Module based training improves and sustains surgical skills: a randomised controlled trial.
OBJECTIVE
Traditional surgical training is challenged by factors such as patient safety issues, economic considerations and lack of exposure to surgical procedures due to short working hours. A module-based clinical training model promotes rapidly acquired and persistent surgical skills.


METHODS
A randomised controlled trial concerning supervised hernia repair in eight training hospitals in Denmark was performed. The participants were 18 registrars [Post graduate year (PGY) 3 or more] in their first year of surgical specialist training. The intervention consisted of different modules with a skills-lab course followed by 20 supervised Lichtenstein hernia repairs. Operative performance was video recorded and blindly rated by two consultants using a previously validated skills rating scale (8-40 points). Outcome measures were change in the ratings of operative skills and operative time.


RESULTS
In the intervention group (n = 10) the average rating of operative skills before intervention was 22.5 (20.6-24.3) and after 26.2 (23.5-28.8), p = 0.044. At follow-up after 1 year, rating was 26.9 (23.4-30.4), p = 0.019. In the conventionally trained group average rating was 23.4 (19.4-27.3) at start and 21.7 (17.3-26.1) at end, p = 0.51. At start no difference was detected between the two groups, p = 0.59; by 1 year the difference was statistically significant favouring intervention, p = 0.044. Operative time showed similar results in favour of the intervention.


CONCLUSIONS
A module-based training model in Lichtenstein hernia repair was preferable in both short and long-term compared with standard clinical training. The model will probably be applicable to other surgical training procedures.
Centre of Medical Education, Aarhus University, Incuba Science Park, Brendstrupgaardsvej 102, 8200, Aarhus N, Denmark. charlotte@greenhesel.dk.
C G
CG
Carlsen
NordSim, Centre for Simulation and Skills Training, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark.
K
K
Lindorff-Larsen
Clinical Institute, Skejby Hospital, Aarhus University, Brendstrupgaardsvej 100, 8200, Aarhus N, Denmark.
P
P
Funch-Jensen
Department of Urology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
L
L
Lund
Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Blegdamsvej 9, 2100, Copenhagen, Denmark.
L
L
Konge
Centre of Medical Education, Aarhus University, Incuba Science Park, Brendstrupgaardsvej 102, 8200, Aarhus N, Denmark.
P
P
Charles
D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D003718:Denmark; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000193:education*; D006801:Humans; D008297:Male; D008953:Models, Anatomic; D061646:Operative Time; D017063:Outcome Assessment, Health Care
Lichtenstein hernia repair; Surgical training; Workplace based assessment