Video Coaching Improving Contemporary Technical and Nontechnical Ability in Laparoscopic Education

ARTICLE IN PRESS ORIGINAL REPORTS

Video Coaching Improving Contemporary Technical and Nontechnical Ability in Laparoscopic Education Chien-Hung Liao, MD, FACS, FICS,*,1 Chun-Hsiang Ooyang, MD,*,1 Chih-Chi Chen, MD,† Chien-An Liao, MD,* Chi-Tung Cheng, MD,* Ming-Ju Hsieh, MD,‡ Chi-Hsun Hsieh, MD, PhD,* Chun-Yi Tsai, MD,x Ta-Sen Yeh, MD, PhD,x Chun-Nan Yeh, MD,x and Chih-Yuan Fu, MD, FICS* *

Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; †Department of Physical medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan Taiwan; ‡Department of Cardiovascular and thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; and §Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan OBJECTIVE: A video coaching (VC) system has been

developed in surgical education. This study compares the educational effect on technical and nontechnical skills of the VC method for teaching laparoscopic surgery. DESIGN: We conducted a prospectively randomized study of an education program to teach laparoscopic procedures. SETTING: The study was performed at the Chang Gung

Memorial Hospital, a university hospital in Taiwan. PARTICIPANTS: We enrolled sixteen first- or second-year

surgical residents.The participants were randomized into VC and conventional teaching (CT) groups, and their surgical skills were judged by the Global Operation Assessment of Laparoscopic Skills (GOALS) and the Objective Structured Assessment of Technical Skills (OSATS). Nontechnical skills were evaluated by the Non-Technical Skills for Surgeons (NOTSS) assessment and self-efficacy questionnaires (SEQs). After the program, posttraining scores were compared to assess improvements. RESULTS: The 16 enrolled participants finished the

entire course and completed all the videos during the study period. Comparing the VC and CT groups, we found that the pretraining GOALS, OSATS, NOTSS and

Correspondence: Inquiries to Chih-Yuan Fu MD, FICS, Department of Trauma and emergency surgery, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, KweiShan Shiang, Taoyuan, Taiwan; e-mail: [email protected] 1

SEQ scores were similar between both groups. However, after training, the OSATS score gain was higher in the VC groupthan in the CT group (9.25 § 2.05 vs. 6.50 § 1.51, p=0.009). Regarding nontechnical skills, the NOTSS score improved more in the VC group than in the CT group (5.50 § 0.93 vs. 4.25 § 0.89, p=0.015). The SEQ score was also higher in the VC group (32.13 § 2.10) than in the CT group (29.50 § 1.77), with a significant difference (p=0.018). CONCLUSION: VC can help surgeons build their exper-

tise using a more accessible method. Additionally, VC can shorten the learning curve and improve self-efficacy, thereby contributing to surgeons’ education. ( J Surg Ed 000:19. Ó 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: video coaching, laparoscopic education,

video teaching, coaching review COMPETENCIES: Medical Knowledge, Professionalism,

Practice-Based Learning and Improvement

INTRODUCTION Learning is a complicated process that is of particular importance in surgery. The Halsted "see one, do one, teach one" surgical training method was developed over a century.1-4 However, because of an appreciation for patient safety and the limitations of working hours, surgical residents have limited operative opportunities and learning experiences.5,6

Both authors contributed this manuscript equally.

Journal of Surgical Education  © 2019 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jsurg.2019.11.012

1

ARTICLE IN PRESS Consequently, a structured and evidence-based approach to surgical education should be developed.7 Laparoscopic surgery has become an option in increasing numbers of abdominal surgeries. However, for novices, the learning process for laparoscopy is longer than that for open surgery.8,9 Therefore, the curriculum for laparoscopic education demands a different set of tools than those used for traditional open surgery. Several studies have suggested that feedback and coaching from instructors improve laparoscopic results. Additionally, experience with laparoscopic simulator training suggests that feedback is best given according to the individual’s needs.9,10 Video coaching (VC) systems are well developed in the area of sports,11 allowing athletes to review their performances on video to improve their competitive ability and correct unnecessary movements.5,12 In recent decades, this approach has been accepted in other fields, such as airplane pilot training and business manager education. In the medical field, video review can be applied to provide demonstrations and education to help novices learn and become familiar with complicated

procedures.7-9 Video recording can help novice surgeons learn a procedure by reviewing clips from teaching videos.13 However, research on the functions and advantages of VC for laparoscopic surgery is still in the development stage, and more evidence is required to complete this educational system. Furthermore, no studies showing the advantages of VC for promoting nontechnical skills in novice surgeons have been published. We conducted a prospective randomized study to compare the educational effects of VC and conventional teaching (CT) methods for laparoscopic surgery. Moreover, we evaluated the differences in how the participating residents’ technical and nontechnical skills improved after each training model.

