The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures

Abstract

Objective: To evaluate the impact of bench model fidelity on the acquisition of technical skill using clinically relevant outcome measures.

Methods: Fifty junior surgery residents participated in a 1-day microsurgical training course. Participants were randomized to 1 of 3 groups: 1) high-fidelity model training (live rat vas deferens; n = 21); 2) low-fidelity model training (silicone tubing; n = 19); or 3) didactic training alone (n = 10). Following training, all participants were assessed on the high- and low-fidelity bench models. Immediate outcome measures included procedure times, blinded, expert assessment of videotaped performance using checklists and global rating scales, anastomotic patency, suture placement precision, and final product ratings. Delayed outcome measures (obtained from the live rat vas deferens 30 days following training) included anastomotic patency, presence of a sperm granuloma, and the presence of sperm on microscopy.

Results: Following training, checklist (P < 0.001) and global rating scores (P < 0.001) on the bench model simulators were higher among subjects who received hands-on training, irrespective of model fidelity. Immediate anastomotic patency rates of the rat vas deferens were higher with increasing model fidelity training (P = 0.048). Delayed anastomotic patency rates were higher among subjects who received bench model training, irrespective of model fidelity (P = 0.02). Rates of sperm presence on microscopy were higher among subjects who received high-fidelity model training compared with subjects who received didactic training (P = 0.039) but did not differ among subjects in the high- and low-fidelity groups.

Conclusions: Surgical skills training on low-fidelity bench models appears to be as effective as high-fidelity model training for the acquisition of technical skill among novice surgeons.

Figures

FIGURE 1. A: High-fidelity training model: live, anesthetized rat vas deferens. B: Low-fidelity training model: silicone tubing.

FIGURE 2. Anastomotic patency testing of the rat vas deferens (high-fidelity model) was determined by the injection of indigo carmine dye past the anastomotic site and out the opposite end of the anastomosis.

FIGURE 3. Improvements in microsurgical drill global ratings of performance were significantly greater among subjects who received hands-on bench model training versus subjects who received didactic training alone.

FIGURE 4. Post-test checklist and global rating scores on the low-fidelity model were significantly greater among subjects who received hands-on bench model training versus subjects who received didactic training alone.

FIGURE 5. Post-test checklist and global rating scores on the high-fidelity model were significantly greater among subjects who received hands-on bench model training versus subjects who received didactic training alone.

FIGURE 6. Open bars: Immediate patency rates of the rat vas deferens were higher with increasing bench model fidelity training. Solid bars: Delayed patency rates were higher among subjects who received hands-on bench model training, irrespective of model fidelity.