Kenneth Wong1, Fiona Stewart. 1. Department of Anatomy and Histology, University of Sydney, Sydney, New South Wales, Australia. kennethwo@yahoo.com
Abstract
BACKGROUND: Increasing constraints on operative training in the clinical setting provide impetus for the development of alternative training models. Anatomy dissection courses utilizing human cadavers have been useful in imparting knowledge of human anatomy for surgical trainees. The present study evaluates the impact of competency-based technical skills instruction as an adjunct to cadaveric dissection courses on the procedural skills of basic surgical trainees (BST). METHODS: A single cohort of BST was prospectively evaluated regarding their self-reported confidence and competency in performing saphenous vein cutdowns immediately before and after an anatomy dissection course. RESULTS: Nine BST were evaluated (66% were male). One subject withdrew from the study, leaving eight BST for final analysis. Mean number of years since graduation from medical school was 2.5 years (range: 2-4 years). Seven BST were in their first year of training. All subjects had completed an early management of severe trauma (EMST) course. Total prior experience of saphenous vein cutdowns for all subjects was a single attempt on a sheep cadaver at the EMST course. The percentage of BST expressing little or no confidence in performing cutdowns decreased after the dissection course (50% vs 0, P < 0.05). Mean time taken for completion of cutdown decreased after the dissection course. (5 min 52 s vs 3 min 52 s, P < 0.05). Mean size of incision used to perform cutdown decreased after the course. (4.5 cm vs 3.4 cm, P < 0.05). The percentage of subjects experiencing complications during cutdown decreased after the course (38% vs 0, P < 0.05). CONCLUSIONS: Anatomy dissection courses using human cadavers may contribute to improving the confidence and competency of BST in performing saphenous vein cutdowns. Technical training components should be considered as an adjunct to future anatomy dissection courses involving surgical trainees.
BACKGROUND: Increasing constraints on operative training in the clinical setting provide impetus for the development of alternative training models. Anatomy dissection courses utilizing human cadavers have been useful in imparting knowledge of human anatomy for surgical trainees. The present study evaluates the impact of competency-based technical skills instruction as an adjunct to cadaveric dissection courses on the procedural skills of basic surgical trainees (BST). METHODS: A single cohort of BST was prospectively evaluated regarding their self-reported confidence and competency in performing saphenous vein cutdowns immediately before and after an anatomy dissection course. RESULTS: Nine BST were evaluated (66% were male). One subject withdrew from the study, leaving eight BST for final analysis. Mean number of years since graduation from medical school was 2.5 years (range: 2-4 years). Seven BST were in their first year of training. All subjects had completed an early management of severe trauma (EMST) course. Total prior experience of saphenous vein cutdowns for all subjects was a single attempt on a sheep cadaver at the EMST course. The percentage of BST expressing little or no confidence in performing cutdowns decreased after the dissection course (50% vs 0, P < 0.05). Mean time taken for completion of cutdown decreased after the dissection course. (5 min 52 s vs 3 min 52 s, P < 0.05). Mean size of incision used to perform cutdown decreased after the course. (4.5 cm vs 3.4 cm, P < 0.05). The percentage of subjects experiencing complications during cutdown decreased after the course (38% vs 0, P < 0.05). CONCLUSIONS: Anatomy dissection courses using human cadavers may contribute to improving the confidence and competency of BST in performing saphenous vein cutdowns. Technical training components should be considered as an adjunct to future anatomy dissection courses involving surgical trainees.
Authors: Sarah D Blaschko; H Mark Brooks; S Michael Dhuy; Cynthia Charest-Shell; Ralph V Clayman; Elspeth M McDougall Journal: JSLS Date: 2007 Oct-Dec Impact factor: 2.172