Surgical Skills Lab Improvement Project: A Cheap, Simple, Effective Place to Start

Jawad T Ali, MD¹, Brent Ford², John Uecker, MD¹. ¹University of Texas at Austin, ²University of Texas Medical Branch

Introduction: Practice of skills outside of the operating room is an integral and evidence based part of surgical training. Our hypothesis is that our surgical skills lab was not reaching its potential due to lack of access, disorganization, and dissatisfaction among surgery residents. We wanted to improve the functionality and usage of the lab as well as track outcomes.

We proposed a three-pronged approach:

1) Improve access

2) Organize equipment around ACS task-based workstations

3) Strategically advanced trainers

Methods: We conducted a pre-intervention survey among all 14 surgical residents (3 per class with the study author excluded). Access was improved by placing keys to the lab along with a sign-out sheet. Extraneous equipment was removed and existing equipment was neatly organized into 7 clearly defined workstations: Knot tying, suturing, abdominal wall closure, intestinal anastomosis, vascular anastomosis, chest tube and central line placement, and laparoscopy. A post-intervention survey was conducted at one month after the changes were instituted.

Residents were asked about their overall satisfaction, if they would recommend the lab to others, if they used it outside of scheduled sessions, and if they were satisfied with ease of access. They were also asked about their satisfaction with regards to training each of the previously described skills. Agree or Strongly agree were marked as positive responses.

Results: Areas that received a dedicated workstation had the largest increase in satisfaction. Vascular anastomosis increased from 43% to 86% and laparoscopic skills from 36% to 79%. Also, simply having a key that was always available dramatically improved issues with accessibility with a 43% to 93% increase. Basic skills like knot tying and suturing were shored up from 71% to 100%. Their likelihood to recommend our lab to other residents increased from 7% to 50%.

Use of the lab outside of scheduled training had some improvement, 36% to 57%. Our post-intervention survey showed areas that had further room for improvement were lab usage outside of didactics as well as advanced laparoscopic maneuvers.

Conclusion: Removing clutter and adding instantly usable workstations were a large part of the improved overall satisfaction. Increased lab usage will be an eventual culture change. An effective approach to enhancing skills lab use and satisfaction among surgery residents consists of organizing equipment around task-based workstations, making the lab easy to access at all times, and strategically filling in gaps in advanced training equipment.