Do not teach me while I am working!

BACKGROUND: The aim of this study was to determine if technical surgical experience enhances the learning of new cognitive information under multitasking conditions. METHODS: Junior (years 1-3) and experienced (years 4 and 5) general surgery residents performed a Nissen fundoplication on a synthetic model (the primary task). While performing the primary task, they listened to and memorized information describing the steps of a computer-assisted hip replacement surgery (the secondary task). Performance on the primary and secondary tasks was assessed using performance metrics and multiple-choice questions. RESULTS: The primary task was performed better by the senior than the junior trainees (P = .001, P = .007). The senior trainees also scored higher on the secondary task than the junior trainees (P = .001). CONCLUSIONS: Senior trainees have superior capacity to multitask. This may have direct implications on both clinical and simulation-based education, such that educators need to adjust the amount of information presented in accordance to trainees' levels of training.

Developing criteria for proficiency-based training of surgical technical skills using simulation: changes in performances as a function of training year.

BACKGROUND: Proficiency-based residency training programs can be more efficient than the current duration-based formats. For their successful implementation, appropriate proficiency criteria must be developed. The objective of this study was to investigate the relationship between technical skill performances assessed using computer- and expert-based methods and training year. An assumption was that asymptotes in performance as a function of training year can be used to set the proficiency level for a technical skill, so the value at which the asymptote occurs can be labeled as the proficiency criteria. STUDY DESIGN: Thirty-eight general surgery residents performed one-handed knot tying on bench-top simulators at two levels of difficulty: superficial and deep. Motion-efficiency measures and expert-based measures were used to evaluate performance. Total number of operations (ie, surgical volume) that each trainee participated in during residency was also acquired. RESULTS: On the superficial model, asymptotes were observed at year 1 for motion-efficiency and year 3 for expert-based measures. On the deep model, asymptotes were observed at year 2 for motion-efficiency and year 4 for expert-based measures. CONCLUSIONS: The data demonstrate the challenges associated with defining technical skills proficiency criteria. Different asymptotes were observed for the two assessment methods and neither covaried substantially with surgical volume. These data suggest that this asymptote approach in defining proficiency criteria can be suitable for development of proficiency-based residency training programs. The sensitivity of this approach to the type of assessment method and to the functional difficulty of the simulators used for assessment must be considered.

Computer-assisted assessment of one-handed knot tying skills performed within various contexts: a construct validity study.

BACKGROUND: The widespread use of computer-assisted assessment of technical proficiency in surgical residents shows the need for further investigations of the construct validity of these devices (eg, hand motion analysis) before implementation into competency testing. METHODS: Thirty general surgery residents performed 1-handed knot tying in 2 contexts: superficial and deep. The Imperial College Surgical Assessment Device (ICSAD) was used to evaluate performance. It was hypothesized that senior residents (postgraduate year [PGY] 4-5) would perform better then junior residents (PGY 1-3) and that the superficial version of the skill would be easier than the deep. RESULTS: Technical efficiency scores were better for seniors than for juniors (P < .001) and on the superficial versus the deep model (P < .001). Both groups were equally affected by the contextual changes to the skill, suggesting a consistent impact on the skill-specific movement patterns. CONCLUSIONS: Additional evidence for the validity of ICSAD as a competency assessment tool has been shown. First, it distinguished senior and junior residents. Second, it discerned differences on the same skill performed in 2 different contexts.