John Murnaghan

Assessment of technical skills transfer from the bench training model to the human model.

BACKGROUND This study examines whether technical skills learned on a bench model are transferable to the human cadaver model. METHODS Twenty-three first-year residents were randomly assigned to three groups receiving teaching on six procedures. For each procedure, one group received training on a cadaver model, one received training on a bench model, and one learned independently from a prepared text. Following training, all residents were assessed on their ability to perform the six procedures. RESULTS Repeated measures analysis of variance revealed a significant effect of training modality for both checklist scores (F(2,44) = 3.49, P <0.05) and global scores (F(2,44) = 7.48, P <0.01). Post-hoc tests indicated that both bench and cadaver training were superior to text learning and that bench and cadaver training were equivalent. CONCLUSIONS Training on a bench model transfers well to the human model, suggesting strong potential for transfer to the operating room.

Evaluating the effectiveness of a 2-year curriculum in a surgical skills center

BACKGROUND This study was a formative evaluation of a 2-year Surgical Skills Center Curriculum (SSCC) using objective measures of surgical performance and self-reported process-oriented evaluations. METHODS Fifty postgraduate third-year (PGY-3) residents participated in an Objective Structured Assessment of Technical Skills (OSATS) examination. Nineteen residents underwent the SSCC and 31 residents did not. During the SSCC, self-reported student and faculty evaluations were completed after each session. RESULTS For the OSATS examination, scores were not significantly different between treatment and control groups, on either the checklist (66.4 +/- 6.1 versus 64.1 +/- 10.8) or global rating scale scores (66.9 +/- 6.9 versus 68.0 +/- 9.6). Further comparisons between groups on individual OSATS stations revealed no significant differences between groups. The majority of student and faculty evaluation remarks were highly positive. CONCLUSIONS The OSATS results failed to support our hypothesis that training on a core procedure in a single session during a SSCC would have an appreciable and sustained effect after 2 years. Self-reported process-oriented evaluations support the utility of our SSCC.

Applying a Relative Ranking Model to the Self-Assessment of Extended Performances

Background: Accurate self-assessment is an important but underdeveloped skill in medicine that, in the past, has received little formal attention from educators.Method: Following an orthopedic rotation, twenty-five orthopedic surgery residents performed a self-assessment task for ten skills using a new relative ranking method, in which an individuals skills are ranked relative to each other rather than being compared to the individuals peers. Supervising faculty assessed residents using the same instrument. Faculty inter-rater reliability was measured and comparisons were made between each residents self-assessment and the faculty assessments using Spearman rank order correlation coefficients.Results: The mean correlation between faculty rating the same resident was 0.27 (sd = 0.49). The mean correlation between resident and faculty rankings was 0.20 (sd = 0.38), but was higher for junior residents (0.33) than for senior residents (0.12), apparently because senior residents do not alter their self-assessments while faculty change their assessments of senior residents.Conclusions: Consistent with the literature in other fields, we find that self-assessment is poor among surgical trainees when they are asked to assess their own performance over an extended time period.

The effect of tutors’ content expertise on student learning, group process, and participant satisfaction in a problem‐based learning curriculum

There is debate about whether problem‐based learning (PBL) tutors should have expertise in the content of each problem. This study addresses three aspects of the debate: student knowledge, the nature of the student‐tutor interaction, and student satisfaction. Four PBL problems were selected from a 2nd‐year clinical medicine course. Expert and nonexpert tutors were identified for each problem. Following each problem, students wrote an examination based on the problems learning objectives and completed a questionnaire evaluating their tutorial experience. In addition, the nature of the student—tutor interaction was assessed in 10 “expert”; and 10 “nonexpert”; tutorials. Analysis revealed no significant difference between tutorial groups led by content experts and those led by nonexperts. If PBL tutorials in an undergraduate curriculum are led by qualified physicians, the addition of problem‐specific expertise does not affect students’ acquisition of knowledge, the tutorial process, or student satisfaction ...

Association between Neuropathic Pain and Reported Disability after Total Knee Arthroplasty

ABSTRACT Purpose: To determine whether reporting neuropathic pain (NP) at an average of 5 years after total knee arthroplasty (TKA) was related to patient age, sex, preoperative comorbidity, arthritis self-efficacy, or disability before surgery and at 1 year after surgery. The estimate of NP prevalence and cross-sectional group differences were explored at 5 years after surgery. Methods: A subsample of participants in a formal research study was contacted via mail approximately 5 years after undergoing surgery and were sent four questionnaires: the Western Ontario and McMaster Universities Osteoarthritis Index, the Patient Health Questionnaire, the Self-Administered Leeds Assessment of Neuropathic Signs and Symptoms (S–LANSS), and a satisfaction questionnaire. NP was defined as an S-LANSS score of 12 or more. Results: Of 89 patients who met the inclusion criteria, data for 63 (71%) patients (47 women; mean age 67 [SD 8] y) were used for analysis. Of these 63, 9 (14%) were identified as having NP. None had a report of failure of prosthesis or other surgical complications according to most recent medical records. There was no relationship between preoperative patient characteristics and development of NP. However, the NP group on average had a higher report of stiffness (p=0.020), physical dysfunction (p=0.019), and pain (p=0.050) at 1 year after surgery. Cross-sectional comparisons showed higher levels of pain (p=0.001), stiffness (p=0.008), physical dysfunction (p=0.003), and depression (p=0.005) and lower satisfaction (p=0.018) at the time of the survey than the patients without NP. Conclusion: The estimated prevalence of NP was 14%. Patients with NP reported higher levels of disability as early as 1 year after surgery. They remained more disabled, with a higher level of depression and less satisfaction, at an average of 5 years after surgery.

The Effectiveness of a Technical Skills Course for Surgical Residents

This study investigates the impact of technical skills courses on first year surgical residents’ performance. Three issues were investigated: 1) the degree of performance improvement, 2) the duration of improvement, 3) the transfer of performance improvement to similar tasks. Twenty-four PGY1 surgical residents were randomized into 2 groups and 12 PGY5 orthopaedic residents were the gold standard. All groups completed a pretest consisting of 2 pairs of surgical tasks: 1) plating and k-wire fixation of a metacarpal fracture and 2) application of a forearm and below-knee plaster. Half of the PGY1 s had a course on plating a metacarpal fracture and half were given a course on application of a forearm plaster. One week postcourse, all residents were retested on the 4 tasks. Six weeks postcourse all PGY1s were retested. Pretest results showed that PGY1s were performing significantly below the PGY5 group on all tasks. When trained on a procedure, the PGY1 groups performance equalled the PGYSs’ and was significantly better than the PGY1 group that received no training. This significant difference was maintained over 6 weeks. However, performance on the tasks sharing similar basic principles did not show any improvement over the pretest scores with the performance of both PGY1 groups remaining significantly below that of the PGY5 group. Focused technical skills courses can result in substantial performance improvements. The effect can last 6 weeks. However, performance did not transfer to other tasks requiring similar basic skills.