Augmented Terminal Feedback in Surgical Education
Research type
Research Study
Full title
To study predictors of assessment for developing augmented terminal feedback for surgical trainees, in laparoscopic robotic colorectal surgery
IRAS ID
330701
Contact name
Mohammad Riaz
Contact email
Sponsor organisation
RD&I, NHS Highland
Duration of Study in the UK
0 years, 11 months, 30 days
Research summary
Summary of Research
In the current surgical training environment, live assessment coupled with verbal feedback is carried out during a long surgical operation. A verbal feedback and written assessment is recorded at the end of the operation called procedure based assessment (PBA). It is a trainer dependent exercise where complexities of a long, technically demanding procedure are translated in words and expected a ‘cognitive overloaded’ trainee to gain the expected level of understanding along with technical skill competence.
Laparoscopic technology exposed this fundamental weakness in current practices and offered a chance to record the video of surgical procedure and have an assessment performed on it; hence, helped to develop a method to learn from procedural videos.
Cognitive psychologists and educationalists are convinced that technically demanding skills are best learnt when trainee’s own performance is recorded and feedback is provided on the video of the task at the end of the task. Preparing a feedback on more than four to five hours long procedure has never been technically feasible; Hence, the lack of its existence.This research theorised a unique method of studying ‘predictors of assessment’ during a complex surgical procedure, translating them into ‘augmented terminal feedback’ i.e., producing feedback on the video at the end of the procedure.
This study aims to develop a purpose built software and integrate the predictors of assessment to develop an augmented feedback. This software is proposed to help assess the surgical skill and translate this assessment into a feedback for future learning of surgical trainees.
Summary of Results
Introduction of robotic assistance in general surgery has highlighted a complex array of educational challenges that are not adequately addressed by the current surgical curriculum. Implementation of robot-assisted operations within the NHS has steadily increased in recent years, accompanied by a limited understanding of its effects on current surgical training standards. Costs associated with maintaining a robotic training program, including courses, devices, and performance evaluations, are substantial. This has limited the capacity to replicate in vitro training models and impeded training in robot-assisted surgery within the existing training framework.
The traditional approach to teaching technical skills frequently depends on subjective criteria for assessing surgical skill. In contrast, cognitive psychologists and educational analysts have promoted the creation of more objective criteria for evaluating technical proficiencies. A universally recognised and validated method for the objective assessment of individual technical skill in the operating theatre environment is lacking. To improve the objectivity of the evaluation process, predictors of assessment (POA) should be independently identified, categorised, and documented for each operation with the educational authority's consent. Contemporary educational assessment should exhibit practicality, comprehensiveness, flexibility, precision, transparency, and relevance for both consultant trainers and trainees.
Establishing a robust link between an objective assessment process and a surgical trainee's cognitive aptitude is essential for effective technical skill acquisition, facilitated by a practical feedback structure. Implementing a procedure-specific in-house training program that incorporates innovative feedback solutions, such as augmented terminal feedback (ATF), is crucial. Consequently, there exists a dual motivation, both intellectual and practical, to adopt ATF as the standard educational method for the acquisition of surgical skills. This approach modernises the assessment and feedback process in surgical training, enhancing trainee efficiency and reducing training duration. The proposed contemporary curriculum addressing technical skills necessitates more than traditional validity and reliability to ensure appropriate safety conditions for surgical training within this robot assisted innovative approach to learning.
Error-based assessment learning should be replaced with error-dynamic based learning. Errors should be viewed as informative indicators and prioritised for identification, categorisation, and labelling based on how they impact on cognitive proficiency in technical knowledge and skills. The specialised nature of a trainee's assessment should improve during transitions between various trainers and technologies through a modernised skill-based curriculum, resulting in a more objective evaluation of their performance.
This study established that a fifteen-minute 'hot feedback' session in the immediate post-operative period, along with its integration into video logs for trainee self-reflection, is both realistic and practical. This allows a trainer to produce and provide error-signatured augmented terminal feedback. The proposed purpose-built software enables trainers to consolidate all operational areas identified as needing additional skill training. This ATF should include annotations, comments, and audio recordings to elucidate errors and potential solutions, thereby improving a surgical trainee's conceptual understanding.
Following more than ten years of incorporating robotic assistance into laparoscopic procedures in the NHS, the demand for a modern and innovative surgical curriculum has emerged. The integration of skills from laparoscopy to robotic assistance should occur promptly in the early stages of surgical specialist training, rather than being postponed to later stages, as this often leads to dependence on costly, commercially driven speciality fellowships.REC name
West of Scotland REC 1
REC reference
23/WS/0124
Date of REC Opinion
2 Aug 2023
REC opinion
Favourable Opinion