A theory-based curriculum for enhancing surgical skillfulness.
BACKGROUND
Curricula for surgical technical skills laboratories have traditionally been designed to accommodate the clinical activities of residents, so they typically consist of individual, episodic training sessions. We believe that the skills laboratory offers an opportunity to design a surgical skills curriculum based on the fundamental elements known to be important for motor skill instruction. We hypothesized that training novices with such a curriculum for a 1-month period would yield skills performance levels equivalent to those of second year surgery residents who had trained in a traditional program.


METHODS
Fourth-year medical students served as study subjects (novice group) during a 4-week senior elective. They were taught each skill during a 1-week period. Subjects received instruction by a content expert followed by a 1-week period of deliberate practice with feedback. The novice performances were videotaped both before and after the intervention, and each videotape was evaluated in a blinded fashion by experts using a validated evaluation instrument. These results were compared with skill performance ratings of first- and second-year surgery residents that had been accumulated over the previous 3 years.


RESULTS
Average performance ratings for the novices substantially improved for all four skills after training. There was no marked difference between average performance ratings of postintervention novice scores when compared with the average scores in the resident group. Inter-rater agreement in scoring for the videotaped novice performances exceeded 0.87 (intraclass correlation) for all ratings of pre- and posttraining.


CONCLUSIONS
These results demonstrate the effectiveness of a laboratory-based training program that includes fundamentals of motor skills acquisition.
Boehler
Margaret L
ML
Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9655, USA.
Schwind
Cathy J
CJ
Rogers
David A
DA
Ketchum
Janet
J
O'Sullivan
Erin
E
Mayforth
Ruth
R
Quin
Jacquelyn
J
Wohltman
Chris
C
Johnson
Colleen
C
Williams
Reed G
RG
Dunnington
Gary
G
D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D017145:Models, Educational; D015397:Program Evaluation; D014743:Videotape Recording