Optimizing the Timing of Expert Feedback During Simulation-Based Spaced Practice of Endourologic Skills

Comparing Peer and Faculty Feedback for Asynchronous Laparoscopic Skill Acquisition

OBJECTIVE

Traditionally, expert surgeons have provided surgical trainees with feedback about their simulation performance, including for asynchronous practice. Unfortunately, innumerable time demands may limit experts' ability to provide feedback. It is unknown whether and how peer feedback is an effective mechanism to help residents acquire laparoscopic skill in an asynchronous setting. As such, we aimed to assess the effect of peer feedback on laparoscopic performance and determine how residents perceive giving and receiving peer feedback.

DESIGN

We conducted a convergent mixed methods study. In the quantitative component, we randomized residents to receive feedback on home laparoscopic tasks from peers or faculty. We then held an end-of-curriculum, in-person laparoscopic assessment with members from both groups and compared performance on the in-person assessment between the groups. In the qualitative component, we conducted interviews with resident participants to explore experiences with feedback and performance. Three authors coded and rigorously reviewed interview data using a directed content analysis.

SETTING

We performed this study at a single tertiary academic institution: the University of California, San Francisco.

PARTICIPANTS

We invited 47 junior residents in general surgery, obstetrics-gynecology, and urology to participate, of whom 37 (79%) participated in the home curriculum and 25 (53%) participated in the end-of-curriculum assessment.

RESULTS

Residents in the peer feedback group scored similarly on the final assessment (mean 70.7%; SD 16.1%) as residents in the faculty feedback group (mean 71.8%; SD 11.9%) (p = 0.86). Through qualitative analysis of interviews with 13 residents, we identified key reasons for peer feedback's efficacy: shared mental models, the ability to brainstorm and appreciate new approaches, and a low-stakes learning environment.

CONCLUSIONS

We found that peer and faculty feedback led to similar performance in basic laparoscopy and that residents engaged positively with peer feedback, suggesting that peer feedback can be used when residents learn basic laparoscopy.

Putting the "learning" in "pre-learning": effects of a self-directed study hall on skill acquisition in a simulation-based central line insertion course

BACKGROUND

Opportunities to practice procedural skills in the clinical learning environment are decreasing, and faculty time to coach skills is limited, even in simulation-based training. Self-directed learning with hands-on practice early in a procedural skill course might help maximize the benefit of later faculty coaching and clinical experience. However, it may also lead to well-learned errors if learners lack critical guidance. The present study sought to investigate the effects of a hands-on, self-directed "study hall" for central line insertion among first-year residents.

METHODS

Learner cohorts before vs. after introduction of the study hall (n = 49) were compared on their pre- and post-test performance of key procedural behaviors that were comparable across cohorts, with all learners receiving traditional instructor-led training between tests.

RESULTS

Study hall participants spent a median of 116 min in hands-on practice (range 57-175). They scored higher at pre-test (44% vs. 27%, p = .00; Cohen's d = 0.95) and at post-test (80% vs. 72%, p = .02; Cohen's d = 0.69). A dose-response relationship was found, such that 2 h of study hall were roughly equivalent to the performance improvement seen with four clinical observations or supervised insertions of central lines.

CONCLUSIONS

Self-directed, hands-on "study hall" supported improved procedural skill learning in the context of limited faculty availability. Potential additional benefits make the approach worth further experimentation and evaluation.

Impact of Early Exposure to Simulation Program on Undergraduate Medical Students' Interest in Urology

BACKGROUND

Urological education is as important as surgical training for undergraduates. However, students in undergraduate medical schools have less exposure to urology as their curriculum focuses more on clinical skills, particularly community-based healthcare for a super-aging society. This study aimed to evaluate whether urology-related hands-on training could increase the interest of undergraduate medical students in urology.

METHODS

A 1-day elective program in urological surgery at the University of Tsukuba, particularly in robotic, laparoscopic, and endoscopic surgeries, was offered to 85 fourth-year medical students from 2018 to 2020, prior to their clinical clerkship. The average age of the participants was 22 (range: 21-25) years. We used a scoring system that comprised 1-5 Likert-type items to assess training activity, interest in surgery, and interest in urology before and after the course.

RESULTS

Before attending the program, the average scores of interest in urology were 3.53 in 2018, 3.15 in 2019, and 3.00 in 2020. The scores in surgery increased after the program; however, this was not significantly different from scores prior to the program. However, the average interest scores in urology were significantly increased to 3.91 ± 0.63 (P < .05), 3.88 ± 0.58 (P < .01), and 4.00 ± 0.61 (P < 0.01) in 2018, 2019, and 2020, respectively. Total likely scores of this program in 2018, 2019, and 2020 were 4.59, 4.76, and 4.88, respectively, indicating a motivation to study surgery and urology during clinical clerkship.

