Are Practicing Surgeons Using the Most Effective Training Methods When Learning New Procedures and Technologies?

Steven J Hasday, BS, Todd A Jaffe, BBA, Meghan C Knol, MS, Jason C Pradarelli, MS, Justin B Dimick, MD, MPH. University of Michigan Medical School

INTRODUCTION: New procedures and technologies are continuously introduced into practice across a variety of surgical fields. Learning curves among surgeons in practice may be steep, leading to avoidable harm during the diffusion process. There is very little information about how practicing surgeons learn new things. Our aim is to understand how practicing surgeons utilize available training methods to learn new procedures and technologies, which methods are perceived as most effective, and to determine barriers to using the most effective methods.

METHODS AND PROCEDURES: We designed a 22-question survey to evaluate how practicing surgeons use available training methods when learning new procedures/technologies, as well as the perceived efficacy of those methods.  Invitations to participate were sent via email to 77 faculty surgeons at a large Midwestern academic health center.  Respondents were asked which of five common learning methods they used “most commonly,” and which they believed to be “most effective.”  Those with discordant responses were prompted to indicate how important various barriers are in accounting for this discrepancy (5-point Likert scale: 1=”Not At All Important;” 5=”Very Important”).  The survey was administered online using Qualtrics Survey Software. Proportions in each response category were compared using chi-square tests. 

RESULTS: The survey response rate was 71% (55/77). Surgeons reported commonly using self-directed study such as videos and textbooks (29%) and didactic short courses (20%) to learn new procedures or technologies. Much fewer surgeons reported using proctoring (10%) or mini-fellowships (0%). However, when asked which training methods were likely to be the most effective for safely implementing new procedures or technologies in their practice, 49% selected the most rigorous approaches (i.e., proctoring or a mini-fellowship). Only 13% of surgeons identified self-directed study or didactic short courses as the most effective methods. 

Surgeons reported that the greatest barriers to using what they perceived as the most effective training method were that it would “require too much time” (mean = 3.63) and be “prohibitively expensive” (3.21).  Surgeons also reported that they have “confidence [they] can implement safely” using a less rigorous training method (3.32). 

CONCLUSIONS: Our results indicate that among surgeons there is a marked disconnect between the most commonly used training methods and those deemed most effective.  Addressing the reasons for this discrepancy could improve diffusion of new procedures and technologies in to practices, reducing the learning curve and improving patient outcomes.

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