François Ducournau1, Nicolas Meyer2, Fred Xavier3, Sybille Facca4, Philippe Liverneaux5. 1. Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France. 2. Service de santé publique, GMRC, Strasbourg University Hospital, 67091 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France. 3. Department of Paediatric Orthopaedics, Armand-Trousseau Hospital, 26, avenue du Dr-Arnold-Netter, 75571 Paris cedex 12, France. 4. Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France. 5. Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France. Electronic address: philippe.liverneaux@chru-strasbourg.fr.
Abstract
BACKGROUND: Performance skills of a surgeon for a specific surgical technique range from 1 (novice) to 5 (expert). Mentoring can bring the surgeon to level 3. Simple experience rarely allows achievement of level 5, in contrast to deliberate practice, in which performance skills are improved by setting learning goals based on feedback about the trainee's previous performance. HYPOTHESIS: When learning a technique for the internal fixation of distal radius fractures, the level of performance skills achieved is higher with deliberate practice than with mentoring or simple experience. MATERIAL AND METHODS: Four surgeons each performed minimally invasive plate osteosynthesis (MIPO) of 15 distal radius fractures. The procedures were recorded by an HD camera. The first five fractures (step 1) were treated after mentoring, the next 5 fractures after reading an article and viewing a reference video (step 2), and the last 5 fractures after viewing and commenting 20 short videos highlighting possible errors (step 3). Each recording of the procedures performed by the surgeons was scored using the Objective Structured Assessment of Technical Skills (OSATS, 10 items on basic skills [B] and 10 on MIPO-specific skills [S]). RESULTS: For the basic skills, the mean OSATS scores (on 50) were 31 for step 1, 31 for step 2, and 43 for step 3. For the specific skills, the mean OSATS scores (on 50) were 25 for step 1, 29 for step 2, and 48 for step 3. For overall skills (B+S), the mean OSATS score (on 100) was 56 for step 1, 60 for step 2, and 91 for step 3. DISCUSSION: Our study confirms that the deliberate practice teaching method is more efficient in improving surgeon skills than simple experience. Deliberate practice consists of four essential steps: (i) setting a well-defined goal; (ii) being motivated to improve one's performance; (iii) receiving immediate feedback; and (iv) having multiple opportunities to repeat and gradually perfect one's performance. Our main hypothesis was verified, since the results of learning a MIPO technique, as assessed using the OSATS scale, were significantly better with a video-assisted deliberate practice technique than with mentoring or simple experience. CONCLUSION: Video-assisted deliberate practice deserves to be widely used in order to optimise learning curves and to improve risk management in surgery. LEVEL OF EVIDENCE: III.
BACKGROUND: Performance skills of a surgeon for a specific surgical technique range from 1 (novice) to 5 (expert). Mentoring can bring the surgeon to level 3. Simple experience rarely allows achievement of level 5, in contrast to deliberate practice, in which performance skills are improved by setting learning goals based on feedback about the trainee's previous performance. HYPOTHESIS: When learning a technique for the internal fixation of distal radius fractures, the level of performance skills achieved is higher with deliberate practice than with mentoring or simple experience. MATERIAL AND METHODS: Four surgeons each performed minimally invasive plate osteosynthesis (MIPO) of 15 distal radius fractures. The procedures were recorded by an HD camera. The first five fractures (step 1) were treated after mentoring, the next 5 fractures after reading an article and viewing a reference video (step 2), and the last 5 fractures after viewing and commenting 20 short videos highlighting possible errors (step 3). Each recording of the procedures performed by the surgeons was scored using the Objective Structured Assessment of Technical Skills (OSATS, 10 items on basic skills [B] and 10 on MIPO-specific skills [S]). RESULTS: For the basic skills, the mean OSATS scores (on 50) were 31 for step 1, 31 for step 2, and 43 for step 3. For the specific skills, the mean OSATS scores (on 50) were 25 for step 1, 29 for step 2, and 48 for step 3. For overall skills (B+S), the mean OSATS score (on 100) was 56 for step 1, 60 for step 2, and 91 for step 3. DISCUSSION: Our study confirms that the deliberate practice teaching method is more efficient in improving surgeon skills than simple experience. Deliberate practice consists of four essential steps: (i) setting a well-defined goal; (ii) being motivated to improve one's performance; (iii) receiving immediate feedback; and (iv) having multiple opportunities to repeat and gradually perfect one's performance. Our main hypothesis was verified, since the results of learning a MIPO technique, as assessed using the OSATS scale, were significantly better with a video-assisted deliberate practice technique than with mentoring or simple experience. CONCLUSION: Video-assisted deliberate practice deserves to be widely used in order to optimise learning curves and to improve risk management in surgery. LEVEL OF EVIDENCE: III.
Authors: François Ducournau; Laela El Amiri; Paul Vernet; Marie-Cécile Sapa; Philippe Liverneaux Journal: Int Orthop Date: 2022-10-20 Impact factor: 3.479