Aimee K. Gardner

The Relationship Between Confidence and Competence in the Development of Surgical Skills

BACKGROUND Confidence is a crucial trait of any physician, but its development and relationship to proficiency are still unknown. This study aimed to evaluate the relationship between confidence and competency of medical students undergoing basic surgical skills training. METHODS Medical students completed confidence surveys before and after participating in an introductory workshop across 2 samples. Performance was assessed via video recordings and compared with pretraining and posttraining confidence levels. RESULTS Overall, 150 students completed the workshop over 2 years and were evaluated for competency. Most students (88%) reported improved confidence after training. Younger medical students exhibited lower pretraining confidence scores but were just as likely to achieve competence after training. There was no association between pretraining confidence and competence, but confidence was associated with demonstrated competence after training (p < 0.001). CONCLUSIONS Most students reported improved confidence after a surgical skills workshop. Confidence was associated with competency only after training. Future training should investigate this relationship on nonnovice samples and identify training methods that can capitalize on these findings.

Developing a Comprehensive Resident Education Evaluation System in the Era of Milestone Assessment

OBJECTIVES In an effort to move training programs toward competency-based education, the Accreditation Council for Graduate Medical Education (ACGME) introduced the Next Accreditation System (NAS), which organizes specific milestones regarding resident skills, knowledge, and abilities along a continuum. In order to foster innovation and creativity, the ACGME has provided programs with minimal guidelines regarding the optimal way to approach these milestones. METHODS The education team at UT Southwestern embraced the milestones and developed a process in which performance assessment methods were critically evaluated, mapped onto an extrapolated performance list corresponding to the areas required by the ACGME milestones, and filled gaps in the previous system by modifying evaluation tools and creating new program components. RESULTS Although the authors are early in the evolution of applying the new milestones system, this approach has thus far allowed them to comprehensively evaluate the residents and the program in an efficient and effective fashion, with notable improvements compared to the prior approach. CONCLUSIONS The authors hope that these experiences can inform others embarking upon similar journeys with the milestones.

Best practices across surgical specialties relating to simulation-based training

INTRODUCTION Simulation-based training is playing an increasingly important role in surgery. However, there is insufficient discussion among the surgical specialties regarding how simulation may best be leveraged for training. There is much to be learned from one another as we all strive to meet new requirements within the context of Undergraduate Medical Education, Graduate Medical Education, and Continuing Medical Education. METHOD To address this need, a panel was convened at the 6th Annual Meeting of the Consortium of the American College of Surgeons-Accredited Education Institutes consisting of key leaders in the field of simulation from 4 surgical subspecialties, namely, general surgery, orthopedic surgery, cardiothoracic surgery, urology, and otolaryngology. CONCLUSION An overview of how the 5 surgical specialties are using simulation-based training to meet a wide array of educational needs for all levels of learners is presented.

Gearing up for milestones in surgery: Will simulation play a role?

BACKGROUND The Consortium of American College of Surgeons-Accredited Education Institutes was created to promote patient safety through the use of simulation, develop new education and technologies, identify best practices, and encourage research and collaboration. METHODS During the 7th Annual Meeting of the Consortium, leaders from a variety of specialties discussed how simulation is playing a role in the assessment of resident performance within the context of the Milestones of the Accreditation Council for Graduate Medical Education as part of the Next Accreditation System. CONCLUSION This report presents experiences from several viewpoints and supports the utility of simulation for this purpose.

In situ simulation to assess workplace attitudes and effectiveness in a new facility.

Introduction In situ simulation within new facilities holds the promise of identifying latent safety threats. The aim of this study was to identify if in situ simulation can also impact important employee perceptions and attitudes. Methods In the current study, health care professionals of an adult, urban, community teaching hospital level 1 trauma center participated in simulated scenarios in a new emergency department. Before and after the simulated scenarios, participants provided responses to the variables regarding their ability to work in the new facility and other work-related variables. Results Significant increases in communication (P = 0.05), facility clinical readiness (P < 0.05), self-efficacy (P < 0.01), trauma readiness (P < 0.01), and work space satisfaction (P < 0.05) were found from presimulation to postsimulation. The results also demonstrated a significant decrease from presimulation to postsimulation with performance beliefs (P < 0.001). Finally, cardiac readiness did not reveal a significant change from presimulation to postsimulation. Discussion In situ simulation exercises before practicing clinically in a new facility can both increase familiarity with new clinical environments and impact important organizational outcomes. Thus, simulation in a new work space can influence factors important to employees, organizations, and patients.

Teledebriefing: connecting learners to faculty members

Simulation has become widespread among medical educators. Although simulation facilities are available at most teaching institutions, the number of qualified instructors to facilitate post‐simulation debriefing is inadequate, resulting in sub‐par educational experiences for learners.

