Improving Neurosurgery Resident Microdissection Through Placental Simulation

Address rehearsal

Construct Validity of a Simple Laparoscopic Ovarian Cystectomy Model Using a Validated Objective Structured Assessment of Technical Skills

A relatively small amount of time is committed to improving psychosocial support skills among clinicians in cancer care. This is problematic given the high prevalence of mental health problems among patients in cancer care, which can have implications for treatment concordance, patient experience and care costs. Improving psychosocial support skills in cancer care staff can contribute to improved staff well-being alongside benefitting patients with mental health problems. There are well-evidenced programmes to support this. However, many education programmes for psychosocial skills in cancer care (e.g., advanced communication skills training) have protocols that can be too lengthy to implement alongside training more directly related to cancer diagnosis and treatment. An innovative education programme was trialled to improve the efficiency and effectiveness of psychosocial support skill acquisition and implementation among cancer care clinicians. This programme was novel in its incorporation of deliberate practice (DP): an approach used to achieve expertise in disciplines such as sport and music. It involves observing baseline skill level, identifying clinicians' individualised, specific microskill deficits, then conducting focused practice of targeted microskills with real-time feedback. Although similar methods are used in other areas of medical education, the approach has only recently been applied to psychosocial support skills1; this was the first application in cancer care. The programme also focused on brief psychosocial therapeutic techniques that clinicians could apply to their own lives in DP as well as with patients. This incorporated genuine responses during DP ‘real-plays’ and allowed clinicians to experience the potential benefits to well-being that each technique offered. The approach was facilitated by using evidence-based psychosocial support methods that aimed to improve universal human processes: Techniques to address problems that are part of the human condition rather than processes only seen in mental disorders. Over two training days, trainers applied each skill to a genuine concern in their own life (that they were comfortable discussing), facilitated by their co-trainer. Clinicians were involved in refinement processes of this real-play and DP demonstration through feedback and discussions. Clinicians then practiced each technique in threes: one practicing skills, one real-playing their problem and one observing. Learning from these training days was consolidated with facilitated, one-hour, monthly, DP-orientated group supervision. The programme was attended by 145 cancer care clinicians who reported improvements in psychosocial assessment and intervention skills at 8-month follow-up from pre-training with a very large effect size. Clinicians also reported significant improvements in mental well-being, work engagement and burnout. Twenty-six clinicians were interviewed about their training experience. Notably, 21 of 26 interviewees reported that observing real-plays and considering the relevance of techniques to their personal circumstances were important and helpful part of the process towards implementation in practice. However, only 27% of clinicians attended monthly supervision sessions, suggesting that greater improvements could be obtained with protected attendance time allocated. Overall, using DP to help clinicians apply psychosocial support skills to their own lives supported improvement in skills, well-being and implementation to practice.

Learning Curves of OBGYN Residents Preparing for the FLS Manual Skills Exam

Surgical ergonomics. Analysis of technical skills, simulation models and assessment methods

Over 25 years ago Ericsson et al. (1993) published the results of their search for the most effective forms of training in music, a domain where knowledge of effective training has been accumulated over centuries. At music academies master teachers provide students individualized instruction and help them identify goals and methods for their practice sessions between meetings – this form of solitary practice was named deliberate practice, and its accumulated duration during development was found to distinguish groups with differing levels of attained music performance. In an influential meta-analysis Macnamara et al. (2014) identified studies that had collected estimates of practice accumulated during development and attained performance and reported that individual differences in deliberate practice accounted for only 14% of variance in performance. Their definition of “deliberate practice” differs significantly from the original definition of deliberate practice and will henceforth be referred to as structured practice. We explicate three criteria for reproducible performance and purposeful/deliberate practice and exclude all effect sizes considered by Macnamara et al. (2014) that were based on data not meeting these criteria. A reanalysis of the remaining effects estimated that accumulated duration of practice explained considerably more variance in performance (29 and 61% after attenuation correction). We also address the argument that the limited amount of variance explained by the duration of practice necessarily implies an important role of genetic factors, and we report that genetic effects have so far accounted for remarkably small amounts of variance – with exception of genetic influences of height and body size. The paper concludes with recommendations for how future research on purposeful and deliberate practice can go beyond recording only the duration of practice to measuring the quality of practice involving concentration, analysis, and problem solving to identify conditions for the most effective forms of training.