CONCLUSIONS

Urological hands-on training facilitated interest in urology in medical students prior to their clinical clerkship.

Use of feedback on medium-term blood pressure measurement skills in medical students: a randomized controlled trial

BACKGROUND

The objective of this study was to assess the effect of feedback on medium-term blood pressure (BP) measurement skills in medical students versus a control group.

METHODS

A randomized controlled trial in first-year medical students was conducted. After theoretical-practical training on measuring BP, the students were randomized into a control group or intervention group. The skill was assessed immediately after the training (T1) by evaluating students with a simulated standardized patient using a checklist. Students in the intervention group received feedback immediately after assessment, whereas the control group received no feedback. After 3 months (T2), each student was reassessed in the same way as for (T1).

RESULTS

Ninety-two first-year medical students took part in the study (45 in control group and 47 in intervention group). At T1, there were no differences in the skill measured. At T2 (after three months), there was a significant difference in the intervention group (score = 23.97 ± 3.82) compared with the control group (score = 20.91 ± 4.87), P < 0.001, d = 0.69. In the intervention group, the scores were maintained at 3 months (T1 = 23.23 and T2 = 23.97, P = 0.335), whereas in the control group, scores declined significantly (T1 = 23.44 and T2 = 20.91; P = 0.002).

CONCLUSION

Receiving feedback promotes retention of learning of BP measurement skills over the medium term. Further studies applying feedback to other skills should be conducted.

Effect of face-to-face verbal feedback compared with no or alternative feedback on the objective workplace task performance of health professionals: a systematic review and meta-analysis

OBJECTIVE

Verbal face-to-face feedback on clinical task performance is a fundamental component of health professions education. Experts argue that feedback is critical for performance improvement, but the evidence is limited. The aim of this systematic review was to investigate the effect of face-to-face verbal feedback from a health professional, compared with alternative or no feedback, on the objective workplace task performance of another health professional.

DESIGN

Systematic review and meta-analysis.

METHODS

We searched the full holdings of Ovid MEDLINE, CENTRAL, Embase, CINAHL and PsycINFO up to 1 February 2019 and searched references of included studies. Two authors independently undertook study selection, data extraction and quality appraisal. Studies were included if they were randomised controlled trials investigating the effect of feedback, in which health professionals were randomised to individual verbal face-to-face feedback compared with no feedback or alternative feedback and available as full-text publications in English. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. For feedback compared with no feedback, outcome data from included studies were pooled using a random effects model.

RESULTS

In total, 26 trials met the inclusion criteria, involving 2307 participants. For the effect of verbal face-to-face feedback on performance compared with no feedback, when studies at high risk of bias were excluded, eight studies involving 392 health professionals were included in a meta-analysis: the standardised mean difference (SMD) was 0.7 (95% CI 0.37 to 1.03; p<0.001) in favour of feedback. The calculated SMD prediction interval was -0.06 to 1.46. For feedback compared with alternative feedback, studies could not be pooled due to substantial design and intervention heterogeneity. All included studies were summarised, and key factors likely to influence performance were identified including components within feedback interventions, instruction and practice opportunities.

CONCLUSIONS

Verbal face-to-face feedback in the health professions may result in a moderate to large improvement in workplace task performance, compared with no feedback. However, the quality of evidence was low, primarily due to risk of bias and publication bias. Further research is needed. In particular, we found a lack of high-quality trials that clearly reported key components likely to influence performance.

TRIAL REGISTRATION NUMBER

CRD42017081796.

Current Educational Interventions for Improving Technical Skills of Urology Trainees in Endourological Procedures: A Systematic Review

Objective: Endourology continues to grow with the introduction of new technologies into clinical practice. Simulators and training models have been developed to improve comfort and proficiency in endoscopic procedures. The purpose of this systematic review was to examine the current educational interventions utilized to improve the performance of endourology trainees and to critically appraise the strengths and limitations of each. Methods: A search of the Ovid MEDLINE, EMBASE, PsycINFO, and the Cochrane Library databases was performed to identify literature focused on current educational interventions for improving technical skills of trainees in endourologic procedures. The Medical Education Research Study Quality Instrument (MERSQI) was used to evaluate the methodological quality of the abstracted articles. Results: Of the 2236 articles identified, 22 met the inclusion criteria. The types of educational interventions included: bench/wet lab models, virtual reality simulators, and instructional courses. Metrics used to quantify the impact of these interventions include global rating scales, Objective Structured Assessment of Technical Skills (OSATS) scores, and task-specific checklists. The setting of these evaluations comprises both virtual reality simulators and live surgery. Conclusions: In the surgical education literature, simulation-based training and assessment continues to play a prominent role in urologic training. The educational interventions highlighted in this review address various aspects of endourology, from stone management to transurethral resection. Additional work is needed to correlate technical performance in clinical and nonclinical settings with patient outcomes and develop a focused approach to nontechnical skill training.