The Sequence of Steps: A Key Concept Missing in Surgical Training—A Systematic Review and Recommendations to Include It

Victor Galvez-Yanjari, Rene de la Fuente (), Jorge Munoz-Gama and Marcos Sepúlveda
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Victor Galvez-Yanjari: Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
Rene de la Fuente: Division of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
Jorge Munoz-Gama: Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
Marcos Sepúlveda: Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile

IJERPH, 2023, vol. 20, issue 2, 1-13

Abstract: Background: Surgical procedures have an inherent feature, which is the sequence of steps. Moreover, studies have shown variability in surgeons’ performances, which is valuable to expose residents to different ways to perform a procedure. However, it is unclear how to include the sequence of steps in training programs. Methods: We conducted a systematic review, including studies reporting explicit teaching of a standard sequence of steps, where assessment considered adherence to a standard sequence, and where faculty or students at any level participated. We searched for articles on PubMed, EMBASE, CINAHL, Web of Science, and Google Scholar databases. Results: We selected nine articles that met the inclusion criteria. The main strategy to teach the sequence was to use videos to demonstrate the procedure. The simulation was the main strategy to assess the learning of the sequence of steps. Non-standardized scoring protocols and written tests with variable validity evidence were the instruments used to assess the learning, and were focused on adherence to a standard sequence and the omission of steps. Conclusions: Teaching and learning assessment of a standard sequence of steps is scarcely reported in procedural skills training literature. More research is needed to evaluate whether the new strategies to teach and assess the order of steps work. We recommend the use of Surgical Process Models and Surgical Data Science to incorporate the sequence of steps when teaching and assessing procedural skills.

Keywords: sequence of steps; teaching; assessment; procedural skills (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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