Opportunities and Applications of Educational Technologies in Surgical Education and Assessment.

BACKGROUND: Surgical education is challenged by continuously increasing clinical content, greater subspecialization, and public scrutiny of access to high quality surgical care. Since the last Blue Ribbon Committee on surgical education, novel technologies have been developed including artificial intelligence and telecommunication. OBJECTIVES AND METHODS: The goals of this Blue Ribbon Sub-Committee were to describe the latest technological advances and construct a framework for applying these technologies to improve the effectiveness and efficiency of surgical education and assessment. An additional goal was to identify implementation frameworks and strategies for centers with different resources and access. All sub-committee recommendations were included in a Delphi consensus process with the entire Blue Ribbon Committee (N=67). RESULTS: Our sub-committee found several new technologies and opportunities that are well poised to improve the effectiveness and efficiency of surgical education and assessment (see Tables 1-3). Our top recommendation was that a Multidisciplinary Surgical Educational Council be established to serve as an oversight body to develop consensus, facilitate implementation, and establish best practices for technology implementation and assessment. This recommendation achieved 93% consensus during the first round of the Delphi process. CONCLUSION: Advances in technology-based assessment, data analytics, and behavioral analysis now allow us to create personalized educational programs based on individual preferences and learning styles. If implemented properly, education technology has the promise of improving the quality and efficiency of surgical education and decreasing the demands on clinical faculty.

Establishing validity evidence for device-assisted advanced laparoscopic suturing tasks using simulation.

BACKGROUND: Laparoscopic suturing (LS) is an essential technique required for a wide range of procedures, and it is one of the most challenging for surgical trainees to master. We designed and collected validity evidence for advanced LS tasks using an automated suturing device and evaluated the perceived educational value of the tasks. METHODS: This project was a multicentre prospective study involving McGill University, University of Toronto (UofT), and Louisiana State University (LSU) Health New Orleans. Novice (NS) and experienced (ES) surgeons performed suturing under tension (UT) and continuous suturing (CS) tasks. ES performed the tasks twice to establish proficiency benchmarks, and they were interviewed to develop formative feedback tools (FFT). Participants were assessed on completion time, error, Global Operative Assessment of Laparoscopic Skills (GOALS), and FFT. Data were analyzed using descriptive and inferential statistical methods. RESULTS: Twenty-seven participants (13 ES, 14 NS, median age 34 years; 85% male) completed the study. Eight were attending surgeons, 7 fellows, 4 PGY5, 5 PGY4, and 3 PGY3 (18 from McGill, 5 UofT, and 4 LSU). Comparing ES and NS, for UT task, ES had significantly greater task scores (570 [563-648] vs 323 [130-464], p value 0.00036) and GOALS scores (14 [13-16] vs 10 [8-12], p value 0.0038). Similarly, for CS, ES had significantly greater task scores (976 [959-1010] vs 785 [626-856], p value 0.00009) and GOALS scores (16 [12-17] vs 12.5 [8.25-15], p value 0.028). After FFTs were developed, comparing ES and NS, for both UT and CS tasks, ES had significantly greater FFT scores (UT 25 [24-26] vs 17 [14-20], p value 0.0016 and CS 30 [27-32] vs 22[17.2-25.8], p value 0.00061). CONCLUSION: In conclusion, preliminary validity evidence was provided for the tasks. Once further validity evidence is established, incorporating the tasks into the training curricula could improve trainee skills and help to meet the need for better advanced suturing models.

Comprehensive Literature Search to Identify Assessment Tools for Operating Room Nontechnical Skills to Determine Common Critical Components.

