Fann JI, Sullivan ME, et al. Teaching behaviours in the cardiac surgery simulation environment. J Thorac Cardiovasc Surg.2013 Jan;145(1):45-53.Epub 2012 Oct 23.

PMID: 23098747

Abstract

OBJECTIVE:
To understand how teaching behaviours contribute to simulation-based learning, we used a 7-category educational framework to assess the teaching behaviours used in basic skills training.

METHODS:
Twenty-four first-year cardiothoracic surgery residents and 20 faculty participated in the Boot Camp vessel anastomosis sessions. A portable chest model with synthetic graft and target vessels and a tissue-based porcine model simulated coronary artery anastomosis. After each 2-hour session on days 1 and 2, residents assessed teaching behaviours of faculty using a 20-item questionnaire based on the 5-point Likert scale. After session on day 1, faculty completed a self-assessment questionnaire. At 3 months, faculty completed self-assessment questionnaires regarding teaching behaviours in simulation and clinical settings. Each questionnaire item represents 1 or more teaching categories: "learning climate," "control of session," "communication of goals," "promoting understanding and retention," "evaluation," "feedback," and "self-directed learning."

RESULTS:
Generally, resident ratings indicated that faculty showed positive teaching behaviours. Faculty self-assessment ratings were all lower (P < .025) than those assigned to them by the residents except for 1 component representative of "feedback," which approached significance (P = .04); 2 items, representative of "promoting understanding and retention" and "evaluation", had mean scores of less than 3. At 3 months, compared with self-assessment at Boot Camp, faculty ratings suggested improved teaching behaviours in their simulation settings in the following: "learning climate," "control of session," "communication of goals," "promoting understanding and retention," and "evaluation." The simulation environment was perceived as more positive for technical skills training in certain aspects compared with clinical setting: instructor reviewed function and operation of equipment with learner before session (representative of "promoting understanding and retention") and instructor allowed the learner ample time to practice (representative of "control of session" and "promoting understanding and retention") (P < .025).

CONCLUSIONS:
Simulation-based skills training is perceived by residents to be associated with positive teaching behaviours. Faculty self-ratings indicate that they do not always use many of these teaching behaviours and that their performance can be improved. The simulation setting may provide greater opportunity for positive teaching behaviours compared with the clinical environment.