1. 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

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

3. 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 - 2007

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

5. 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 - 1979, Gerber et al - 1985

6. 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

7. 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

8. 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

9. Third Year Students

10. Fourth Year Students

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

12. Rating items: Process and Product Square knots at both ends 1 50% or less of the time 23 75% of the time 45 100% of the time Places appropriate depth sutures 1 50% or less of the time 23 75% of the time 45 100% of the time Uses appropriate tension 1 50% or less of the time 23 75% of the time 45 100% of the time Avoids penetration of the epidermis 1 50% or less of the time 23 75% of the time 45 100% of the time Enters each suture directly across from the previous exit 1 50% or less of the time 23 75% of the time 45 100% of the time Avoids leaving large gaping areas of skin 1 50% or less of the time 23 75% of the time 45 100% of the time

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

14. Baseline Experience Survey

15. Mean Performance by Training Group

16. 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 = 0.77 1 50% or less of the time 23 75% of the time 45 100% of the time

17. 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

18. 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

19. 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.

20. 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

21. Questions/Discussion