Diastolic Learning: Making the Tacit, Explicit

Introduction: Surgery is a motor skill that has to be learnt through practice. The acquisition of motor skills and the principles are well documented especially in sport. Deliberate practice is the engagement in structured activities created specifically to improve performance in a domain and requires feedback. The experience needed to become an expert can be helped in the early stages of training with deliberate practice and observation by a skilled trainer. The aim of this project is to establish whether a combination of low fidelity simulation models and deliberate practice can reliably predict achievement of basic surgical skills competency. Video based scoring was used to quantify progress. Methods: We recruited thirty junior doctors and medical students with minimal exposure to surgery. They were provided with appropriate instruments and materials. They were given a demonstration of low fidelity simulation models, principles of needle handling and feedback on their first attempts. An initial video was taken. Subsequently they were given specific exercises to practice at home. They were reassessed after a period of one week and a second video was taken. Results: The participants were scored on four parameters: Time/pace, flow/rhythm, precision, rotation. There was significant improvement on all four parameters in twenty-eight out of thirty participants. This ranged from 18.9% (time) to 40% (flow). Conclusion: This project has enhanced our knowledge and practice in surgical education and training. Our work provides evidence on how low-fidelity simulation models can reliably be used to achieve significant progress through early stages of the learning curve. Furthermore it demonstrates the principles that need to be observed in order for deliberate practice to be effective and efficient in acquisition of surgical skills.