MATERIAL AND METHODS We conducted a prospectively randomized education program from July 2016 to December 2017 to teach laparoscopic surgeries to novice surgeons.

FIGURE 1. Study design and participant flow chart.

2

Journal of Surgical Education  Volume 00 /Number 00  Month 2019

ARTICLE IN PRESS Our institute, Chang Gung Memorial Hospital (CGMH) Linkou, is a university hospital that trains 100 surgical residents per year (20 residents per postgraduated year, and there are 5 or 6 years of residency). We are a 3000bed medical center, and we perform 600 laparoscopic appendectomies and 1200 laparoscopic cholecystectomies per year on average.

COHORT RECRUITMENT The recruited participants were first- and second-year residents at CGMH who were enrolled in the mandatory “Video review laparoscopic coaching program” training course. We enrolled 16 surgical residents in this program by the principle as first-come-first-served self-selected. Balanced randomization was performed by ordering the list of participants by randomly assigned numbers and dividing the list equally. All participants were randomized into 2 groups: the VC group and the CT group. All participants were well informed of the study’s purpose and risks and signed the consent form. The Internal Review Board of CGMH approved this study: IRB No: 104-9857B.

STUDY FLOW We introduced laparoscopic teaching via class lectures delivered to all the residents in the surgical department. The lectures included the anatomical and scientific basis of laparoscopic surgery as well as instrument instruction and surgical simulations conducted on a dry box in the simulation room. Each resident participated in at least 2 surgical simulations. Then, we sought study participants from among the first- and second-year residents in this study, and a total of 16 residents were enrolled. All the included residents had limited experience and had completed fewer than 3 laparoscopic surgeries before this study. The study flow chart is shown in Figure 1. All the residents were asked to record videos of the 10 laparoscopic appendectomies in which they participated. At the same time, with agreement, the interaction among members of the operative team in the operating room was also recorded for nontechnical skill evaluation. One fixed camera was placed on the right side of the operating table, just at the edge the operating room, and was focused on the resident. With the CT method, the clinical mentor introduced each resident to the laparoscopic technique and perioperatively provided supplemental knowledge about the surgery. In the VC group, additional video review coaching was provided by the coaches for the residents. Each resident has 10 coaching sessions and the coaching sessions were performed within one week after recorded operation. The coaches were surgeons other than the

Journal of Surgical Education  Volume 00 /Number 00  Month 2019

operative attending surgeons and were well instructed and educated in the coaching process. Our coach development program was created several years ago. All coaching candidates were experienced laparoscopic surgeons with more than ten years of laparoscopic surgical experience. We also introduced the coaches to the standard coaching system and provided a workshop to allow them to practice the coaching process. All the coaches received a 40-hour training course about medical education. Five coaches participate into this program and the same coach was assigned to the same resident throughout the study. The coaching programs emphasized the surgical anatomy and skill, knowledge of instrument usage, critical view of procedures and alternative management. We also instructed the residents regarding how to communicate with assistants during the operation. We standardized the coaching course to ensure the quality and standardization of the coaching and feedback sessions provided during video review. During video review, the coaches assessed the video with the residents and emphasized the critical points during the operation. Each coaching sessions were performed 45 minutes per time. We also recorded some coaching sessions for internal validation of the quality of the VC. All video clips were declassified and stored in a video databank. Examinations were performed by a third group of 2 experienced surgeons as raters who were experienced coaches in the laparoscopic surgery society. Like the coaches, they had also completed more than a 40-hour course in medical education and the coaching process. Primary raters conducted blind reviews and ratings of all videos. All the video clips received a technical score and nontechnical score, both of which were recorded in our databank. All the videos were reviewed again by another rater to ensure that the scales and grades were appropriate and had no obvious deviation bias. Once the disparities occurred, the rater consensus will make the final score.