What Do We Know About Intraoperative Teaching?: A Systematic Review

Background: There is increasing attention on enhancing surgical trainee performance and competency. The purpose of this review is to identify characteristics and themes related to intraoperative teaching that will better inform interventions and assessment endeavors. Methods: A systematic search was carried out of the Ovid MEDLINE, Ovid MEDLINE InProcess, Ovid Embase, and the Cochrane Library databases to identify all studies that discussed teaching in the operating room for trainees at the resident and fellow level. Evidence for main outcome categories was evaluated with the Medical Education Research Study Quality Instrument (MERSQI). Results: A total of 2101 records were identified. After screening by title, abstract, and full text, 34 studies were included. We categorized these articles into 3 groups on the basis of study methodology: perceptions, best practices, and interventions to enhance operative teaching. Overall strength of evidence for each type of study was as follows: perceptions (MERSQI: 7.5–10); best practices (6.5–11.5), and interventions (8–15). Although very few studies (n = 5) examined interventions for intraoperative teaching, these studies demonstrate the efficacy of techniques designed to enhance faculty teaching behaviors. Conclusions: Interventions have a positive impact on trainee ratings of their faculty intraoperative teaching performance. There is discordance between trainee perceptions of quantity and quality of teaching, compared with faculty perceptions of their own teaching behaviors. Frameworks and paradigms designed to provide best practices for intraoperative teaching agree that effective teaching spans 3 phases that take place before, during, and after cases.

Frame-of-reference training for simulation-based intraoperative communication assessment

BACKGROUND The purpose of this study was to examine the impact of frame-of-reference (FOR) training on assessments of intraoperative communication skills and identify areas of need to inform curricular efforts. METHODS Simulation instructors (M.D., Ph.D., Research Fellow, Simulation Technician) underwent a 2-hour FOR training session with the operating room communication instrument. They then independently rated communication skills of 19 PGY1s who participated in a team-based simulation. Residents completed self-assessments via video review of the scenario. Intraclass correlation coefficients were used to examine inter-rater reliability. Relationships between trained raters and resident scores were assessed with Pearson correlation coefficients and paired sample t tests. RESULTS Inter-reliability after FOR training was .91. The correlation between trained rater scores and resident evaluations was nonsignificant. Residents significantly underestimated their intraoperative communication skills (P < .05). Use of names, closed loop communication, and sharing information with team members demonstrated consistently low ratings among all residents. CONCLUSIONS These findings reveal that a number of individuals can be trained to reliably rate resident intraoperative communication performance and that residents tend to under-rate their communication skills.

Simulation-Based Selection of Surgical Trainees: Considerations, Challenges, and Opportunities

Received April 23, 2016; Revised May 17, 2016; Accepted May 23 From the Department of Surgery, University of Texas Southwester cal Center, Dallas (Gardner), Department of Surgery, Houston M Hospital, Houston (Dunkin), TX, Department of Surgery, Uniform vices University and Walter Reed National Military Medical Bethesda, MD (Ritter), Department of Surgery, Louisiana State U Health Sciences Center, New Orleans, LA (Paige), Department o gency Medicine, Summa Akron City Hospital, Akron, OH (Ahm Department of Surgery, Baystate Medical Center, Springfiel (Fernandez). Correspondence address: Aimee K Gardner, PhD, Department of University of Texas Southwestern Medical Center, 5323 Harry Hin Dallas, TX 75390. email: aimee.gardner@utsouthwestern.edu

Different Goals, Different Pathways: The Role of Metacognition and Task Engagement in Surgical Skill Acquisition

BACKGROUND The purpose of this study is to understand why learning goals and performance goals may produce different outcomes in surgical skills training for novices, with specific attention to metacognition and task engagement. METHODS Third-year medical students were randomized to a performance or learning-goal condition during a knot tying and suturing training program. Performance was assessed by blinded videotaped review. Demographics, goal orientation, and metacognition were captured with pre- and posttraining questionnaires. RESULTS A total of 90 students participated in the training program. Trainees in the learning goals group demonstrated better performance on knot tying (4.30 ± 0.78 vs 3.86 ± 0.95; p < 0.05) and suturing (4.10 ± 0.77 vs 3.54 ± 0.73; p < 0.001). Participants in the learning goals group reported higher task engagement during both knot tying (4.32 ± 0.66 vs 3.90 ± 0.52; p < 0.001) and suturing (4.48 ± 0.42 vs 4.01 ± 0.46; p < 0.001). Additionally, the learning goals group also reported higher metacognition during both knot tying (3.88 ± 0.75 vs 3.59 ± 0.52; p < 0.05) and suturing (3.96 ± 0.75 vs 3.68 ± 0.48; p < 0.05). CONCLUSIONS Our findings suggest that learning goals may be optimal for trainees learning new surgical tasks because they elicit increased task engagement and metacognition among trainees.