BACKGROUND: Effective use of nontechnical skills (NTS) contributes to the provision of safe, quality care in the fast-paced, dynamic setting of the operating room (OR). Inter-professional education of NTS to OR team members can improve performance. Such training requires the accurate measurement of NTS in order to identify gaps in their utilization by OR teams. Although several instruments for measuring OR NTS exist in the literature, each tool tends to define specific NTS differently. AIM: We aimed to determine commonalities in defined measurements among existing OR NTS tools. METHODS: We undertook a comprehensive literature review of assessment tools for OR NTS to determine the critical components common to these instruments. A PubMed search of the literature from May 2009 to May 2019 combined various combinations of keywords and Medical Subject Headings (MeSH) related to the following subjects: teamwork, teams, assessment, debriefing, surgery, operating room, nontechnical, communication. From this start, articles were selected describing specific instruments. Three reviewers then identified the common components measured among these assessment tools. Reviewers collated kin constructs within each instrument using frequency counts of similarly termed and conceptualized components. RESULTS: The initial PubMed search produced 119 articles of which 24 articles satisfied the inclusion criteria. Within these articles, 10 assessment tools evaluated OR NTS. Kin constructs were grouped into six NTS categories in the following decreasing frequency order: communication, situation awareness, teamwork, leadership, decision making, and task management/decision making (equal). CONCLUSION: NTS OR assessment tools in the literature have a variety of kin constructs related to the specific measured components within the instruments. Such kin constructs contain thematic cohesion across six primary NTS groupings with some variation in scale and scope. Future plans include using this information to develop an easy-to-use assessment tool to assist with debriefing in the clinical environment.

Improvement in student-led debriefing analysis after simulation-based team training using a revised teamwork assessment tool.

BACKGROUND: Team debriefing is an important teamwork development intervention for improving team outputs in healthcare. Debriefing is a key component of experiential team training teamwork development interventions such as simulation-based training. Improving the quality of debriefing of healthcare teams, therefore, has multiple benefits. We investigated whether the quality of student-led debriefing improved using a shortened guide. METHODS: Senior medical students, nurse anesthesia students, and senior undergraduate nursing students participated in student operating room team training at a health sciences center in the southeastern United States. Student teams participated in a dual-scenario simulation-based training session with immediate after-action debriefings after each scenario. In 2018, student teams conducted the second debriefing using as a guide the teamwork assessment scale, an 11-item, 3-subscale, 6-point Likert-type instrument. In 2019, they used a shortened, revised, 5-item version of the teamwork assessment scale, the quick teamwork assessment scale. Trained observers rated the quality of the student-led debriefings using the Objective Structured Assessment of Debriefing, an 8-item, 5-point instrument. The Wilcoxon-Mann-Whitney test was used to compare the teamwork assessment scale-guided and the quick teamwork assessment scale-guided mean item debriefing scores. RESULTS: Two observers rated 3 student-led team debriefings using the teamwork assessment scales as a guide in 2018, and 6 such debriefings happened using the quick teamwork assessment scale as a guide in 2019. For each debriefing, observer scores were averaged for each Objective Structured Assessment of Debriefing item; these mean scores were then averaged with other mean scores for each year. The use of the quick teamwork assessment scale resulted in a statistically significant higher mean score for the Analysis Objective Structured Assessment of Debriefing item compared with the use of the teamwork assessment scale (4.92 [standard deviation 0.20] versus 3.83 [standard deviation 0.76], P = .023). CONCLUSION: The use of a shortened teamwork assessment instrument as a debriefing guide for student teams in student operating room team training was more effective in analysis of actions than the original, longer tool. Next steps include determining the efficacy of the quick teamwork assessment scale in an actual clinical setting.

Something for everyone: the benefits of longitudinal mentorship with the application of the acquisition of data for outcomes and procedure transfer (ADOPT) program to a SAGES hands-on colectomy course.

Continued professional development of surgeons remains a challenging and unstandardized enterprise. The Continuing Education Committee of SAGES created the Acquisition of Data for Outcomes and Procedure Adoption (ADOPT) program, incorporating a standardized training approach into hands-on courses with a year-long longitudinal mentorship experience. To evaluate the program's transferability to other procedures following its successful application to a SAGES hernia course, the ADOPT method was applied to the SAGES 2017 laparoscopic colectomy course. Participant data included demographics, training and experience, as well as pre-and post-course self-reported colectomy case volumes and procedure confidence. Confidence levels were for techniques taught in the course using a 5-point scale: 1 = not confident at all to 5 = completely confident. Participants reported confidence in the following skills for laparoscopic right and left colectomy: (1) formulating an operative plan, (2) identifying proper anatomical planes and isolating anatomic structures, and (3) competently conducting the technical steps of the procedure. A total of 18 surgeons enrolled in the SAGES 2017 Colon Program, 10 of whom completed the 6-month post-course questionnaire (56%). Participants reported significantly higher confidence in all skills at 6 months compared to pre-course (p ≤ 0.015). Most participants (60%) reported an increase in the number of procedures performed. The lowest pre-course case volume group (≤ 5 annual cases, n = 5 6-month survey responders) demonstrated a trend for increased procedure volume post-course (5.6 vs. 2, p = 0.057). The overwhelming majority of survey respondents (90%) felt either "confident" or "extremely confident" performing the procedures learned (range 80-100% across tasks). Participants found the program to be an advantageous method of becoming competent and confident in performing these procedures. The application of the ADOPT program to the laparoscopic colectomy course was successful in increasing surgeon confidence and demonstrated a trend in improving surgeon procedure counts in the novice participant group.

