Immediate Surgical Skills Feedback in the Operating Room Using “SurF” Cards

摘要

Introduction Duty hour limitations and increased pressures for clinical efficiencies provide serious challenges to the long-standing system of “learning by doing” in the operating room.1–3 The principles of guided learning, deliberate practice, and directed feedback provide effective, evidence-based strategies to address some of these teaching challenges.4–6 Using these principles, surgical teachers can provide learners with preprocedural preparation (guided learning), intraoperative direction (deliberate practice), and immediate postprocedure feedback (directed feedback), with benefits including improvements in immediate retention, delayed retention, and problem solving.5 The objectives of this study were to create and implement a curricular tool to promote both guided, procedural “key” step review as well as immediate feedback on surgical skills in the operating room. We also examined teacher and learner satisfaction with frequency, quality, and timeliness of surgical skills feedback to residents, before and after using this tool.;Methods Residents, fellows, and faculty in the Department of Obstetrics and Gynecology at the University of North Carolina participated in this study from December 2010 through May 2011. Prior to the intervention study, there was no systematic approach to surgical skills feedback. The Surgical Skills Feedback card or “SurF” card was modified from an evaluation tool presented at the 2010 Association of Professors of Gynecology and Obstetrics (APGO) Faculty Development workshop (A. Currens, S. T. Romero, and S. L. Galvin, written communication, November 2010). SurF cards were created by applying key concepts on which the objective structured clinical examination is based: (1) Expert opinion input guides content for instruction and evaluation,7,8 and (2) Faculty development aims to ensure consistency with instruction and assessment.9–12 The SurF cards were developed using publications from the Council on Resident Education in Obstetrics and Gynecology13,14 and Te Linde's Operative Gynecology,15 with these resources used to outline the key steps of each procedure. Key steps were reviewed by faculty, and agreement was reached regarding specific key steps to include. Development of the SurF cards took approximately 20?hours. The 8 procedures selected for SurF card development (shown in the box) were typically scheduled in advance in the Department of Obstetrics and Gynecology. An example of a SurF card (figure?1) shows that the rating scale uses the Dreyfus model for the acquisition of competence.16 In December 2010, residents, fellows, and faculty in the program were oriented to the study and to SurF cards. Participants were instructed to complete a SurF card for each scheduled case involving 1 of the 8 procedures. Postprocedure, residents completed self-assessments of individual key steps and overall procedure ability level. Then, while in the operating room with the resident, faculty performed a similar review. View larger version (35K) FIGURE 1Surgical Skills Feedback (“SurF”) Card (front and back): Laparoscopic BSO Note: Although exact time was not recorded, roughly 20?hours was used to develop the SurF cards. SurF card copies are available upon request.;Results From December 2010 through May 2011, participants completed SurF cards for relevant operating room cases. In May 2011, the poststudy survey was administered. Fellow and faculty data are reported together as “Faculty” because fellows provide feedback to residents on these generalist procedures. Prestudy surveys were completed by 31 of 37 eligible faculty (84%) and 20 of 20 (100%) eligible residents, with key step review before surgery reported by 17 of 31 (55%) faculty and 1 of 20 (5%) residents (table?1). All study participants reported low rates of satisfaction with the prestudy practice of providing feedback on procedures (tables?2 and 3). View larger version (16K) TABLE 1“Key” Step Review;Discussion The SurF card process provided real-tim