Immediate Surgical Skills Feedback in the Operating Room Using “SurF” Cards

Abstract

Background Ensuring residents develop operative skills requires application of the principles of guided learning, deliberate practice, and directed feedback. Objective We sought to create and implement a tool to promote procedural ‘‘key’’ step review and immediate feedback on surgical skills, and examined faculty and resident satisfaction with surgical skills feedback. Methods We created surgical skills feedback (SurF) cards for 8 gynecologic procedures. Faculty/fellows and residents completed prestudy surveys querying frequency of preoperative key step review and satisfaction with surgical skill feedback, a SurF card each time 1 of 8 procedures was performed, and poststudy surveys to evaluate for changes. Results Prestudy surveys were completed by 31 faculty/ fellows and 20 residents, with 55% (17 of 31) of the faculty/fellows and 5% (1 of 20) of the residents reporting key step review before surgery. All reported Introduction Duty hour limitations and increased pressures for clinical efficiencies provide serious challenges to the long-standing AnnaMarie Connolly, MD, is Professor, Department of Obstetrics and Gynecology, University of North Carolina; Darci Hansen, MD, is Private Practitioner, Portland, Oregon; Kevin Schuler, MD, is Assistant Professor, Department of Obstetrics and Gynecology, Good Samaritan Hospital; Shelley L. Galvin, MA, is Director, Center for Research, Department of Obstetrics and Gynecology, Mountain Area Health Education Center; and Honor Wolfe, MD, is Professor and Division Director of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MacDonald Women’s Hospital and Department of Reproductive Biology, Case School of Medicine. Funding: The authors report no external funding source for this study. Conflict of interest: The authors declare they have no competing interests. This study was presented orally at the CREOG/APGO Annual Meeting, in Orlando, FL, March 2012. The authors would like to thank Dr Andrea Currens and the Mountain Area Health Education Center Obstetrics and Gynecology Residency Program for allowing us to modify their formative evaluation card designed by Dr Currens and Ms Galvin for this project. Corresponding author: AnnaMarie Connolly, MD, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, 3032 Old Clinic Building, CB 7570, Chapel Hill, NC 27599, 919.966.4717, fax 919.843.9952, amc004@med.unc.edu Received February 9, 2014; revisions received July 27, 2014, and August 8, 2014; accepted August 15, 2014. DOI: http://dx.doi.org/10.4300/JGME-D-14-00132 low satisfaction rates with feedback frequency, quality, and timeliness. After implementation of SurF cards, preoperative key step review occurred in 78% (82 of 105) of the procedures. Twenty-one faculty/ fellows (68%) and 16 residents (80%) completed our poststudy survey. Faculty/fellows reported statistically similar key step review (n 5 15 [71%], P 5.23), while residents reported that key step review had significantly improved (n 5 6 [38%], P 5.01). Resident satisfaction with feedback frequency (5% to 50%, P 5.002) and quality (15% to 50%, P 5.02) increased significantly. Conclusions The SurF cards we developed facilitated procedural key step review, were associated with significantly improved resident satisfaction with surgical feedback, and could prove helpful with outcomes assessments, such as Accreditation Council for Graduate Medical Education–required documentation of Milestone attainment