Surgical residents need structured and objective feedback to develop their skills and become capable of performing surgical procedures autonomously. A shortage of experienced surgical staff has prompted residents to seek feedback from self-assessment and peer assessments. We investigated whether surgical residents can reliably rate their own and their peers' basic surgical skills using the Global Rating Scale (GRS) from the Objective Structured Assessment of Technical Skills. The study was a prospective and descriptive study conducted using gap analysis at the Copenhagen Academy for Medical Education and Simulation (Copenhagen, Denmark) from 2016 to 2017. Surgical residents were recruited during a course in basic open surgical skills. Among 102 course participants, 53 met the inclusion criteria and 22 participated in the study. We recruited surgical residents based in the Capital Region and Zealand Region of Demark, and 42% of eligible residents participated in the study. Surgical residents underestimated their own surgical performance (median, 17 [range, 15-18] vs. 20 [range, 19.75-22]; P < 0.001). They also rated their peers lower than an experienced rater did (median 10 [range, 8.75-14] vs. 15 and median 20.5 [range, 19-22] vs. 23; both P < 0.001). Gap analysis revealed residents had unrecognized strengths (ie, self-underappraisal) in most GRS domains. Ratings are unreliable when surgical residents assess their own and their peers' performances using GRS. A gap analysis revealed unrecognized strengths in time and motion, instrument handling, knowledge of instruments and sutures, and knowledge of specific procedure as well as unrecognized weaknesses in flow of operation and forward planning.

The amount of intense and focused training with the specific goal to improve performance (i.e. deliberate practice) is a predictor of expert-level performance in multiple domains of psychomotor skill learning. Simulation training improves surgical skills in cardiac surgery. We established a training programme that enables early surgical exposure and assessment. We investigated the training effects in coronary surgery simulations in trainees with different levels of surgical experience. The early surgical exposure and assessment programme comprises a low- and high-fidelity simulation, self-organized training, instructed workshops and a stepwise challenge increase. Performance was assessed with a multidimensional skill matrix using video recordings. Two groups of trainees [students (N = 7), 1-/2-year residents (N = 6)] completed introductory training (pretraining, level 1) and two 3-week training periods (levels 2 and 3). Fellows (N = 6) served as controls. Residents and students underwent deliberate practice training with specific training targets. Fellows performed regularly scheduled coronary surgery cases. Entry and exit assessments were conducted for levels 2 and 3. Fellows did not improve overall performance. Residents and students showed significant improvements in both technical accuracy and completion times. Residents reached an overall performance level comparable to fellows. Students reached similar accuracy of surgical skills with longer completion times [level 3 exit score/time: fellows 27 (24-29)/min; residents 27 (21-30)/min, P = 0.94; students 17 (17-25)/min, P = 0.068]. Deliberate practice training resulted in a fast and substantial increase in surgical skills in residents and students. Unexperienced residents reach performance levels of fellows. Deliberate practice simulation programmes should be a mandatory component of surgical training.

Exploring Entrustment: Housestaff Autonomy and Patient Readmission

Residency programs are charged with teaching, assessing, and documenting resident competency for a multitude of skills. Documentation of competency requires demonstrating specific milestones mandated by the Accreditation Council for Graduate Medical Education. Our department designed an innovative, competition-based approach to objectively assess the skill level of postgraduate year 1 residents in performing basic anesthesia-related tasks after 1 month of anesthesiology training. We launched an "Olympic" event to assess requisite skills in an environment of friendly competition. A simulation format was chosen to allow standardized objective assessment of the resident's skill level at an early stage of training, with possible identification of and intervention for skills needing improvement. Our experience may serve as a template for other programs and specialties developing processes for assessing and documenting improvement in skill and competency over the course of residency training.

