S. J. Gannon3, K. E. Law2, R. D. Ray1, A. D. D’Angelo1, C. M. Pugh1,2 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA 2University Of Wisconsin,Department Of Industrial And Systems Engineering,Madison, WI, USA 3University Of Wisconsin,Department Of Kinesiology,Madison, WI, USA
Introduction: This study used a simulated environment to explore issues relating to skills decay in research residents. We assessed operative leadership skills and conducted a survey evaluation of residents’ perception of skills decay and prediction of task difficulty. The purpose was to compare residents’ perception of technical skill decay and difficulty with their leadership skills during a simulated bowel repair. Leadership was assessed by the resident’s ability to direct their assistant. We hypothesize that resident’s ratings of difficulty and expected skill decay will be correlated to their utilization of the operative assistant during the simulation.
Methods: Surgical residents (PGY 2-4) in their research years were given 15 minutes to perform a simulated bowel repair. Prior to the procedure, residents were given a survey to rate their perceived difficulty and expected skill decay in performing the repair. The procedure consisted of a simulated gunshot wound to the abdomen that left one small and large full thickness injuries to the anti-mesenteric border of the small bowel. Residents were asked to repair the injuries with an operative assistant. The assistant was instructed not to provide feedback on the repair; however, could clarify with prefixed responses what was expected of the resident. Interactions with the assistant were coded by a researcher using TransanaTM coding software to identify the total number of directional instructions given by the resident during the simulation. Correlations between the number of directional instructions and perceived skill decay and task difficulty were performed.
Results: Twenty-eight residents (55.3% female) participated in the study. Residents provided 3-40 (M=13.96, SD=9.90) directional instructions to the operative assistant during the procedure. Residents who expected to have less decay in their small bowel repair skills during their research time were able to utilize the assistant more by giving them more directions on how to assist during the repair (R2=-.468, p=.016, df = 26). Those who perceived more difficulty on the repair and its related steps gave fewer directional instructions to their assistant. Expected procedural difficulties included selecting the correct suture (R2=-.401, p=.042, df = 26), selecting the correct stitch (R2=-.361, p=.070, df = 26), and successfully performing the entire surgical task (R2=-.398, p=.044, df = 26).
Conclusion: We assessed research residents’ expected skill decay and difficulty during an operative task and then evaluated the relationship of each item to residents’ use of operative assistants. Residents who gave more directional instruction to the operative assistant expected to have less skill decay and difficulty during a small bowel repair. These findings support the use of operative leadership skills as a potential metric for technical confidence and warrants further work regarding leadership and technical competence.