C1 - 11: ATTENTION SELECTIVITY AND AUTOMATICITY PREDICT SIMULATOR ACQUIRED SKILL TRANSFER TO THE CLINICAL ENVIRONMENT
Nicholas E Anton, MS1, Tomoko Mizota, MD1, Lisa D Howley, PhD2, Lava Timsina, PhD1, Jake Whiteside1, Erinn Myers, MD3, Dimitrios Stefanidis, MD, PhD1; 1Indiana University School of Medicine, 2Association of American Medical Colleges, 3Carolinas HealthCare System
Background: Simulation-based skills training of surgical trainees promotes robust skill acquisition outside the operating room and is becoming the norm in US training programs. Several studies demonstrate, however, that the transfer of simulator-acquired skill to the operating room is incomplete. Identification of trainee characteristics at baseline that influence skill transfer may be important for curriculum design, allow for more focused training, and help optimize transfer of skills and clinical performance. Our objective was to determine baseline trainee characteristics that impact the transfer of simulator acquired surgical skill to the operating room.
Methods: Surgery residents voluntarily enrolled in this IRB-approved study and completed a comprehensive baseline assessment including assessment of intracorporeal suturing (IS) performance on a box trainer, an objective assessment of attention (d2-test), self-reported use of performance enhancing mental skills (Test of Performance Strategies; TOPS) and self-reported prior clinical and simulated laparoscopic experience. Residents then followed proficiency-based laparoscopic skills training in IS and their skill transfer on the same task was assessed on a live-anesthetized Nissen fundoplication porcine model. The predictive nature of the aforementioned baseline characteristics for IS performance during the transfer test were assessed using multiple linear regression.
Results: Thirty-eight residents completed the study. Their average age was 29.7±3.7 years, 47% were women, and average PGY was 2.1±1.1. D2 test subscale scores for attentional selectivity (p = 0.01), and TOPS automaticity subscale (p = 0.02) were significantly predictive of IS performance during the transfer test. The number of prior laparoscopic cases the resident had performed and assisted with, perceived laparoscopic ability, and previous simulator experience approached significance or were significantly correlated with transfer test performance (all p values < 0.10).
Conclusions: This study identified attentional selectivity and automaticity at baseline as good predictors of resident simulator-acquired skill transfer to clinical performance. Prior clinical experience remains a very important predictor of performance during transfer. Using interventions that promote attention selectivity and focus on learner automaticity may help improve the transfer of simulator acquired skill. Mental skills training and training to automaticity may therefore be needed interventions to achieve this goal.