Implementation, Construct Validity, and Benefit of a Proficiency-Based Knot-Tying and Suturing Curriculum

Goova, Mouza T.; Hollett, Lisa A.; Tesfay, Seifu T.; Gala, Rajiv B.; Puzziferri, Nancy; Kehdy, Farid; Scott, Daniel J.

doi:10.1016/j.jsurg.2008.04.004

Cited by 74 publications

(36 citation statements)

References 36 publications

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“…Surgical skill instructors have attempted to do this. Expert instruction enhances performance of simple surgical procedures, specifically joint injection and knot-tying [8,9,12]. Evidence also suggests that the use of computer-based video instruction can be effective in teaching learners surgical skills such as knot-tying [11,21].…”

Section: Discussionmentioning

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: Discussionmentioning

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 efficacy of bench-top and laparoscopic box simulators in improving surgical skills has been validated by multiple studies (32,(38)(39)(40)(41). Observed benefits from using these simulators include the development of handeye coordination and dexterity in performing surgical tasks.…”

Section: Bench-top and Laparoscopic Box Simulatorsmentioning

confidence: 99%

Innovations in surgery simulation: a review of past, current and future techniques

Badash¹,

Burtt²,

Solorzano³

et al. 2016

Ann. Transl. Med.

261

165

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As a result of recent work-hours limitations and concerns for patient safety, innovations in extraclinical surgical simulation have become a desired part of residency education. Current simulation models, including cadaveric, animal, bench-top, virtual reality (VR) and robotic simulators are increasingly used in surgical training programs. Advances in telesurgery, three-dimensional (3D) printing, and the incorporation of patient-specific anatomy are paving the way for simulators to become integral components of medical training in the future.Evidence from the literature highlights the benefits of including simulations in surgical training; skills acquired through simulations translate into improvements in operating room performance. Moreover, simulations are rapidly incorporating new medical technologies and offer increasingly high-fidelity recreations of procedures. As a result, both novice and expert surgeons are able to benefit from their use. As dedicated, structured curricula are developed that incorporate simulations into daily resident training, simulated surgeries will strengthen the surgeon's skill set, decrease hospital costs, and improve patient outcomes.

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“…Los participantes, al realizar un punto simple, obtuvieron una mediana de puntaje OSATS pre entrenamiento de 10 [5][6][7][8][9][10][11][12][13][14][15][16][17] …”

Section: Evaluación De Punto Simpleunclassified

“…La simulación ha permitido la adquisición de competencias técnicas en cirugía tradicional abierta [6][7][8] y laparoscópica para postgrado [9][10][11][12] . Para su demostración se utilizan pautas que miden objetivamente la adquisión de habilidades, evaluando la técnica quirúrgica aprendida bajo una escala de puntaje, como el OSATS (Objective Structured Assessment of Technical Skills) 6 .…”

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Programa Pionero De Simulación en Sutura Para Estudiantes De Medicina De Pregrado

Alvarado

et al. 2015

Rev Chil Cir

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a pioneer simulation curriculum of suture technique training for medical students introduction: Simulation has demonstrated utility in suture skills training on surgical residents. Objective: Evaluate validity of a simulated training curriculum of basic suture skills for medical students. methods: Study conducted on 2013. Medical students were selected from the School of Medicine of Pontificia Universidad Católica de Chile (EMPUC). The program included four theoretical sessions and six practical sessions in order to training basic surgical tasks (five in total) on a simulated rubber model: one handed knot-tying, simple suture, vertical mattress suture, subcuticular interrupted suture and subcuticular running suture. A survey was applied to the participants to qualify each element of the program, on a scale of 1 to 7 (face-validity). One task (simple suture) was recorded on video, before and after training, to be evaluated by two experts on a blind fashion (content validity). Experts measure participant skills using an OSATS (Objective Structured Assessment of Technical Skills) and operative time. Statistical analysis for non-parametric variables, median and interquartile range, significant p-value < 0.05. results: Thirty-six medical students participated, with assistance percentage was over 80%. Students qualified the experience favorably: simulated bench-model 6.0 ; p < 0.001) after training in every participant. conclusion: This simulated curriculum delivers an alternative method for the development of technical competencies in medical students and could be incorporated on medical schools curricula.

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Implementation, Construct Validity, and Benefit of a Proficiency-Based Knot-Tying and Suturing Curriculum

Cited by 74 publications

References 36 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?

Innovations in surgery simulation: a review of past, current and future techniques

Programa Pionero De Simulación en Sutura Para Estudiantes De Medicina De Pregrado

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