Is participation enough? Impact of simulation curriculum structure on performance of basic surgical skills

Abstract Purpose The optimal strategy for curricular construction and feedback implementation, both critical for skill acquisition, is unknown in the simulation curricula setting. To address this gap, we examined the impact of individual components of our basic surgical skills curriculum on intern performance. Methods The basic surgical skills curriculum consists of skills lab sessions, self-recorded “homework” exercises graded with a score and narrative feedback, and a scored final assessment. Using linear regression, we assessed the association between assessment performance (scores) and four other curricular components (skills lab attendance, homework submission, homework scores, and receipt of feedback on homework). Narrative feedback quality was graded by three raters for relevance, valence, and specificity. Pearson’s r was used to calculate the association of each feedback variable with the assessment score. Results Among the 71 (73%) surgical interns who completed the curriculum, for each additional homework assignment that received structured feedback, assessment score increased by 0.54% ( p < 0.001; effect size 0.16). For each percentage point increase in homework score, assessment score increased by 0.21% ( p = 0.02; effect size 0.07). Pearson’s r revealed significant correlations between assessment score and relevant feedback (r = 0.26, p = 0.02), relevant feedback and corrective feedback (r = 0.70, p < 0.001), and between relevant and specific feedback (r = 0.74, p < 0.001). Relevant feedback comments were not correlated with reinforcing feedback (r = 0.01, p = 0.47). Conclusions Our findings reiterate the value of practice when accompanied by relevant feedback. We identified a default to providing lower-quality reinforcing feedback and higher-quality corrective feedback. Future feedback training may yield positive results.