Using Small-group Workshops to Improve Surgical Residentsʼ Technical Skills (2001)

Objective: Historically, the operating room has been the primary venue for surgical education. Although this environment provides surgical residents with real-time, hands-on experiences, there are situations and procedures that should be addressed in a more formal, standardized curriculum. It was with this in mind that we revised the curriculum for our general surgery residents to include regular workshop sessions in our state-of-the-art Minimally Invasive Surgery Center (MISC). Our objectives in revising this curriculum are (1) to create a low-risk but intensive learning environment where surgical residents can learn and practice technical skills, (2) to develop better evaluation methods to assess their skill development, and (3) to help the residents become adept in self-assessment and reflective practice. Description: As technologic advances in surgical instrumentation are introduced by industry specialists, and as new procedures using these tools are developed by expert surgeons, the need to create new training methods for experienced and novice surgeons to use these technologies has become acute. Surgery has lagged behind other disciplines by being slow in updating its approach to professional training; the apprentice system long abandoned by high-tech industries remains at the center of much advanced surgical training. Models and simulations can create realistic environments for training, and industry has taken advantage of these innovations. Standardized curricula allow trainees to be uniformly introduced to situations they will encounter and to techniques for solving problems that arise by eliminating the unpredictable nature of training surgeons in the OR. Our curriculum consists of intensive, small-group workshops for all residents, with faculty supervision and feedback, lectures, and videotapes to illustrate specific techniques, and individualized evaluation of resident progress in technical skills. Unlike in most other residency programs, in our program each cohort of our residents (PGY1 through PGY5) spends a full day in the MISC lab every five weeks, with three or four surgical faculty members in attendance. The workshops maximize the opportunity for the residents to reflect on the theory and practice of each specific skill; each workshop consists of a didactic session conducted by a faculty member and a free-form discussion of the topic during lunch, followed by skills training supervised by attending surgeons. The workshop topics in 1999–2000 included open suturing and surgical techniques, basic laparoscopic instrumentation and techniques, laparoscopic cholecystectomy, and laparoscopic ventral hernia repair. Discussion: During the first 15 months of the program, we conducted 55 workshops; each of our residents has attended at least ten. On the weekly evaluations, the items “satisfaction with hands-on portion of the workshop” and “extent to which faculty individualized feedback meets [your] needs” were rated very high, generally averaging over 4.5 on a five—point scale. During the next year, we anticipate creating new skill-evaluation models and checklists to quantify changes in the residents' technical skills over time. By the end of the year a new Website—on which faculty can evaluate video-tapes of residents' performances of surgical skill tests and where residents can view these evaluations—will also be operational. We feel that these formative evaluation techniques will prove valuable to our residents during their training.