R. D. Ray1, P. B. Barlow1, A. D. D’Angelo1, C. M. Pugh1 1University Of Wisconsin,Department Of Surgery, School Of Medicine And Public Health,Madison, WI, USA
Introduction: Surgery residents may take years away from clinical responsibilities for dedicated research time. Evaluating the potential reduction in surgical skill and knowledge is critical to ensuring competent, independent performance at the end of training. As part of a longitudinal project, the study aim was to investigate residents’ perceptions of clinical skill reduction during dedicated research time. Our hypothesis was that residents would perceive a greater potential reduction in skill during research time for procedures they were less confident in performing prior to entering the lab.
Methods: Surgical residents (PGY 2-3) from Midwestern training programs participated in four simulated clinical procedures (Laparoscopic ventral hernia (LVH) repair, Bowel anastomosis, Subclavian central line insertion, and Urinary catheterization). Prior to performing the simulated procedures, participants rated procedures in terms of difficulty (1=Not difficult to 5=Extremely difficult) and confidence (1=Not confident to 5=Extremely confident). They also rated what reduction, if any, they believed their time in the lab would have on their ability to perform the four procedures (1=No reduction to 5=Very large reduction). Analysis of variance tested differences in ratings among surgical tasks, and Pearson correlations calculated the relationship between months spent in the lab, confidence in performing the procedures, and estimated skill reduction.
Results:Twenty-five residents (60% female) completed the four clinical simulators. Residents had completed between 0-36 months in a lab (M=9.5 months, SD=10.3). Table 1 shows the pairwise comparisons of participants’ average perceived difficulty, confidence, and skills reduction. As the number of months in the lab increased, Confidence ratings for the bowel anastomosis and urinary catheterization decreased (p<0.05). Also, aside from LVH (r=.010), residents' perceived skill reduction was significantly, negatively related to their confidence on the surgical tasks for Bowel anastomosis (r=-.489, p<.005); Central line (r=-.688, p<.001); and Urinary catheter (r=-.531, p<.005).
Conclusion:Residents who were less confident in performing the bowel anastomosis, subclavian central line insertion and urinary catheterization perceived a greater skills reduction during research time. This relationship was not true for the LVH repair, which may result from participants’ not considering themselves to have sufficient baseline skill to accurately predict any future reduction. Future work is required to understand how resident’s perception of skills decay relates to actual changes in performance during dedicated research time and confidence when re-entering clinical practice.