Moving Along: Team Training for Emergency Room Trauma Transfers (T2ERT2).

OBJECTIVES: To determine whether high fidelity simulation-based training (SBT) of interprofessional teams involving trauma transfers has an immediate impact on participants' team-based attitudes and behaviors. DESIGN: A quasi-experimental, pre-/postintervention comparison design examined high fidelity SBT of inter-professional teams using a 2 scenario format with immediate after action structured debriefing. Pre-/postsession Readiness for Inter-Professional Learning Scale (RIPLS, 19 items, Likert-type) surveys as well as Interprofessional Teamwork (IPT, 15 items, Likert-type) questionnaires, and postscenario participant- and observer-rated Teamwork Assessment Scales (TAS, 3 subscales, 11 items, Likert-type) were completed during each training session. Mean RIPLS, IPT, and TAS scores were calculated and matched pre-/postscore differences compared using paired t-test or analysis of variance with Bonferroni adjustment. SETTING: A large, urban, academic, state health sciences institution in the Southeastern United States during the 2014 to 2015 academic year. PARTICIPANTS: General surgery residents, emergency medicine residents, and senior undergraduate nursing students comprising ten interprofessional teams. RESULTS: From approximately 48 participants, matched pre-/postsession IPT surveys were available for 42 individuals; 45 had an observer TAS evaluation for both scenarios; and 40 completed TAS peer evaluations for both scenarios. 47 participants had matched RIPLS surveys. Statistically significant improvements in matched pre-/postscore differences occurred for all 15 IPT items. Observer TAS scores significantly improved on 2 of the 3 subscales comparing the second to the first scenario. Peer evaluations statistically improved comparing the second to the first scenario. Two of the 19 RIPLS items demonstrated statistically significant improvement. CONCLUSIONS: Interprofessional trauma team transfer training using SBT changes attitudes toward key team-based competencies and leads to learning them in the simulated environment. Such improvement in team-based skill and attitudes is an important first step in adopting team-based behaviors in the actual clinical environment and improving transfer care.

Modulation of inflammation in wounds of diabetic patients treated with porcine urinary bladder matrix.

Aim: To determine if porcine urinary bladder matrix (UBM) treatment is associated with modulation of wound inflammation in diabetic patients. Patients & methods: mRNA associated with M1 and M2 macrophages were measured in wounds of diabetic and nondiabetic patients pre- and post-treatment with UBM and an M1:M2 score was calculated. Results: Wound tissue from diabetic subjects exhibited elevated M1:M2 scores compared with nondiabetic patients, suggesting a greater pro-inflammatory state prior to treatment. Post-treatment, there was significantly greater reduction in the magnitude of the individual M1:M2 scores in the diabetic patients resulting in similar levels in both groups of patients. Conclusions: UBM may assist in diabetic wound healing by restoring an inflammatory state similar to that of nondiabetic patients.

Quality with quantity? Evaluating interprofessional faculty prebriefs and debriefs for simulation training using video.

