Skills coaches as part of the educational team: a randomized controlled trial of teaching of a basic surgical skill in the laboratory setting.

Department of Surgery, University of Rochester, Rochester, NY, USA.
American journal of surgery (Impact Factor: 2.36). 01/2010; 199(1):94-8. DOI: 10.1016/j.amjsurg.2009.08.016
Source: PubMed

ABSTRACT The aim of this study was to compare the laboratory teaching of a basic technical skill by a nonphysician skills coach and a faculty surgeon.
Medical students were randomized to instruction of skin suturing in the skills laboratory by a faculty surgeon or by a nonphysician skills coach. Testing of performance occurred at 3 time points. Other faculty surgeons, blinded to identities and training groups, rated performance.
Forty-nine students participated. Baseline fourth-year student mean scores showed no significant difference between training groups. Third-year and fourth-year student performance showed no difference between training groups on postintervention testing. Delayed testing also showed no difference in third-year student scores.
Training by either a nonsurgeon skills coach or a faculty surgeon resulted in no difference in performance on a basic surgical skill. This was true for students with and without prior experience and was also true after subsequent clinical experiences. Nonphysician coaches may ease the teaching burden of surgical faculty members while providing similar quality of instruction for trainees.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: Laboratory skills training is now required for general surgery residents. The optimal method of teaching vascular anastomosis (VA) is not well defined. Teaching VA skills one-on-one with a faculty instructor will result in a more rapid accumulation of skills than teaching in a large group setting. Residents were shown an instructional video on how to perform a VA using a standardized model (cadaver saphenous vein and porcine aorta). Each resident then performed a baseline VA. Sixteen first and second year surgical residents were then randomized to two VA teaching sessions that consisted of either: 1) group teaching (GT) (eight residents in a room with one faculty instructor circulating) or 2) one-on-one teaching (1-on-1) (faculty member focused on individual resident). After each of these sessions, residents performed a standardized VA. The anastomoses were video recorded. Performance was evaluated using a standardized scoring system by a separate expert who viewed the video recordings in a blinded fashion. Outcome measures included total errors, total time, global rating scale, and an anastomosis specific end-product evaluation (leak and passage of coronary dilator). Overall, significant decreases in total errors (21 to 15, p = 0.001), and time to complete anastomoses (42 to 38 minutes, p = 0.02), and an increase in global rating scales (7 to 11, p = 0.003) were noted in both groups from baseline after two VA teaching session. The 1-on-1 group demonstrated significantly greater improvement in terms of reduced anastomotic time (30 minutes vs. 42 minutes, p = 0.007) and in reduction of errors (13 versus 19 errors, p = 0.09) than the GT group. The high fidelity VA model is a useful tool for junior general surgery residents. Both GT and 1-on-1 groups demonstrated significant improvement in total errors and time after only two sessions. Greater improvement was noted using the one-on-one model.
    Annals of Vascular Surgery 01/2014; · 0.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals. To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students. Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills' training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs' skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances. The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills' training) was considered large (>0.80) in all measurements. The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials.
    Indian Journal of Dermatology 03/2014; 59(2):169-75.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the acquisition of suture skills by training on ethylene-vinyl acetate bench model in novice medical students. Sixteen medical students without previous surgery experience (novices) were randomly divided into two groups. During one hour group A trained sutures on ethylene-vinyl acetate (EVA) bench model with feedback of instructors, while group B (control) received a faculty-directed training based on books and instructional videos. All students underwent a both pre-and post-tests to perform two-and three-dimensional sutures on ox tongue. All recorded performances were evaluated by two blinded evaluators, using the Global Rating Scale. Although both groups have had a better performance (p<0.05) in the post-test when compared with the pre-test, the analysis of post-test showed that group A (EVA) had a better performance (p<0.05) when compared with group B (control). The ethylene vinyl acetate bench model allowed the novice students to acquire suture skills faster when compared to the traditional model of teaching.
    Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 03/2012; 27(3):271-8. · 0.48 Impact Factor