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Mastery Learning of Surgical Skills

  • Ezra N. TeitelbaumEmail author
  • Katherine A. Barsness
  • Eric S. Hungness
Chapter
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Part of the Comprehensive Healthcare Simulation book series (CHS)

Abstract

Simulation-based mastery learning (SBML) is a powerful tool for teaching both technical and cognitive skills. In medical education, SBML has been used effectively to teach a number of procedural skills. Simulator-based practice can act synergistically with traditional clinical education to produce trainees who are better prepared to perform procedures and care for patients safely and effectively. Using SBML to teach surgical skills is a natural extension of traditional educational models. However, several complexities basic to learning surgical operations make using the SBML model a difficult proposition. Operations have multiple steps, each requiring a deep understanding of anatomy, technical maneuvers, surgical instruments, and potential complications. In addition to technical skills, the surgeon must be competent in the preoperative evaluation and preparation of the patient and have a good grasp of intraoperative decision-making. Incorporating all of the necessary knowledge and skills into a surgical SBML curriculum poses a challenge. This chapter describes the methods used to apply SBML principles to several curricula developed to teach surgical skills and entire operations. The educational and clinical impact of these curricula and potential applications of SBML in future surgical education are discussed.

Keywords

Mastery learning Surgical education Simulation-based training Resident education Competency-based training Surgical skills training Procedural learning 

