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accuracy, Acceptance and Compliance in the Use of a Web Based Audit Tool – Results of Phase 1

Abstract

Traditionally, surgical trainees have acquired their technical skills whilst working in the operating theatre alongside more senior surgeons in an apprenticeship model. Recently, changes in surgical practice have challenged this traditional approach, including reduced working hours, decreased availability of operating theatre time, increased cost of operating theatre time and increasing complexity of surgical procedures. Most importantly, public opinion is increasingly resistant to having patients used as teaching material. Moving forward in the 21st century, we need to develop a new model of technical skills acquisition. Surgical simulation offers a means of practicing surgical skills in a laboratory environment with no risk to patients. Simulators range from simple bench models, which are relatively inexpensive, to high tech virtual reality simulators. The Royal College of Surgeons in Ireland has developed a syllabus for operative surgery which is based on simulation and all trainees attend the National Surgical Training Centre on a regular recurrent basis, six times each year, for concentrated skills training. Simulation allows the standardisation of teaching technical skills and, most importantly, standardisation of assessment of technical skills. Furthermore, simulation offers trainees "permission to make mistakes" -a valuable learning exercise. Our trainees are assessed in the laboratory setting and must demonstrate proficiency before moving to the next stage of training (proficiency based progression). Simulation has played a key role in this process. PurposeAttaining procedural competence requires a combination of specific cognitive and psychomotor skills. The Multimedia Clinical Skills Trainer (MCST, GoVirtual Medical Ltd) is software program that integrates text, anatomy, video and simulation for teaching a range of procedures. The purpose of this study was to determine the face, content and construct validity of MCST for laparoscopic appendicectomy (LA). MethodologyThe study was supported by the RACS. Basic surgical trainees (BST) in NZ were recruited and randomized into a control group and an intervention group. The latter received MCST for ad libitum use on their personal computers. Participant received three questionnaires: at the start of the study to determine demographics, at 2 weeks to assess knowledge and problem solving ability, and at four months to assess operative confidence and usefulness of MCST. ResultsFifty-eight BST's were randomized. The first questionnaire was returned by 46% of participants, and third questionnaire by 44%. The intervention group scored more highly than the control group in the second questionnaire (14.69/20 vs 13.48/20). This difference was more apparent for first year BST's (14.93/20 vs 12.13/20, p = 0.04). Operative confidence was similar at four months for the two groups. First year BST's scored MCST more highly for its usefulness (5.2/7 vs 3.7/7, p = 0.04). ConclusionsMCST has face, content and construct validity for BST's learning LA, is a useful pre-learning t...