A structured self-directed basic skills curriculum results in improved technical performance in the absence of expert faculty teaching.
BACKGROUND
We developed a novel curriculum teaching 20 open surgical skills in 5 general domains (instrument handling, knot tying, simple wound closure, advanced wound closure, and hemostasis). The curriculum includes online didactics, skills practice, and defined performance metrics, but is entirely self-guided with no expert oversight or teaching.


METHODS
Subjects included first- and second-year medical students (n = 9). Subjects first viewed a demonstration video depicting proper technique. The pretest was video-recorded performance of each skill. Subjects then completed the self-guided skills curriculum at their own pace, returning for posttesting once they met defined self-assessment criteria. Performance was evaluated through both self-assessment and blinded video review by 2 expert reviewers using previously validated scales.


RESULTS
After completion of the curriculum, performance improved significantly by both self-assessment (3,754 ± 1,742 to 6,496 ± 1,337; P < .01, Wilcoxon signed ranks) and expert assessment (10.1 ± 2.6 to 14.6 ± 2.7; P = .015). When analyzed by the 5 general domains, performance was significantly better for all domains by self-assessment (P < .05 for all domains) and in 4 domains by expert assessment (P < .04 for all domains other than instrument handling).


CONCLUSIONS
Completion of a self-guided basic surgical skills curriculum allows novice learners to significantly improve performance in basic open surgical skills, without traditional expert teaching. This curriculum is useful for medical students and incoming junior residents.
Department of Surgery, University of Washington, Seattle, WA, USA. awright2@uw.edu
Andrew S
AS
Wright
Jill
J
McKenzie
Abraham
A
Tsigonis
Aaron R
AR
Jensen
Edgar J
EJ
Figueredo
Sara
S
Kim
Karen
K
Horvath
D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum / Q000592:standards*; D004521:Educational Measurement; D005180:Faculty, Medical; D013502:General Surgery / Q000193:education*; D006801:Humans; D011380:Programmed Instructions as Topic / Q000592:standards*; D015203:Reproducibility of Results; D012647:Self-Assessment; D013337:Students, Medical; D013647:Task Performance and Analysis; D014741:Video Recording