Surgeons managing conflict: a framework for understanding the challenge.
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Attitude of Health Personnel↗
Biomedical subjects
David A Rogers
Publications and source records attributed to David A Rogers.
An investigation of medical student reactions to feedback: a randomised controlled trial.
BACKGROUND: Medical educators have indicated that feedback is one of the main catalysts required for performance improvement. However, medical students appear to be persistently dissatisfied with the feedback that they receive. The purpose of this study was to evaluate learning outcomes and perceptions in students who received feedback compared to those who received general compliments. METHODS: All subjects received identical instruction on two-handed surgical knot-tying. Group 1 received specific, constructive feedback on how to improve their knot-tying skill. Group 2 received only general compliments. Performance was videotaped before and after instruction and after feedback. Subjects completed the study by indicating their global level of satisfaction. Three faculty evaluators observed and scored blinded videotapes of each performance. Intra-observer agreement among expert ratings of performance was calculated using 2-way random effects intraclass correlation (ICC) methods. Satisfaction scores and performance scores were compared using paired samples t-tests and independent samples t-tests. RESULTS: Performance data from 33 subjects were analysed. Inter-rater reliability exceeded 0.8 for ratings of pre-test, pre-intervention and post-intervention performances. The average performance of students who received specific feedback improved (21.98 versus 15.87, P<0.001), whereas there was no significant change in the performance score in the group who received only compliments (17.00 versus 15.39, P=0.181) The average satisfaction rating in the group that received compliments was significantly higher than the group that received feedback (6.00 versus 5.00, P=0.005). DISCUSSION: Student satisfaction is not an accurate measure of the quality of feedback. It appears that satisfaction ratings respond to praise more than feedback, while learning is more a function of feedback.
Adult↗
Variables influencing medical student learning in the operating room.
BACKGROUND: The operating room (OR) is an important venue where surgeons do much of medical student teaching and yet there has been little work evaluating variables that influence learning in this unique environment. We designed this study to identify variables that affected medical student learning in the OR. METHODS: We developed a questionnaire based on surgery faculty observations of learning in the OR. The medical students completed the questionnaire on 114 learning episodes in the OR. Pearson correlation coefficient was used to establish the strength of association between various variables and the student's overall perception of learning. RESULTS: The students evaluated 27 variables that might impact their learning in the OR. Strong correlations were identified between the attending physician's attitude, interactions and teaching ability in the OR and the environment being conducive to learning. CONCLUSIONS: Surgical faculty behavior is a powerful determinant of student perceptions of what provides for a favorable learning environment in the OR.
Behavior↗
A senior elective designed to prepare medical students for surgical residency.
BACKGROUND: The transition from medical student to surgery internship can be stressful. The goal of this project was to design, implement, and evaluate a 1-month long elective course that would meet the majority of the American College of Surgeons Graduate Medical Education Committee prerequisites for graduate surgical education METHODS: The major elements of the curriculum included faculty- and resident-facilitated case-based sessions and cadaver dissections. In addition, the students participated in skills laboratory experiences, Intensive Care Unit rounds, and mock interviews and clinical pages. The students took a knowledge pretest and post-test that was compared with the performance of 8 surgical interns on the same examination. RESULTS: The highest rated elements of the course were those that provided hands-on experience or practical knowledge. The post-test knowledge examination scores were significantly higher than pretest scores and surgical intern scores. CONCLUSIONS: It was possible to develop a 1-month senior medical student elective course that provided students with the essential prerequisites believed to be essential for all surgical interns.
Curriculum↗
Who are the surgery clerkship directors and what are their educational needs?
BACKGROUND: The surgery clerkship director is a key individual in the surgery department's educational mission and yet there has been no prior effort to describe this group or identify their learning needs. The purpose of this study was to develop a demographic profile and an educational needs assessment for surgery clerkship directors. METHODS: A survey instrument was designed based on existing literature and distributed to surgery clerkship directors in the United States and Canada. RESULTS: Surveys were returned from 108 subjects (77%). The majority of clerkship directors strongly agree that directing is a positive experience but express concern that the job demands may impede their professional careers. The perceived educational needs identified related primarily to the development and management of the student education curriculum. CONCLUSIONS: Surgery clerkship directors are experienced academic surgeons who report high levels of satisfaction. They identify a number of important educational needs of the position and express concern about the requirements of the position on their academic careers.
Adult↗
Self-assessment in simulation-based surgical skills training.
