Surgical Education Module Improves Operative Proficiency in Endoscopic Carpal Tunnel Release: A Blinded Randomized Controlled Trial of Trainees

• Published in: Journal of surgical education 2018-03, Vol.75 (2), p.442-449
• Main Authors: Kempton, Steve J., Salyapongse, A. Neil, Israel, Jacqueline S., Mandel, Benjamin A.
• Format: Article
• Language: English
• Subjects: carpal tunnel; Carpal Tunnel Syndrome - surgery; Clinical Competence; Decompression, Surgical - instrumentation; Decompression, Surgical - methods; Education, Medical, Graduate - methods; Endoscopy - methods; Female; hand surgery; Humans; Internship and Residency - methods; Male; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; resident education; simulation; Simulation Training - methods; Single-Blind Method
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2017.08.004

The purpose of this study is to evaluate whether an interactive endoscopic carpal tunnel release (ECTR) surgical education module can improve knowledge of surgical indications and improve procedural competency. An ECTR education module was developed and trainees at various level of training were enrolled and randomized to surgical module and nonmodule (control) groups. Subjects were instructed that they would be the primary surgeon performing an ECTR. A written assessment was administered before and after module completion or independent case preparation to test comprehension of the procedure. The senior author evaluated each subject’s intraoperative performance using a 5-point scoring system. Statistical analysis was performed using chi-square and paired t-tests. This study took place at a tertiary care hospital at the University of Wisconsin. In all, 30 subjects were tested (15 surgical module and 15 nonmodule). There were no differences in prepreparation test scores between groups. Postpreparation test scores following use of the module were significantly higher compared to the nonmodule group. The average operation performance scores for the surgical module group and nonmodule group were 96% and 82%, respectively. The surgical module group performed significantly better on all operative steps except for dressing application. Surgical module subjects without prior ECTR experience (n = 7) had operative scores that were significantly higher than those for nonmodule subjects without previous ECTR experience (n = 8) (95% vs. 75%). There was no difference in operative scores between surgical module subjects with no prior experience (n = 7) and nonmodule subjects who had performed at least 1 prior case (n = 7) (95% vs. 89%). The use of an ECTR surgical education module demonstrates a significant benefit in ECTR-naïve subjects. When compared to subjects with previous ECTR experience, ECTR-naïve subjects trained using the surgical module demonstrate better familiarity with the equipment and equivalent performance of the procedure.