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Acquiring Basic Surgical Skills: Is a Faculty Mentor Really Needed?

Acquiring Basic Surgical Skills: Is a Faculty Mentor Really Needed?. AR Jensen MD, AS Wright MD, AE Levy MD, LK McIntyre MD, HM Foy MD, CA Pellegrini MD, KD Horvath MD, and DJ Anastakis MD MEd MHCM Institute for Surgical and Interventional Simulation University of Washington, Seattle, WA.

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Acquiring Basic Surgical Skills: Is a Faculty Mentor Really Needed?

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  1. Acquiring Basic Surgical Skills: Is a Faculty Mentor Really Needed? AR Jensen MD, AS Wright MD, AE Levy MD, LK McIntyre MD, HM Foy MD, CA Pellegrini MD, KD Horvath MD, and DJ Anastakis MD MEd MHCM Institute for Surgical and Interventional Simulation University of Washington, Seattle, WA

  2. Background Operating Room The role of expert-directed training for Basic Skills is poorly defined Simulation Lab Self-Directed Potential to develop bad habits Expert-Directed Expensive Resource Intensive

  3. Definitions Technical Skills: Fundamentals of surgical technique Satava, et al. Surgical Endoscopy 2003

  4. Definitions Technical Skills: Fundamentals of surgical technique Complete Tasks: Isolated exercises requiring integration of multiple skills Satava, et al. Surgical Endoscopy 2003

  5. Definitions Technical Skills: Fundamentals of surgical technique Complete Tasks: Isolated exercises requiring integration of multiple skills Surgical Procedures: Surgical operations requiring the integration of several Skills and Tasks Satava, et al. Surgical Endoscopy 2003

  6. Definitions Technical Skills: Fundamentals of surgical technique Goal of Basic Skill training is transfer of training to more complex Tasks Complete Tasks: Isolated exercises requiring integration of multiple skills Surgical Procedures: Surgical operations requiring the integration of several Skills and Tasks Satava, et al. Surgical Endoscopy 2003

  7. Hypothesis The addition of an expert mentor to a Basic Skills training session (as compared to self-directed training) will improve performance on subsequent surgical Tasks • Two tasks evaluated • Three outcome measures per task

  8. Skill Training Self-Directed A Expert-Directed B Monday Methods • 45 Surgical Residents • 28-R1 and 17-R2 • 14 small groups • Groups stratified by R-Level and randomly assigned Task Outcomes Standardized Skin Excision and Closure Bowel Anastomosis • OSATS • Time to Completion • Final Product Quality Not Protected Cognitive Materials Wednesday

  9. Self-Directed 8 hours protected time 14 skills Access to materials Unlimited suture Books Knot-tying manuals Online text Streaming video Expert-Directed 8 hours protected time 14 skills Access to materials Unlimited suture Books Knot-tying manuals Online text Streaming video Faculty surgeon in lab Same surgeon for all labs Demonstration Feedback Basic Skills Training (Day One)

  10. Knot-tying Two-handed square Two-handed surgeon’s One-handed (left) One-handed (right) Suturing Simple Running Mattress Subcuticular Pursestring Figure-of-eight Basic Skills Training 14 Skills • Ligature • Free-tie (left) • Free-tie (right) • Sutured (left) • Sutured (right)

  11. Outcome Measures Transfer to More Complex Tasks - Day 2 • OSATS rating (Video) • Time to completion • Final Product Quality: • Aesthetic Rating (Photos) • Anastomotic Leak Pressure • Survey Data/Perceptions

  12. Experimental Design Skill Training Task Outcomes Self-Directed Standardized Skin Excision and Closure Bowel Anastomosis • OSATS • Time to Completion • Final Product Quality A Not Protected Expert-Directed Cognitive Materials B Monday Wednesday

  13. Results – Skin Closure 1Analysis of Covariance (ANCOVA), Covariates: Months of Training and Prior Post-Graduate Training 2Mann-Whitney U Test

  14. Results – Bowel Anastomosis 1Analysis of Covariance (ANCOVA), Covariates: Months of Training and Prior Post-Graduate Training 2Mann-Whitney U Test

  15. Results – Resident Perceptions Laboratory Factors

  16. Results – Resident Perceptions Transfer of Training

  17. Results – Resident Perceptions Trainee Preferences

  18. Summary of Results Subjective • Training is stress free • Training will transfer to OR • Expert-directed training is superior Objective • No significant differences between treatment groups except anastomotic leak pressure

  19. Interpretation of Results Really No Difference • Simple fundamental skills • Availability of multimedia Real Difference Not Seen • 14 skills/8 hours • Not enough time to practice • Distributed mentoring may be beneficial • Did not train to competence • Basic Skills not formally measured

  20. Conclusions • In this context, we must question the utility of faculty-directed training in Basic Technical Skills • It remains unclear what the role of faculty is for laboratory-based instruction of Basic Skills in other contexts • Intermittent mentorship/distributed learning

  21. Acknowledgements ASE Foundation SERF Faculty and Fellows

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