OUTCOMES AND MEASUREMENTS The primary endpoint (dependent variable) of this study was the residents’ learning achievement in terms of technical and nontechnical surgical skills. Learning achievement was measured by the difference in the pre- and post-training test scores. After the residents finished the introductory class and surgical simulations, we conducted a pretraining interview and administered a selfconfidence test. The Global Operation Assessment of Laparoscopic Skills (GOALS) and the modified Objective Structured Assessment of Technical Skills (OSATS) were used to score the participants’ laparoscopic technique.14,15 The GOALS is a 5-item global rating scale that evaluates laparoscopic skills. The original OSATS includes 7 categories:

3

ARTICLE IN PRESS including (1) Respect of tissue, (2) Time and motion, (3) Instrument handling, (4) Knowledge of instruments, (5) Flow of procedure, (6) Knowledge of procedure, and (7) Use of assistance. We modified the OSATS by removing the “Use of assistance” category because we cannot evaluate this category by recorded video clearly. Furthermore, in order to compatible with laparoscopic appendectomy, our modified version of the OSATS included (1) Respect of tissue: Additional injuries or bleeding; (2) Time and motion: Time required to extract the specimen; (3). Instrument handling: Loss of grasp or loss of clip; (4) Knowledge of instruments: Safe cautery skills; (5) Flow of procedure: Smooth operation or presence of complications; (6) Knowledge of procedure: Understanding how to convert to laparotomy. The nonoperative skills were evaluated by the NonTechnical Skills for Surgeons (NOTSS) assessment and selfefficacy questionnaires (SEQs). The NOTSS scale consists of 4 categories that assess the following: (1) situational awareness; (2) decision making; (3) communication and teamwork; and (4) leadership. Each category contains 3 elements evaluated on a 4-point scale with the following performance labels: 1 = poor, 2 = marginal, 3 = acceptable, and 4 = good. The maximum possible score is 16. The SEQ was self-administered by the participants before and after the training session. The modified scale used to assess self-

efficacy for surgery included a 10-item questionnaire, and each item was rated on a 4-grade Likert-type scale.16 The maximum possible score is 40. The interval between the pre- and postcoaching skill measurements was 18 months. Each recorded video was scored in terms of technical (GOALS1»10, OSATS1»10) and nontechnical (NOTSS1»10) skills, and we compared the differences in both the technical and nontechnical scores between the CT and VC groups. Statistical Analysis Student’s t tests were used to compare quantitative variables. Subsequently, an analysis of covariance was used to compare the GOALS, OSATS, and NOTSS outcome scores to the corresponding baseline scores in each group. The Mann-Whitney U test was used to evaluate the differences in self-efficacy between the 2 groups. The Wilcoxon matched-pairs signed-rank sum test was used to compare the self-efficacy scores before and after training and the surgical performance between sessions. One-way analysis of variance was used to compare the differences in improvement between pre- and post-training in the 2 groups. Statistical analyses were performed with SPSS v 20.0 for Macintosh (SPSS, Inc., Chicago, IL). A p value < 0.05 was considered statistically significant.

TABLE 1. Comparison Between Video Coaching and Conventional Teaching Groups

Age (y) Gender (n, %) Male Female Residency year (n, %) First year Second year Laparoscopic experience (past cases number) Technical skill Pretraining score GOALS1 OSATS1 Post-training score GOALS10 OSATS10 Non-Technical Skill Pretraining score NOTSS1 SQE1 Post-training score NOTSS10 SQE10

VC Group N=8

CT Group N=8

p Value

25.75 § 1.389

26.00 § 1.195

0.705

6 (75.0%) 2 (25.0%)

7 (87.5%) 1 (12.5%)

0.410

6 (75.0%) 2 (25.0%) 2.7 § 0.6

6 (75.0%) 2 (25.0%) 2.3 § 1.0

0.563

3.63 § 0.518 12.38 § 1.506

3.75 § 0.707 13.00 § 1.309

0.693 0.391

7.25 § 0.463 21.63 § 1.685

6.75 § 0.707 19.50 § 1.414

0.120 0.013*

4.63 § 0.518 27.38 § 1.690

4.50 § 0.756 28.50 § 2.820

0.706 0.354

10.13 § 0.641 32.13 § 2.100

8.75 § 0.463 29.50 § 1.773

<0.001* 0.018y

0.623

CT, conventional teaching; GOALS, Global Operation Assessment of Laparoscopic Skills; OSATS, Objective Structured Assessment of Technical Skills; NOTSS, Non-Technical Skills for Surgeons; SEQ, self-efficacy questionnaires; VC, video coaching. *Student t test. † Mann-Whitney U test.