BACKGROUND: High-fidelity simulation-based training is used increasingly for prelicensure student teams. Such sessions rely on faculty who are able to provide quality prebriefing and debriefing to foster learning among participants. We investigated how well faculty conducted prebriefing and debriefing as part of high-fidelity simulation-based training for interprofessional education. METHODS: Two trained observers independently rated 38 video-recorded sessions of combinations of 4 faculty conducting prebriefings and debriefings of prelicensure student teams after high-fidelity simulation-based training. Assessment was undertaken using the Objective Structured Assessment of Debriefing, an 8-item tool using a 5-point Likert scale (1 as minimum and 5 as maximum). Mean scores for each item were calculated. Inter-rater agreement was determined using Cohen's kappa. A one-way between-subjects analysis of variance with post-hoc Tukey's studentized range procedure was conducted to compare the effect of team facilitator grouping on the quality of team performance of each Objective Structured Assessment of Debriefing element during a prebriefing or a debriefing. Trend analyses of teams with 4 or more observations were performed using Kendall's Tau coefficient test and linear regression analyses to identify whether teams showed improvement through time. Statistical significance was set at P < .05. RESULTS: A total of 7 combinations of faculty conducted between 1 to 14 prebriefings or debriefings. In general, faculty combinations performed better during debriefings compared with prebriefings, with only 1 team having 1 mean item score <3.50. Statistically significant differences between faculty combinations in mean item scores was more pronounced during the prebriefings (2 of 3 Objective Structured Assessment of Debriefing items rated) than during debriefings (1 of 8 Objective Structured Assessment of Debriefing items rated). Effect sizes were strong for all differences. Linear regression analysis revealed a statistically significant change through time for the 3 rated prebriefing items and for 7 of the 8 rated debriefing items. CONCLUSION: Interprofessional faculty combinations in this study tended to have good quality prebriefings and debriefings. The quality of the prebriefings and debriefings can, however, be influenced by the composition of the facilitator teams, most prominently for prebriefings, and team performance does appear to change through time, especially during the debriefing. Future work will focus on whether the quality of prebriefings and debriefings influences learning by trainees.

Priorities Related to Improving Healthcare Safety Through Simulation.

STATEMENT: Improving healthcare safety is a worthwhile and important endeavor. Simulation-based activities can help with such a goal through research and training. In this manner, it can focus on education and training, assessment and metrics, process improvement, and culture change to help move forward both patient safety and quality of care.This article will address the following three main topics: (1) designing simulation-based activities to promote high reliability in healthcare, (2) developing simulation-based activities to foster resilience in healthcare systems, and (3) evaluating the impact of adverse events in healthcare and how simulation-based activities can be used to determine and potentially to prevent their cause. These topics will be treated sequentially, providing synopses of concepts and giving examples of research currently being undertaken. It will then highlight current priorities for simulation-based research in this domain by drawing from insights obtained and a targeted literature review.

All in: expansion of the acquisition of data for outcomes and procedure transfer (ADOPT) program to an entire SAGES annual meeting hands-on hernia course.

BACKGROUND: Continuing professional development (CPD) for the surgeon has been challenging because of a lack of standardized approaches of hands-on courses, resulting in poor post-course outcomes. To remedy this situation, SAGES has introduced the ADOPT program, implementing a standardized, long-term mentoring program as part of its hernia hands-on course. Previous work evaluating the pilot program showed increased adoption of learned procedures as well as increased confidence of the mentored surgeons. This manuscript describes the impact of such a program when it is instituted across an entire hands-on course. METHODS: Following collection of pre-course benchmark data, all participants in the 2016 SAGES hands-on hernia course underwent structured, learner-focused instruction during the cadaveric lab. All faculty had completed a standardized teaching course in the Lapco TT format. Subsequently, course participants were enrolled in a year-long program involving longitudinal mentorship, webinars, conference calls, and coaching. Information about participant demographics, training, experience, self-reported case volumes, and confidence levels related to procedures were collected via survey 3 months prior to 9 months after the course. RESULTS: Twenty surgeons participated in the SAGES ADOPT 2016 hands-on hernia program. Of these, seventeen completed pre-course questionnaires (85%), ten completed the 3-month questionnaire (50%), and four completed the 9-month questionnaire (20%). Nine of ten respondents of the 3-month survey (90%) reported changes in their practice. In the 9-month survey, significant increases in the annualized procedural volumes were reported for open primary ventral hernia repair, open components separation, and mesh insertion for ventral hernia repair (p < 0.001). CONCLUSIONS: The expansion of the ADOPT program to an entire hands-on hernia course is both feasible and beneficial, with evidence of Kirkpatrick Levels 1-4a training effectiveness. This expanded success suggests that it is a useful blueprint for the CPD of surgeons wishing to learn new techniques and procedures for their patients.

