Video education, simulation improve surgical training among dermatology residents

Among dermatology residents, researchers saw an increase in the Objective Structured Assessment of Technical Skills instrument after implementing a video-based surgical curriculum, and residents self-reported enjoying the video-based and simulation method.

“Importantly, the residents found the hands-on sessions helpful in preparing them for live surgical procedures and found simulation to be a helpful adjunct to the existing apprenticeship model,” Kristina J. Liu, MD, MHS, of the department of dermatology at Brigham and Women’s Hospital in Boston, and colleagues wrote.

Traditional in-person lectures were replaced with at-home viewing of instructional videos followed by three hands-on sessions using simulated skin models among 31 first- and second-year dermatology residents at three institutions in the northeastern U.S. The 13 videos were posted to a private YouTube channel.

Before and after the new curriculum, the Objective Structured Assessment of Technical Skills (OSATS) instrument was used to assess a simulated elliptical excision with intermediate repair. Residents also completed pre- and post-curriculum surveys.

In the simulation model, residents worked at separate stations while being observed by eight fellowship-trained dermatologic surgeons. Residents wore GoPro cameras mounted on their heads during the surgical exercise. The videos were de-identified and randomized before assigned to graders using the OSATS tool.

The educational objectives covered included aseptic technique, knowledge of instruments, suturing, knot tying, cyst excision, elliptical excision and intermediate repair, according to researchers.

The total median OSATS score increased from 27 at baseline (P < .001; interquartile range [IQR], 22-38.5) to 46 after the curriculum (P < .001; IQR, 39.5-51.5).

The median global rating scale (GRS) also increased from a baseline score of 14 (P < .001; IQR, 9.5-19) to 26 after the curriculum (P < .001; IQR, 20-30).

Moreover, inter-rater reliability was very high for all metrics: OSATS alpha = 0.96, GRS alpha = 0.96 and checklist alpha = 0.93.

Across all three teaching sites, the improvements in all metrics did not vary significantly. Researchers found an increase in total OSATS, GRS and checklist score for both first- and second-year residents.

According to the post-curricular surveys completed by the residents, improvements were reported in confidence in aseptic technique, knowledge of instruments and sutures, cyst excision, elliptical excision and intermediate repair.

Among all 31 residents who completed the training curriculum, 97% thought that simulation added to surgical teaching received in clinics and 83% of second-year residents believed that simulation training would have been helpful if taught earlier in residency.

“As simulation becomes more mainstream and potentially mandatory (as it already is in other surgical specialties), dermatology programs should embrace the use of these evidence-based training programs and objective evaluations,” Liu and colleagues wrote. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.