4

Journal of Surgical Education  Volume 00 /Number 00  Month 2019

ARTICLE IN PRESS

FIGURE 2. The improvement in Global Operation Assessment of Laparoscopic Skills (GOALS) and Objective Structured Assessment of Technical Skills (OSATS) scores after 10 laparoscopic surgeries for both groups.

§ 0.518, CT: 3.75 § 0.707, p = 0.693), as were the OSATS scores for the first operation (OSATS1; VC: 12.38 § 1.506, CT: 13.00 § 1.309, p = 0.391). The GOALS score for the 10th operation (GOALS10) was higher in the VC group (7.25 § 0.463) than in the CT group (6.75 § 0.707), but no significant difference was observed (p = 0.120). However, the OSATS score for the 10th operation (OSATS10) was higher in the VC group (adjusted mean 21.63 § 1.685) than in the CT group (adjusted mean19.50 § 1.414), and the difference was significant (p = 0.013), as shown in Fig. 2. The improvement in the OSATS score was also significantly higher in the VC group (9.25 § 2.053) than that in the CT group (6.50 § 1.512) (p = 0.009), as shown in Table 2.

RESULTS There were 41 first-and second-year residents in our surgical department during this study period. This study enrolled 16 of these residents, who were randomly divided into 2 groups. Based on the pretraining test scores, the grades, ability and knowledge of laparoscopic surgery were comparable between groups, as Table 1 shows. When comparing the VC and CT groups, we found that the pretraining GOALS, OSATS, NOTSS, and SEQ scores were similar between the 2 groups. (Table 1) All participants showed excellent improvement in their surgical skill scores, after training with 10 operations; their OSATS scores increased from 12.69 § 1.40 to 20.38 § 1.93 (p < 0.01). The GOALS scores improved significantly, from 3.69 § 0.602 to 7.00 § 0.632 (p < 0.01). The NOTSS scores increased from 4.56 § 0.63 to 9.44 § 0.89 (p < 0.01). In terms of self-confidence, the pretraining scores (27.94 § 2.32) and post-training scores (30.81 § 2.32) were significantly different (p = 0.002).

MEASUREMENTS OF NONTECHNICAL SKILLS For the SEQs, as Table 1 shows, the pretraining scores were similar between the VC and CT groups (27.38 § 1.690 vs 28.50 § 2.820, p = 0.354). However, after training, the SEQ score was higher in the VC group (32.13 § 2.100) than in the CT group (29.50 § 1.773, p = 0.018). Moreover, the pretraining NOTSS1 scores were similar between the VC and CT groups (4.63 § 0.518 vs 4.50 §

MEASUREMENT OF TECHNICAL SKILLS In comparing the VC and CT groups, as Table 1 shows, we found that the GOALS scores for the first operation (GOALS1) were similar between the 2 groups (VC: 3.63

TABLE 2. Comparison the Gain Scores of Technical and Non-Technical Scales Between Video Coaching and Conventional Teaching Groups

GOALS Gain OSATS Gain NOTSS Gain

VC Group

CT Group

F Score

p

3.63 § 0.744 9.25 § 2.053 5.50 § 0.926

3.00 § 0.926 6.50 § 1.512 4.25 § 0.886

2.215 9.308 9.524

0.159 0.009y 0.015y

CT, conventional teaching; GOALS, Global Operation Assessment of Laparoscopic Skills; NOTSS, Non-Technical Skills for Surgeons; OSATS, Objective Structured Assessment of Technical Skills; VC, video coaching. Bold p values < 0.05 was thought statistically significance. † p < 0.05 was considerred statisitically significance by Student t test. Journal of Surgical Education  Volume 00 /Number 00  Month 2019

5

ARTICLE IN PRESS

FIGURE 3. The increase in the NOTSS score for the CT group and the video coaching group.