References

  1. 1.
    Osborne MP. William Stewart Halsted: his life and contributions to surgery. Lancet Oncol. 2007;8(3):256–65.CrossRefGoogle Scholar
  2. 2.
    Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME, et al. National cluster-randomized trial of duty-hour flexibility in surgical training. N Engl J Med. 2016;374(8):713–27.CrossRefGoogle Scholar
  3. 3.
    Bell RH Jr, Biester TW, Tabuenca A, Rhodes RS, Cofer JB, Britt LD, et al. Operative experience of residents in US general surgery programs: a gap between expectation and experience. Ann Surg. 2009;249(5):719–24.CrossRefGoogle Scholar
  4. 4.
    Malagoni MA, Biester TW, Jones AT, Klingensmith ME, Lewis FR Jr. Operative experience of surgery residents: trends and challenges. J Surg Educ. 2013;70(6):783–8.CrossRefGoogle Scholar
  5. 5.
    Mattar SG, Alseidi AA, Jones DB, Jeyarajah DR, Swanstrom LL, Aye RW, et al. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258(3):440–9.CrossRefGoogle Scholar
  6. 6.
    Klingensmith ME, Cogbill TH, Luchette F, Biester T, Samonte K, Jones A, et al. Factors influencing the decision of surgery residency graduates to pursue general surgery practice versus fellowship. Ann Surg. 2015;262(3):449–55.CrossRefGoogle Scholar
  7. 7.
    Coleman JJ, Esposito TJ, Rozycki GS, Feliciano DV. Early subspecialization and perceived competence in surgical training: are residents ready? J Am Coll Surg. 2013;216(4):764–73.CrossRefGoogle Scholar
  8. 8.
    Napolitano LM, Savarise M, Paramo JC, Soot LC, Todd SR, Gregory J, et al. Are general surgery residents ready to practice? A survey of the American College of Surgeons Board of Governors and Young Fellows Association. J Am Coll Surg. 2014;218(5):1063–72.CrossRefGoogle Scholar
  9. 9.
    Schwab B, Hungness E, Barsness KA, McGaghie WC. The role of simulation in surgical education. J Laparoendosc Adv Surg Tech A. 2017;27(5):450–4.CrossRefGoogle Scholar
  10. 10.
    Peters JH, Fried GM, Swanstrom LL, Soper NJ, Sillin LF, Schirmer B, et al. Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery. 2004;135(1):21–7.CrossRefGoogle Scholar
  11. 11.
    Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;180(1):101–25.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Fraser SA, Klassen DR, Feldman LS, Ghitulescu GA, Stanbridge D, Fried GM. Evaluating laparoscopic skills: setting the pass/fail score for the MISTELS system. Surg Endosc. 2003;17(6):964–7.CrossRefGoogle Scholar
  13. 13.
    McCluney AL, Vassiliou MC, Kaneva PA, Cao J, Stanbridge DD, Feldman LS, et al. FLS simulator performance predicts intraoperative laparoscopic skill. Surg Endosc. 2007;21(11):1991–5.CrossRefGoogle Scholar
  14. 14.
    Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM. Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room – a randomized controlled trial. Am J Surg. 2010;199(1):115–20.CrossRefGoogle Scholar
  15. 15.
    Poulose BK, Vassiliou MC, Dunkin BJ, Mellinger JD, Fanelli RD, Martinez JM, et al. Fundamentals of endoscopic surgery cognitive examination: development and validity evidence. Surg Endosc. 2014;28(2):631–8.CrossRefGoogle Scholar
  16. 16.
    Vassiliou MC, Dunkin BJ, Fried GM, Mellinger JD, Trus T, Kaneva P, et al. Fundamentals of endoscopic surgery: creation and validation of the hands-on test. Surg Endosc. 2014;28(3):704–11.CrossRefGoogle Scholar
  17. 17.
    Gardner AK, Scott DJ, Willis RE, Van Sickle K, Truitt MS, Uecker J, et al. Is current surgery resident and GI fellow training adequate to pass FES? Surg Endosc. 2017;31(1):352–8.CrossRefGoogle Scholar
  18. 18.
    Ritter EM, Taylor ZA, Wolf KR, Franklin BR, Placek SB, Korndorffer JR Jr, et al. Simulation-based mastery learning for endoscopy using the endoscopy training system: a strategy to improve endoscopic skills and prepare for the fundamentals of endoscopic surgery (FES) manual exam. Surg Endosc. 2018;32(1):413–20.CrossRefGoogle Scholar
  19. 19.
    Ritter EM, Cox TC, Trinca KD, Pearl JP. Simulated colonoscopy objective performance evaluation (SCOPE): a non-computer-based tool for assessment of endoscopic skills. Surg Endosc. 2013;27(11):4073–80.CrossRefGoogle Scholar
  20. 20.
    Trinca KD, Cox TC, Pearl JP, Ritter EM. Validity evidence for the simulated colonoscopy objective performance evaluation scoring system. Am J Surg. 2014;207(2):218–25.CrossRefGoogle Scholar
  21. 21.
    Thomas PA, Kern DE, Hughes MT, Chen BY. Curriculum development for medical education: a six-step approach. 3rd ed. Baltimore: Johns Hopkins University Press; 2016.Google Scholar
  22. 22.
    Cushieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, et al. E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc. 1999;13(10):952–7.CrossRefGoogle Scholar
  23. 23.
    Noble H, Tranter S, Chesworth T, Norton S, Thompson M. A randomized, clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech A. 2009;19(6):713–20.CrossRefGoogle Scholar
  24. 24.
    Wandling MW, Hungness ES, Pavey ES, Stulberg JJ, Schwab B, Yang AD, et al. Nationwide assessment of trends in choledocholithiasis management in the United States from 1998 to 2013. JAMA Surg. 2016;151(12):1125–30.CrossRefGoogle Scholar
  25. 25.
    Helling TS, Khandelwal A. The challenges of resident training in complex hepatic, pancreatic, and biliary procedures. J Gastro Surg. 2008;12(1):153–8.CrossRefGoogle Scholar
  26. 26.
    Santos BF, Beif TJ, Soper NJ, Nagle AP, Rooney DM, Hungness ES. Development and evaluation of a laparoscopic common bile duct exploration simulator and procedural rating scale. Surg Endosc. 2012;26(9):2403–15.CrossRefGoogle Scholar
  27. 27.
    Teitelbaum EN, Soper NJ, Santos BF, Rooney DM, Patel P, Nagle AP, et al. A simulator-based resident curriculum for laparoscopic common bile duct exploration. Surgery. 2014;156(4):880–7, 90–3.CrossRefGoogle Scholar
  28. 28.
    McGaghie WC. Medical education research as translational science. Sci Transl Med. 2010;2:19cm8.CrossRefGoogle Scholar
  29. 29.
    Schwab B, Teitelbaum EN, Barsuk JH, Soper NJ, Hungness ES. Single-stage laparoscopic management of choledocholithiasis: an analysis after implementation of a mastery learning resident curriculum. Surgery. 2018;163(3):503–8.CrossRefGoogle Scholar
  30. 30.
    Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350(18):1819–27.CrossRefGoogle Scholar
  31. 31.
    Zendejas B, Cook DA, Bingener J, Huebner M, Dunn WF, Sarr MG, et al. Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial. Ann Surg. 2011;254(3):502–11.CrossRefGoogle Scholar
  32. 32.
    Gause CD, Hsiung G, Schwab B, Clifton M, Harmon CM, Barsness KA. Advances in pediatric surgical education: a critical appraisal of two consecutive minimally invasive pediatric surgery training courses. J Laparoendosc Adv Surg Tech A. 2016;26(8):663–70.CrossRefGoogle Scholar
  33. 33.
    Schwab B, Rooney DM, Hungness ES, Barsness KA. Preliminary evaluation of a laparoscopic common bile duct simulator for pediatric surgical education. J Laparoendosc Adv Surg Tech A. 2016;26(10):831–5.CrossRefGoogle Scholar
  34. 34.
    Vassiliou, et al. FLS and FES: comprehensive models of training and assessment. Surg Clin North Am. 2010;90(3):535–48.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ezra N. Teitelbaum
    • 1
    Email author
  • Katherine A. Barsness
    • 2
  • Eric S. Hungness
    • 2
  1. 1.Northwestern University Feinberg School of Medicine, Department of SurgeryChicagoUSA
  2. 2.Northwestern University Feinberg School of Medicine, Departments of Surgery and Medical EducationChicagoUSA

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