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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2024; 09(01): e89-e96
DOI: 10.1055/s-0044-1786982
Original Article

Gathering Dust—Resistance to Simulator-based Deliberate Practice in Microsurgical Training

Claire F. Temple-Oberle
1   University of Calgary, Departments of Surgery and Oncology, Section of Plastic Surgery Calgary, Alberta, Canada
,
A. Robertson Harrop
1   University of Calgary, Departments of Surgery and Oncology, Section of Plastic Surgery Calgary, Alberta, Canada
,
Carmen E. Webb
1   University of Calgary, Departments of Surgery and Oncology, Section of Plastic Surgery Calgary, Alberta, Canada
,
Susan G. Somerville 
2   Centre for Medical Education & Dundee Institute for Healthcare Simulation, University of Dundee, Scotland
› Author Affiliations Funding This work was supported by the Robert Maudsley Fellowship for Studies in Medical Education.
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Abstract

Background Despite unrestricted access to a simulated microsurgery model, learners have not consistently self-regulated their learning by completing practice. This paper explores the lived experience of learners regarding how practice is perceived and why it is resisted.

Methods A qualitative study was conducted, including recorded and transcribed focus groups and semistructured interviews. First and second pass coding was conducted by one reviewer, with feedback from another. Transcripts were analyzed with a constant comparative approach customary to thematic analysis. Theory was engaged to help explain and support the findings.

The study was undertaken at the University of Calgary plastic surgery residency training program in Calgary, Alberta, Canada, involving 15 informants (9 residents and 6 surgeons).

Results Four themes emerged: (1) barriers to practice, (2) motivation to practice, (3) owning learning/solutioning, and (4) expectations of practice. Competing priorities and time constraints were barriers. Motivation to practice ranged from extrinsic (gaining access to the next course) to intrinsic (providing optimal patient care). Learners described a range of ownership of learning and depth of effort at solutioning of practice opportunities. Learners expressed high expectations around model fidelity, ease of setup, and feedback. Learners self-regulating their learning, with surgeons acculturating practice at work, can overcome some barriers. As per self-determination theory (SDT), learners need explicit linkage to how the task aligns with their goals. Assessment may be required to motivate learners. In respect of adult learning theory, homework needs to be allocated by a respected trainer. Modeling simulation practice may encourage adult learners. Finally, the tenets of deliberate practice (DP) need to be explained in order that learners can optimize their practice time.

Conclusion Microsurgical simulation practice is valued but barriers exist that invite resolution. Assisting residents to overcome barriers, maintain motivation, take ownership, and assimilate DP will help improve their microsurgery practice.

Keywords

microsurgical training - deliberate practice - resistance - barriers - motivation - adult learning


Publication History

Received: 22 November 2021

Accepted: 03 August 2022

Article published online:
07 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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