Skills coaches as part of the educational team: A randomized controlled trial Skills coaches as part of the educational team: A randomized controlled trial Michael J. Kim 1, Margaret L. Boehler 2, Janet K. Ketchum 2, Reuben Bueno, Jr. 2, Reed G. Williams 2, Gary L. Dunnington 2 Departments of Surgery 1 University of Rochester 2 Southern Illinois University

Riding a wave of simulation  Literature on surgical skills training/assessment  2008 RRC requirement  FLS  ACS/APDS Curriculum  Who’s teaching?

What’s currently available?  Survey of GS Program Directors (n=162)  72% have supervision  79% staff are attending physicians Korndorffer, Stefanidis, and Scott – 2006  Survey of established skills labs (n=34)  Instructors: 100% Physicians100% Physicians 42% Residents42% Residents 35% Lab Staff35% Lab Staff  65% Difficult to find instructors Kapadia, DaRosa, MacRae and Dunnington

Barriers to implementation  Cost  Curriculum development  Finding Instructors!  Clinical demands on faculty  M.D. needed to teach?

Non-physicians & physicians-in-training  SP as Instructors  Trained by physician  Exam techniques and teaching skills  SP vs. MD trained students  ≥ Physician trained  Lasting differences  Less intimidation  Frees faculty for other teaching Behrens et al , Gerber et al

Current study  Compare teachers:  Skills coach vs. faculty surgeon  Teaching basic surgical skill  Subcuticular Suturing  No complex technical or cognitive tasks  One method of suturing

Methods  Selected excellent teaching surgeon  Clinical expertise  Superb teacher  Selected excellent skills coach  Years of O.R. experience  Experience with learners in O.R.  Laboratory director  Trained the coach  Technique, theory, teaching methods

Methods  Subjects:  MS3 and MS4  Surgical clerkship/Resident Readiness  Consent and randomized  Skills Coach vs. Surgeon  Survey of baseline experience  Training on foam model  Observers during instruction

Third Year Students

Fourth Year Students

Methods  Video suturing performance  Same model  Gowns/gloves  Blinded video review  4 Faculty Surgeons

Rating items: Process and Product Square knots at both ends 1 50% or less of the time 23 75% of the time % of the time Places appropriate depth sutures 1 50% or less of the time 23 75% of the time % of the time Uses appropriate tension 1 50% or less of the time 23 75% of the time % of the time Avoids penetration of the epidermis 1 50% or less of the time 23 75% of the time % of the time Enters each suture directly across from the previous exit 1 50% or less of the time 23 75% of the time % of the time Avoids leaving large gaping areas of skin 1 50% or less of the time 23 75% of the time % of the time

Visual Anchors: “Enters each suture directly across from the previous exit”

Baseline Experience Survey

Mean Performance by Training Group

Results  Sample size needed?  Mean difference = 1.0 point  Power = 0.99 → N = 25  Post-test group adequate  Ability to detect difference 99x/100 –α = 0.05 –Mean Sample Variance = % or less of the time 23 75% of the time % of the time

Results  Qualitative Observations  Surgeon: Started with lecture: tissue layers, suture types, etc. → DemonstrationStarted with lecture: tissue layers, suture types, etc. → Demonstration Competing factors:Competing factors: –Pager, Clinic, etc. Brought residentsBrought residents  Skills Coach: Started with demonstrationStarted with demonstration Incorporated discussion during practiceIncorporated discussion during practice No competing tasksNo competing tasks

Limitations  Not a novice coach –Teaching and OR skills –Understood students –Already established reputation  Single skill trained –One way of doing things  No Transfer –Only tested in vitro  Need more study of retention –Limited sample size

Conclusions  A trained surgical skills coach is capable of teaching a basic surgical skill.  Skills coaches can concentrate on teaching with fewer conflicts.  Skills coaches may have increased role on educational team.

Thank you SIU Jennifer Bartlett Dr. Andreas Meier Heather Rogers Dr. Hilary Sanfey Cathy Schwind Dr. Leslie Smith Dr. Jared Wall U of Rochester Dr. Jacob Moalem Dr. Mary Santos Dr. Michael Singh

Questions/Discussion