Take-home laparoscopic simulators to develop surgical skills: Analysing attitudes to, and barriers and enablers of, their use in gynaecology training
DOI:
https://doi.org/10.11157/fohpe.v20i3.352Keywords:
curriculum, education, medical, gynaecology, laparoscopy, simulation training, Theoretical Domains FrameworkAbstract
Introduction: Providing specialty trainees with take-home laparoscopic simulators may overcome known barriers to simulation-based surgical training such as limited time and access to equipment; however, programs utilising these simulators have reported suboptimal engagement from trainees. The purpose of this study was to understand factors influencing the use of take-home laparoscopic simulators and make suggestions to optimise engagement in future programs.
Methods: We interviewed 10 of the 16 gynaecology trainees who participated in a take-home laparoscopic box trainer simulation program. Interview transcripts were analysed and themes sorted using the Theoretical Domains Framework. Articulation of these domains with the Behaviour Change Wheel directed the formulation of targeted interventions.
Results: Trainees had positive attitudes towards simulation training; however, they experienced numerous under-recognised barriers to training. Trainees found their professional role, duties and competing life priorities limited time for training. Trainees experienced feelings of inertia and did not train as much as they anticipated. They were disengaged from training by a lack of real operating, a perceived poor relationship between training tasks and surgery and difficulties with equipment set-up. Self-directed practice, goal setting, task deadlines, perceived supervision, a recognition of personal skill development and an understanding of the need for simulation enabled training. Interventions were proposed to address the barriers to training.
Conclusions: Trainee attitudes towards simulation and take-home trainers were positive, yet numerous barriers prevented them from training. Following a theory-driven process, we were able to devise targeted, evidence-based interventions, which may be incorporated into future versions of the program.
References
Aggarwal, R., & Darzi, A. (2011). Simulation to enhance patient safety: Why aren't we there yet? Chest, 140(4), 854–858. doi:10.1378/chest.11-0728
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. doi:10.1016/0749-5978(91)90020-t
Ajzen, I., & Madden, T. J. (1986). Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control. Journal of Experimental Social Psychology, 22(5), 453–474. doi:10.1016/0022-1031(86)90045-4
Albarracín, D., Gillette, J. C., Earl, A. N., Glasman, L. R., Durantini, M. R., & Ho, M.-H. (2005). A test of major assumptions about behavior change: A comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic. Psychological Bulletin, 131(6), 856–897. doi:10.1037/0033-2909.131.6.856
Arden, D., Hacker, M. R., Jones, D. B., & Awtrey, C. S. (2008). Description and validation of the Pelv-Sim: A training model designed to improve gynecologic minimally invasive suturing skills. Journal of Minimally Invasive Gynecology, 15(6), 707–711. doi:10.1016/j.jmig.2008.08.004
Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., . . . Michie, S. (2017). A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation Science, 12(1), 77. doi:10.1186/s13012-017-0605-9
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.
Bandura, A. (2001). Social cognitive theory of mass communication. Media Psychology, 3(3), 265–299. doi:10.1207/S1532785XMEP0303_03
Bennett, J., Carter, J., Fory, C., Rodd, C., & Longman, R. (2016). Unsupervised use of laparoscopic box trainers in a cohort of UK core surgical trainees. Journal of Surgical Simulation, 3, 32–42. doi:10.1102/2051-7726.2016.0006
Bisson, D. L. (2018). Assessing practical skills in obstetrics and gynaecology: Educational issues and practical implications. The Obstetrician & Gynaecologist, 8(2), 107–112. doi:10.1576/toag.8.2.107.27230
Brown, K. M., & Paige, J. T. (2015). Simulation in surgical training and practice. The Surgical Clinics of North America, 95(4), xvii-xviii. doi:10.1016/j.suc.2015.06.002
Burden, C., Fox, R., Hinshaw, K., Draycott, T. J., & James, M. (2016). Laparoscopic simulation training in gynaecology: Current provision and staff attitudes. A cross-sectional survey. Journal of Obstetrics and Gynaecology, 36(2), 234–240. doi:10.3109/01443615.2015.1060199
Caban, A. M., Guido, C., Silver, M., Rossidis, G., Sarosi, G., & Ben-David, K. (2013). Use of collapsible box trainer as a module for resident education. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 17(3), 440–444. doi:10.4293/108680813x13693422521430
Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7(1), 37. doi:10.1186/1748-5908-7-37
Chang, A. M., & Crowe, L. (2011). Validation of scales measuring self-efficacy and outcome expectancy in evidence-based practice. Worldviews on Evidence-Based Nursing, 8(2), 106–115. doi:10.1111/j.1741-6787.2011.00215.x
Chang, L., Petros, J., Hess, D. T., Rotondi, C., & Babineau, T. J. (2007). Integrating simulation into a surgical residency program: Is voluntary participation effective? Surgical Endoscopy, 21(3), 418–421. doi:10.1007/s00464-006-9051-5
Chummun, K., Burke, J. P., O’Sullivan, R., & Prendiville, W. (2012). The influence of a "take home" box trainer on laparoscopic performance for gynaecological surgeons. Gynecological Surgery, 9(3), 303–308. doi:10.1007/s10397-011-0720-6
Cialdini, R. B. (1993). Influence: Science and practice (3rd ed.). New York, NY: HarperCollins College Division.
