February 1998 Bulletin

Continuing Medical Education

Are skills courses effective?

Study to measure if training transfers to operating room

Orthopaedists improve skills in the Orthopaedic Learning Center

Surgical skills courses, such as those presented at the Orthopaedic Learning Center (OLC), are gaining in popularity but do they improve the participantsí skills?

"Those of us on the Academyís Council on Education and the Committee on Surgical Skills Education certainly think skills courses make for better surgeons, and most course participants would probably agree," said Richard H. Gelberman, MD, council chairman. "But there is little controlled, scientific investigation that documents the acquisition and retention of surgical skills techniques. Thatís why we asked the board to fund this study."

A two-phase study, approved by the Board of Directors in December, will not only measure whether participants demonstrate an improvement in surgical skills after taking an OLC course, but also whether the improvement transfers to the operating room, says Carol R. Hutchison, MD, MEd, director of the University of Toronto Surgical Skill Center at the Mount Sinai Hospital and principal investigator for the study.

In the first phase of the study, junior and senior residents will be assessed using the Objective Structured Assessment of Technical Skills (OSATS), a test used to evaluate residentsí surgical skills, to measure its validity and reliability in measuring orthopaedic skills. Two groups will undergo surgical skills training on two different procedures. After the instruction, their performance on four surgical procedures will be reassessed. At the same time, evaluators also will determine the effect of didactic training on skills.

In the second phase, the OSATS will be used in a standard OLC course. Fifteen orthopaedic surgeons attending a knee course for total knee arthroplasty and 15 attending a knee course for ACL reconstruction will participate in the OSATS before and after the course. The intent of the second phase of the study is to determine whether an OSATS form of evaluation is valid and practical for assessment of OLC courses.

Dr. Hutchison says the study will be significant in its potential for eventual application of testing as part of larger, long-term studies to determine the effectiveness of skills education as well as an ongoing measure of a particular courseís effectiveness.

Surgical skills courses are gaining momentum for several reasons, says Dr. Hutchison. First, if a new technology or procedure is developed, surgeons should be trained in the surgery outside of the operating room. Also, she says the traditional apprenticeship method of training residents is becoming less and less feasible for economic reasons. "The cost of the surgical minute is extremely high," says Dr. Hutchison. "You canít afford to have the operation take longer than it does on average." Furthermore, she adds, that there may be higher risk of blood loss and infection when the patient is exposed to longer surgery to allow time for training.

"From an educational perspective, it doesnít make sense for residents or practicing surgeons to learn a new procedure in the operating room," she says. "If you are learning a gymnastic routine, you donít perform it the first time in an Olympic competition. You have time to practice and get good at it. In the operating room, the resident is performing the procedure for the first time, itís a performance. We need to allow surgeons to practice skills outside of the operating room before transferring those skills to the operating room."

Dr. Hutchinson believes the OLC "is an outstanding facility that has potential to be the best in the world in this area. It is ahead of the game because of the timing when it was built. If we find out ways to evaluate surgical skills and determine effectiveness of the skills, the Academy will be further ahead than anyone else who is offering CME surgical skills."

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