Communication Skills Training through the use of Virtual Simulation for General Surgery Residency

Caitlin Halbert, DO, MS, Kathryn Fulda, Susan Coffey-Zern, MD, Beth Fitzgerald, Gerard Fulda, MD. Christiana Care Health System.

Simulation labs have enabled surgical residents to become familiar and gain proficiency on various procedures prior to operating on real patients. Not only can residents practice their technical skills, but the simulation lab can also be utilized to foster and improve communication skills.

The goal of this station is to assess the role of proper communication in the operating room between senior and junior residents.

The residents were randomly divided into two groups, the “study group” and the “control group,” equally distributing each PGY class. Within each group, a senior (PGY4 or PGY5) resident was randomly paired with a junior (PGY1 or PGY2) resident. The task to be performed by the junior resident involved placement of trochars in preparation for a laparoscopic cholecystectomy.

The abdominal cavity was simulated using a laparoscopic torso simulator. The seniors from the study group received a didactic focusing on the importance of accurate, concise, and clear communication in the operating room. The importance of utilizing anatomy references was stressed to the senior residents in this group. The seniors from the control group received a “sham” didactic.

The junior residents were explained the task by the senior resident. The senior helped instruct the junior on placement of those trochars through verbal cues. Each pair was given 15 minutes to complete the task.

The trochar placement in each room was videotaped for review. The assessment included clarity and frequency of communication, efficiency, utilization of anatomic references, proper trochar placement and time to completion.

A total of eight pairs of residents were included in the study, four in each group. When the times for the two groups were compared using the Student’s t-test, the p value was 0.80. The percentages of the task completed for the control and study groups were compared using the Student’s t-test, the p value was 0.65.
The pairs were each videotaped during the completion of their task. A third-party observer reviewed the videos to evaluate the communication between the junior and senior resident.

The overall experience of learning trochar handling and placement was positive for the junior residents, especially the interns. Giving them the ability to place trochars in a controlled, simulated environment gave them confidence when they entered the operating room.

The control and study groups had similar strengths and weakness when their ability to communicate was assessed. All of the senior residents were able to provide a clear briefing of the task at the onset. Most of the senior residents in both groups failed to give a concise debriefing at the conclusion of the task. Strengths and weaknesses were often not addressed and feedback was not elicited

The two groups were not significantly different when comparing length of time for completion of a task and percent completion.

The pairs will be debriefed on their performance. All pairs will be included in this debriefing. Future tasks will be reviewed to assess if communication skills have been learned and implemented into their repertoire of teaching skills.

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