First Impressions (Student Perspective): With the decreasing resident work hours but no concurrent increase in the length of residency training, it is becoming progressively more important that surgical skills are taught in not only the most effective manner, but also the most efficient. It is a long studied topic in surgical education, however, there has been little consensus on the optimal techniques to use. One topic that has received attention is the idea of preoperative practice before entering the operating room. The authors of this paper pointed out that while it is common for musicians and athletes to practice immediately before a performance or competition, surgeons, who perform comparable feats requiring physical and mental acuity, do not typically practice before a surgery.
The authors of this study wanted to build on prior research that has been done that has shown a benefit of preoperative practice on surgical trainee’s intraoperative performance. They designed a randomized controlled study to look at the effects of preoperative practice with instructor feedback compared to preoperative practice alone or feedback alone on the score of an assessment of laparoscopic salpingectomy. The study was performed in the Department of Obstetrics and Gynecology at the University of Toronto and included 18 OBGyn residents in years two through six of training. The participants were first tested on a virtual reality surgical simulator to be assigned a baseline score of 0-100%. This was done at least one day prior to their study intervention and outcome assessment. Then before the scheduled operation, they were either allowed 15 minutes of practice on the laparoscopic salpingectomy module or given standardized instructor feedback or both depending on which group they were assigned. The median score on the assessment tool for laparoscopic salpingectomy in the PPF group was the highest, however, the study failed to find a significant difference in score on the laparoscopic assessment between the groups of trainees.
Unfortunately, the study described in this paper failed to find a significant difference between the groups, and thus was unable to make conclusions about using instructor feedback effectively to train surgical residents. However, according to the paper, prior studies have provided some evidence that preoperative practice is effective. The paper pointed out that their study had multiple limitations including that they chose to use terminal feedback, but that it could be that a different type of feedback may be better in training. Additionally, the sample size was small and that although the sample size calculation was validated, it may require a larger sample size to show a significant difference. The main take away from this study is that further research needs to be focused on looking for the most effective techniques in training residents in a surgical setting.
Ali Falkenstrom, MD
Medical College of Georgia
Augusta University
Abstract: BACKGROUND: There is evidence that preoperative practice prior to surgery can improve trainee performance, but the optimal approach has not been studied. OBJECTIVE: We sought to determine if preoperative practice by surgical trainees paired with instructor feedback improved surgical technique, compared to preoperative practice or feedback alone. METHODS: We conducted a randomized controlled trial of obstetrics-gynecology trainees, stratified on a simulator-assessed surgical skill. Participants were randomized to preoperative practice on a simulator with instructor feedback (PPF), preoperative practice alone (PP), or feedback alone (F). Trainees then completed a laparoscopic salpingectomy, and the operative performance was evaluated using an assessment tool. RESULTS: A total of 18 residents were randomized and completed the study, 6 in each arm. The mean baseline score on the simulator was comparable in each group (67% for PPF, 68% for PP, and 70% for F). While the median score on the assessment tool for laparoscopic salpingectomy in the PPF group was the highest, there was no statistically significant difference in assessment scores for the PPF group (32.75; range, 15–36) compared to the PP group (14.5; range, 10–34) and the F group (21.25; range, 10.5–32). The interrater correlation between the video reviewers was 0.87 (95% confidence interval 0.70–0.95) using the intraclass correlation coefficient. CONCLUSIONS: This study suggests that a surgical preoperative practice with instructor feedback may not improve operative technique compared to either preoperative practice or feedback alone.
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