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Barriers and facilitators to deliberate practice using take-home laparoscopic simulators.

Vivienne I Blackhall1,2,3,4, Jennifer Cleland5,6, Philip Wilson6

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Summary

Poor engagement with surgical simulation training is linked to competing commitments and a focus on career points over skill development. Improving feedback and trainer support are key to enhancing participation in home-based programs.

Keywords:
Deliberate practiceLaparoscopySimulationSurgical training

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Area of Science:

  • Medical Education
  • Surgical Training
  • Simulation-Based Learning

Background:

  • Home-based laparoscopic simulation programs in the UK and Ireland aim to improve surgical trainees' skills through deliberate practice.
  • Engagement with these simulation programs has been notably low, necessitating an investigation into underlying barriers.

Purpose of the Study:

  • To identify barriers hindering engagement with home-based laparoscopic simulation programs.
  • To inform the development of an improved and more effective simulation program for surgical trainees.

Main Methods:

  • A qualitative study design was employed, utilizing focus groups with key stakeholders.
  • Participants included junior surgical trainees, consultants/attendings, and simulation faculty across four regions in three countries.
  • Thematic analysis of audio-recorded and transcribed data was conducted using NVivo software.

Main Results:

  • Trainees reported competing commitments as a significant barrier, prioritizing career progression metrics over skill development.
  • A perceived lack of consultant interest and confidence in providing training, coupled with dissatisfaction with metric feedback, were identified.
  • Some consultants were unaware of the simulation programs or lacked confidence in their ability to deliver effective training.

Conclusions:

  • Implementing scheduled simulation sessions with consultant feedback could enhance trainee engagement.
  • Addressing the 'point-scoring' culture requires modified assessment structures and greater accountability for trainers.
  • Increased recognition and funding for simulation strategies, including in-house skills sessions, are recommended to improve program effectiveness.