Lisa A. Hollett

Preparing medical students to enter surgery residencies

BACKGROUND This study was designed to develop and evaluate an integrated cognitive and proficiency-based skills curriculum based on American College of Surgeons Graduate Medical Education Committee (ACGME) competencies to prepare students for surgery internships. METHODS Course content included cadaver dissections, didactic sessions, team training, and training in clinical and technical skills. Using previously validated skills curricula (12 open and 5 Fundamental Laparoscopic Surgery [FLS] tasks), trainees underwent pretest, self-practice to proficiency, and post-test. Surveys regarding confidence levels and skills were administered. RESULTS Mean course evaluation score was 4.5 +/- .6 on a 5-point Likert scale. Trainees (n = 9) achieved proficiency on open tasks and FLS tasks 2-5. The mean confidence self-rating on 51 skills increased on a 5-point Likert scale from 2.4 +/- .6 to 4.0 +/- .6 (P < .001). CONCLUSIONS This integrated curriculum did improve confidence levels, and skills proficiency can be achieved in an abbreviated time. The anticipated result would be enhanced baseline abilities for internship.

Implementation, construct validity, and benefit of a proficiency-based knot-tying and suturing curriculum

OBJECTIVES The aim of this proficiency-based, open knot-tying and suturing study was to evaluate the feasibility of implementing this curriculum within a residency program, and to assess construct validity and educational benefit. METHODS PGY1 residents (n = 37) were enrolled in an Institutional Review Board (IRB)-approved prospective study that was conducted over a 12-week period. Trainees viewed a video tutorial during orientation and as needed; they self-practiced to proficiency for 12 standardized knot-tying, practiced suturing tasks; performed 1 repetition of each task at baseline and posttesting; and completed questionnaires. RESULTS Curriculum implementation required 376 person-hours, and material costs were

Two-year skill retention and certification exam performance after fundamentals of laparoscopic skills training and proficiency maintenance

776. All trainees achieved proficiency within allotted 12 weeks. Overall, trainees completed 141 +/- 80 repetitions over 12.7 +/- 5.3 hours in addition to performing 13.4 +/- 12.4 operations. Baseline trainee and expert performance were significantly different for all 12 tasks and composite score (732 +/- 294 vs 1488 +/- 26, p < 0.001), which supported construct validity. Baseline trainees demonstrated significant improvement at posttesting according to composite scores (732 +/- 294 vs 1503 +/- 131, p < 0.001), which validates skill acquisition. CONCLUSIONS Implementation of this proficiency-based curriculum within the constraints of a residency program is feasible. This curriculum is educationally beneficial and cost effective; our data support construct validity. Evaluation of transferability to the operating room and more widespread adoption of this curriculum are warranted.

Can medical students achieve skills proficiency through simulation training

BACKGROUND The purpose of this study was to determine 2-year performance retention and certification exam pass rate after completion of a proficiency-based fundamental laparoscopic skills (FLS) curriculum and subsequent interval training. METHODS Surgery residents (postgraduate year [PGY]1-5, n = 91) were enrolled in an Institutional Review Board approved protocol. All participants initially underwent proficiency-based training on all 5 FLS tasks. Subsequently, available residents were enrolled every 6 months in an ongoing training curriculum that included retention tests on tasks 4 and 5, with mandatory retraining to proficiency if the proficiency levels were not achieved. The final retention test included the actual FLS certification examination for PGY4-5 trainees. RESULTS A 96% participation rate was achieved for all curricular components during the 2-year study period (PGY3-5, n = 33). Skill retention at retention 1-4 was 83%, 94%, 98%, and 91% for task 4 and 85%, 95%, 96%, and 100% for task 5, respectively. All PGY4-5 (n = 20) residents passed the FLS certification examination, achieving 413 +/- 28 total score on the skills portion (passing score > or =270) and demonstrating 92% retention for all 5 tasks. CONCLUSION Proficiency-based training with subsequent ongoing practice results in a very high level of skill retention after 2 years and uniformly allows trainees to pass the FLS certification examination.

Pretraining on Southwestern Stations Decreases Training Time and Cost for Proficiency-Based Fundamentals of Laparoscopic Surgery Training

BACKGROUND The purpose of this study was to determine whether third-year medical students can become proficient in open technical skills through simulation laboratory training. METHODS A total of 204 students participated in a structured curriculum including bladder catheterization, breast examination, and knot-tying. Proficiency was documented using global rating scales and validated, objective, model-based metrics. RESULTS For catheterization and breast examination, all trainees showed proficiency, and self-rated comfort increased in more than 90%. For knot-tying, 83% completed the curriculum; 57% and 44% of trainees showed proficiency for 2- and 1-handed tasks, respectively. Objective performance scores improved significantly for 2- and 1-handed knot-tying (62.9-94.4 and 49.2-89.6, respectively; P < .001) and comfort rating also increased (28%-91% and 19%-80%, respectively; P < .001). CONCLUSIONS Objective scores and trainee self-ratings suggest that this structured curriculum using simulator training allows junior medical students to achieve proficiency in basic surgical skills.

Trauma operative skills in the era of nonoperative management: the trauma exposure course (TEC).

BACKGROUND We previously reported a proficiency-based Fundamentals of Laparoscopic Surgery (FLS) curriculum that uniformly resulted in passing the technical skills certification criteria. We hypothesized that pretraining using the Southwestern (SW) videotrainer stations would decrease costs and training time and maintain benefits. STUDY DESIGN Group I (2nd-year medical student, n = 10) underwent FLS pretesting (Pretest 1), SW station proficiency-based training, repeat FLS testing (Pretest 2), FLS proficiency-based training, and final FLS testing (Posttest). These data were compared with a historic control, group II (2nd-year medical student, n = 10), which underwent FLS pretesting (Pretest 1), proficiency-based training, and final FLS testing (Posttest). RESULTS During training, group I achieved proficiency (85.4 + or - 26.2 repetitions) for all SW tasks. For both groups, proficiency was achieved for 96% of the FLS tasks, with substantial differences detected for group I and group II repetitions (100.5 + or - 15.9 versus 114 + or - 25.5) and training time (6.0 + or - 1.5 versus 9.2 + or - 2.2 hours), respectively. Per-person material costs were considerably different for groups I and II (

A Randomized Comparison of Laparoscopic, Flexible Endoscopic, and Wired and Wireless Magnetic NOTES Cameras On Ex-Vivo and In-Vivo Surgical Performance

827 + or - 116 versus

Transvaginal Single Access “Pure” NOTES Sleeve Gastrectomy Using a Deployable Magnetically Anchored Video Camera

1,108 + or - 393). Group I demonstrated significant improvement from Pretest 1 (149 + or - 39; 0% FLS pass rate) to Pretest 2 (293 + or - 83; p < 0.001; 60% FLS pass rate), and to Posttest (444 + or - 60; p < 0.001; 100% FLS pass rate). Group II demonstrated significant improvement from Pretest 1 (158 + or - 78; 0% FLS pass rate) to Posttest (469.7 + or - 12.0; p < 0.001; 100% FLS pass rate). CONCLUSIONS Pretraining on SW stations decreases training time for FLS skill acquisition and maintains educational benefits. This strategy decreases costs associated with using consumable materials for training.