Department of Surgery Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts.
Department of Surgery Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts.
J Surg Educ. 2019 Nov-Dec;76(6):e225-e231. doi: 10.1016/j.jsurg.2019.07.019. Epub 2019 Aug 27.
In order to increase selected skills at onset of training, we provided newly matched PGY-1 trainees with materials and instructions to practice these skills, as well as the opportunity to share video-recorded performance and receive feedback based on these videos.
Knot tying and suturing kits, instruments and supplies, and video instructions for task performance were sent to newly matched trainees to our program (n = 10), with instructions to practice 4 tasks (1- and 2-handed knot tying, interrupted and running suturing) until self-assessed comfort with each task was achieved or the 8-week time point before start of training was reached. Each trainee returned a video of each task, which was graded by blinded reviewers for time and errors using an itemized evaluation instrument (12 items for suturing and five items for knot-tying). Feedback (annotations of submitted videos) was provided after grading was completed. Task performance was repeated and reassessed at the time of new intern "Boot Camp" and again 8 weeks after start of training. Performance scores were compared for the 3 time points and with scores of PGY 2-4 residents using ANOVA with posthoc tests.
Compliance with instruction for practice and return of video recorded tasks in the months before start of PGY-1 training was high, with only 1 of 10 failing to return knot-tying videos. A significant pattern of performance change (p < 0.05) was observed for all tasks with an initial decrease between the pre-employment practice period and the Boot Camp test followed by an increase to the highest level of performance 2 months after start of training. At that point, scores were not significantly different than those of more senior residents.
A high level of compliance was achieved with requested skills practice and video documentation of performance. We attribute the consistently lower scores on the tasks during Boot Camp tests to higher stress test environment which was apt to be less favorable than having the trainee choose to submit their best possible preresidency video recording of performance in a low-stress situation. Subsequent achievement of significantly higher performance even compared to more senior residents may have been helped by incentivized pretraining practice.
为了在培训开始时提高选定的技能，我们为新匹配的 PGY-1 受训者提供了练习这些技能的材料和说明，以及分享视频记录的表现并根据这些视频提供反馈的机会。
将打结和缝合套件、仪器和用品以及任务执行的视频说明寄给我们项目中的新匹配受训者（n=10），并指示他们练习 4 项任务（单手和双手打结、间断和连续缝合），直到每个任务达到自我评估的舒适程度或在培训开始前的 8 周时间点。每位受训者都返回了每个任务的视频，由盲审员使用逐项评估工具（缝合 12 项和打结 5 项）根据时间和错误进行评分。在评分完成后提供反馈（提交视频的注释）。在新 intern“新兵训练营”时和培训开始后 8 周再次重复和重新评估任务表现。使用方差分析和事后检验比较了 3 个时间点和 PGY 2-4 住院医师的分数。
在 PGY-1 培训前的几个月里，对练习和返回视频记录任务的指令的遵守率很高，只有 10 人中有 1 人未能返回打结视频。所有任务的表现都呈现出显著的变化模式（p<0.05），在就业前练习期和新兵训练营测试之间先下降，然后在培训开始后 2 个月达到最高水平。此时，得分与更高级别的住院医师没有显著差异。
对请求的技能练习和绩效视频记录达到了很高的合规水平。我们将新兵训练营测试中任务得分较低归因于更高的压力测试环境，这比让受训者选择在低压力情况下提交其最佳的预培训表现视频记录更不利。即使与更高级别的住院医师相比，随后取得的绩效显著提高可能也得益于激励性的培训前练习。
