Goal Setting Program in Surgical Training Curriculum To Improve Laparoscopic Skills

Ryota Tanaka, MD, PhD, Yalini Vigneswaran, MD, Francis DeAsis, BS, BA, JoAnn Carbray, BA, Alexandre Derevianko, MD, Michael Ujiki, MD. Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University HealthSystem

INTRODUCTION: The purpose of this study was to determine whether a goal setting program integrated into a surgical training curriculum would improve performance on Fundamentals of Laparoscopic Surgery (FLS) testing and confidence with laparoscopic surgical skills.

METHODS: Beginning in 2013, medical students and general surgery residents at all levels of training were enrolled in the study and evaluated on the five FLS tasks at our center. Trainees were randomized to one of the following three goal-setting groups. Trainees were either given no time goals for each FLS task (No Goals), time goals that were the best time scores reported in the literature for each task (Expert) or the mean time scores reported for passing each task seen in the literature (Mean). All trainees were evaluated with the FLS score sheet, a confidence survey and time scores for each task both prior to and after the assignment. The associations of categorical variables in demographic data were analyzed using one-way analysis of variance. Scores were compared between groups using t-test. The differences were considered to be statistically significant if the p value was less than 0.05.

RESULTS: A total of 23 medical students and 21 residents were enrolled in the study. Matched for level of training, we observed on average higher FLS score improvement for the Mean group (27.1 points) than the Expert (25.1 points) and No Goals (22.8 points) groups. Confidence survey scores improved more in the Expert group than the Mean and No Goals groups. For time scores, no participants achieved the expert time goals on evaluations before or after the program. Overall we noted time score improvements were higher for the Mean group than the Expert or the No Goals group on three of the five tasks (peg transfer, pattern cutting and intracorporeal suturing) (table 1). Adjusted for level of training, time score improvements for pattern cutting were statistically greater for the Mean group than No Goals group (p=0.02). However time score improvements for extracorporeal suture task were statistically greater for the Expert group compared to the Mean group (p=0.02). We additionally observed that when excluding residents, the students in the Mean group demonstrated statistically higher time scores than the Expert group for intracorporeal suturing (p =0.04).

CONCLUSION: Trainees given an achievable goal, as we saw with the Mean group, will achieve higher improvement in total standardized FLS scores as well as time scores in the several tasks as compared to trainees given expert goals or no goals. Although not statistically higher for all tasks, there was a clear trend towards higher scores for the Mean group. Thus we conclude that trainees should be given achievable goals to enhance success in mastering specific surgical skills, especially during simulation.

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