BACKGROUND: Simulation-based training provides minimal feedback and relies heavily on self-assessment. Research has shown medical trainees are poor self-assessors. The purpose of this study was to examine trainees' ability to self-assess technical skills using a simulation-trainer. METHODS: Twenty-one medical students performed 10 repetitions of a simulated task. After each repetition they estimated their time and errors made. These were compared with the simulator data. RESULTS: Task time (P < 0.0001) and errors made (P < 0.0001) improved with repetition. Both self-assessment curves reflected their actual performance curves (P < 0.0001). Self-assessment of time did not improve in accuracy (P = 0.26) but error estimation did (P = 0.01) when compared with actual performance. CONCLUSIONS: Novices demonstrated improved skill acquisition using simulation. Their estimates of performance and accuracy of error estimation improved with repetition. Clearly, practice enhances technical skill self-assessment. These results support the notion of self-directed skills training and could have significant implications for residency training programs.
Clinical Competence↗
A role for error training in surgical technical skill instruction and evaluation.
BACKGROUND: During the evaluation of many instances of the same basic surgical skill, we observed that there were several errors that occurred frequently. Two studies were undertaken to examine the use of these errors for improving the instruction and evaluation of the skill. MATERIALS AND METHODS: For both studies, two types of rater training videotapes were developed. One involved the use of examples of common errors (error) and the other demonstrated the skill being performed correctly (correct). A testing videotape was created consisting of 24 performances of the skill that ranged in quality of the performance. The first study was designed to assess the impact of error instruction on skill acquisition. In this study, a group of 30 senior medical students were randomly assigned to one of four different training groups: none, error only, correct only, and error+correct. Subjects were videotaped performing the skill before and after the training and three experts evaluated these performances independently using a 7-point rating scale. The second study was designed to assess the impact of error training on skill evaluation and was done using both novice and expert raters. The same group of 30 senior medical students used in the first study was used as novice raters. Following training in one of the four training groups, each subject rated the 24 performances on the testing videotape and interrater reliability was assessed for each group. Surgical faculty served as expert raters in this study and were randomly assigned to receive either error training or no training. Each subject viewed the testing videotape, rating the performances and giving "feedback" commentary. Interrater reliability was calculated for the two groups and the precision of the feedback was assessed. RESULTS: Significant improvement in posttest performance scores was seen only in the "error+correct" training group. Interrater reliability was somewhat lower for the "correct only" and "error only" training groups in both the student and faculty studies. Faculty raters receiving error training had a higher proportion of specific comments than the group that received no training although this difference was not statistically significant. CONCLUSIONS: Instruction about common errors, when combined with instruction about the correct performance enhanced the acquisition of this surgical skill. This suggests a role for the use of errors in surgical technical skill instruction. Our study provides no support for a role for error training in improving skill evaluation.
Analysis of Variance↗
Medical student contact with patients on a surgery clerkship: is there a chance to learn?
BACKGROUND: Earlier studies of medical students on nonsurgical rotations have shown that clinical clerks usually first interact with their patients late in the clinical course. This would seem disadvantageous to the student's learning because they would have less opportunity to generate diagnoses or a management plan. STUDY DESIGN: A questionnaire designed to assess the nature of medical student-patient interactions in all potential clinical sites was administered to third year medical students during their surgical clerkship. Students received questionnaires each day to evaluate their clinical experiences from the previous day. RESULTS: The results from 311 student-patient encounters were collected and analyzed by clinical site as follows: outpatient clinics, outpatient surgery, inpatient surgery, day of surgery admission, inpatient consults, or emergency room consults. Students reported significantly more opportunities to elicit chief complaint, generate potential diagnosis, develop or suggest a management plan, and perform the initial examination when in the clinic setting. CONCLUSIONS: Overall, students were given relatively few opportunities to be the first to interact with any patient in any setting. They infrequently had an opportunity to independently generate a hypothesis or generate a management plan. Currently, the clinic offers the best opportunity for the student to complete these processes.
Clinical Clerkship↗
Ethical and educational considerations in minimally invasive surgery training for practicing surgeons.
There is an opportunity to improve the training of practicing surgeons in minimal access techniques. Such improvement is desirable because it would allow for the introduction of innovation in a way that maximizes the benefit for patients while minimizing the harm that can result from the introduction of new techniques after inadequate training. This goal is consistent with basic biomedical principles that govern the behavior of surgeons. Individuals who place themselves in the role of a teacher of surgeons accept another level of responsibility and are governed not only by biomedical ethics but also by the ethics of teaching. Adherence to these two different governing ethical principles compels these teachers to apply the best educational principles in the development of educational courses. Review of motor skill learning theory would suggest that effective feedback and adequate practice opportunities are essential for the acquisition of motor skill and should be integrated into all skills-type continuing medical educational courses. The present trend is toward more objectivity in skill evaluation although evidence that this actually improves evaluation is lacking. Curriculum development and evaluation of this specific type of training course should follow those general principles proposed for the development of effective continuing medical education.
Clinical Competence↗