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Laboratory-Based Instruction for Skin Closure and Bowel Anastomosis for Surgical Residents
Aaron R. Jensen, MD;
Andrew S. Wright, MD;
Lisa K. McIntyre, MD;
Adam E. Levy, MD;
Hugh M. Foy, MD;
Dimitri J. Anastakis, MD, MEd, MHCM;
Carlos A. Pellegrini, MD;
Karen D. Horvath, MD
Arch Surg. 2008;143(9):852-859.
Hypothesis Multimedia delivery of cognitive content paired with faculty-supervised partial task simulation for both excision of a simulated skin lesion with subsequent wound closure and hand-sewn bowel anastomosis would be an effective method for developing appropriate procedural skills among junior residents.
Design Prospective cohort study.
Setting University-based surgical residency.
Participants First- and second-year surgical residents (n = 45).
Interventions Surgical residents were given comprehensive instructional materials, including structured curricula with goals and objectives, text, figures, and narrated expert digital video, before the training session. A 4-hour, standardized, laboratory-based instruction session was then performed in small groups, which emphasized faculty-supervised practice. Residents were asked to (1) excise a skin lesion and close the wound and (2) perform hand-sewn bowel anastomosis. These 2 tasks were assessed before and after supervised practice. Performances were video recorded. Residents were surveyed before and after training.
Main Outcome Measures Time to completion and Objective Structured Assessment of Technical Skill global rating scale score based on video recordings were evaluated by blinded reviewers. Final product quality was measured by anastomotic leak pressure and by wound closure aesthetic quality.
Results Residents perceived the laboratory training to be equal to training in the operating room for skin closure and superior to training in the operating room for bowel anastomosis. Residents perceived time spent on both tasks to be "perfect." Mean objective scores improved significantly on 5 of 6 outcome measures.
Conclusions Junior resident surgical performance improved substantially with 4 hours of laboratory-based, faculty-supervised practice. Both first- and second-year residents benefited from this training. These data show that curriculum-driven, faculty-supervised instruction in a laboratory setting is beneficial in the training of junior surgical residents.
Author Affiliations: Department of Surgery (Drs Jensen, Wright, McIntyre, Levy, Foy, Pellegrini, and Horvath) and College of Education (Dr Jensen), University of Washington, Seattle; and Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada (Dr Anastakis).
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