It is important to improve the efficiency of resident education and surgical feedback in an impactful way. As health care delivery changes and hospitals put more emphasis on generating revenue, physicians’ time becomes increasingly constrained. There is increased financial pressure for departments to do more and individual surgeons to get more cases done in a day. This time pressure limits the ability of surgeons to spend time teaching and giving feedback, impacting the residents’ ability to learn. There is great need for a more efficient means of giving residents surgical feedback to optimize their learning. Now with the Covid-19 pandemic further exacerbating the situation, making the learning process as efficient as possible is more important than ever.
Making learning more efficient is hard to do. To be valuable, feedback has to be informative and timely. It is not helpful for a resident to find out they performed well or poorly on a case three months ago. To make learning efficient, they need feedback on every case immediately so they can apply that information to the next case of that type. Most surgeons offer immediate feedback in the operating room, talking the resident through the operation. Most residents will only remember one or two points; this surgical feedback combined with bi-annual reviews with the program director constitutes much of the operative feedback residents receive. These reviews, temporally remote from the operation are subject to recency bias and are perhaps not accurate.
Ideally, every resident should receive timely feedback regarding his/her performance on every procedure. Progress should be trackable by the resident and the program. Incorporation of such an assessment tool into the daily workflow requires the tool to be easily accessible. Present day assessment tools developed by the various surgical subspecialties tend to be difficult to access and/or time-consuming, and poor compliance.
A new mobile device application, SIMPL (System for Improving and Measuring Procedural Learning), has been developed by a nonprofit consortium of surgical training programs to address these challenges. We have published our experience with this application in World Neurosurgery (https://www.sciencedirect.com/science/article/abs/pii/S1878875020303247). This two-way tool application tracks resident performance, operative autonomy and case complexity. In addition, it allows for short dictated feedback that can be accessed outside of the operating room. SIMPL has been evaluated in general surgery-training programs, and has shown to be feasible, reliable and valid with strong interrater reliability. Now, over 93 training programs across 11 surgical specialties use it.
Currently, a number of neurosurgery programs have at least six months’ experience with this tool. At the University of Michigan, this application is used for both instant and dictated feedback. A composite analysis of these evaluations is provided in summary to each resident biannually. The feedback is vital to the resident; it should provide both quantitative and qualitative assessment of each trainee’s surgical experience.
In addition to affording immediate feedback, this tool may offer insight into neurosurgical training, providing answers to the following questions:
Graduating residents are proficient at which operations? With which do they struggle? What case volume predicates surgical autonomy? Answers to these questions will serve to improve neurosurgical training.
