Exploring possibilities and barriers in effective surgical training

Medicine (Perspectives on Learning) 2023-02-03

Abstract

Surgical training is changing because surgical standards have changed rapidly over the past two decades. For instance, the introduction of laparoscopy has enabled simulated training. The aim of this project was to scope the possibilities and barriers of efficient surgical training with current theories of learning as the theoretical foundation and to apply these theories to teaching the laparoscopic appendectomy more efficiently.  Behaviorism and cognitive theory are the mainstay of teaching practical skills. Cognitive load theory describes the learning of a new activity in three different phases where automation is increasing throughout the learning. In order to meet the student’s current needs, the student’s skill should be assessed and teaching adapted accordingly. Social cognitive theory contains theories on three domains that affect learning. Modifiable factors such as self-efficacy, a sense of belonging, and form and timing of feedback are included as important factors for efficient learning. Applying these theories on teaching the laparoscopic appendectomy has led to the following conclusions: A standard for the operation has to be agreed upon. The procedure needs to be broken down and taught step-by-step and information is supposed to be presented to the student at the student’s current level of knowledge. Feedback has to be timely and precise. Because automation occurs as ability increases, experts might be worse teachers than experienced but not yet expert surgeons because the experts might have forgotten how to verbalize important steps of the procedure. Training is preferably spaced in time to avoid cognitive overload and fatigue.