Role of Instruction Method in Novices' Acquisition of Minimally Invasive Surgical Basic Skills

Abstract

We investigated the impact of instruction method on novices' acquisition of minimally invasive surgical (MIS) basic skills. One hundred five novice medical students underwent text-based (TB), video-based (VB), or faculty-tutored (FT) single-session instruction in three basic MIS skill tasks on a box trainer. Pre- and postsession, participants completed a 12-item, 5-point Likert-type scale (1=Not confident at all, 5=Completely confident) of self-efficacy for performing basic MIS skills and had performances on each task recorded. Four raters evaluated every video performance of one task, a two-handed peg transfer, using a 16-cm visual analog measurement (VAM). Inter-rater reliability was good (intra-class correlation coefficient=0.82). The relationship between instruction method, self-efficacy mean score change, and mean VAM change was examined using ANOVA analysis. Eighty-five participants (TB=32, VB=24, FT=29) had valid matched data. Mean scores in self-efficacy and task performance increased from pre- to postsession for every instruction method: (1) Δ self-efficacy=1.04±0.64 (TB), 1.36±0.69 (VB), and 1.41±0.82 (FT); (2) Δ VAM=3.77±2.87 (TB), 3.82±2.35 (VB), and 2.57±2.60 (FT). Analysis of variance revealed no relationship between instruction method and self-efficacy (P=.10) or VAM mean score change (P=.14). Self-directed instruction methods (e.g., TB and VB) for novices' acquisition of MIS basic skills offer flexible, learner-centered, and cost-effective alternatives to the more expensive FT method.