Massachusetts Chapter of the American College of Surgeons

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Formal leadership curriculum for surgical fellows: Assessing non-technical skill acquisition
Ingrid M. Ganske, MD MPA1, David N. Williams, MA PhD2, Peter M. Waters, MD MMSc(Ed)2
1Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA and Harvard Medical School 2Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA and Harvard Medical School

Background: Non-technical surgical skills are as important as technical proficiency, yet rarely formally taught. In 2018, a leadership curriculum was initiated for orthopedic, plastic, urologic and otolaryngologic subspecialty fellows. This study summarizes our assessment of non-technical skills acquired during the course.
Methods: Students in the 2019-2020 leadership course were administered clinical vignettes (ie incorrect consent form, patient with excessive bleeding) at the beginning and the end of the course. They were requested to define the problem and describe how they would respond as an attending surgeon. During the course, monthly group discussions with the department chiefs of the participating specialties covering topics such as self-awareness, leadership styles, and included case studies as well as simulated practice sessions. The clinical vignette responses were compared from pre- to post-course by a faculty member (IMG) and behavioral biostatistician (DNW), rating answers based on the Non-technical Skills for Surgeons (NOTSS) system.
Results: Ten respondents completed 50 vignettes. Seven responses were disqualified because the student answered the wrong question or simply copied the pre-test answer. Of the 43 vignettes scored, 24 (56%) demonstrated “good” post-course improvement and 19 revealed only minor differences. Fifty-six unique enhancements in responses were noted and spanned all categories: Leadership (41%), Situational Awareness (30%), Communication (25%) and Decision Making (4%).
Conclusion: CONCLUSION: In aggregate, surgical fellows’ nontechnical skills improved over the year, as quantified from pre- and post-course evaluations. Future studies are needed to compare skill development in fellows who are and are not enrolled in the leadership curriculum.


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