Proficient before practice: Graduate simulation-based surgical skills training increases confidence in technical skills

Introduction

Surgical graduate training to achieve practice-ready students is needed, yet is often lacking. This study evaluates a proficiency-based, simulation-based course for basic surgical skills at graduate level. This study aims to show the effect of a preclinical curriculum to teach 21st century Surgical Skills (Halfwerk et al., 2020), and evaluate this curriculum with a pre-post-course questionnaire on confidence.

MethodsGraduate Technical Medicine students from academic year 2020-2021 entered a mandatory 10-week, 3 European Credit Transfer and Accumulation System (ECTS) graduate surgical skills course. Learning outcomes are measured at the level of knowledge and skills and are evaluated with a pre-post-course questionnaire on confidence based on the Task Confidence Measure (Bevilacqua et al., 2020). The New General Self-Efficacy Scale (NGSE) is used as control, where no improvements in self-efficacy are expected. A Wilcoxon signed-rank test with Holm-Bonferroni correction is used to assess differences between time points.

Results & DiscussionIn total 107 students enrolled the surgical skills course. 84 students completed the pre-course survey (79%), and 61 students (57%) completed the post-course survey. The control questionnaire (NGSE) on self-efficacy did now show higher self-efficacy scores in 7 questions (p > 0.05). However, students stated after the course more often that “compared to other people, they can do most tasks very well” (p < 0.01).

Students felt more confident in all technical surgical skills after the surgical skills course (p < 0.001), as well as obtaining informed consent (p < 0.001), see attached Figure. Confidence in interpreting medical imaging did not improve with the course (p > 0.05).

Often limited time is scheduled for preclinical surgical skills training, which results in limited skills development and only a small increase in confidence. This study shows that it is feasible to have a major increase in confidence in technical surgical skills with a graduate curriculum. We recommend that proficiency-based training using simulation should be standard in surgical curricula before students are allowed to practice on patients.