Developing Interdisciplinary Models for Surgical Education (2025-2026)

Background

As technology has advanced and surgery has become highly subspecialized, residents face pressure to master an increasingly wide range of skills without exceeding their permitted work hours. The ability to master these skills is highly dependent upon the availability of high-quality feedback on their technical performance.

The American College of Surgeons has advocated for a transition to competency-based training with increasing feedback in the form of Core Entrustable Professional Activities, which describes tasks that trainees must be able to perform independently to further demonstrate mastery of required skills and knowledge. Currently, surgical educators have few validated metrics for assessing trainee skills. Most instruments rely on qualitative assessments of surgical skills, which can vary in reliability between evaluators and require significant time and resources.

The Duke General Surgery Residency has historically required an assessment of its residents across all five clinical training years in various components of technical skills. This assessment tested residents on their ability to use robotic tools for surgery, along with skills like tying knots and working with small instruments. However, these tests came without associated validation to show that the results correlated with clinical surgical proficiency. The assessments changed each year, limiting the ability to track individual improvement quantitatively, and residents did not receive feedback on their performance that could target specific skill development. This is a common trend across surgery programs and data on optimal strategies for assessing technical skills in an objective and validated way needs to be improved.

Project Description

This project team will work to develop high-quality assessment tools for surgical training on validated models that elucidate opportunities for improvement in technical skill acquisition. The team has created a core list of skills and assessments that can be used to assess general surgery technical skill competence in various domains, including open suturing and knot tying (sewing tissues and tying knots together during open surgeries), laparoscopic skills (conducting minimally invasive surgeries using small instruments and a camera), hand strength/dexterity and stress management. These assessments will be developed under the supervision of surgical education and simulation staff and faculty, including prototyping and testing high fidelity models and creating quantitative assessment tools.

Team members will assess the validity of assessment tools, including required models and metrics. The assessments will then be tested with content validation by core education faculty and validity will be constructed by scoring general surgery-interested medical students, a selection of residents and faculty. Team members will have the assessments linked to skills curricula to help improve any detected deficiencies and track re-assessment results.

Team members will break into two subteams – an engineering model team and a surgical education team. Members of the engineering model team will discuss and develop the technical elements of model design and generation. Members of the surgical education team will discuss the teaching method component of the project, including what is needed from the models and how to assess their performance.

Anticipated Outputs

Validated surgical training and assessment models; validation of novel assessment; conference presentations and publications; data collection for further research grants

Student Opportunities

Ideally, this project team will include 6 graduate students and 6 undergraduate students with interests in clinical medicine, model development, surgery, engineering, 3D printing, laser cutting, prototyping, education methodology, surgical training, education and performance assessment.

Engineering model subteam members will have the opportunity to engage with hands-on prototyping and development of models, assessment data collection, validation data analysis and assessment development. Surgical education subteam members will learn to define outcomes in surgical education and develop assessment tools for trainee technical skill performance. All students will learn the foundations of health professions education team leads.

Engineering Ph.D. students and surgical residents on the team will build their capacity for managing teams, leading scientific projects, communicating scientific findings and generating scientific manuscripts for dissemination in the engineering, surgical and education literature.

In Fall 2025, the team will meet on Mondays from 10:20 a.m.-12:50 p.m.

An optional part-time summer opportunity will also be available for team members, requiring 15-20 hours per week.

Timing

Summer 2025 – Summer 2026

• Summer 2025 (optional): Produce a literature review; begin model development; begin faculty recruitment for testing and data collection; recruit study participants from the Duke General Surgery Residency
• Fall 2025: Continue model development; recruit and test faculty; initiate the faculty bell curve development; test students and residents with available models; generate initial abstracts for presentation at local and state meetings for early feedback
• Spring 2026: Continue model development; recruit and test faculty; develop the faculty bell curve; test students and residents with available models; submit findings to national meetings in engineering, surgery and education, including Association for Surgical Education.
• Summer 2026 (optional): Develop manuscript of the models and assessment tools to be published for adoption at outside institutions (target journals include: Journal of Surgical Education, Global Surgical Education).

Crediting

Academic credit available for fall and spring semesters; summer funding available