See one, do one, teach one: A randomized controlled study evaluating the benefit of autonomy in surgical education

Michael LeCompte; Melissa Stewart; Timothy Harris; Gregory Rives; Christy Guth; Jesse Ehrenfeld; Kevin Sexton; Kyla Terhune

doi:10.1016/j.amjsurg.2018.10.037

See one, do one, teach one: A randomized controlled study evaluating the benefit of autonomy in surgical education

Am J Surg. 2019 Feb;217(2):281-287. doi: 10.1016/j.amjsurg.2018.10.037. Epub 2018 Nov 1.

Authors

Michael LeCompte¹, Melissa Stewart², Timothy Harris³, Gregory Rives⁴, Christy Guth⁵, Jesse Ehrenfeld⁶, Kevin Sexton⁷, Kyla Terhune⁸

Affiliations

¹ Vanderbilt University Medical Center Department of Surgery, 1161 21st Avenue South D4313 MCN, Nashville, TN, 37232-2730, USA. Electronic address: mtleco01@gmail.com.
² Vanderbilt University Medical Center Department of Surgery, 1161 21st Avenue South D4313 MCN, Nashville, TN, 37232-2730, USA. Electronic address: melissa.k.stewart@vanderbilt.edu.
³ University of Arkansas for Medical Sciences, College of Medicine, 4301 W Markham St #550, Little Rock, AR, 72205, USA. Electronic address: TJHarris@uams.edu.
⁴ University of Arkansas for Medical Sciences, College of Medicine, 4301 W Markham St #550, Little Rock, AR, 72205, USA. Electronic address: grives@uams.edu.
⁵ Vanderbilt University Medical Center Department of Surgery, 1161 21st Avenue South D4313 MCN, Nashville, TN, 37232-2730, USA. Electronic address: Christy.m.guth@vanderbilt.edu.
⁶ Vanderbilt University Medical Center Department of Surgery, 1161 21st Avenue South D4313 MCN, Nashville, TN, 37232-2730, USA. Electronic address: jesse.ehrenfeld@vanderbilt.edu.
⁷ University of Arkansas for Medical Sciences, Department of Surgery, Division of Acute Care Surgery, 4301 W Markham St, Little Rock, AR, USA. Electronic address: kevin.sexton@uams.edu.
⁸ Vanderbilt University Medical Center Department of Surgery, 1161 21st Avenue South D4313 MCN, Nashville, TN, 37232-2730, USA. Electronic address: kyla.terhune@vanderbilt.edu.

PMID: 30420092
DOI: 10.1016/j.amjsurg.2018.10.037

Abstract

Introduction: "See one, do one, teach one" has represented the model for surgical education for over a century, however recent changes in education have reduced autonomy in training. The goal of this study was to assess the impact of autonomy on learning a procedural skill.

Methods: Senior medical students were randomized and trained to performance a vascular anastomosis utilizing progressive autonomy vs. constant supervision. Performance was tested using videotaped technical grading and anastomotic pressure testing.

Results: Mean baseline performance times and technical ratings were similar in both groups. Final completion times was faster in the autonomy group, 14:03min vs. 19:09min (p = 0.02). Final technical ratings were similar, 40.0 vs. 39.2points (max = 50), for each group and both demonstrated similar improvement in leak test against a standardized sample.

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.

Keywords: Autonomy; Simulation; Surgical education; Teaching.

Publication types

Randomized Controlled Trial

MeSH terms

Anastomosis, Surgical / education
Clinical Competence*
Computer Simulation*
Curriculum
Education, Medical, Graduate / standards*
Educational Measurement / methods*
Female
General Surgery / education*
Humans
Internship and Residency / methods*
Learning
Male
Personal Autonomy*