Z. J. Ahola1, C. W. Lee1, S. Agarwal1, H. Jung1, A. O’Rourke1, A. Liepert1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: Nontechnical skills demonstrated by surgeons in the operating room are known to play an important role in ensuring patient safety and good surgical outcomes. Recognition of communication, leadership, and interpersonal skills as vital components of formal surgical training has resulted in ACGME-accredited skills training initiatives among residencies nationwide. However, early evaluation among medical students considering surgical careers has yet to be studied, and no specific training interventions have been initiated among graduating medical students to date. The purpose of this study was to examine and identify the influences of an early training intervention on teamwork and team performance among medical school graduates continuing onto surgical internship through the use of video recordings of an animal model operative simulation.
Methods: Video recordings of nine graduating medical student interactions were obtained during a full-day surgical case simulation utilizing porcine models. The animal model simulation was the final day of a two-week surgery intern preparatory curriculum for graduating medical students accepted into ACGME-accredited surgical internships. Two randomly assigned groups of students utilized two separate porcine models to perform common operative procedures, termed learning modules. Students received real-time instruction and feedback from residents and attending surgeons. The tasks were primarily performed by the students. All video recordings were reviewed for outcomes pertaining to teamwork knowledge, skills, and attitudes of the participants. The number of actions initiated and task, skill, and team activities were recorded for each individual. This study was qualitative and observational in nature.
Results: Nine medical students were de-identified and randomly divided into two groups, A and B. Team A consisted of 5 subjects, and Team B consisted of 4. The primary observations among participants included various dimensions of teamwork as follows: willingness to participate, encouragement of others, and self-appointed versus instructor-appointed leadership. Dominant individuals were identified as having the greatest hands-on participation and the greatest number of self-initiated actions within each learning module. The cumulative count of self-initiated actions was 55 in Team A and 41 in Team B. The cumulative count of instructor-initiated behaviors was 44 in Team A and 42 in Team B.
Conclusion: Dominant leadership was evident within each learning module. However, cumulative results of self and instructor-initiated behaviors were similar between groups. Common learning characteristics among early surgical trainees include shared learning, willingness for participation, and self and instructor-initiated leadership roles. This study demonstrates that video recordings of high-fidelity surgical scenarios in porcine operative models may be used to identify leadership and teamwork behaviors.