Vivienne I Blackhall, Miss1, Jennifer Cleland, Professor2, Kenneth G Walker, Professor1, Philip Wilson, Professor3, Susan J Moug, Miss4. 1Highland Academic Surgical Institute, 2Institute of Education in Medical and Dental Sciences, University of Aberdeen, 3Centre for Rural Health, Aberdeen University, 4Department of General Surgery, Royal Alexandria Hospital
Introduction: Laparoscopic skills can be learned using portable simulators and these skills are transferrable to the operating room. Several training regions within the UK have therefore developed and delivered home-based laparoscopic training programmes for junior surgical trainees. Although performance improved in some, overall engagement has been poor. Similar results have been observed in North America. The aim of our study was to uncover the reasons for poor engagement with home-based simulation with a view to developing a future, more successful, programme.
Methods: This was a qualitative study utilising focus groups. Interviews were undertaken with key stakeholders involved in various laparoscopic home-based simulation programmes through the UK. Training equipment comprised the eoSim portable simulator paired with online training tasks. The tasks were similar to those used in the Fundamentals of Laparoscopic surgery programme (FLS). Basic metric feedback was provided (eg time to complete task). A total of 45 individuals were interviewed, including surgical trainees, consultant trainers, training directors and programme faculty. This generated approximately 7 hours of data which was coded using nVIVO software. A basic thematic analysis was performed.
Results: Trainees cited multiple competing professional commitments as a barrier to engaging with home-based simulation. They tended to focus on scoring ‘points’ which contributed toward career progression rather than tasks which were interesting, or associated with personal development. This approach is perpetuated by the surgical training system, which rewards trainees with points for publications and exams, but not for operative skill. This leads to conflict between trainers and trainees, the former expecting trainees to instead focus upon developing their technical abilities. Trainees were unsatisfied with metric feedback and wanted individual feedback from consultant trainers (attending equivalent). Trainees generally perceived consultants as lacking interest toward the programmes and training in general. However, some consultants were in fact unaware of the programmes being delivered and others felt lacking in confidence to deliver necessary training to trainees.
Conclusions: Our findings are widely generalizable and have implications for any institution delivering a similar programme. As a means of improving engagement, the the inception of scheduled simulation study days, providing trainees with the opportunity for personalised feedback from consultants, has been suggested. Equipping trainers with the necessary competencies to deliver training can be achieved by ensuring attendance at the necessary professional development courses. Tackling the ‘box ticking’ culture is more challenging and may involve a move toward restructuring the current surgical training scheme.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86328
Program Number: P327
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster