Applying Deliberate Practice to Plastic Surgery Residency Training

Abstract

INTRODUCTION: To assess the impact of K. Anders Ericsson’s theory of deliberate practice1 on resident education by evaluating procedure times of breast reconstruction utilizing transverse rectus abdominis myocutaneous (TRAM) flaps. METHODS: TRAM flap breast reconstruction cases with resident participation at the Moffitt Cancer Center from 2009-2011 were retrospectively reviewed. Residents were trained according to the deliberate practice didactic model over their four-month rotations and trained along a continuum of increasing resident independence.2, 3, 4 Operative times were assessed and categorized into the 1st, 2nd, 3rd, and 4th months of the rotation to determine improvement in operating room efficiency. RESULTS: A total of 75 cases (n=75) met inclusion criteria. The median procedure duration for the 1st, 2nd, 3rd, and 4th months was 5.63 hours, 5.17 hours, 4.93 hours, and 4.80 hours, respectively. While the decline in procedure time during the four-month interval was not statistically significant (p=0.2440), the correlation coefficient for operative times for these cases over the four months was significant (r=0.25, p=0.048) (Table 1, Figure 1).Table 1: Procedure duration of TRAM cases categorized by month of four-month rotation. The median procedure duration decreased during each of the month-long blocks, but the results were not signification (p=0.2440).Figure 1: Duration in OR (hours) versus training months. The black line represents all cases, whereas unilateral cases are in red and bilateral cases are in green. The correlation coefficient was -0.25, which is represented by the slope of the black line. The correlation coefficient was significant (p=0.048).CONCLUSION: This study marks the first application in the surgical literature of the theory of deliberate practice to a complex skill set. The data shows a decrease in operative times over each month interval of the residents’ rotations. Further evaluation is warranted to determine whether this didactic model can be formalized and accelerate the acquisition of the complex skill set required for breast reconstruction.