A Novel Paradigm for Surgical Skills Training and Assessment of Competency

Abstract

Sustainment of comprehensive procedural skills in trauma surgery is a particular problem for surgeons in rural, global, and combat settings. Trauma care often requires open surgical procedures for low-frequency/high-risk injuries at a time when open surgical experience is declining in general and trauma surgery training.OBJECTIVE To determine whether general surgeons participating in a 2-day standardized trauma skills course demonstrate measurable improvement in accuracy and independent performance of specific trauma skills.DESIGN, SETTING, AND PARTICIPANTS General surgeons in active surgical practice were enrolled from a simulation center with anatomic laboratory from October 2019 to October 2020. Differences in pretraining/training and posttraining performance outcomes were examined using (1) pretraining/posttraining surveys, (2) pretraining/posttraining knowledge assessment, and (3) training/posttraining faculty assessment. Analysis took place in November 2020.INTERVENTIONS A 2-day standardized, immersive, cadaver-based skills course, developed with best practices in instructional design, that teaches and assesses 24 trauma surgical procedures was used. MAIN OUTCOMES AND MEASURESTrauma surgery capability, as measured by confidence, knowledge, abilities, and independent performance of specific trauma surgical procedures; 3-month posttraining skill transfer. RESULTSThe study cohort included 65 active-duty general surgeons, of which 16 (25%) were women and 49 (75%) were men. The mean (SD) age was 38.5 (4.2) years. Before and during training, 1 of 65 participants (1%) were able to accurately perform all 24 procedures without guidance. After course training, 64 participants (99%) met the benchmark performance requirements for the 24 trauma procedures, and 51 (78%) were able to perform them without guidance. Procedural confidence and knowledge increased significantly from before to after the course. At 3 months after training, 37 participants (56%) reported skill transfer to trauma or other procedures. CONCLUSIONS AND RELEVANCEIn this study, direct measurement of procedural performance following standardized training demonstrated significant improvement in skill performance in a broad array of trauma procedures. This model may be useful for assessment of procedural competence in other specialties.

Self-efficacy and application of skills in the workplace after multidisciplinary trauma masterclass participation: a mixed methods survey and interview study

“…An increase in self-efficacy in trauma management skills after the trauma masterclass participation is in line with the preceding research among participants of the DSATC courses between 2013 and 2016, the ASSET, ATOM, and Norwegian trauma course [8][9][10]12]. Remarkably, Ali et al found that knowledge on trauma management measured on a multiple-choice test did not improve as much as expected after the ATLS course [9].…”

“…Various courses have been developed to provide alternative training opportunities in trauma care, beyond the basic principles of the Advanced Trauma Life Support (ATLS). The Advanced Surgical Skills for Exposure in Trauma (ASSET), Advanced Trauma Operative Management (ATOM), Definitive Surgical and Anesthetic Trauma Care (DSTC and DATC), and Norwegian trauma courses have demonstrated a correlation with greater trauma skills and self-efficacy levels [8][9][10][11][12][13]. However, the educational rationale on how these teaching formats enhance domainspecific skills and self-efficacy in the workplace has been insufficiently explored.…”

The Experienced Surgeon and New Tricks—It’s Time for Full Adoption and Support of Automated Performance Metrics and Databases

“…2 Independent of learning modality, the fundamental foundation for training success both in and outside of the operating room still lies in the assessment. 3 In this issue of JAMA Surgery, using cadavers, procedurespecific assessments, and coaching, Bowyer et al 4 found that general surgeons (N = 65) with no prior trauma training could be trained to a proficiency benchmark for 24 trauma skills during a 2-day course. A major feature of the course was realtime formative and summative assessments combined with one-on-one meetings with coaches to review performance assessment details.…”

Acquisition and retention of military surgical competencies: a survey of surgeons’ experiences in the UK Defence Medical Services

“…The UK Defence Medical Services (DMS) and our allies recognise the difficulties associated with acquisition and retention of militarily relevant surgical knowledge, skills and abilities among their surgical cadres 3–6. Training opportunities have been limited by factors such as the limited penetrating trauma workload in non-deployed roles,4 interruptions to training during the COVID-19 pandemic,7 and reduced deployed experience since the cessation of combat operations in Iraq and Afghanistan.…”