91][92][93] This program should constitute knowledge-based learning, a stepwise technical skills pathway, provision of ongoing feedback as based on validated metrics, and measurable progression toward proficiency goals, thereby enabling transfer to a realistic environment. Scott and Dunnington 93 described the National Skills Curriculum designed by the American College of Surgeons; the College stated that ''distributed, deliberate and structured practice using performance-based endpoints is an ideal method for teaching many technical skills using simulators to ensure ''operating room readiness'' for residents.…”

Section: Van Empel Et Almentioning

confidence: 99%

Mapping the Maze of Minimally Invasive Surgery Simulators

Empel

Veer

Rijssen

et al. 2012

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Conforming to, among other considerations, legal and ethical concerns for patient safety, there is an increasing demand to assess a surgeon's skills prior to performance in the operating room in pursuit of higherquality treatment. Training in minimally invasive surgery (MIS) must therefore be intensified, including team training. New methods to train and assess minimally invasive surgical skills are gaining interest. The goal of this review is to provide instructors with an overview of available MIS training tools. In this review, we discuss currently available simulators for MIS training. Applicability, validity, and construction of simulators are reviewed. Also, some of the leading training programs and assessment methods in MIS are reviewed. Methods: A literature search was performed on studies evaluating surgical task performance on a simulator, reviewing satisfaction with laparoscopic training programs, or validating simulators or assessment methods. Results: Simulators may be divided into simple box trainers and computer-based systems, such as virtual and augmented simulators. All have advantages and disadvantages. An overview is provided of currently available training systems, validity, trainee assessment, and the importance of training programs in MIS. Conclusions:No simulator yet provides the ability to train the entire set of required psychomotor skills or procedures for MIS. A multiyear training program combining various simulators for multiple-level training, including team training, should be constructed.

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The New ACS/APDS Skills Curriculum: Moving the Learning Curve Out of the Operating Room

Cited by 286 publications

References 45 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?

Review of Influential Articles in Surgical Education: 2002–2012

Mapping the Maze of Minimally Invasive Surgery Simulators

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