Colquhoun, H., Leeman, J., Michie, S., Lokker, C., Bragge, P., Hempel, S., . . . Grimshaw, J. (2014). Towards a common terminology: A simplified framework of interventions to promote and integrate evidence into health practices, systems and policies. Implementation Science, 9, 51. doi:10.1186/1748-5908-9-51
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50. doi:10.1186/1748-5908-4-50
Driessen, S. R. C., Janse, J. A., Schreuder, H. W. R., & Jansen, F. W. (2015). Proficiency for advanced laparoscopic procedures in gynecologic residency program: Do all residents need to be trained? Journal of Surgical Education, 72(5), 942–948. doi:10.1016/j.jsurg.2015.03.008
Eccles, M. P., & Mittman, B. S. (2006). Welcome to implementation science. Implementation Science, 1(1), 1. doi:10.1186/1748-5908-1-1
Francis, J. J., O'Connor, D., & Curran, J. (2012). Theories of behaviour change synthesised into a set of theoretical groupings: Introducing a thematic series on the theoretical domains framework. Implementation Science, 7(35). doi:10.1186/1748-5908-7-35
Furnee, E. J., van Empel, P. J., Mahdavian Delavary, B., van der Peet, D. L., Cuesta, M. A., & Meijerink, W. J. (2009). Evaluation of a technical skills training program in surgical residents. Journal of Laparoendoscopic and Advanced Surgical Techniques, 19(5), 615–621. doi:10.1089/lap.2009.0074
Guntupalli, S. R., Doo, D. W., Guy, M., Sheeder, J., Omurtag, K., Kondapalli, L., . . . Muffly, T. M. (2015). Preparedness of obstetrics and gynecology residents for fellowship training. Obstetrics & Gynecology, 126(3), 559–568.
doi:10.1097/AOG.0000000000000999
Issenberg, S. B., McGaghie, W. C., Petrusa, E. R., Lee Gordon, D., & Scalese, R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher, 27(1), 10–28. doi:10.1080/01421590500046924
Kobayashi, S. A., Jamshidi, R., O'Sullivan, P., Palmer, B., Hirose, S., Stewart, L., & Kim, E. H. (2011). Bringing the skills laboratory home: An affordable webcam-based personal trainer for developing laparoscopic skills. Journal of Surgical Education, 68(2), 105–109. doi:10.1016/j.jsurg.2010.09.014
Korndorffer, J. R., Arora, S., Sevdalis, N., Paige, J., McClusky, D. A., & Stefanidis, D. (2013). The American College of Surgeons/Association of Program Directors in Surgery national skills curriculum: Adoption rate, challenges and strategies for effective implementation into surgical residency programs. Surgery, 154(1), 13–20. doi:10.1016/j.surg.2013.04.061
Korndorffer, J. R., Bellows, C. F., Tekian, A., Harris, I. B., & Downing, S. M. (2012). Effective home laparoscopic simulation training: A preliminary evaluation of an improved training paradigm. American Journal of Surgery, 203(1), 1–7. doi:10.1016/j.amjsurg.2011.07.001
Lipworth, W., Taylor, N., & Braithwaite, J. (2013). Can the theoretical domains framework account for the implementation of clinical quality interventions? BMC Health Services Research, 13, 530. doi:10.1186/1472-6963-13-530
Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., & Walker, A. (2005). Making psychological theory useful for implementing evidence based practice: A consensus approach. Quality & Safety in Health Care, 14(1), 26–33. doi:10.1136/qshc.2004.011155
Michie, S., van Stralen, M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42. doi:10.1186/1748-5908-6-42
Motola, I., Devine, L. A., Chung, H. S., Sullivan, J. E., & Issenberg, S. B. (2013). Simulation in healthcare education: A best evidence practical guide [AMEE Guide No. 82]. Medical Teacher, 35(10), e1511–e1530. doi:10.3109/0142159X.2013.818632
Munro, M. G. (2012). Surgical simulation: Where have we come from? Where are we now? Where are we going? Journal of Minimally Invasive Gynecology, 19, 272–283.
Nicol, L. G., Walker, K. G., Cleland, J., Partridge, R., & Moug, S. J. (2016). Incentivising practice with take-home laparoscopic simulators in two UK core surgical training programmes. BMJ Simulation and Technology Enhanced Learning, 2, 112–116.
