title: Verification of accurate technical insight: a prerequisite for self-directed surgical training.
abstract: Simulation-based surgical skills training during preclinical education is a persistent challenge due to time constraints of trainees and instructors alike. Self-directed practice is resource-efficient and flexible; however, insight into technical proficiency among trainees is often lacking. The purpose of this study is to prospectively assess the accuracy of self-assessments among medical students learning basic surgical suturing. Over seven weekly practice sessions, preclinical medical students performed serial repetitions of a simulation-based suturing task under one-on-one observation by one of four trainers. Following each task repetition, self- and trainer-assessments (SA-TA) were performed using a 36-point weighted checklist of technical standards developed a priori by expert consensus. Upon study completion, agreement between SA and TA was measured using weighted Cohen's kappa coefficients. Twenty-nine medical students each performed a median of 25 suture task repetitions (IQR 21.5-28). Self-assessments tended to overestimate proficiency during the first tertile of practice attempts. Agreement between SA and TA improved with experience, such that the weighted kappa statistics for the two-handed and instrument ties were >0.81 after 18-21 task attempts. Inexperienced trainees frequently overestimate technical proficiency through self-assessments. However, this bias diminishes with repetitive practice. Only after trainees have attained the capacity to accurately self-assess can effective self-directed learning take place.
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, PO Box 800709, Charlottesville, VA, 22908-0679, USA, YH9B@virginia.edu.
authors.forename: Yinin
authors.initials: Y
authors.lastname: Hu
authors.forename: Helen
authors.initials: H
authors.lastname: Kim
authors.forename: Adela
authors.initials: A
authors.lastname: Mahmutovic
authors.forename: Joanna
authors.initials: J
authors.lastname: Choi
authors.forename: Ivy
authors.initials: I
authors.lastname: Le
authors.forename: Sara
authors.initials: S
authors.lastname: Rasmussen
mesh_terms: D002983:Clinical Competence; D004504:Education, Medical, Undergraduate; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012647:Self-Assessment; D000066908:Simulation Training; D013337:Students, Medical / Q000523:psychology*; D013536:Suture Techniques / Q000193:education*; D055815:Young Adult