![Page 1: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/1.jpg)
Impact of a Structured Skills Lab Curriculum on
Operative Judgment Deb DaRosa, David Rogers,
Reed Williams, Linnea Hauge,
Ken Murayama, Alex Nagle,
Keith Millikan, and Gary Dunnington
![Page 2: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/2.jpg)
PurposeDevelop and test an instructional
design template for skills lab curriculum that is:
1. Based on pertinent theories
2. Focuses on judgment & procedural skills
3. Is feasible and portable
4. Includes evaluation component
![Page 3: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/3.jpg)
Research Question
Is there a difference….
in the judgment and technical skills of residents exposed to a skills lab curriculum based on a structured instructional design template?
![Page 4: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/4.jpg)
TeamLeaders
Curriculum Team
David Rogers*
Linnea Hauge
Ken Murayama
Deb DaRosa
Evaluation TeamReed Williams*Keith MillikanAlex NagleGary DunningtonDeb DaRosa
![Page 5: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/5.jpg)
Cognitive Task Analysis
• Arises from Human Factors
• Group of analytical techniques designed to capture expert thinking
Elstein AS. Decision analysis in surgical education. World J. Surg 1989;13:287-91.
![Page 6: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/6.jpg)
CTA Example
During the course of a laparoscopic cholecystectomy, the surgery resident variously strays into the lumen of the gallbladder and the parenchyma of the liver.
![Page 7: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/7.jpg)
Experimental Design
T group RO1 X O2
C group RO3 O4
Institution T C Total A 9 7 16
B 13 15 28C 10 9 19
Total 32 31 63
![Page 8: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/8.jpg)
Instructional Design Template
Curriculum & Learning Theories• Whole-Part Method• Objectives• Feedback – written/oral• Distributed learning episodes• Active & learner-centered• Repetition and practice• Problem & experience-oriented
![Page 9: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/9.jpg)
Curriculum: Session 1
Both T and C Groups - Baseline
• Orientation by Chair or PD
• Written pretest
• View MedAscend CD of Lap Chole
• Question/Answer period
• Box trainer exercises
![Page 10: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/10.jpg)
Written Exam ItemsWhich trocar placement is optimal
for a laparoscopic cholecystectomy?
![Page 11: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/11.jpg)
Example: Written TestWhich retraction of the gallbladder
provides optimal exposure of the cystic duct?
![Page 12: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/12.jpg)
Example: Written Exam
List up to three methods for determining whether the veress needle has penetrated into the abdominal cavity.
![Page 13: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/13.jpg)
Curriculum: Session 2Homework: Pblm centered exercise
Assigned readings
• Pre trial testimony
• Review designed CD-ROM
– 12 critical steps of LC
• Worksheet to record steps
• Error brainstorm session
• Summary
![Page 14: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/14.jpg)
Curriculum: Session 3• Recall exercise w/
CD-ROM
• Review/Discussion
• Porcine Practice
– Think aloud rehearsal
– Peer feedback using Porcine checklist
![Page 15: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/15.jpg)
Curriculum: Session 4
Both Groups
• Written post-test
• Porcine exercise (45 minutes) using think aloud rehearsal
• Faculty (blinded) direct observation with final feedback – Porcine checklist
![Page 16: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/16.jpg)
Measures and AnalysisMeasurement Instruments
• Written pre and post-test
• LC Porcine Evaluation Form
• LC Evaluation Form for OR
Data Analysis
• Cronbach’s Alpha Coefficients
• Student’s T-test
![Page 17: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/17.jpg)
Results: Reliability of Measures
Measure Knowledge Skill Errors
Pretest .75
Post test .64
LC Porcine
.83 .90 .53
LC OR
Eval
.74 .71 .50
![Page 18: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/18.jpg)
Results: LC Porcine
Items T
M (sd)
C
M (sd)
t p
Knowledge 36(5.8) 36(6.9) -.10 ns
Technical 68(21.5) 56(26.7) -1.6 ns
Errors 47(52.9) 41(48.6) -.33 ns
![Page 19: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/19.jpg)
Results – OR Evaluation
Items T
M (sd)
C
M (sd)
t p
knowledge 34(3.1) 32(4.5) -1.31 ns
Technical 25(2.7) 23(2.9) -0.10 ns
Errors 4.0(3.7) 4.2(3.3) 0.12 ns
![Page 20: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/20.jpg)
Written Pre and Post-test
Measure T
M (sd)
C
M (sd)
t p
Pretest 48(11.1) 51(9.2) 1.16 ns
Post-test 61(6.2) 55(8.0) -2.47 .02*
Pre/Post
Difference
11 (0.6) 4(10.3) -2.38 .02*
![Page 21: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/21.jpg)
Study Limitations• Small sample size
• Subject mortality – OR evaluation
• Insufficient practice time
• Changes in study personnel
• Outcome evaluation flaws– Talk aloud– Eubanks items– Direct observation by faculty
![Page 22: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/22.jpg)
ConclusionsInstructional Design Template
Effective in:
• CTA methodology – blueprint for cohesive curriculum and reliable exams
• Enhancing intra-operative judgment as assessed on written examination
![Page 23: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/23.jpg)
Revised Instructional Design Template: Part 1
Descriptive Information• Assumptions about learners• Description of skill
- Cognitive task analysis - Procedural task analysis
• Potential errors and complications - Prevention, anticipation, &management strategies
![Page 24: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/24.jpg)
Revised Instructional Design Template: Part 2
Instructional Plan
• Objectives and Teaching plan
– Time, resources, sequence, etc
• Homework/assignments
• Guidelines for facilitator/learners
• Practice guidelines
– Frequency, intensity, duration
![Page 25: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/25.jpg)
Practice, Practice, Practice
Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance. Acad Med, 2004.
![Page 26: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/26.jpg)
Revised Instructional Design Template: Part 3
Feedback and Evaluation
• Practice performance standards – Time, conditions, etc.
• How feedback will be given
• Pre-test description
• Post-test description
• Outcome evaluation criteria
![Page 27: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/27.jpg)
Thank You!
Foundation of the Association for Surgical Education (CESERT)
SIU: Janet Ketchum
Rush: Daniel Deziel, MD
Northwestern: John Coyle,MD, Tom Powers & Deb Rooney
![Page 28: Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith](https://reader031.vdocuments.us/reader031/viewer/2022032104/56649ca65503460f94967bbe/html5/thumbnails/28.jpg)