Using Simulation to Improve Systems-Based Practices.

BACKGROUND: Ensuring the safe, effective management of patients requires efficient processes of care within a smoothly operating system in which highly reliable teams of talented, skilled health care providers are able to use the vast array of high-technology resources and intensive care techniques available. Simulation can play a unique role in exploring and improving the complex perioperative system by proactively identifying latent safety threats and mitigating their damage to ensure that all those who work in this critical health care environment can provide optimal levels of patient care. METHODS: A panel of five experts from a wide range of institutions was brought together to discuss the added value of simulation-based training for improving systems-based aspects of the perioperative service line. Panelists shared the way in which simulation was demonstrated at their institutions. The themes discussed by each panel member were delineated into four avenues through which simulation-based techniques have been used. RESULTS: Simulation-based techniques are being used in (1) testing new clinical workspaces and facilities before they open to identify potential latent conditions; (2) practicing how to identify the deteriorating patient and escalate care in an effective manner; (3) performing prospective root cause analyses to address system weaknesses leading to sentinel events; and (4) evaluating the efficiency and effectiveness of the electronic health record in the perioperative setting. CONCLUSION: This focused review of simulation-based interventions to test and improve components of the perioperative microsystem, which includes literature that has emerged since the panel's presentation, highlights the broad-based utility of simulation-based technologies in health care.

Learning how to "teach one": A needs assessment of the state of faculty development within the Consortium of the American College of Surgeons Accredited Education Institutes.

BACKGROUND: Developing faculty competencies in curriculum development, teaching, and assessment using simulation is critical for the success of the Consortium of the American College of Surgeons Accredited Education Institutes program. The state of and needs for faculty development in the Accredited Education Institute community are unknown currently. The Faculty Development Committee of the Consortium of the Accredited Education Institutes conducted a survey of Accredited Education Institutes to ascertain what types of practices are used currently, with what frequency, and what needs are perceived for further programs and courses to guide the plan of action for the Faculty Development Committee. METHODS: The Faculty Development Committee created a 20-question survey with quantitative and qualitative items aimed at gathering data about practices of faculty development and needs within the Consortium of Accredited Education Institutes. The survey was sent to all 83 Accredited Education Institutes program leaders via Survey Monkey in January 2015 with 2 follow-up reminders. Quantitative data were compiled and analyzed using descriptive statistics, and qualitative data were interpreted for common themes. RESULTS: Fifty-four out of the 83 programs (65%) responded to the survey. Two-thirds of the programs had from 1 to 30 faculty teaching at their Accredited Education Institutes. More than three-quarters of the programs taught general surgery, emergency medicine, or obstetrics/gynecology. More than 60% of programs had some form of faculty development, but 91% reported a need to expand their offerings for faculty development with "extreme value" for debriefing skills (70%), assessment (47%), feedback (40%), and curriculum development (40%). Accredited Education Institutes felt that the Consortium could assist with faculty development through such activities as the provision of online resources, sharing of best practices, provision of a blueprint for development of a faculty curriculum and information related to available, credible master programs of faculty development and health professions education. CONCLUSION: Many Accredited Education Institutes programs are engaged in faculty development activities, but almost all see great needs in faculty development related to debriefing, assessment, and curricular development. These results should help to guide the action and decision-making of the Consortium Faculty Development Committee to improve teaching within the American College of Surgeons Accredited Education Institutes.

Introductions During Time-outs: Do Surgical Team Members Know One Another's Names?

