PS1 - 09: SEE ONE, DO ONE, TEACH ONE: A RANDOMIZED CONTROLLED STUDY EVALUATING THE BENEFIT OF AUTONOMY IN SURGICAL EDUCATION.
Michael T LeCompte, MD1, Melissa K Stewart, MD1, Timothy J Harris2, Tyler Rives2, Guth M Christy, MD1, Jesse M Ehrenfeld, MD, MPH1, Kevin Sexton, MD2, Kyla P Terhune, MD, MBA1; 1Vanderbilt University Medical Center, 2University of Arkansas Medical Center
Introduction: The mantra "see one, do one, teach one" has represented the traditional model for surgical education since the time of Halstead. However, recent economic, regulatory and legal pressures have threatened this model and reduced autonomy in surgical training. The goal of this study was to assess the impact of autonomy and whether teaching a procedure, as a final step in a graded program of instruction, improves performance and the retention of procedural skills
Methods: Fourth-year medical students entering into surgical specialties were randomized to either a see one, do one, teach one (S1D1DT1) or see one, do one (S1D1) group. Participants performed vascular anastomoses on an operative simulation model with a senior surgical resident providing instruction in the role of attending surgeon. Participants each performed a total of 10 procedures with the S1D1 group progressing through graduated assistant, and surgeon junior roles, while the S1D1T1 group included 3 teaching assistant roles with a more junior student. Performance was tested at baseline, completion and 1 month after the study period. The results were videotaped and graded using a modified Objective Assessment of Technical Skills (OSATS) rating scale. Anastomosis samples were tested for minimum intraluminal pressure required for anastomotic leak.
Results: Sixteen participants were randomized into groups of eight. Mean baseline performance times and technical ratings were similar in both groups. Final completion times was faster in the S1D1T1 group, 14.12min vs. 19.4min (p=0.04). Improvement in time from baseline was 8.88min for S1D1T1 vs 5.8min. Final technical ratings were similar, 40.0 vs. 39.2points (max=50), for the S1D1T1 and S1D1 groups respectively and both demonstrated significant improvement from baseline. The S1D1T1 anastomoses had a trend towards higher performance in the leak test with a leak pressure of 32.31mmHg vs. 27.22mmHg in the S1D1 group, although this was not statistically significant (p=0.49).
Conclusion: Teaching a procedure, as a final step in graded autonomy, results in superior performance in timing while maintaining equal technical performance compared to trainees with less autonomy. These findings highlight the need for preservation of autonomy in surgical education.