0.756, p = 0.706). After training, the NOTSS10 score was higher in the VC group (10.13 § 0.641) than in the CT group (8.75 § 0.463, p < 0.001) (Table 1). We also found that the NOTSS score showed significantly greater improvement in the VC group (5.50 § 0.926) than in the CT group (4.25 § 0.886) (p = 0.015, Fig. 3).

ENROLLEES COMPARED WITH NONENROLLEES A total of 16 of the hospital’s first- and second-year residents were enrolled in the study, while 25 were not enrolled (Table 3). Comparing both groups, we found no obvious difference in age and gender. However, we found that compared with the nonenrollees, more of the enrollees had participated in more than 10 laparoscopic surgeries over the 18-month study period (100% vs 56%, p < 0.01), and the enrollees had a lower rate of dropout from surgical training (6.25% vs 32.00%, p = 0.052). The average number of laparoscopic appendectomy experiences required to obtain self-confidence was approximately 4.50 § 0.80 in the enrollee group, which was less than the 7.60 § 2.17 reported for the nonenrollee group (p < 0.01).

DISCUSSION In this study, we found that VC improved not only technical skills but also nontechnical skills and self-efficacy

6

in novice surgeons. Coaching is the process of partnering with residents in a thought-provoking and creative way to inspire them to maximize their personal and professional potential.17 We designed a series of education courses to demonstrate that a VC program is an additional tool for surgical residents that can improve both technical and nontechnical skills5,18,19 and offered the measurement of these skills. With a structured method of coaching, residents can efficiently gain surgical techniques and easily identify their nontechnical ability. During video reviews, coaches can deliver specific lessons and clarify information in a time-saving and tension-free manner. Surgical education has evolved in recent decades. Although lectures and textbooks can provide knowledge, surgical techniques are still communicated through the master-apprentice model. Surgical residents sometimes experience disparity with attending surgeons during intraoperative teaching,20 and these can be decreased by discussion and communication during coaching. During VC, because of the absence of concurrent clinical responsibility, attending surgeons are more likely to perform educational needs assessments 21 and residents are more likely to bring up teaching points than they are in the operating room. We also found that improvements in surgical skill occurred more quickly in the VC group than in the CT group because the VC participants could identify their mistakes and weaknesses and amend them in subsequent operations. Using this method, residents can record their operations and subsequently discuss them

Journal of Surgical Education  Volume 00 /Number 00  Month 2019

ARTICLE IN PRESS

TABLE 3. Comparison Between Enrolled and Nonenrolled Residents in the Video Coaching Program Age

Enrollees (N = 16) 25.88 § 1.26

Nonenrollees (N = 25) 25.88 § 1.20

p value 0.990

13 (81.25%) 16 (100.00%) 1 (6.25%) 4.50 § 0.80

20 (80.00%) 14 (56.00%) 8 (32.00%) 7.60 § 2.17

0.992 <0.01 0.052 <0.01

Male gender Experience with more than 10 laparoscopic surgeries Dropout from surgical training Average number of laparoscopic appendectomies required to obtain self-confidence

with coaches, which can shorten operation times by reducing discussion during the surgery. Some studies have shown a long learning curve for laparoscopic appendectomy and cholecystectomy.22-25 However, the image imprint effect using video review can help residents learn laparoscopic appendectomy in an effective way and can shorten the learning time. VC has been demonstrated to be useful for teaching a variety of topics, both technical and nontechnical. Both the self-efficacy and NOTSS scores improved more in the VC group than in the CT group. We found that the residents liked to engage in discussions with their coaches even when the topics or surgical details were not present in the video review. Some placebo effects exist for postoperation discussions between master and apprentice because these discussions make residents feel safe and confident.26 Moreover, 1 study suggested that teachers and residents have different perceptions of feedback: 86% of surgeons felt that feedback was often and/or always given immediately after an activity, but only 12.5% of residents felt the same.27 Feedback and teaching are usually conducted in a calm way that improves the teaching atmosphere. The learning environment can also contribute to perceived self-efficacy.28 Some previous studies suggest that feedback improves self-efficacy and provides recipients with a feeling of proficiency. Although we identified several advantages of VC for laparoscopic surgery, there are still some limitations to this study. First, extra work and time commitments are required for the coaching model, which will prolong working hours. The work hours of residents are especially limited; therefore, spending more time on coaching may not be globally feasible. Second, some surgical skills, such as bimanual movements or suturing skills, cannot be improved through video review alone; practice also plays a role. Because these techniques require practice, the need to participate in operations and practice independently cannot be ignored.18 This finding may explain why the improvement in the GOALS score was not as significant in the VC group as in the CT group, in contrast with the OSATS score. Third, given our training capacity, we decided to recruit 16 participants into this study and opened it to residents on a firstcome-first-served basis. There might be a selection bias