BACKGROUND: Introductions are the first item of the time-out in the World Health Organization Surgical Safety Checklist (SSC). It has yet to be established that surgical teams use colleagues' names or consider the use of names important. A study was conducted to determine if using the SSC has a measurable impact on name retention and to assess if operating room (OR) personnel believe it is important to know the names of their colleagues or for their colleagues to know theirs. METHODS: All OR personnel were individually interviewed at the end of 25 surgical cases in which the SSC was used. They were asked (1) to name each OR participant, and (2) if they believed it is important to know the names of their team members and (3) for their team members to know their name. RESULTS: Of the 150 OR personnel interviewed, 147 (98%) named the surgery attending correctly. The surgery attending named only 44% of other OR staff (p <0.001). Only 62% of the OR staff correctly named the anesthesiology attending. The anesthesiology resident was the least well known but was able to name 82% of the others. The anesthesiology attending named his or her resident 100% of the time; the surgery attending correctly named his or her resident only 68% of the time (p = 0.002). CONCLUSION: This study suggests that OR personnel may consider introductions to be another bureaucratic hurdle instead of the safety check they were designed to be. It appears that this first step of the time-out is often being performed perfunctorily.

Acute Liver Failure During Deferasirox Chelation: A Toxicity Worth Considering.

This case report details a unique case of acute, reversible liver failure in a 12-year-old male with sickle cell anemia on chronic transfusion protocol and deferasirox chelation. There is substantial literature documenting deferasirox-induced renal injury, including Fanconi syndrome, but less documentation of hepatic toxicity and few reports of hepatic failure. The case highlights the importance of close monitoring of ferritin, bilirubin, and transaminases for patients on deferasirox.

Team Training of Inter-Professional Students (TTIPS) for improving teamwork.

Objective: In surgery, dysfunctional teamwork is perpetuated by a 'silo' mentality modelled by students. Interprofessional education using high-fidelity simulation-based training (SBT) may counteract such modelling. We sought to determine whether SBT of interprofessional student teams (1) changes long-term teamwork attitudes and (2) is an effective form of team training. Design: A quasiexperimental, pre/postintervention comparison design was employed at an academic health sciences institution. High-fidelity simulation-based training of 42 interprofessional teams of third year surgery clerkship medical students and senior undergraduate nursing students was undertaken using a two-scenario format with immediate after action debriefing. Pre/postintervention TeamSTEPPS Teamwork Attitudes questionnaires (5 subscales, 30 items, Likert type) were given to the medical student and undergraduate nursing student classes. Pre/postsession Readiness for Inter-Professional Learning (RIPL; 19 items, Likert type) surveys and postscenario participant-rated and observer-rated Teamwork Assessment Scales (3 subscales, 11 items, Likert type) were given during each training session. Mean TeamSTEPPS Teamwork Attitudes Questionnaire, RIPL and Teamwork Assessment Scales scores were calculated; matched pre/postscore differences and trained versus non-trained TeamSTEPPS Teamwork Attitudes Questionnaire scores were compared using paired t-test or analysis of variance. Results: Both student groups had 10 significantly improved RIPL items as well as TeamSTEPPS Teamwork Attitudes Questionnaire (TTAQ) mutual support subscales. Medical students had a significantly improved TTAQ team structure subscale. Over a simulation-based training session, each observer-rated Teamwork Assessment Scales subscale and two self-rated Teamwork Assessment Scales subscales significantly improved. Trained students had significantly higher TTAQ team structure subscales than non-trained students. Conclusions: Interprofessional education using high-fidelity simulation-based training of students is effective at teaching teamwork, changing interprofessional attitudes and improving long-term teamwork attitudes.

Selection bias: Examining the feasibility, utility, and participant receptivity to incorporating simulation into the general surgery residency selection process.

BACKGROUND: Opportunities exist to revise the current residency selection process to capture desirable candidate competencies. We examined the extent to which components of the American College of Surgeons/Association for Surgical Education simulation-based medical student curriculum combined with a teamwork activity could be used as potential screening method. METHODS: Students participated in a workshop consisting of training/evaluation of knot tying, suturing, airway management, gowning/gloving, and teamwork. Surveys were given to medical students (MS) and faculty/resident/staff (FRS) to examine their opinions about the residency screening process, the most critical competencies to assess, and the effectiveness of each station for candidate evaluation. RESULTS: Communication (FRS, 4.86 ± .35; MS, 4.93 ± .26), leadership (FRS, 4.41 ± .80; MS, 4.5 ± .76), judgment (FRS, 4.62 ± .74; MS, 4.67 ± .62), professionalism (FRS, 4.64 ± .73; MS, 5.00 ± .00), integrity (FRS, 4.71 ± .78; MS, 4.87 ± .35), and grit/resilience (FRS, 4.71 ± .78; MS, 4.53 ± .74) were considered most valuable for candidate screening. The simulation-based curriculum for evaluation of residency candidates was rated lowest by both groups. Open response comments indicated positive perceptions of this process. CONCLUSIONS: Employing simulation to assess candidates may be most beneficial for examining nontechnical attributes. Future work should continue to explore this area.

