TY - JOUR
T1 - Creating a Proficiency-based Remote Laparoscopic Skills Curriculum for the COVID-19 Era
AU - Nagaraj, Madhuri B.
AU - AbdelFattah, Kareem R.
AU - Scott, Daniel J.
AU - Farr, Deborah E.
N1 - Funding Information:
Our study aimed to create a feasible and effective remote laparoscopic skills curriculum to support skill acquisition in novice trainees who matriculated during the COVID-19 pandemic. Interns were provided with at-home training equipment and then self-practiced to reach expert-derived proficiency benchmarks for 5 novel tasks that reflected basic laparoscopic skills. Significant differences in scores between intern pre-test data and expert data were detected for all tasks, supporting construct validity of the assessment metrics. In the previous in-person curriculum, all interns demonstrated proficiency during scheduled proctored sessions in December. With the at-home curriculum, 28% of interns reached proficiency after 1 month of training with fewer than 18 repetitions of each task. This demonstrates the feasibility of expected skill acquisition in a reasonable amount of time and repetitions. Furthermore, skill acquisition was supported by the convergence of composite scores in those who met proficiency, despite the high variability of pre-test scores ( Fig. 3 ).
Publisher Copyright:
© 2021 Association of Program Directors in Surgery
PY - 2022/1/1
Y1 - 2022/1/1
N2 - OBJECTIVE: Social distancing restrictions due to COVID-19 challenged our ability to educate incoming surgery interns who depend on early simulation training for basic skill acquisition. This study aimed to create a proficiency-based laparoscopic skills curriculum using remote learning. DESIGN: Content experts designed 5 surgical tasks to address hand-eye coordination, depth perception, and precision cutting. A scoring formula was used to measure performance: cutoff time - completion time - (K × errors) = score; the constant K was determined for each task. As a benchmark for proficiency, a fellowship-trained laparoscopic surgeon performed 3 consecutive repetitions of each task; proficiency was defined as the surgeon's mean score minus 2 standard deviations. To train remotely, PGY1 surgery residents (n = 29) were each issued a donated portable laparoscopic training box, task explanations, and score sheets. Remote training included submitting a pre-test video, self-training to proficiency, and submitting a post-test video. Construct validity (expert vs. trainee pre-tests) and skill acquisition (trainee pre-tests vs. post-tests) were compared using a Wilcoxon test (median [IQR] reported). SETTING: The University of Texas Southwestern Medical Center in Dallas, Texas PARTICIPANTS: Surgery interns RESULTS: Expert and trainee pre-test performance was significantly different for all tasks, supporting construct validity. One trainee was proficient at pre-test. After 1 month of self-training, 7 additional residents achieved proficiency on all 5 tasks after 2-18 repetitions; trainee post-test scores were significantly improved versus pre-test on all tasks (p = 0.01). CONCLUSIONS: This proficiency-based curriculum demonstrated construct validity, was feasible as a remote teaching option, and resulted in significant skill acquisition. The remote format, including video-based performance assessment, facilitates effective at-home learning and may allow additional innovations such as video-based coaching for more advanced curricula.
AB - OBJECTIVE: Social distancing restrictions due to COVID-19 challenged our ability to educate incoming surgery interns who depend on early simulation training for basic skill acquisition. This study aimed to create a proficiency-based laparoscopic skills curriculum using remote learning. DESIGN: Content experts designed 5 surgical tasks to address hand-eye coordination, depth perception, and precision cutting. A scoring formula was used to measure performance: cutoff time - completion time - (K × errors) = score; the constant K was determined for each task. As a benchmark for proficiency, a fellowship-trained laparoscopic surgeon performed 3 consecutive repetitions of each task; proficiency was defined as the surgeon's mean score minus 2 standard deviations. To train remotely, PGY1 surgery residents (n = 29) were each issued a donated portable laparoscopic training box, task explanations, and score sheets. Remote training included submitting a pre-test video, self-training to proficiency, and submitting a post-test video. Construct validity (expert vs. trainee pre-tests) and skill acquisition (trainee pre-tests vs. post-tests) were compared using a Wilcoxon test (median [IQR] reported). SETTING: The University of Texas Southwestern Medical Center in Dallas, Texas PARTICIPANTS: Surgery interns RESULTS: Expert and trainee pre-test performance was significantly different for all tasks, supporting construct validity. One trainee was proficient at pre-test. After 1 month of self-training, 7 additional residents achieved proficiency on all 5 tasks after 2-18 repetitions; trainee post-test scores were significantly improved versus pre-test on all tasks (p = 0.01). CONCLUSIONS: This proficiency-based curriculum demonstrated construct validity, was feasible as a remote teaching option, and resulted in significant skill acquisition. The remote format, including video-based performance assessment, facilitates effective at-home learning and may allow additional innovations such as video-based coaching for more advanced curricula.
KW - COVID-19. Abbreviations : TC
KW - Laparoscopic curriculum
KW - Practice-Based Learning and Improvement
KW - at-home simulation training
KW - remote training
KW - time to task completion
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U2 - 10.1016/j.jsurg.2021.06.020
DO - 10.1016/j.jsurg.2021.06.020
M3 - Article
C2 - 34301520
AN - SCOPUS:85110722683
SN - 1931-7204
VL - 79
SP - 229
EP - 236
JO - Journal of Surgical Education
JF - Journal of Surgical Education
IS - 1
ER -