Journal of Surgical Education  Volume 00 /Number 00  Month 2019

because we assume that those who chose to participate had high motivation and interest in learning laparoscopic surgery via a new training style. Finally, when we proceeded with this study, all of the residents also had access to other approaches for learning laparoscopic procedures. Because all residents may not have had equal learning opportunities, there may have been an unpreventable bias. Although there were some limitations of this study, we demonstrated that VC can shorten the learning curve, learning time, and operative time for novice surgeons performing laparoscopic procedures. Furthermore, we showed that VC can help to develop residents’ confidence and interest in laparoscopic surgery. In conclusion, we demonstrate that VC can provide a more accessible method for helping surgeons build their expertise. VC can reduce the learning curve of minimally invasive surgery and improve both the technical and nontechnical skills of residents, which can benefit their education in the era of restricted work hours.

THE AUTHOR DISCLOSURE STATEMENT All of the authors have no financial or personal conflicts which could potentially and inappropriately influence the work and conclusions with this manuscript

AUTHORS’ CONTRIBUTION C-H Liao and M-R Hsieh designed this study; C-A Liao and C-Y Tsai acquired of data; C-S Ooyang, C-T Cheng, C-C Chen and T-S Yeh analyzed the data; C-S-Ooyang and C-H Liao drafted the article; C-N Yeh, C-C Chen and C-Y Fu revised it critically. C-H Hsieh, C-H Liao and C-Y Fu approved the final version to be submitted.

ACKNOWLEDGEMENT The authors thank the CGMH research program CDRPG3F0021 & CDRPG3E0041 for supporting this research.

7

ARTICLE IN PRESS REFERENCES 1. Cameron JL, William Stewart Halsted. Our surgical

heritage. Ann Surg. 1997;225:445–458.

12. Anders Ericsson K. Deliberate practice and acquisi-

tion of expert performance: a general overview. Acad Emerg Med. 2008;15:988–994. https://doi. org/10.1111/j.1553-2712.2008.00227.x.

2. Romero P, G€ unther P, Kowalewski K-F, et al.

13. Grantcharov TP, Schulze S, Kristiansen VB. The

Halsted’s “See One, Do One, and Teach One” versus Peyton’s Four-Step Approach: a randomized trial for training of laparoscopic suturing and knot tying. J Surg Educ. 2018;75:510–515. https://doi.org/ 10.1016/j.jsurg.2017.07.025.

impact of objective assessment and constructive feedback on improvement of laparoscopic performance in the operating room. Surg Endosc. 2007;21:2240– 2243. https://doi.org/10.1007/s00464-007-9356-z.

3. Rutkow I. The education, training, and specializa-

tion of surgeons: turn-of-the-century America and its postgraduate medical schools. Ann Surg. 2013;258:1130–1136. https://doi.org/10.1097/ SLA.0b013e3182a6f6a6.

14. Vassiliou MC, Feldman LS, Andrew CG, et al. A global

assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg. 2005;190:107–113. https://doi.org/10.1016/j.amjsurg.2005.04.004. 15. Kramp KH, van Det MJ, Hoff C, Lamme B, Veeger

ticeship: teaching the crafts of reading, writing, and mathematics. Know Learn Instruction: Essays Honor Robert Glaser. 1989;18:32–42.

NJGM, Pierie J-PEN. Validity and reliability of global operative assessment of laparoscopic skills (GOALS) in novice trainees performing a laparoscopic cholecystectomy. J Surg Educ. 2015;72:351–358. https:// doi.org/10.1016/j.jsurg.2014.08.006.

5. Hu Y-Y, Mazer LM, Yule SJ, et al. Complementing

16. Schwarzer R, Jerusalem M. The general self-efficacy

operating room teaching with video-based coaching. JAMA Surg. 2017;152:318–325. https://doi.org/ 10.1001/jamasurg.2016.4619.

scale (GSE). Anxiety Stress Coping. 1993;12:329–343.

