Teaching First or Teaching Last: Does the Timing Matter in Simulation-Based Surgical Scenarios?
published online 05 July 2010. Corrected Proof
Objective
The optimal timing of instruction in simulation-based scenarios remains unclear. We sought to determine how varying the timing of instruction, either before (teaching first) or after (teaching last) the simulation, affects knowledge outcomes of surgical trainees.
Design
We conducted a pretest/posttest crossover study in which fourth-year medical students and general surgery residents (PGY 1–3) participated in 3 instructional modules, each repeated twice in consecutive weeks: endocrine surgery (sessions 1 and 2), trauma resuscitation (sessions 3 and 4), and team training (sessions 5 and 6). Each session comprised 3 cases, each involving a prescenario briefing, a simulated scenario, and a postscenario debriefing. The timing of instruction varied between sessions. For the teaching-first sequence (sessions 1, 4, and 6), participants received a lecture during each prescenario briefing. In the teaching-last sequence (sessions 2, 3, and 5), trainees received an identical lecture during the postscenario debriefings. We assessed attitudes and knowledge using a postsession survey and identical 10-question multiple-choice tests at the start (pretest) and end (posttest) of each session, respectively. The mean differences in knowledge scores between groups were analyzed with repeated-measures analysis of variance (ANOVA).
Results
Forty-nine participants (11 medical students and 38 surgical residents) attended at least 1 session, providing 76 observations. Mean pretest scores were equivalent (p > 0.05). The change in scores from pretest to posttest varied between the 2 groups (p = 0.002). The mean posttest score was 8.24 (standard error [SE], 0.29) for the teaching-last group and 6.68 (SE, 0.27) for the teaching-first group (mean difference, 1.56; 95% confidence interval, 0.79–2.33). Both teaching-last and teaching-first group participants preferentially rated debriefings and scenarios, respectively, as the better learning experience.
Conclusions
Participants who received instruction after simulated scenarios achieved higher mean knowledge scores than those who received instruction before simulated scenarios. Cognitive overload, stress, or activation of prior knowledge could all be involved as causal mechanisms.
⁎Department of Surgery, College of Medicine, Mayo Clinic, Rochester, Minnesota
†Mayo Clinic Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota
‡Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota
§Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota
Correspondence: Inquiries to David R. Farley, MD, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905; fax: (507) 284-5196
Supported by Grant 1 UL1 RR024150 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and by the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH.
ABSTRACT