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Background

Randomized double-blinded trial investigating the impact of a curriculum focused on error recognition on laparoscopic suturing training. J Bingener, T Boyd, K Van Sickle, I Jung, A Saha, J Winston, P Lopez, H Ojeda, W Schwesinger, D Anastakis. Background.

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Background

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  1. Randomized double-blinded trial investigating the impact of a curriculum focused on error recognition on laparoscopic suturing training J Bingener, T Boyd, K Van Sickle, I Jung, A Saha, J Winston, P Lopez, H Ojeda, W Schwesinger, D Anastakis

  2. Background • Laparoscopic intracorporeal suturing not easy to learn • Best learned outside patient care setting • Computer and box training tools

  3. Background • Suturing skills – imitation learning • “ this is how I do it” - “don’t do it like this” • Knowledge based errors

  4. Surgical skill is predicted by the ability to detect errors (Bann S et al. Am J Surg 189 (2005) 412-415) Observed surgical skill (OSATS) Error detection on 22 models presented

  5. Question Will the inclusion of an error recognition module in the laparoscopic suturing curriculum • enable error recognition and • improve the technical proficiency of the learner?

  6. Study design • Study population: • 30 novices • randomized to A: control group B: intervention group • Learners blinded to group assignment • Video-instruction for laparoscopic suturing

  7. Questionnaire Suturing video (1) Pretest: suturing task time OSATS video score Group B Group A Error recognition video (2) Suturing practice Suturing practice post test: post test: OSATS video score Error counting video (3) Error counting video (3) OSATS video score Suturing task time Suturing task time

  8. Study design • No feed-back during study • Same investigator • Study period: 2 summer months • Time line Group A Group B

  9. Metrics • Pre and post training laparoscopic suturing task time (seconds) • Pre and post training OSATS score (1-5) • Post training error recognition score (% errors recognized in video compared to experts)

  10. Reviewer preparation • Reviewers watched novice and expert video for “calibration” • Blinded to group assignment • Independent review after study period • Kendall’s Tau for correlation 0.6 <τ <0.99

  11. Demographics

  12. Results – Task Time

  13. Task Time by covariates

  14. Mean overall OSATS scores

  15. OSATS sub-scores p=0.63 P=0.53 Mean OSATS scores for instrument handling Mean OSATS scores for task forward flow

  16. p=0.43 p=0.62 Mean OSATS scores for knowledge of task Mean OSATS scores for respect for tissue p=0.066 Mean OSATS scores for time motion efficiency

  17. Errors recognized (video 3)

  18. Results - summary • Additional error recognition teaching • Slowed down learner in task performance • Did not change OSAT scores • Led to cognitive error recognition

  19. Visual information overload? Group B Corrrect pattern Error pattern Incorrect pattern Group A • Timing of error teaching module • Time to practice • Repetitive practice • Separate days

  20. Attentional capacity threshold Attentional resources Use of Attentional Resources Gallagher et al Gaining additional knowledge Comprehending Attending instruction Judgement & Decision making Depth & Spatial judgments Psychomotor performance Novice surgeon Pre-trained Novice Master surgeon

  21. Future Research Directions • Modify instruction timing • Modify learner group (pre-trained novice/ intermediate learner) • Use video-game experience as randomization criterion

  22. Thank you

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