Obermair, A., Tang, A., Charters, D., Weaver, E., & Hammond, I. (2009). Survey of surgical skills of RANZCOG trainees. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49(1), 84–92.
Page, D., Gilroy, M., Hurrion, E., Clark, L., & Wilkinson, S. (2017). Optimising early neonatal nutrition using translational research methodology. Nutrition & Dietetics, 74(5), 460–470. doi:10.1111/1747-0080.12333
Russo, M., & Tsuda, S. (2010, April). Portable, self-practice laparoscopic box trainers underutilized by surgical trainees. Paper presented at the SAGES 12th World Congress of Endoscopic Surgery 2010, North Harbor, MD.
Savoldelli, G. L., Naik, V. N., Hamstra, S. J., & Morgan, P. J. (2005). Barriers to use of simulation-based education. Canadian Journal of Anaesthesia, 52(9), 944–950. doi:10.1007/bf03022056
Scott, T., Mannion, R., Davies, H. T., & Marshall, M. N. (2003). Implementing culture change in health care: Theory and practice. International Journal for Quality in Health Care, 15(2), 111–118.
Shetty, S., Zevin, B., Grantcharov, T. P., Roberts, K. E., & Duffy, A. J. (2014). Perceptions, training experiences, and preferences of surgical residents toward laparoscopic simulation training: A resident survey. Journal of Surgical Education, 71(5), 727–733.
Stefanidis, D., Sevdalis, N., Paige, J., Zevin, B., Aggarwal, R., Grantcharov, T., & Jones, D. B. (2015). Simulation in surgery: What's needed next? Annals of Surgery, 261(5), 846–853. doi:10.1097/SLA.0000000000000826
Stovall, D. W., Redick, D. L., & Prettyman, S. T. (2010). The usefulness of a personal laparoscopic trainer in resident education. Journal of Minimally Invasive Gynecology, 17(6), S132. doi:10.1016/j.jmig.2010.08.476
Straus, S. E., Tetroe, J., Graham, I., & Graham, I. D. (2009). Knowledge translation in health care: Moving from evidence to practice. Hoboken, NJ: Wiley-Blackwell.
Thinggaard, E. (2017). Take-home training in laparoscopy. Danish Medical Journal, 64(4), B5335.
Thinggaard, E., Kleif, J., Bjerrum, F., Strandbygaard, J., Gogenur, I., Matthew Ritter, E., & Konge, L. (2016). Off-site training of laparoscopic skills: A scoping review using a thematic analysis. Surgical Endoscopy, 30(11), 4733–4741. doi:10.1007/s00464-016-4834-9
Thinggaard, E., Konge, L., Bjerrum, F., Strandbygaard, J., Gögenur, I., & Spanager, L. (2017). Take-home training in a simulation-based laparoscopy course. Surgical Endoscopy, 31(4), 1738–1745. doi:10.1007/s00464-016-5166-5
van Dongen, K. W., van der Wal, W. A., Rinkes, I. H. M. B., Schijven, M. P., & Broeders, I. A. M. J. (2008). Virtual reality training for endoscopic surgery: Voluntary or obligatory? Surgical Endoscopy, 22(3), 664–667. doi:10.1007/s00464-007-9456-9
van Empel, P. J., Verdam, M. G., Strypet, M., van Rijssen, L. B., Huirne, J. A., Scheele, F., . . . Meijerink, W. J. (2012). Voluntary autonomous simulator based training in minimally invasive surgery, residents' compliance and reflection. Journal of Surgical Education, 69(4), 564–570. doi:10.1016/j.jsurg.2012.04.011
Wilson, E., Janssens, S., Hewett, D. G., Jolly, B., & Beckmann, M. (2016). Simulation training in obstetrics and gynaecology: What's happening on the frontline? Australian and New Zealand Journal of Obstetrics and Gynaecology, 56(5), 496–502. doi:10.1111/ajo.12482
Wilson, E., Janssens, S., McLindon, L. A., Hewett, D. G., Jolly, B., & Beckmann, M. (2018). Improved laparoscopic skills in gynaecology trainees following a simulation‐training program using take‐home box trainers. Australian and New Zealand Journal of Obstetrics and Gynaecology, 59(1), 110–116. doi:10.1111/ajo.12802
Zapf, M. A., & Ujiki, M. B. (2015). Surgical resident evaluations of portable laparoscopic box trainers incorporated into a simulation-based minimally invasive surgery curriculum. Surgical Innovation, 22(1), 83–87. doi:10.1177/1553350614535858
Ziv, A., Wolpe, P. R., Small, S. D., & Glick, S. (2003). Simulation-based medical education: An ethical imperative. Academic Medicine, 78, 783–788.
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
On acceptance for publication in FoHPE the copyright of the manuscript is signed over to ANZAHPE, the publisher of FoHPE.
