Enhancing surgical training by audio-visual simulation with hazard cognitive training and reflection tools: a design-based study in laparoscopic cholecystectomy

Abstract

Abstract

Background
Surgical training has become more challenging in the UK with the reduction in training time and the reduced training opportunities, making every training opportunity precious. This study aims to address this curriculum challenge by enhancing surgical training and assessment in the surgical training environment.

Methodology
Using a design-based approach a two-step design was created. Step One involved creating an online, standalone, Cognitive Hazard Training module. It uses videos of real operations to mentally train candidates to recognise, anticipate and avoid hazards during the operation. An online example of this Module was created for laparoscopic cholecystectomy.

The second design step was a Reflective Formative Assessment. The trainee and supervisor reviewed the trainee’s video-recording of a supervised-operation which involved reassessing the trainee’s performance to enhance feedback and reflection.

Design feasibility was tested in the Northern Deanery training environment and the feasibility study was complemented by a theatre observation study to capture the details of the complex surgical training environment.
Results
The feasibility of this two-step design was tested with 2 experts, 32 trainees and 15 trainers. Trainee and trainer qualitative feedback was collected, via semi-structured interviews. Users’ feedback along with multiple additional data from the operation-recordings and video-review session were analysed and triangulated to improve the design and establish the feasibility and role of this style of video-review in the current surgical training. Observational data was also collected during live surgery in theatre to identify any factors affecting safety and training.

Discussion
This study has developed a novel approach to enhance surgical training, which has been tested and has received overwhelming support from both supervisors and their trainees. Cognitive Hazards Training steepened the learning curve and increased adherence to safety. The videoed operations were found to be an excellent teaching tool, which enhanced feedback and reflection. It increased trainees’ confidence and competence by tailoring the training to their individual needs. The success of this work forms the foundation for future development and testing of this new approach to surgical skills training in the UK.