1. Evaluating the Briefing, Intraoperative Teaching, Debriefing (BID) method for surgical skills teaching: a pilot study
Daniel Hoppe MD MEd
Oleg Safir MD FRCS(C) MEd
Adam Dubrowski PhD

2. What is BID?

3. Intra-operative Teaching
Journal of the American College of Surgeons (2009)
Step
Task
Briefing
Set learning objectives
Intra-operative Teaching
Teaching during the encounter
Debriefing
Reflection
Rules
Reinforce
Correct

4. Why the BID?

5. WHAT LEARNERS WANT* WHAT ACTUALLY HAPPENS**
Instructor “game-plan”
Involvement in the learning process
Ongoing and direct feedback
WHAT ACTUALLY HAPPENS**
“Opportunistic” teaching
Passive transfer of information
Limited feedback given
*Vikis et al. (2008), Cox and Swanson (2001), Snyder et al (2012)
**Scallon et al. (1992), Irby (1995), Roberts et al. (2008), Jefree and Clarke (2010)

6. Objective
To evaluate whether the BID method is an effective framework for surgical skills teaching
Learner reactions, satisfaction

7. Methods

8. BID Method Training Session
First year orthopaedic residents (n=12)
Allocated to control group (n=6)
Allocated to BID group (n=6)
PRE-TEST (OSATS)
Learned Control Skill
(Central Line)
BID Method Training Session

9. BID Method Training Session
First year orthopaedic residents (n=12)
Allocated to control group (n=6)
Allocated to BID group (n=6)
PRE-TEST (OSATS)
Learned Control Skill
(Central Line)
BID Method Training Session

10. BID Method Training Session
60 minute session
Interactive - presentation, discussion, role- play
Given to both instructor and BID group separately
Learners trained to create synergistic learning effect*
-evidence that suggests that both teacher and learner play a major role in the creation of an effective learning interaction
*Aagaard et al. (2004), Manyon et al. (2003), Vikis et al. (2008)

11. BID Method Training Session
First year residents (n=12)
Allocated to control group (n=6)
Allocated to BID group (n=6)
PRE-TEST (OSATS)
Learned Control Skill
(Central Line)
BID Method Training Session
Learned Test Skill 1
(Bone Wedge)
Learned Test Skill 2
(Bone Plating)
POST-TEST (OSATS)

12. Change in individual OSATS scores - checklist and GRS
Outcome Measures

13. Rizzolo (2006), National League for Nursing (2007)
Outcome Measures
Satisfaction Questionnaire, Educational Practices Questionnaire*
Focus group data
Rizzolo (2006), National League for Nursing (2007)

14. Standardization of Instructors
Used a number of measures to try and ensure approximate instructor equivalency
1. Perception of Preparedness Questionnaire no differences
2. “Assessing Teaching Skills” assignment (adapted from Ramsden et al. 1995)
3. “Control Skill” (Central Line Insertion) taught to each group prior to BID training

15. Results

16. Assessing Instructor Equivalency
Perception of Preparedness Questionnaires similar between both instructors
also had similar teaching ideologies/experience
-no formal educational training
-no familiarity with educational theory
-preferred small-group learning to lectures
-feedback important (but neither knew framework for delivering feedback)
-use questions to confirm understanding

17. Central Line Insertion
OSATS Pre-test Data
no significant differences in baseline pre-test scores between groups for checklist and GRS scores
Skill
GRS
Checklist
Central Line Insertion
P=0.326
P=0.102
Bone Wedge
P=0.478
P=0.536
Bone Plating
P=0.927
P=0.263

18. Control Skill: Central Line Insertion
Global Rating Scale
Pre-Test
Post-Test
Control 46 96
BID 53 81
P=0.129

19. After BID training

20. Test Skill 1: Bone Wedge Cut
Global Rating Scale
P=0.049
Pre-Test
Post-Test
Control 59 69
BID 66 94

21. Test Skill 2: Bone Plating
Global Rating Scale
P=0.011
Pre-Test
Post-Test
Control 42 56
BID 43 82

22. Checklist Scores
No significant difference in improvement in checklist scores for any skills

23. Secondary Outcome Measures

24. Questionnaire Data After first skill (both groups untrained)
Control Group (%)
BID Group
(%)
Satisfaction with Teaching Method 85
Objectives/Information 83 77
Active Learning/Faculty Interaction 79
Feedback 72

25. Questionnaire Data After last skill Control Group (%) BID Group (%)
Satisfaction with Teaching Method 77 90
Objectives/Information 74 84
Active Learning/Faculty Interaction 72 88
Feedback 69 81

26. Focus Group Data Easy to use and remember
For majority, first time setting objectives
Formal time for feedback appreciated
Less time wasted during sim sessions

27. Conclusions
training both the learners and instructors in the BID method produced significant improvement in GRS scores for specific surgical skills
trend towards higher learner satisfaction
BID provides an easy-to-implement framework for surgical simulation teaching

28. Limitations Small sample size Choice of skills - limited
Retention/transfer not tested
In vivo vs. in vitro effects?

29. Future Directions
these results are promising enough to continue with a larger-scale study
more residents, more skills, more instructors
simulation vs. OR
role in Competency-Based Education?

30. “These sessions seemed a bit like a study group”
Quotes from BID Group
“These sessions seemed a bit like a study group”
“Having an objective to work on focused me on a specific task”
“I can see this working in the OR but it would need to have staff buy-in”
“This may not work when I’m on call and it is very busy”
“I think using this approach improved the flow of teaching”
“I really liked the debriefing part, and I wish this would happen in real life!”

31. Thank you Acknowledgments:
Thanks to Lisa Satterthwaite, Dr. Ranil Sonnandara, Carween Hui, Polina Mironova, Dr. Hesham Abdelbary, Dr. Michael Drexler, and the staff of the Mount Sinai Surgical Skills Centre

32. Intra-operative Teaching
Step
Task
Script
Briefing
Set learning objectives
“What would you like to focus on?”
Intra-operative Teaching
Teaching during the encounter
Focus on stated objectives
Debriefing
Reflection
Rules
Reinforce
Correct
“How did you think you did?”
“You did well at...”
“Next time, do...”