Methods - The study design is prospective nonrandomized comparison of training of surgical skills in two groups (CEVL-naïve vs. CEVL aware).
Briefly, the CEVL method is as follows. First, a CEVL e-learning is created as a multimedia online interactive instructional module that guides the resident step by step through the procedure as performed by the local institution. Next, residents access CEVL to study the procedure during on or off duty hours. They suffice an online surgical readiness test prior to surgery. Skill performance scores (Likert ratings 1-7) drive the provision of feedback and remediation. To permit intergroup statistical comparisons the performance score was scaled (0-100) then modulated for both case difficulty (1-5) and the percentage of the procedure the resident performed as the lead surgeon. CEVL modules show face and content validity being judged as realistic and a useful educational tool by residents.
Performance of Sleeve Circumcision: From 9/1/11 to 4/10/12 residents were evaluated on their performance after each sleeve circumcision as either CEVL naïve (before 1-31-2012) or CEVL aware (after 2-1-2012). The CEVL naïve group prepared for circumcision using traditional methods; the CEVL aware group accessed CEVL to prepare for circumcision. All residents were informed that their performance was being evaluated. For each case done one author (BP) assessed performance of the 10 procedure components and an inventory of 7 general surgical abilities. Attainment of training “proficiency” was defined as a score of > 80% and of “skilled” as > 90%.
Results - All Urology residents (7) enrolled in the study performed 62 circumcisions (PGY 2=1, PGY 3=50, and PGY 4=11). Overall, the CEVL aware group showed a higher score (mean=92.7) vs. CEVL naïve (mean=79) (t(48)=5.35, p<0.0005). Additionally, subgroup analysis of PGY3 residents shows scores of the CEVL aware PGY3 residents was significantly higher (mean=92) than the CEVL naïve subgroup scores (mean=78) (t(43)=5.26, p<0.0005). Training as assessed by attainment of proficiency and skill required fewer cases for CEVL aware group than the CEVL naïve group (mean=1 vs 11.2 cases for proficiency and 2.6 vs 15 cases for skill acquisition, respectively).
Conclusion - We show resident utilization of a CEVL module to prepare for sleeve circumcision improves training as demonstrated by significantly higher surgical performance scores and fewer cases performed in order to attain proficiency and skill. We propose further research using the CEVL method will help develop “gold standards” to train pediatric urology residents to do surgery.