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Randomized double-blinded trial investigating the impact of a curriculum focused on error recognition on laparoscopic suturing training. J Bingener, T Boyd, K Van Sickle, I Jung, A Saha, J Winston, P Lopez, H Ojeda, W Schwesinger, D Anastakis. Background.

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slide1

Randomized double-blinded trial investigating the impact of a curriculum focused on error recognition on laparoscopic suturing training

J Bingener, T Boyd, K Van Sickle, I Jung, A Saha, J Winston, P Lopez, H Ojeda, W Schwesinger, D Anastakis

background
Background
  • Laparoscopic intracorporeal suturing not easy to learn
  • Best learned outside patient care setting
  • Computer and box training tools
background1
Background
  • Suturing skills – imitation learning
  • “ this is how I do it” - “don’t do it like this”
  • Knowledge based errors
surgical skill is predicted by the ability to detect errors bann s et al am j surg 189 2005 412 415
Surgical skill is predicted by the ability to detect errors (Bann S et al. Am J Surg 189 (2005) 412-415)

Observed surgical skill (OSATS)

Error detection on 22 models presented

question
Question

Will the inclusion of an error recognition module in the laparoscopic suturing curriculum

  • enable error recognition and
  • improve the technical proficiency of the learner?
study design
Study design
  • Study population:
  • 30 novices
  • randomized to

A: control group

B: intervention group

  • Learners blinded to group assignment
  • Video-instruction for laparoscopic suturing
slide7

Questionnaire Suturing video (1)

Pretest:

suturing task time

OSATS video score

Group B

Group A

Error recognition video (2)

Suturing practice

Suturing practice

post test:

post test:

OSATS video score

Error counting video (3)

Error counting video (3)

OSATS video score

Suturing task time

Suturing task time

study design1
Study design
  • No feed-back during study
  • Same investigator
  • Study period: 2 summer months
  • Time line

Group A

Group B

metrics
Metrics
  • Pre and post training laparoscopic suturing task time (seconds)
  • Pre and post training OSATS score (1-5)
  • Post training error recognition score (% errors recognized in video compared to experts)
reviewer preparation
Reviewer preparation
  • Reviewers watched novice and expert video for “calibration”
  • Blinded to group assignment
  • Independent review after study period
  • Kendall’s Tau for correlation

0.6 <τ <0.99

osats sub scores
OSATS sub-scores

p=0.63

P=0.53

Mean OSATS scores for instrument handling

Mean OSATS scores for task forward flow

slide16

p=0.43

p=0.62

Mean OSATS scores for knowledge of task

Mean OSATS scores for respect for tissue

p=0.066

Mean OSATS scores for time motion efficiency

results summary
Results - summary
  • Additional error recognition teaching
    • Slowed down learner in task performance
    • Did not change OSAT scores
    • Led to cognitive error recognition
visual information overload
Visual information overload?

Group B

Corrrect pattern

Error pattern

Incorrect pattern

Group A

  • Timing of error teaching module
  • Time to practice
  • Repetitive practice
  • Separate days
slide20

Attentional capacity threshold

Attentional

resources

Use of Attentional Resources

Gallagher et al

Gaining additional

knowledge

Comprehending

Attending

instruction

Judgement &

Decision making

Depth & Spatial

judgments

Psychomotor

performance

Novice surgeon

Pre-trained Novice

Master surgeon

future research directions
Future Research Directions
  • Modify instruction timing
  • Modify learner group (pre-trained novice/ intermediate learner)
  • Use video-game experience as randomization criterion