Surgical instruction for general practitioners: how, who and how often?
ABSTRACT Educational programmes, designed to meet the training needs of General Practitioners (GPs) performing minor surgical procedures, have previously been shown to increase their surgical workload. The change in the level of competence following these programmes has not been assessed. The aims of this study were two-fold: to evaluate the vertical mattress suture for construct validity and to assess the impact of plastic surgery training on the surgical skill of GPs. Thirty non-consultant hospital doctors and 27 self-selected GPs were included. Using a modified objective structured assessment of technical skills (OSATS) scoring system, construct validity of the vertical mattress suture was confirmed. The median total OSATS score was 16 points (26.7%) in the novice group (medical registrars), 38.5 points (64.2%) in the intermediate group (surgical SHOs) and 59 points (98.3%) in the expert group (surgical registrars, p<0.001, Kruskal-Wallis test). Objective assessment in the GP group immediately following practical instruction revealed a median overall improvement of 31.7% (19 points) in total OSATS scores (p<0.001, Friedman non-parametric test, F). At six months follow-up all course participants had improved compared to their baseline. A median overall improvement of 13 points (21.7%) was noted (p<0.001, F). However, the majority (80%, n=20) had deteriorated from the standard set immediately after the course with a median overall reduction in total OSATS scores of six points (10%, p=0.001, F). Plastic surgery training is immediately efficacious in improving the technical proficiency of GPs. Through objective assessment of a standardised suture task we demonstrated a low rate of educational decay of 10% over a six-month period.
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ABSTRACT: Although several inanimate bench models have been described for training of suture skills, so far, there is no ideal method for teaching and learning this skill during medical education. The aim was to evaluate whether bench model fidelity interferes in the acquisition of suture skills by novice medical students. 36 medical students with no surgical skills' background (novices) were randomized to three groups (n = 12): theoretical suture training alone (control); low-fidelity suture training model (synthetic ethylene-vinyl acetate bench model); or high-fidelity suture training model (pig feet skin bench model). Pre- and post-tests were applied (performance of simple interrupted sutures and subdermal interrupted sutures on ox tongue). Three tools (Global Rating Scale with blinded assessment, effect size, and self-perceived confidence based on Likert scale) were used to measure all suture performances. The post-training analysis showed that the students that practiced on bench models (hands-on training) presented better (all p < 0.0000) performance in the Global Rating Scale evaluation, compared with the control, regardless of the model fidelity. The magnitude of the effect (training) was considered large (> 0.80) in all measurements. Students felt more confident (all p < 0.0000) to perform both types of sutures after training. The acquisition of suture skills on the low-fidelity bench model was similar to that of the high-fidelity bench model, and the increase in the performance of participants that received bench model training was superior to those who received training based on theoretical teaching materials.Revista da Associação Médica Brasileira 10/2012; 58(5):600-6. · 0.77 Impact Factor
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ABSTRACT: Due to shortage of time and limited availability of faculty surgeons to teach basic surgical skills during medical graduation, the search for alternative ways of simulated training with feedback is needed. The purpose of this study was to compare the simulated teaching of suture skills to novice medical students by senior medical students and by experienced faculty surgeons. Forty-eight novice medical students were randomly assigned to three practice conditions on bench model (n = 16): self-directed suture training (control), senior medical student-directed suture skills' training, or experienced faculty surgeon-directed suture skills' training. Pre- and post-tests were applied. Global Rating Scale with blinded evaluation and self-perceived confidence based on Likert scale were used to assess all suture performances in pre- and post-training. Effect size was also calculated. The analysis made after training showed that the students who received feedback from the instructors had better performance based on the Global Rating Scale (all p < 0.0000) and felt more confident to carry out sutures (all p < 0.0000) when compared to the control. There was no significant difference (all p > 0.05) between the student-directed teaching and faculty-directed teaching groups. The magnitude of the effect (instructor-directed training suture) was considered large (>0.80) in all measurements. The acquisition of suture skills after student-directed training was similar to the training supervised by faculty surgeon, and the increase in suture performances of trainees that received instructor administered training was superior to self-directed learning.Updates in surgery. 02/2013;
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ABSTRACT: Because of ethical and medico-legal aspects involved in the training of cutaneous surgical skills on living patients, human cadavers and living animals, it is necessary the search for alternative and effective forms of training simulation. To propose and describe an alternative methodology for teaching and learning the principles of cutaneous surgery in a medical undergraduate program by using a chicken-skin bench model. One instructor for every four students, teaching materials on cutaneous surgical skills, chicken trunks, wings, or thighs, a rigid platform support, needled threads, needle holders, surgical blades with scalpel handles, rat-tooth tweezers, scissors, and marking pens were necessary for training simulation. A proposal for simulation-based training on incision, suture, biopsy, and on reconstruction techniques using a chicken-skin bench model distributed in several sessions and with increasing levels of difficultywas structured. Both feedback and objective evaluations always directed to individual students were also outlined. The teaching of a methodology for the principles of cutaneous surgery using a chicken-skin bench model versatile, portable, easy to assemble, and inexpensive is an alternative and complementary option to the armamentarium of methods based on other bench models described.Indian Journal of Dermatology 05/2013; 58(3):200-7.