Surgeon-Authored Virtual Laparoscopic Adrenalectomy Module Is Judged Effective and Preferred Over Traditional Teaching Tools.

OBJECTIVE: The study assesses user acceptance and effectiveness of a surgeon-authored virtual reality (VR) training module authored by surgeons using the Toolkit for Illustration of Procedures in Surgery (TIPS). METHODS: Laparoscopic adrenalectomy was selected to test the TIPS framework on an unusual and complex procedure. No commercial simulation module exists to teach this procedure. A specialist surgeon authored the module, including force-feedback interactive simulation, and designed a quiz to test knowledge of the key procedural steps. Five practicing surgeons, with 15 to 24 years of experience, peer reviewed and tested the module. In all, 14 residents and 9 fellows trained with the module and answered the quiz, preuse and postuse. Participants received an overview during Surgical Grand Rounds session and a 20-minute one-on-one tutorial followed by 30 minutes of instruction in addition to a force-feedback interactive simulation session. Additionally, in answering questionnaires, the trainees reflected on their learning experience and their experience with the TIPS framework. RESULTS: Correct quiz response rates on procedural steps improved significantly postuse over preuse. In the questionnaire, 96% of the respondents stated that the TIPS module prepares them well or very well for the adrenalectomy, and 87% indicated that the module successfully teaches the steps of the procedure. All participants indicated that they preferred the module compared to training using purely physical props, one-on-one teaching, medical atlases, and video recordings. CONCLUSIONS: Improved quiz scores and endorsement by the participants of the TIPS adrenalectomy module establish the viability of surgeons authoring VR training.

Utilization of standardized patients to evaluate clinical and interpersonal skills of surgical residents.

BACKGROUND: This project was designed to determine the growth of interpersonal skills during the first year of a surgical residency. METHODS: All categorical surgical residents were given a clinical skills examination of abdominal pain using standardized patients during their orientation (T1). The categorical residents were retested after 11 months (T2). The assessment tool was based on a 12-item modified version of the 5-point Likert Interpersonal Scale (IP) used on the National Board of Medical Examiners prototype Clinical Skills Examination and a 24-item, done-or-not-done, history-taking checklist. Residents' self-evaluation scores were compared to standardized patients' assessment scores. Data were analyzed using the Pearson correlation coefficient, Wilcoxon signed rank test, Student t test, and Cronbach alpha. RESULTS: Thirty-eight categorical residents were evaluated at T1 and T2. At T1, in the history-taking exercise, the scores of the standardized patients and residents correlated (Pearson = .541, P = .000). In the interpersonal skills exercise, the scores of the standardized patients and residents did not correlate (Pearson = -0.238, P = .150). At T2, there was a significant improvement in the residents' self-evaluation scores in both the history-taking exercise (t = -3.280, P = .002) and the interpersonal skills exercise (t = 2.506, P = 0.017). In the history-taking exercise, the standardized patients' assessment scores correlated with the residents' self-evaluation scores (Pearson = 0.561, P = .000). In the interpersonal skills exercise, the standardized patients' assessment scores did not correlate with the residents' self-evaluation scores (Pearson = 0.078, P = .646). CONCLUSIONS: Surgical residents demonstrate a consistently low level of self-awareness regarding their interpersonal skills. Observed improvement in resident self-evaluation may be a function of growth in self-confidence.

Maintaining outcomes in a surgical residency while complying with resident working hour regulations.

BACKGROUND: Regulatory requirements for resident working hours were designed to improve patient care. Compliance challenges a training program to meet procedural and clinical requirements. This is a retrospective study of a 5-year experience in addressing the challenges and studying the impact of compliance on resident caseload and board performance. METHODS: Our surgical program adopted strict start/stop working hours for clinical contact. Program leadership modified the program to establish procedural and performance criteria. Procedures were prioritized and assignments were changed to maximize clinical and procedural experience while reducing redundancy of experience. Procedural activity was monitored frequently. Compliance with working hour regulations was monitored and behavior modified where necessary. A web based computer program was developed to improve measurement of compliance and provide feedback. Outcome measures included both the number of procedures as reported by the ACGME and performance on the American Board of Surgery, Qualifying Examination. RESULTS: Working hour compliance is greater than 95%. First time pass rate on the Qualifying examination is 90% (45/50). There is no significant difference in the procedural activity. CONCLUSION: Complying with working hour regulations improves the quality of a resident's life and can be achieved while maintaining procedural experience and guaranteeing academic development.