Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith Millikan, and Gary Dunnington
Purpose Develop and test an instructional design template for skills lab curriculum that is: • Based on pertinent theories • Focuses on judgment & procedural skills • Is feasible and portable • Includes evaluation component
Research Question Is there a difference…. in the judgment and technical skills of residents exposed to a skills lab curriculum based on a structured instructional design template?
TeamLeaders Curriculum Team David Rogers* Linnea Hauge Ken Murayama Deb DaRosa Evaluation Team Reed Williams* Keith Millikan Alex Nagle Gary Dunnington Deb DaRosa
Cognitive Task Analysis • Arises from Human Factors • Group of analytical techniques designed to capture expert thinking Elstein AS. Decision analysis in surgical education. World J. Surg 1989;13:287-91.
CTA Example During the course of a laparoscopic cholecystectomy, the surgery resident variously strays into the lumen of the gallbladder and the parenchyma of the liver.
Experimental Design T group RO1 X O2 C group RO3 O4 • Institution T C Total • A 9 7 16 • B 13 15 28 • C 10 9 19 • Total 32 31 63
Instructional Design Template • Curriculum & Learning Theories • Whole-Part Method • Objectives • Feedback – written/oral • Distributed learning episodes • Active & learner-centered • Repetition and practice • Problem & experience-oriented
Curriculum: Session 1 Both T and C Groups - Baseline • Orientation by Chair or PD • Written pretest • View MedAscend CD of Lap Chole • Question/Answer period • Box trainer exercises
Written Exam Items Which trocar placement is optimal for a laparoscopic cholecystectomy?
Example: Written Test Which retraction of the gallbladder provides optimal exposure of the cystic duct?
Example: Written Exam List up to three methods for determining whether the veress needle has penetrated into the abdominal cavity.
Curriculum: Session 2 Homework: Pblm centered exercise Assigned readings • Pre trial testimony • Review designed CD-ROM – 12 critical steps of LC • Worksheet to record steps • Error brainstorm session • Summary
Curriculum: Session 3 • Recall exercise w/ CD-ROM • Review/Discussion • Porcine Practice • Think aloud rehearsal • Peer feedback using Porcine checklist
Curriculum: Session 4 Both Groups • Written post-test • Porcine exercise (45 minutes) using think aloud rehearsal • Faculty (blinded) direct observation with final feedback – Porcine checklist
Measures and Analysis Measurement Instruments • Written pre and post-test • LC Porcine Evaluation Form • LC Evaluation Form for OR Data Analysis • Cronbach’s Alpha Coefficients • Student’s T-test
Study Limitations • Small sample size • Subject mortality – OR evaluation • Insufficient practice time • Changes in study personnel • Outcome evaluation flaws • Talk aloud • Eubanks items • Direct observation by faculty
Conclusions Instructional Design Template Effective in: • CTA methodology – blueprint for cohesive curriculum and reliable exams • Enhancing intra-operative judgment as assessed on written examination
Revised Instructional Design Template: Part 1 Descriptive Information • Assumptions about learners • Description of skill - Cognitive task analysis - Procedural task analysis • Potential errors and complications - Prevention, anticipation, & management strategies
Revised Instructional Design Template: Part 2 Instructional Plan • Objectives and Teaching plan • Time, resources, sequence, etc • Homework/assignments • Guidelines for facilitator/learners • Practice guidelines • Frequency, intensity, duration
Practice, Practice, Practice Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance. Acad Med, 2004.
Revised Instructional Design Template: Part 3 Feedback and Evaluation • Practice performance standards • Time, conditions, etc. • How feedback will be given • Pre-test description • Post-test description • Outcome evaluation criteria
Thank You! Foundation of the Association for Surgical Education (CESERT) SIU: Janet Ketchum Rush: Daniel Deziel, MD Northwestern: John Coyle,MD, Tom Powers & Deb Rooney