4. Collins A, Brown JS, Newman SE. Cognitive appren-

6. Teman NR, Gauger PG, Mullan PB, Tarpley JL,

Minter RM. Entrustment of general surgery residents in the operating room: factors contributing to provision of resident autonomy. J Am Coll Surg. 2014;219:778–787. https://doi.org/10.1016/j.jamcollsurg.2014.04.019. 7. Patel VM, Warren O, Ahmed K, et al. How can we

build mentorship in surgeons of the future. ANZ J Surg. 2011;81:418–424. 8. Aggarwal R, Moorthy K, Darzi A. Laparoscopic skills

training and assessment. Br J Surg. 2004;91:1549– 1558. https://doi.org/10.1002/bjs.4816. 9. Ahlborg L, Weurlander M, Hedman L, et al. Individual-

17. Diener RB. Personal coaching as a positive interven-

tion. J Clin Psychol. 2009;65:544–553. https://doi. org/10.1002/jclp.20589. 18. Aggarwal R, Grantcharov T, Moorthy K, et al. An

evaluation of the feasibility, validity, and reliability of laparoscopic skills assessment in the operating room. Ann Surg. 2007;245:992–999. https://doi. org/10.1097/01.sla.0000262780.17950.e5. 19. Aggarwal R, Grantcharov T, Moorthy K, Milland T,

Darzi A. Toward feasible, valid, and reliable videobased assessments of technical surgical skills in the operating room. Ann Surg. 2008;247:372–379. https://doi.org/10.1097/SLA.0b013e318160b371. 20. Butvidas LD, Anderson CI, Balogh D, Basson MD.

ized feedback during simulated laparoscopic training:a mixed methods study. Int J Med Educ. 2015;6:93– 100. https://doi.org/10.5116/ijme.55a2.218b.

Disparities between resident and attending surgeon perceptions of intraoperative teaching. Am J Surg. 2011;201:385–389. https://doi.org/10.1016/j.amjsurg.2010.08.027.

10. Stefanidis D, Korndorffer JR, Heniford BT, Scott DJ.

21. Zigmont JJ, Kappus LJ, Sudikoff SN. Theoretical

Limited feedback and video tutorials optimize learning and resource utilization during laparoscopic simulator training. Surgery. 2007;142:202–206. https:// doi.org/10.1016/j.surg.2007.03.009.

foundations of learning through simulation. Semin Perinatol. 2011;35:47–51. https://doi.org/10.1053/ j.semperi.2011.01.002.

11. Groom R, Cushion C, Nelson L. The delivery of video-

based performance analysis by England youth soccer coaches: towards a grounded theory. Journal of Applied Sport Psychology. 2011;23:16–32. https:// doi.org/10.1080/10413200.2010.511422.

8

22. Club TSS, Moore MJ, Bennett CL. The learning curve

for laparoscopic cholecystectomy. Am J Surg. 1995;170:55–59. 23. Jung YK, Kwon YJ, Choi D, Lee KG. What is the safe

training to educate the laparoscopic cholecystectomy

Journal of Surgical Education  Volume 00 /Number 00  Month 2019

ARTICLE IN PRESS for surgical residents in early learning curve? J Minim Invasive Surg. 2016;19:70–74. 24. Kim SY, Hong SG, Roh HR, Park SB, Kim YH, Chae

GB. Learning curve for a laparoscopic appendectomy by a surgical trainee. J Korean Soc Coloproctol. 2010;26:324. 25. Jaffer U, Cameron AE. Laparoscopic appendectomy: a

junior trainee’s learning curve. JSLS. 2008;12:288–291. 26. Trehan A, Barnett-Vanes A, Carty MJ, Mcculloch P,

Maruthappu M. The impact of feedback of

Journal of Surgical Education  Volume 00 /Number 00  Month 2019

intraoperative technical performance in surgery: a systematic review. BMJ Open. 2015;5(6): e006759. 27. Sender Liberman A, Liberman M, Steinert Y, McLeod

P, Meterissian S. Surgery residents and attending surgeons have different perceptions of feedback. Med Teach. 2005;27:470–472. https://doi.org/10.1080/ 0142590500129183. 28. Bandura A, Locke EA. Negative self-efficacy and

goal effects revisited. J Appl Psychol. 2003;88: 87–99.

9