Creating a Proficiency-based Remote Laparoscopic Skills Curriculum for the COVID-19 Era.

OBJECTIVE: Social distancing restrictions due to COVID-19 challenged our ability to educate incoming surgery interns who depend on early simulation training for basic skill acquisition. This study aimed to create a proficiency-based laparoscopic skills curriculum using remote learning. DESIGN: Content experts designed 5 surgical tasks to address hand-eye coordination, depth perception, and precision cutting. A scoring formula was used to measure performance: cutoff time - completion time - (K × errors) = score; the constant K was determined for each task. As a benchmark for proficiency, a fellowship-trained laparoscopic surgeon performed 3 consecutive repetitions of each task; proficiency was defined as the surgeon's mean score minus 2 standard deviations. To train remotely, PGY1 surgery residents (n = 29) were each issued a donated portable laparoscopic training box, task explanations, and score sheets. Remote training included submitting a pre-test video, self-training to proficiency, and submitting a post-test video. Construct validity (expert vs. trainee pre-tests) and skill acquisition (trainee pre-tests vs. post-tests) were compared using a Wilcoxon test (median [IQR] reported). SETTING: The University of Texas Southwestern Medical Center in Dallas, Texas PARTICIPANTS: Surgery interns RESULTS: Expert and trainee pre-test performance was significantly different for all tasks, supporting construct validity. One trainee was proficient at pre-test. After 1 month of self-training, 7 additional residents achieved proficiency on all 5 tasks after 2-18 repetitions; trainee post-test scores were significantly improved versus pre-test on all tasks (p = 0.01). CONCLUSIONS: This proficiency-based curriculum demonstrated construct validity, was feasible as a remote teaching option, and resulted in significant skill acquisition. The remote format, including video-based performance assessment, facilitates effective at-home learning and may allow additional innovations such as video-based coaching for more advanced curricula.

In-person versus virtual suturing and knot-tying curricula: Skills training during the COVID-19 era.

BACKGROUND: The coronavirus disease 2019 restrictions on in-person simulation activities necessitated modifying the traditional boot camp skills curriculum for matriculating PGY1 general surgery residents to a virtual format. This study investigated the relative effectiveness of in-person versus virtual instruction on the development of suturing and knot-tying skills. METHODS: In all, 55 residents participated in a validated, proficiency-based, preinternship skills curriculum, 26 in 2019 and 29 in 2020. Both groups received an introduction to the curriculum, were given time for practice and offered one-on-one tutoring by faculty by request, and completed a filmed posttest. The 2019 class received in-person instruction during a boot camp at the end of June, while the 2020 class was provided with suture kits and received instruction via Zoom throughout June. The 2 groups were compared by post-test performance, date of task proficiency, and additional coaching required. RESULTS: In 2019, 5.7% of the posttest tasks were graded as proficient versus 87% in 2020. The 2020 class outperformed the 2019 class on every metric in every task (P < .001). In 2019, faculty spent 55.5 hours with residents in one-on-one remediation, resulting in proficiency in 64% of the tasks by November. In 2020, 18 hours of one-on-one remediation resulted in proficiency in 92% of the tasks by September. CONCLUSION: Learners who received virtual instruction with access to materials at home gained proficiency in suturing and knot-tying skills earlier and with less coaching. These data demonstrate that the virtual curriculum is effective and an improvement on the previous in-person curriculum.

The Impact of COVID-19 on Surgical Education.

BACKGROUND: At the onset of social distancing, our general surgery residency transitioned its educational curriculum to an entirely virtual format with no gaps in conference offerings. The aim of this study is to examine the feasibility of our evolution to a virtual format and report program attitudes toward the changes. METHODS: On March 15, 2020, due to the coronavirus disease (COVID-19) our institution restricted mass gatherings. We immediately transitioned all lectures to a virtual platform. The cancellation of elective surgeries in April 2020 then created the need for augmented resident education opportunities. We responded by creating additional lectures and implementing a daily conference itinerary. To evaluate the success of the changes and inform the development of future curriculum, we surveyed residents and faculty regarding the changes. Classes and faculty answers were compared for perception of value of the online format. RESULTS: Pre-COVID-19, residency-wide educational offerings were concentrated to one half-day per week. Once restrictions were in place, our educational opportunities were expanded to a daily schedule and averaged 16.5 hours/week during April. Overall, 41/63 residents and 25/94 faculty completed the survey. The majority of residents reported an increased ability (56%) or similar ability (34.1%) to attend virtual conferences while 9.9% indicated a decrease. Faculty responses indicated similar effects (64% increased, 32% similar, 4% decreased). PGY-1 residents rated the changes negatively compared to other trainees and faculty. PGY-2 residents reported neutral views and all other trainees and faculty believed the changes positively affected educational value. Comments from PGY1 and 2 residents revealed they could not focus on virtual conferences as it was not "protected time" in a classroom and that they felt responsible for patient care during virtual lectures. A majority of both residents (61%) and faculty (84%) reported they would prefer to continue virtual conferences in the future. CONCLUSIONS: The necessity for adapting our academic offerings during the COVID-19 era has afforded our program the opportunity to recognize the feasibility of virtual platforms and expand our educational offerings. The majority of participants report stable to improved attendance and educational value. Virtual lectures should still be considered protected time in order to maximize the experience for junior residents.