Design and validation of a novel assessment tool for laparoscopic suturing of the vaginal cuff during hysterectomy.

OBJECTIVE: The aim of this study was to design and validate a new assessment tool for laparoscopic vaginal cuff suturing in a box trainer. DESIGN: A primary grading tool was constructed including a novel checklist component and a previously validated global rating scale. A four-step validation process was then undertaken. Face validity was determined by a survey of a panel of experts in the field of minimally invasive gynecologic surgery. Content validity was assessed via analysis of consistency and variability of the experts' ratings, and items were removed or rephrased according to the experts' comments. PARTICIPANTS: Overall, five novices and five expert laparoscopic surgeons were videotaped performing suture closure of a latex vaginal cuff model in a box trainer. The videotapes were reviewed by two raters. Discriminate validity, along with interrater and intrarater reliabilities, was assessed by analysis of the video ratings. SETTING: The Simulation, Training, Research, and Technology Utilization System center at Brigham and Women's Hospital, a tertiary medical center in Boston, MA. RESULTS: The final assessment tool is presented. CONCLUSION: We have validated an assessment tool for vaginal cuff suturing in a box trainer.

Residents can successfully teach basic surgical skills in the simulation center.

OBJECTIVES: Basic surgical skills are frequently taught to surgical interns in simulation centers. Faculty recruitment for teaching of these sessions can be difficult. The goal of this study was to determine whether senior surgical residents can effectively teach basic surgical skills to provide an alternative to faculty-led instruction. DESIGN, SETTING, AND PARTICIPANTS: Academic medical center. Twenty-eight surgical interns. In this randomized controlled trial, interns were randomized to receive teaching by either faculty or senior residents. Two-hour teaching sessions for each group consisted of modeling and guided practice. All interns underwent baseline knot-tying and suturing skill assessment using a previously validated standardized task scoring scheme and completed a confidence survey. After teaching sessions, both groups underwent repeated skill testing and were again surveyed. RESULTS: Twenty-eight interns started in the surgery program at our institution during the year of this study. Seventeen of 27 (62.9%) interns participated in both teaching sessions and completed all skill assessments and surveys; 7 (41.2%) interns were taught by faculty, 10 (58.8%) by residents. Overall, skills training improved in both groups for knot-tying, running suture, and subcuticular suture performance. Confidence performing knot-tying tasks also improved. Interns taught by faculty members and residents demonstrated similar levels of improvement in speed and accuracy, although faculty instruction improved speed of performing the simple suturing task (-144 vs -27 s, p = 0.04). CONCLUSIONS: In the simulation center, teaching by senior surgical residents and faculty members resulted in comparable improvement in interns' basic surgical skills. These findings could increase the skill instructor pool for teaching in the simulation center, potentially easing recruitment and providing senior residents with teaching opportunities.

Assessing physician leadership styles: application of the situational leadership model to transitions in patient acuity.

BACKGROUND: The situational leadership model suggests that an effective leader adapts leadership style depending on the followers' level of competency. PURPOSE: We assessed the applicability and reliability of the situational leadership model when observing residents in simulated hospital floor-based scenarios. METHODS: Resident teams engaged in clinical simulated scenarios. Video recordings were divided into clips based on Emergency Severity Index v4 acuity scores. Situational leadership styles were identified in clips by two physicians. Interrater reliability was determined through descriptive statistical data analysis. RESULTS: There were 114 participants recorded in 20 sessions, and 109 clips were reviewed and scored. There was a high level of interrater reliability (weighted kappa r = .81) supporting situational leadership model's applicability to medical teams. A suggestive correlation was found between frequency of changes in leadership style and the ability to effectively lead a medical team. CONCLUSIONS: The situational leadership model represents a unique tool to assess medical leadership performance in the context of acuity changes.