Role of instruction method in novices' acquisition of minimally invasive surgical basic skills.

摘要

INTRODUCTION: We investigated the impact of instruction method on novices' acquisition of minimally invasive surgical (MIS) basic skills. MATERIALS AND METHODS: One hundred five novice medical students underwent text-based (TB), video-based (VB), or faculty-tutored (FT) single-session instruction in three basic MIS skill tasks on a box trainer. Pre- and postsession, participants completed a 12-item, 5-point Likert-type scale (1=Not confident at all, 5=Completely confident) of self-efficacy for performing basic MIS skills and had performances on each task recorded. Four raters evaluated every video performance of one task, a two-handed peg transfer, using a 16-cm visual analog measurement (VAM). Inter-rater reliability was good (intra-class correlation coefficient=0.82). The relationship between instruction method, self-efficacy mean score change, and mean VAM change was examined using ANOVA analysis. RESULTS: Eighty-five participants (TB=32, VB=24, FT=29) had valid matched data. Mean scores in self-efficacy and task performance increased from pre- to postsession for every instruction method: (1) Delta self-efficacy=1.04+/-0.64 (TB), 1.36+/-0.69 (VB), and 1.41+/-0.82 (FT); (2) Delta VAM=3.77+/-2.87 (TB), 3.82+/-2.35 (VB), and 2.57+/-2.60 (FT). Analysis of variance revealed no relationship between instruction method and self-efficacy (P=.10) or VAM mean score change (P=.14). CONCLUSIONS: Self-directed instruction methods (e.g., TB and VB) for novices' acquisition of MIS basic skills offer flexible, learner-centered, and cost-effective alternatives to the more expensive FT method.