Use of a Modified Shadowbox Technique to Deliver Training in Surgical Decision-Making

Area of Science:

• Medical Education
• Surgical Training
• Simulation-Based Learning

Background:

• Early-career doctors require enhanced preparedness in recognizing complex factors influencing surgical patient decision-making.
• Traditional training methods may not adequately address the multifaceted nature of clinical decision-making in surgery.

Purpose of the Study:

• To evaluate the effectiveness of a novel, modified video-based simulation technique (Shadowbox) in improving surgical decision-making skills among early-career doctors.
• To assess the impact of the simulation on participants' ability to identify and weigh various factors influencing clinical decisions.

Main Methods:

• A modified Shadowbox simulation technique was employed, utilizing realistic case vignettes with added complexities.
• Participants worked through scenarios, formulated management plans, and reviewed unscripted responses from senior surgical residents.
• Facilitated debriefing sessions encouraged reflection on decision-making processes and factor weighting; pre- and post-simulation preparedness was measured using a Likert scale.

Main Results:

• The simulation was well-received, with 75.4% of participants finding it helpful in developing decision-making skills.
• Significant improvements were observed in the identification of patient, surgical, radiological, and social factors influencing decision-making (p < 0.01 for most).
• Recognition of when to transition from conservative to operative management also significantly improved (p = 0.01).

Conclusions:

• The modified Shadowbox technique offers an effective and scalable approach to enhance surgical decision-making training for early-career doctors.
• This simulation method holds potential for adaptation to train higher surgical residents across diverse specialties.