JMIR Publications

ABSTRACT

Background:

Cadaveric training is rapidly gaining popularity as the ultimate surgical simulation. Cadaveric simulation is expensive to provide and residents will generally be limited to one attempt at each procedure during a course. It is therefore essential to maximise the impact of that training opportunity, so as to allow for the greatest educational gains, in the most cost and time-efficient way. Deliberate practice (DP) is an educational-theory driven way to maximise the efficiency of surgical simulation training.

Objective:

The objectives were 1) to assess the impact of a freestyle, deliberate-practice cadaveric hand surgery simulation training intervention on self-reported operative confidence for three different procedures and 2) assess subjective transfer validity, perceived educational value and simulation fidelity of the training.

Methods:

Design This study used validated questionnaires to assess the training impact on a cohort of orthopedic residents. The freestyle course structure allowed residents to prospectively define personalised learning objectives, which were then addressed through deliberate practice. Setting The study was conducted at Keele Anatomy and Surgical Training Centre, a medical school with integrated cadaveric training laboratory in England, United Kingdom Participants Twenty-two PGY 5-10 orthopedic surgery residents from three regional surgical training programmes.

Results:

The most junior (PGY5-6) residents had the greatest self-reported confidence gains after training for the three procedures (ORIF distal radius, flexor tendon repair, ulnar shortening osteotomy), and these gains diminished with resident seniority. The confidence gains were proportional to the perceived procedural complexity, with the most complex procedure having the lowest pre-training confidence score across all experience levels, and the greatest increase post-training. Mid-stage (PGY 7-8) residents reported receiving the highest level of educational benefit from the training, but perceived the simulation to be less realistic than either the junior or senior residents. The most senior residents (PGY9-10) reported the greatest satisfaction with the self-directed, freestyle nature of the training. All groups reported they were extremely likely to transfer their technical skill gains to their workplace, that they would change their current practice based on these, and that their patients would benefit as a result of having undertaken the training.

Conclusions:

Freestyle, resident-directed cadaveric simulation provides optimum deliberate practice conditions whereby residents can target their individualised learning needs. By receiving intensive, directed feedback from faculty they can make rapid skill gains in a short amount of time. Subjective transfer validity potential from the training was very high, and objective, quantitative evidence of this is required from future work. Clinical Trial: Not applicable