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Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith.

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Presentation on theme: "Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith."— Presentation transcript:

1 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

2 Purpose Develop 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

3 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?

4 Team Leaders Curriculum Team David Rogers* Linnea Hauge Ken Murayama Deb DaRosa Evaluation Team Reed Williams* Keith Millikan Alex Nagle Gary Dunnington Deb DaRosa

5 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:

6 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.

7 Experimental Design T group RO 1 X O 2 C group RO 3 O 4 InstitutionTC Total A B C Total

8 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

9 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

10 Written Exam Items Which trocar placement is optimal for a laparoscopic cholecystectomy?

11 Example: Written Test Which retraction of the gallbladder provides optimal exposure of the cystic duct?

12 Example: Written Exam List up to three methods for determining whether the veress needle has penetrated into the abdominal cavity.

13 Curriculum: Session 2 Homework: 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

14 Curriculum: Session 3 Recall exercise w/ CD-ROM Review/Discussion Porcine Practice –Think aloud rehearsal –Peer feedback using Porcine checklist

15 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

16 Measures and Analysis Measurement 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

17 Results: Reliability of Measures MeasureKnowledgeSkillErrors Pretest.75 Post test.64 LC Porcine LC OR Eval

18 Results: LC Porcine Items T M (sd) C M (sd) t p Knowledge36(5.8)36(6.9)-.10ns Technical68(21.5)56(26.7)-1.6ns Errors47(52.9)41(48.6)-.33ns

19 Results – OR Evaluation Items T M (sd) C M (sd) t p knowledge34(3.1)32(4.5)-1.31ns Technical25(2.7)23(2.9)-0.10ns Errors4.0(3.7)4.2(3.3)0.12ns

20 Written Pre and Post-test Measure T M (sd) C M (sd) tp Pretest48(11.1)51(9.2)1.16ns Post-test61(6.2)55(8.0) * Pre/Post Difference 11 (0.6)4(10.3) *

21 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

22 Conclusions Instructional Design Template Effective in: CTA methodology – blueprint for cohesive curriculum and reliable exams Enhancing intra-operative judgment as assessed on written examination

23 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

24 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

25 Practice, Practice, Practice Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance. Acad Med, 2004.

26 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

27 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

28


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