The "teaching time-out": a novel framework for surgical education (original) (raw)
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Building an effective training continuum in surgery:Developing a safe practitioner.pdf
Medical education has initiated major paradigm shifts in the last few decades aimed primarily at meeting the challenges of medical practice in the 21st century and also because of patient safety concerns. It is imperative that the design of a curriculum appropriate for surgical trainees in this new millennium must ensure a continuum of learning from undergraduate to postgraduate education and training. Educational leaders and team members responsible for planning and implementation of any curriculum reform should apply the principles of Best Evidence Medical Education (BEME) in the decisionmaking process in order to optimise the educational process and results. It is best to adopt a result oriented course design in developing and planning a surgical training programme which would equip the surgeon with the requisite professional competencies for practice in the 21st century.
Training in Basic Surgical Skills: Need of the Hour
Indian Journal of Surgery, 2017
One of the major components of medical education is training individuals in various skills related to health care. Training directly on patients has its challenges due to limited opportunities, concerns for patient safety and reluctance of patients. Clinical Skills Laboratory provides a stress-free environment for learning and honing skills under direct supervision. Surgery is predominantly a craft-based branch of medicine and undergraduate medical students have very little exposure to it. With an objective of improving basic surgical skills and improving the competency, a short-term training programme in the form of a workshop was planned, executed in a dedicated Clinical Skills Laboratory for interns posted in the surgical branches. The core areas of training were basic surgical skills required in day-today practice in the surgical specialties. Five broad categories of skills, gowning and gloving, instrument handling, knot tying, suturing techniques and universal precautions, were dealt with demonstration and handson practice sessions. A total of 14 skills lab training sessions over a period of 3 years from February 2014-March 2017 were conducted where a total of 264 interns participated. Analysis of the feedback showed 62.87% of the participants felt that the content was excellent, 63.63% opined that the presentations were excellent, 76.13% appreciated the demonstration and 60.6% were satisfied with the time allotted for practice sessions. This short-term training in basic surgical skills in a controlled environment helped in improving the interns' skills and confidence. Implementation of basic surgical skills training provided a complementary experience that facilitates the shortening of the learning curve and enhances the ability of the new doctors to perform various procedures. This model of training in skills laboratories could be inculcated in the curriculum as practical training for effective delivery of health care.
Journal of surgical education
Quality of surgical training in the era of resident duty-hour restrictions (RDHR) is part of an ongoing debate. Most training elements are provided during surgical service. As exposure to surgical procedures is important but time-consuming, RDHR may affect quality of surgical training. Providing structured training elements may help to compensate for this shortcoming. This binational anonymous questionnaire-based study evaluates frequency, time, and structure of surgical training programs at 2 typical academic teaching hospitals with different RDHR. Departments of Surgery of University of Basel (Basel, Switzerland) and the Queen's University (Kingston, Ontario, Canada). Surgical consultants and residents of the Queen's University Hospital (Kingston, Ontario, Canada) and the University Hospital Basel (Basel, Switzerland) were eligible for this study. Questionnaire response rate was 37% (105/284). Queen's residents work 80 hours per week, receiving 7 hours of formal traini...
The Contemporary Context of Surgical Education
Advancing Surgical Education, 2019
Overview The development of a competent surgeon has evolved over centuries from a predominantly apprenticeship model to one that incorporates modern theories of learning accompanied by increasing awareness of the significant contribution from the hidden curriculum. Increasing public awareness and demands from educators and trainees have emphasised the importance of nontechnical competencies. The Royal Australasian College of Surgeons has determined nine core competencies as a basic requirement for surgical training. It has responded to emerging demands by the introduction of formal educational processes supporting the development of an educationally aware surgical teaching community. A challenge for surgical training is to balance the increasing demands on the surgical education workforce while delivering an expanded surgical curriculum that best serves the modern community. This chapter explores the changing field of surgical education and provides an overview of the future challenges.
Practice does not always make perfect: need for selection curricula in modern surgical training
Surgical Endoscopy, 2017
Background It is hypothesized that not all surgical trainees are able to reach technical competence despite ongoing practice. The objectives of the study were to assess a trainees' ability to reach technical competence by assessing learning patterns of the acquisition of surgical skills. Furthermore, it aims to determine whether individuals' learning patterns were consistent across a range of open and laparoscopic tasks of variable difficulty. Methods Sixty-five preclinical medical students participated in a training curriculum with standardized feedback over forty repetitions of the following laparoscopic and open technical tasks: peg transfer (PT), circle cutting (CC), intracorporeal knot tie (IKT), one-handed tie, and simulated laparotomy closure. Data mining techniques were used to analyze the prospectively collected data and stratify the students into four learning clusters. Performance was compared between groups, and learning curve characteristics unique to trainees who have difficulty reaching technical competence were quantified. Results Top performers (22-35%) and high performers (32-42%) reached proficiency in all tasks. Moderate performers (25-37%) reached proficiency for all open tasks but not all laparoscopic tasks. Low performers (8-15%) failed to reach proficiency in four of five tasks including all laparoscopic tasks (PT 7.8%; CC 9.4%; IKT 15.6%). Participants in lower performance clusters demonstrated sustained performance disadvantage across tasks, with widely variable learning curves and no evidence of progression towards a plateau phase. Conclusions Most students reached proficiency across a range of surgical tasks, but low-performing trainees failed to reach competence in laparoscopic tasks. With increasing use of laparoscopy in surgical practice, screening potential candidates to identify the lowest performers may be beneficial. Keywords Selection Á Technical skills Á Competence Á Surgical trainees Á Simulation training Á Learning curves Emerging evidence suggests that trainees acquire technical skills at variable rates, with a subset of students unable to reach competence [1-4]. Recent studies propose that 5-17% of trainees have an innate technical ability that allows them to rapidly acquire skills, achieving competence with minimal practice or effort [1, 3] In contrast, most trainees (63-70%) are moderate performers [1, 3]. They improve with practice, ultimately reaching a level of technical competence that is acceptable and safe. However, studies have also identified a smaller subgroup of trainees (8-20%) who struggle to learn technical skills and fail to reach competence even with continued practice (low performers) [1, 3]. Given that technical skill is a requirement for a successful surgical career, identifying these individuals early may benefit both prospective trainees and surgical programs. This is an original article, with no communication to a society or meeting.
Surgical Training: The Impact of Changes in Curriculum and Experience
Journal of Surgical Education, 2011
Craft specialties, such as surgery, rely on practice to acquire skill. Yet recent changes in training in the United Kingdom have decreased experience and altered the balance of curriculum content. Most recently, the European Working Time Directive has led to a reduction in working hours and expansion in the number of trainees. The impact that these changes have had on operative experience, patient management, communication, and teaching skills is unclear. This study aims to assess the effects of the changing curriculum and work patterns on the experience of trainees at senior house officer (SHO, equivalent to junior resident) level in general surgery.
A Novel Paradigm for Surgical Skills Training and Assessment of Competency
JAMA Surgery, 2021
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 MEASURES Trauma surgery capability, as measured by confidence, knowledge, abilities, and independent performance of specific trauma surgical procedures; 3-month posttraining skill transfer. RESULTS The 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 RELEVANCE In 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.