Training the Trainers – Surgical Style

Susannah M Wyles, MSc MRCS, Chee Wan Lai, MBBS MRCS, Melody Ni, PhD, Nader Francis, PhD FRCS, John T Jenkins, FRCS, Amjad Parvaiz, MD FRCS, Tom Cecil, MD FRCS, Roland Valori, MD FRCP, George Hanna, PhD FRCS, Mark G Coleman, MD FRCS. Imperial College London, Derriford Hospital, Yeovil Hospital, St Marks Hospital Harrow, Queen Alexandra Hospital Portsmouth, Basingstoke and North Hampshire Hospital, Gloucester Hospital

INTRODUCTION
The aim of this study was to design, role out and assess a surgical teaching training course to ensure, and if necessary improve, the skills of laparoscopic colorectal surgery (LCS) trainers within the English National Training Programme (Lapco).
METHODS AND PROCEDURES
A training committee of five expert surgeons (performing LCS >10 years) and three educationalists developed and piloted a two day course. Participants were Lapco trainers, with 6-8 within a group. Day one of the course consisted of educational theory interspersed with role-play and laboratory-based practical sessions. Live-operating took place on the second day, with each course participant (trainer) training a trainee surgeon on LCS resection, whilst being observed directly by another course member and a faculty member. The trainers were concurrently observed indirectly by the remainder of the course participants and experts via a video-link. After a twenty minute training episode the trainer stopped teaching and received extensive feedback from both the trainee, the observer (course member) and the expert. There was also an opportunity for further discussion with the others. Course participants gave their opinion about the course through a standardised anonymised questionnaire with a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = undecided, 4 = agree, 5 = strongly agree). Before and after the course trainers were assessed by their trainees using the Structured Training Trainer Assessment Report (mini-STTAR) in the clinical setting to determine the impact of the course. This is a 24-point validated assessment that enables the trainee to give their opinion regarding their trainer’s training through a 5-point Likert scale. Data were analysed using SPSS, Kruskal-Wallis and Mann Whitney tests. Mean scores are quoted and a p value of <0.05 was considered to be significant.
RESULTS
Over a twelve month period (June 2010-June 2011), four courses ran, attended by 27 trainers (26 male, 1 female), aged 45.1( range 34-53) with between 5-10 years experience in LCS. From January 2011 the mini-STTAR assessments were introduced into Lapco and were completed after each training episode in the clinical setting. Trainers agreed that after the course they had a greater understanding of educational theory (4.54 (4-5)), that the coaching practical sessions were interesting(4.48 (4-5)), that they were aware of a variety of coaching techniques for LCS(4.23 (3-5)) and that the course was well structured and organised(4.4 (4-5)). With regard to the scores on the mini-STTAR, the experts scored most highly(3.59 ±0.45), followed by those who had not been on the course(3.54 ± 0.37) then by those who had attended(3.49 ± 0.46). However Kruskal-Wallis tests found no significant differences among the groups(p=0.524). Mann-Whitney test found no significant difference in the trainers scores before and after the course(p=0.788).
CONCLUSION
Overall the course was found to be well designed and educational. The quality of trainers was uniformly high throughout the programme training centres. The next step would be to open the course to other surgeons outside of the programme where it is more likely to have a significant impact on their training.

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