title: Impact of a structured skills laboratory curriculum on surgery residents' intraoperative decision-making and technical skills.
abstract: BACKGROUND
  This project sought to study the effectiveness of a curriculum to enhance the intraoperative clinical judgment and procedural skill of surgical residents.
  
  
  METHODS
  A multiinstitutional, prospective, randomized study was performed. A cognitive task analysis of laparoscopic cholecystectomy (LC) was conducted on which instructional activities and measurement instruments were designed. Residents were randomly assigned to a control or intervention group. Subjects took written pre- and posttests examining procedure-related judgment and knowledge. The intervention group participated in a three-session curriculum emphasizing LC critical decisions and error prevention. All subjects were evaluated performing the procedure on a cadaveric model. Scores from written and practical exams were compared using independent-sample and paired Student t tests.
  
  
  RESULTS
  Written examination scores increased for both groups. The intervention group scored significantly higher (P < .05) on the written posttest than the control group. There were no differences between groups on the practical examination. Reliability coefficients for the written examination ranged from .65 to .75. Reliability coefficients for the oral exam, technical skill, and error items on the porcine practical exam were .83, .90, and .53.
  
  
  CONCLUSIONS
  The curriculum resulted in enhanced performance on a written exam designed to assess intraoperative judgment, but no differences in technical skills, showing important implications for future skills lab curriculum formats.
authors.affiliation: Department of Surgery, 251 E. Huron, Galter 3-150, Chicago, IL 60611, USA. ddarosa@nmh.org
authors.forename: Debra
authors.initials: D
authors.lastname: DaRosa
authors.forename: David A
authors.initials: DA
authors.lastname: Rogers
authors.forename: Reed G
authors.initials: RG
authors.lastname: Williams
authors.forename: Linnea S
authors.initials: LS
authors.lastname: Hauge
authors.forename: Heather
authors.initials: H
authors.lastname: Sherman
authors.forename: Kenric
authors.initials: K
authors.lastname: Murayama
authors.forename: Alexander
authors.initials: A
authors.lastname: Nagle
authors.forename: Gary L
authors.initials: GL
authors.lastname: Dunnington
mesh_terms: D002983:Clinical Competence; D015331:Cohort Studies; D003657:Decision Making; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007600:Judgment; D010535:Laparoscopy; D018794:Problem-Based Learning / Q000458:organization & administration*; D015397:Program Evaluation