Coronary Surgery Simulation Training Using the Deliberate Practice Approach: Results from Three Different Training Protocols

Background: The amount of intense and focused training with the specific aim to improve performance (i.e., deliberate practice) predicts expert level performance in multiple domains of psychomotor skill learning. We have established a deliberate practice curriculum for coronary surgery simulation training in the past. The aim of this study was to compare the effects of three different training protocols.

Method: Protocol 1: Six-week curriculum: Three training workshops with feedback session; two periods of self-organized training (three weeks each; n = 19). Protocol 2: Four-day curriculum on site (net training time 24 hours; continuous feedback; N = 16). Protocol 3: 4-day mixed curriculum (12 hours on site, 12 hours home based; N = 16). Video assessment matrix: quality Likert scale 1–5 for handling of instruments, motion with the needle, tissue handling. Handling and motion are doubly weighed. time/stich (sec) and score/time (1/min) were calculated. Trainees were informed about the training results of previous groups.

Results: Trainees reached better results with each adjustment of the protocol, mostly driven by better completion times. With the “24 hour mixed” curriculum students outperformed fellows according to the integrated Score/Time parameter, but presented significantly less surgical quality (score/time: 27 /min [IQR: 24–29] vs. 36/min [IQR 26–43]; p < 0.05). Scatter plot analysis of individual quality (score) and speed (time/stich) performance was performed: With both 24-hour curricula, trainees increased performance towards better quality and speed, but focused more on speed improvement. Trainees failed to reach target quality performance after the 24-hour protocols.

Conclusion: Deliberate practice protocols result in significant skill improvements during coronary surgery simulation training. Focused and intense short term trainings can accomplish similar results compared with longer training periods. We hypothesize that (with identical target parameters) shorter training periods trigger trainees to maintain a stricter training discipline. We hypothesize that with knowledge of the performance of previous trainees, new trainees seem to push themselves harder to outperform previous results. However, trainees tend to focus too much on speed improvement during a short term training program to improve overall performance. This calls for the adjustment of the assessment matrix to reward surgical quality rather than sheer speed. Further studies are warranted to test the effect of assessment matrix adjustments. Specific training protocols should be devised for residents and fellows to present a skill-adjusted training challenge. Assessed simulation trainings should be mandatory part of surgical training.

Publication History

Article published online:
03 February 2022