Association for Surgical Education
Acquiring basic surgical skills: Is a faculty mentor really needed?

Presented at the 2008 Association for Surgical Education, April 17, 2008, Toronto, Ontario, Canada.
https://doi.org/10.1016/j.amjsurg.2008.06.039Get rights and content

Abstract

Background

We evaluated the impact of expert instruction during laboratory-based basic surgical skills training on subsequent performance of more complex surgical tasks.

Methods

Forty-five junior residents were randomized to learn basic surgical skills in either a self-directed or faculty-directed fashion. Residents returned to the laboratory 2 days later and were evaluated while performing 2 tasks: skin closure and bowel anastomosis. Outcome measures included Objective Structured Assessment of Technical Skill, time to completion, final product quality, and resident perceptions.

Results

Objective Structured Assessment of Technical Skill, time to completion, and skin esthetic ratings were not better in the faculty-directed group, although isolated improvement in anastomotic leak pressure was seen. Residents perceived faculty-directed training to be superior.

Conclusions

Our data provided minimal objective evidence that faculty-directed training improved transfer of learned skills to more complex tasks. Residents perceived that there was a benefit of faculty mentoring. Curriculum factors related to training of basic skills and subsequent transfer to more complex tasks may explain these contrasting results.

Section snippets

Study population and group assignment

First- and second-year (R1 and R2) surgical residents, both preliminary and categorical, were recruited to participate in the study during a dedicated rotation in which residents have time protected for laboratory-based technical skills training. Study procedures were performed over the course of 12 months at the University of Washington Institute for Surgical and Interventional Simulation. Participation in basic skills training and subsequent task performance were required by the residency

Results

Forty-five surgical residents participated in the study. Confounding factors were not significantly different between groups (Table 1). Prior surgical experience was homogenous among residents and was not suitable for inclusion as a covariate in the statistical model. Most residents had performed a significant number of skin closures and few had performed a bowel anastomosis. Inter-rater reliability of skin closure esthetic quality composite scores was acceptable (Cronbach α = .8). Significant

Comments

This study was designed to help elucidate the effect of 8 hours of expert-directed basic technical skills instruction as a function of differential transfer of learned skills to more complex tasks. Other studies of transfer of training after isolated partial-task simulation have shown the following: (1) correlation between performance on a laboratory model and operating room performance for saphenofemoral dissection; (2) equivalence between cadaver-based training and low-fidelity bench models

Conclusions

The addition of an expert mentor to a day-long basic technical skills training laboratory did not result in objective improvements in the performance of 2 more complex tasks. Indeed, outcomes for skin closure and bowel anastomosis were similar among residents who had acquired 14 basic skills by self-directed practice when compared with those who acquired those skills under faculty-directed supervision. In this context, we must question the utility of using valuable faculty time. Other contexts

References (22)

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None of the authors has received financial support or has a conflict of interest related to this study to disclose.

University of Washington Human Subjects Approval # 06-1593-E/A 01.

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