PS8-07: SIMULATION-BASED BOWEL ANASTOMOSES: IMPROVING STANDARDS OF COMPETENCY-BASED EDUCATION IN RESIDENCY
Tiffany N Anderson, MD, Edmund W Lee, MD, Richard W Sapp, MS, Sylvia B Merrell, DrPh, Dana Lin, MD, Natalie Kirilcuk, MD, James Lau, MD, MHPE; Stanford University

Purpose: Bowel anastomoses are one of the most common procedures performed by general surgeons.  Both hand-sewn (HSA) and stapled anastomosis (SA) are core essential surgical techniques. Yet, many residents report a lack of confidence in performing HSA and SA.   Our objective is to implement a robust blended-learning curriculum in both HSA and SA that improves the confidence of residents and culminates in verification of technical proficiency.

Methods: Using Kern’s model for curriculum development, we developed a multimodal blended learning experience consisting of 1) pre-session multimedia presentations followed by 2) expert-facilitated practice. Residents were assessed in both HSA and SA techniques on a cadaveric porcine intestinal model. Modified Objective Structured Assessment of Technical Skills (OSATS) checklists and global rating scales were used to assess performance.  Utilizing Classical Test Theory, we conducted internal consistency tests on the modified OSATS checklists (Cronbach's alpha). Pre/post-session, residents were asked to rate on a 5-point modified Likert scale their confidence in performing and comfort in teaching, both procedures.

Results: 14 PGY2/3 general surgery residents participated in the program. The majority demonstrated competency on initial assessment (78% for HSA and 80% SA). Competency for those requiring  remediation was achieved after approximately one hour of additional mentored practice. There was no difference in performance between the two clinical year levels (p=0.14 HSA and p=0.20 SA). Confidence increased significantly from fair to above average on both tasks (p<0.001, respectively).  Similarly, comfort in teaching others increased significantly from not comfortable to above average for both task (p<.001, respectively). The internal-consistency of the OSATS HSA checklists was 0.77 and SA checklist was 0.47.

Discussion: The evidence for the robustness of our curriculum is promising.  We have been able to demonstrate a high reliability for our HSA tool and the intended boost in the resident’s procedural confidence.  With this early program evaluation we will continue to refine our competency-based education program and promote simulation-based skills as a means toward optimizing resident preparedness for and accelerating autonomy in the operating room.