All for knots: evaluating the effectiveness of a proficiency-driven, simulation-based knot tying and suturing curriculum for medical students during their third-year surgery clerkship.

BACKGROUND: We evaluated the effectiveness of implementing a proficiency-driven, simulation-based knot tying and suturing curriculum for medical students during their 3rd-year surgery clerkship. METHODS: Medical students on the 3rd-year surgical clerkship completed a proficiency-driven, simulation-based knot tying and suturing curriculum consisting of 6 tasks. The effectiveness was evaluated by comparing the initial presession scores to the final postsession scores on an 8-item self-efficacy scale and evaluating pass rates on end of clerkship skills testing. A paired t test was used to analyze data. RESULTS: Sixty-five students had matched preintervention and postintervention questionnaires for analysis. Pass rates approached 100% by the 3rd attempt on all tasks. Significant gains on all 8 items of the self-efficacy questionnaire from pretraining to post-training were noted. Timing of the general surgery rotation did not impact results. CONCLUSIONS: Implementation of a simulation-based training, proficiency-driven knot tying and suturing curriculum for 3rd-year medical students during the surgery clerkship is feasible and effective in improving student self-efficacy and objective proficiency toward performance of the tasks taught.

Surgical skills curricula in American College of Surgeons Accredited Education Institutes: An international survey.

BACKGROUND: A clear understanding of simulation-based curricula in use at American College of Surgeons Accredited Education Institutes (ACS-AEIs) is lacking. METHODS: A 25-question online survey was sent to ACS-AEIs. RESULTS: The response rate approached 60%. The most frequent specialties to use the ACS-AEIs are general surgery and obstetrics/gynecology (94%). Residents are the main target population for programming/training (96%). Elements of the ACS/Association of Program Directors in Surgery Surgical Skills Curriculum are used by 77% of responding ACS-AEIs. Only 49% of ACS-AEIs implement the entire curriculum and 96% have independently developed their own surgical skills curricula. "Home-grown" simulators have been designed at 71% of ACS-AEIs. Feasibility (80%), evidence of effectiveness (67%), and cost (60%) were reasons for curriculum adoption. All programs use operative assessment tools for resident performance, and 53% use Messick's unitary framework of validity. Most programs (88%) have financial support from their academic institute. Majority of ACS-AEIs had trainees evaluate their faculty instructors (90%), and the main form of such faculty evaluation was postcourse surveys (97%). CONCLUSION: This study provides specific information regarding simulation-based curricula at ACS-AEIs.

Multicenter proficiency benchmarks for advanced laparoscopic suturing tasks.

BACKGROUND: Advanced laparoscopic suturing (LS) tasks were developed based on a needs assessment. Initial validity evidence has been shown. The purpose of this multicenter study was to determine expert proficiency benchmarks for these tasks. METHODS: 6 tasks were included: needle handling (NH), offset-camera forehand suturing (OF), offset-camera backhand suturing (OB), confined space suturing (CF), suturing under tension (UT), and continuous suturing (CS). Minimally invasive surgeons experienced in LS completed the tasks twice. Mean time and median accuracy scores were used to establish the benchmarks. RESULTS: Seventeen MIS surgeons enrolled, from 7 academic centers. Mean (95% CI) time in seconds to complete each task was: NH 169 (149-189), OF 158 (134-181), OB 189 (154-224), CF 181 (156-205), UT 379 (334-423), and CS 416 (354-477). Very few errors in accuracy were made by experts in each of the tasks. CONCLUSIONS: Time- and accuracy-based proficiency benchmarks for 6 advanced LS tasks were established. These benchmarks will be included in an advanced laparoscopic surgery curriculum currently under development.