A national survey on the impact of the COVID-19 pandemic upon burnout and career satisfaction among neurosurgery residents

Surgical education has traditionally relied on apprenticeship, which is limited by the availability of operations and case variability. Deliberate practice (DP) is a structured, goal-directed training method that emphasizes targeted objectives and individualized feedback. This study compared trainee performance in distal radius malunion osteotomy on three-dimensional-printed bone models using naïve practice (NP) versus video-assisted DP. Twelve participants were stratified by expertise level (levels 1 and 2), assigned to either the NP or DP group, and tasked to complete five consecutive trials (E1–E5). Performance was assessed using the Objective Structured Assessment of Technical Skill (score range: 15–75) and analyzed with appropriate statistical methods. Baseline scores (E1) were similar between NP (57.7 ± 7.4) and DP (60.2 ± 9.1; p = 0.87). By E5, DP participants achieved higher scores (72.0 ± 2.8) than NP (67.0 ± 4.5; p = 0.038). Improvement was greatest in level 1 trainees, who demonstrated larger relative gains, despite lower absolute scores compared with level 2 participants These results are consistent with the literature demonstrating the effectiveness of DP in orthopaedics and highlight the complementarity between DP and mental practice. The systematic integration of active, feedback-guided methods—such as video-assisted DP—may shorten the learning curve and raise the performance level of surgical trainees.

IntroductionChild neurology has unique challenges in communication due to complex disorders with a wide array of prognoses and treatments. Effective communication is teachable through deliberate practice and coaching. Objective structured clinical exams (OSCEs) are one method of providing practice while assessing communication skills. Yet OSCEs have not been reported for child neurology residents.MethodsWe developed simulated clinical cases centering on communication skills for child neurology residents, all with challenging clinical scenarios (e.g., disclosure of a medical error, psychogenic nonepileptic events). Standardized patients (SPs) portrayed the parents of pediatric patients and, in some scenarios, an adolescent patient. We used a modified Gap-Kalamazoo Communication Skills Assessment Form to assess communication skills. The assessment was completed by faculty, SPs, and the resident, and we measured agreement among raters. Residents were surveyed afterward regarding their experience.ResultsNine cases were developed and piloted. A total of 27 unique resident-case encounters with 16 individual trainees occurred over three annual implementations. Scores on the 360-degree assessment of communication skills showed that residents overwhelmingly underassessed their skills compared to other rater groups. Among 18 responses on the post-OSCE survey, the majority (77%) found the experience useful to their education and felt that the feedback from the SPs was helpful (61%) and the case portrayals were realistic (89%).DiscussionWe implemented simulated cases for assessment and formative feedback on communication skills for child neurology residents. We provide a blueprint to develop this educational activity in other programs.

Use of a simulation-based mastery learning curriculum for neurology residents to improve the identification and management of status epilepticus

The Accreditation Council for Graduate Medical Education (ACGME) duty hour standards that began July 2011 will further limit resident duty hours. To survey neurosurgery residents in the United States on duty hour violations under the current system and the predicted effects on education and patient safety of the new regulations. Surveys were mailed to every neurosurgery training program in the United States and Puerto Rico. Program directors and coordinators were asked to distribute surveys to their residents. Three hundred seventy-seven neurosurgery residents mailed surveys back to the study center (34% response rate). More than one-third of respondents reported violating the 80-hour rule occasionally or frequently (36%). Thirty-one residents (8%) reported having been involved in a motor vehicle collision or life-threatening event and 20 (6%) reported having made a medical error resulting in patient harm after an extended shift. Eighty-three percent disagreed with the 16-hour proposed regulation for postgraduate year 1. The majority of respondents thought that the new standards will have a negative or strongly negative effect on their residency training (72%). This national duty hour survey of neurosurgical residents reveals considerable concern over the new ACGME proposed standards. The majority of respondents believe that the new standards will have a negative effect on their residency training. Furthermore, this survey indicates an overwhelming negative attitude toward mandated duty hour regulations among neurosurgical residents. Duty hour violations reported in this survey may be a more honest depiction of true violations than previous surveys and are higher than expected.