Supersymmetry Hitoshi Murayama Taiwan Spring School March 29, 2002.
Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed...
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Transcript of Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed...
Impact of a Structured Skills Lab Curriculum on
Operative Judgment Deb DaRosa, David Rogers,
Reed Williams, Linnea Hauge,
Ken Murayama, Alex Nagle,
Keith Millikan, and Gary Dunnington
PurposeDevelop and test an instructional
design template for skills lab curriculum that is:
1. Based on pertinent theories
2. Focuses on judgment & procedural skills
3. Is feasible and portable
4. Includes evaluation component
Research Question
Is there a difference….
in the judgment and technical skills of residents exposed to a skills lab curriculum based on a structured instructional design template?
TeamLeaders
Curriculum Team
David Rogers*
Linnea Hauge
Ken Murayama
Deb DaRosa
Evaluation TeamReed Williams*Keith MillikanAlex NagleGary DunningtonDeb DaRosa
Cognitive Task Analysis
• Arises from Human Factors
• Group of analytical techniques designed to capture expert thinking
Elstein AS. Decision analysis in surgical education. World J. Surg 1989;13:287-91.
CTA Example
During the course of a laparoscopic cholecystectomy, the surgery resident variously strays into the lumen of the gallbladder and the parenchyma of the liver.
Experimental Design
T group RO1 X O2
C group RO3 O4
Institution T C Total A 9 7 16
B 13 15 28C 10 9 19
Total 32 31 63
Instructional Design Template
Curriculum & Learning Theories• Whole-Part Method• Objectives• Feedback – written/oral• Distributed learning episodes• Active & learner-centered• Repetition and practice• Problem & experience-oriented
Curriculum: Session 1
Both T and C Groups - Baseline
• Orientation by Chair or PD
• Written pretest
• View MedAscend CD of Lap Chole
• Question/Answer period
• Box trainer exercises
Written Exam ItemsWhich trocar placement is optimal
for a laparoscopic cholecystectomy?
Example: Written TestWhich retraction of the gallbladder
provides optimal exposure of the cystic duct?
Example: Written Exam
List up to three methods for determining whether the veress needle has penetrated into the abdominal cavity.
Curriculum: Session 2Homework: Pblm centered exercise
Assigned readings
• Pre trial testimony
• Review designed CD-ROM
– 12 critical steps of LC
• Worksheet to record steps
• Error brainstorm session
• Summary
Curriculum: Session 3• Recall exercise w/
CD-ROM
• Review/Discussion
• Porcine Practice
– Think aloud rehearsal
– Peer feedback using Porcine checklist
Curriculum: Session 4
Both Groups
• Written post-test
• Porcine exercise (45 minutes) using think aloud rehearsal
• Faculty (blinded) direct observation with final feedback – Porcine checklist
Measures and AnalysisMeasurement Instruments
• Written pre and post-test
• LC Porcine Evaluation Form
• LC Evaluation Form for OR
Data Analysis
• Cronbach’s Alpha Coefficients
• Student’s T-test
Results: Reliability of Measures
Measure Knowledge Skill Errors
Pretest .75
Post test .64
LC Porcine
.83 .90 .53
LC OR
Eval
.74 .71 .50
Results: LC Porcine
Items T
M (sd)
C
M (sd)
t p
Knowledge 36(5.8) 36(6.9) -.10 ns
Technical 68(21.5) 56(26.7) -1.6 ns
Errors 47(52.9) 41(48.6) -.33 ns
Results – OR Evaluation
Items T
M (sd)
C
M (sd)
t p
knowledge 34(3.1) 32(4.5) -1.31 ns
Technical 25(2.7) 23(2.9) -0.10 ns
Errors 4.0(3.7) 4.2(3.3) 0.12 ns
Written Pre and Post-test
Measure T
M (sd)
C
M (sd)
t p
Pretest 48(11.1) 51(9.2) 1.16 ns
Post-test 61(6.2) 55(8.0) -2.47 .02*
Pre/Post
Difference
11 (0.6) 4(10.3) -2.38 .02*
Study Limitations• Small sample size
• Subject mortality – OR evaluation
• Insufficient practice time
• Changes in study personnel
• Outcome evaluation flaws– Talk aloud– Eubanks items– Direct observation by faculty
ConclusionsInstructional Design Template
Effective in:
• CTA methodology – blueprint for cohesive curriculum and reliable exams
• Enhancing intra-operative judgment as assessed on written examination
Revised Instructional Design Template: Part 1
Descriptive Information• Assumptions about learners• Description of skill
- Cognitive task analysis - Procedural task analysis
• Potential errors and complications - Prevention, anticipation, &management strategies
Revised Instructional Design Template: Part 2
Instructional Plan
• Objectives and Teaching plan
– Time, resources, sequence, etc
• Homework/assignments
• Guidelines for facilitator/learners
• Practice guidelines
– Frequency, intensity, duration
Practice, Practice, Practice
Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance. Acad Med, 2004.
Revised Instructional Design Template: Part 3
Feedback and Evaluation
• Practice performance standards – Time, conditions, etc.
• How feedback will be given
• Pre-test description
• Post-test description
• Outcome evaluation criteria
Thank You!
Foundation of the Association for Surgical Education (CESERT)
SIU: Janet Ketchum
Rush: Daniel Deziel, MD
Northwestern: John Coyle,MD, Tom Powers & Deb Rooney