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

To improve early-career doctor preparedness for recognizing factors influencing decision-making in surgical patients, using novel simulation.

A modified video-based simulation technique (Shadowbox) was used to develop decision-making skills. Case vignettes reflecting real-life scenarios were developed, with additional complexities (e.g., anticoagulation therapy) included. After working through cases and formulating a management plan, participants were shown videos of how senior surgical residents responded, unscripted, to each scenario. The facilitated debrief allowed for participant reflection on the differences between management plans and exploration of how the surgical resident weighted decision-making factors. Participants mean pre- and post self-reported preparedness to identify factors influencing decision-making in surgical patients were compared using a 7-point Likert scale, and free-text comments were used to provide further insights.

Three hospitals delivering acute surgical services, within a single Scottish health board.

Postgraduate year 2 doctors not in a formal surgical training program.

Over 3 sessions, 57 participants attended. The majority felt the simulation helped develop decision-making skills (n = 43, 75.4 % rating 6 or 7) and that the cases were "engaging." Identification of patient (4.9 vs. 5.6, p < 0.01), surgical (3.9 vs. 5.3, p < 0.01), radiological (3.4 vs. 4.8, p < 0.01), and social factors (5.1 vs. 5.8, p = 0.02) influencing decision-making all improved. Recognition of when to consider a change from conservative to operative management also improved (4.2 vs. 5.5, p = 0.01).

A modified Shadowbox technique is an effective and scalable method of enhancing surgical decision-making training. Through adapting cases, a similar approach could be used for higher surgical residents, across a range of surgical specialties.