Board 428 - Research Abstract Development of an Integrated Surgical Skills Course
Bibliographic record
Abstract
Introduction/Background Hybrid simulation, combining simulated/standardized patients (SPs) and technical skill training kits (e.g. suture pads attached to the arm) can lead to immediate improvements in surgical residents communication skills while preserving technical proficiency.1 Our goals were: 1) to assess whether learning on hybrid simulations is sustained on a delayed-post intervention retention test; 2) to evaluate the added role of feedback vs simple exposure in leading to improvements and 3) to assess the level of acceptance for SP-based hybrid simulations in a highly technical domain. Methods The study design was a prospective randomized control study, with a delayed post-test to assess retention. Twenty four residents were randomly divided into the Feedback or Exposure groups. All residents were exposed to four, 15-minute SP-based hybrid simulations over five weeks during their regularly scheduled weekly procedural skill laboratory (one hybrid simulation per week), combining a procedural and communication challenge (e.g. wound closure on intoxicated patient). Residents in the Feedback group remained for a further 15- minute, video-prompted feedback session with the SP, focused on their communication and interpersonal skills. Similar feedback was given to each participant in the Exposure group but not until after the post-test assessment was completed. All residents were assessed on a pre-test using two hybrid scenarios and on a delayed post-test using two (new) hybrid scenarios. The post-test occurred two weeks after the last teaching simulation. The residents also completed an exit survey about their experience of the hybrid simulations.` Results Performance was assessed by two independent raters using a communication global rating scale (GRS), a technical skills global rating scale and a combined assessment of technical and communication skills. Raters were blinded to the study hypotheses and group allocation. There were no differences between the two groups at baseline. At post-test, residents in the Feedback group outperformed the Exposure group on the communication GRS (p<.05) and the combined assessment (p<.05). There was a trend toward higher scores on the technical skills GRS, but this difference did not reach significance (p=.16). Analysis of the exit survey revealed that while a subset of the residents reported feeling ill-prepared (37.5%), confused (8%) and frustrated (12.5%) by the simulations, a large subset reported the exposure as enjoyable (70.8%) and valuable (87.5%). Ninety six percent of the residents had previously experienced similar communication challenges in their residency training. Conclusion Improvements in communication skills following SP-based hybrid simulations are maintained at delayed post-test for retention and appear to depend on feedback received from SPs. References 1. Moulton CA, Tabak D, Kneebone R, Nestel D, MacRae H, LeBlanc VR. (2009). Teaching. Communication Skills Using the Integrated Procedural Performance Instrument (IPPI): A Randomized Controlled Trial. American Journal of Surgery, 197, 113-118. D Tabak3, C Moulton1, A Robb3, H MacRae1, D Nestel5, R Kneebone4, V LeBlanc1 1Wilson Centre, Faculty of Medicine, University of Toronto, Ontario, Canada. 2Department of Surgery, University of Toronto, Ontario, Canada. 3Standardized Patient Program, University of Toronto, Ontario, Canada. 4Department of Biosurgery & Surgical Technology, Imperial College London, London UK. 5School of Rural Health, HealthPEER, Monash University, Churchill, Australia. Disclosures None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.093 | 0.017 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".