title: Ward simulation to improve surgical ward round performance: a randomized controlled trial of a simulation-based curriculum.
abstract: OBJECTIVE
  This study aimed to investigate the effects of a simulation-based curriculum for ward-based care on ward round (WR) performance.
  
  
  BACKGROUND
  Variability in surgical outcomes does not relate to surgical skill alone. Prevention, diagnosis, and treatment of peri- and postoperative morbidity are dependent on provision of high-quality ward-based care. The focal point of this is the surgical WR. Although WR conduct is learned primarily through experience, a simulated environment and validated assessment tools may enable measurement and enhancement of WR quality.
  
  
  METHODS
  Junior surgical residents were randomized either to a half-day educational intervention with lectures, structured feedback, and debriefing, or to standard practice (control). All conducted a standardized, validated, simulated WR of 3 patients. Surgical Ward Care Assessment Tool and W-NOTECHS rating scales were used for technical and nontechnical skills assessment, respectively, and compared between groups. Subjects completed pre- and posttest confidence questionnaires and feedback forms.
  
  
  RESULTS
  Twenty-nine trainees were randomized to intervention (n = 14) or control (n = 15). Baseline confidence and demographics were equal between groups. Intervention group demonstrated better patient assessment: 63.5 ± 8.1% (control) versus 79.8 ± 11.9% (P = 0.002), management 56.0% ± 19.7% versus 72.2 ± 10.3% (P = 0.014), and nontechnical skills: W-NOTECHS 17.75 ± 2.06 versus 23.33 ± 1.21 (P < 0.001). Hundred percent of subjects felt that the curriculum improved their practice.
  
  
  CONCLUSIONS
  Conducting WRs is a crucial skill but not currently subject to formal training. Implementation of a comprehensive curriculum for surgical WRs led to significant improvement in quality of patient assessment, management, and nontechnical skills. Improved WR performance may lead to earlier identification and amelioration of complications and improve patient outcomes.
authors.affiliation: *Department of Surgery and Cancer, Imperial College London, London, United Kingdom; and †Department of Gastrointestinal Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Pucher
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Pritam
authors.initials: P
authors.lastname: Singh
authors.forename: Tharanny
authors.initials: T
authors.lastname: Srisatkunam
authors.forename: Ahmed
authors.initials: A
authors.lastname: Twaij
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D003198:Computer Simulation; D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D019317:Evidence-Based Medicine; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D016544:Patient Simulation; D011182:Postoperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000517:prevention & control; D011785:Quality Assurance, Health Care