University Report: Deliberate Practice Effects on Surgical Proficiency

This report presents a comprehensive literature review investigating the effects of deliberate practice on enhancing surgical skills and technical proficiency. The study analyzes research articles from databases like CINAHL, MEDLINE, and SCOPUS, focusing on studies published after 2012. The review examines the impact of deliberate practice, virtual reality training, and simulation-based medical education on surgical performance. Key findings highlight the benefits of deliberate practice, including improved technical skills, increased surgical performance, and enhanced proficiency in laparoscopic surgery and other surgical procedures. The report emphasizes the role of structured training, feedback, and repetition in skill development, concluding that deliberate practice is crucial for medical professionals to continuously improve and deliver superior healthcare. The analysis also suggests the importance of virtual simulation environments for training, reducing surgical errors, and enhancing skill acquisition among both novice and experienced surgeons. The report underscores the need for continuous learning and the significance of simulation-based training to reduce risks and improve patient outcomes.

Running head: MEDICAL EDUCATION
Medical Education
Name of the Student
Name of the University
Author Note

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Deliberate practice related to any skills is used to refer to a special kind of practice that is
systematic and purposeful. Regular practice of any task involves mindless repetitions. However,
practicing a task deliberately requires more attention and focus. Its main goal is performance
improvement. It helps in maximizing the potential by turning the former into reality. Surgery
refers to medical specialties that utilize operative instrumental and manual techniques upon a
patient and investigates any serious pathological condition to improve body functioning
(Hambrick et al., 2014). Deliberate clinical practice fosters surgical skills by motivating learning,
providing detailed feedback and refinement opportunities. This report will include a literature
review that will illustrate the effect of deliberate practice in enhancing surgical skills and
technical proficiency.
The overall purpose of the literature review is to investigate the effects of deliberate
practice results in enhanced technical performance in an operation theatre. The research studies
were selected from databases like CINAHL, MEDLINE and SCOPUS. The inclusion criteria
included peer reviewed journals, published in English not before 2012. Studies published prior to
2012 were excluded. One study conducted by Palter & Grantcharov, (2014) used a blinded
randomized trial to assess the effects of deliberate practice on surgical skill improvements. 16
novice surgical residents were recruited to a deliberate practice group and conventional training
group. A video recording of laparoscopic cholecystectomy was done for both the groups. 3
assessment tools measured the technical performance of the residents. The trainees practiced a
task again if the scores were less than 60%. It was found that DP residents showed improved
technical skills post intervention (17.0 median score). Another study that assessed the effect of
deliberate practice on expert surgical performance recruited 15 junior residents and the practice
group was given 30 minutes of practice sessions between laparoscopic surgeries while, the

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control group read journals or viewed educational videos. On comparing the performance using
Mann-Whitney U test and Wilcoxon signed rank test it was found that the DP group showed
increased surgical performance in procedure-specific rating scale and global scale. However, the
control group did not show any significant improvement in procedure-specific rating scale. This
study provided evidence for the improvement in LC performance over many sessions
(Hashimoto et al., 2015). A randomized controlled trial was conducted to evaluate the effect of
virtual reality training on laparoscopic surgery that included 32 trainees who did not have any
experience of laparoscopic surgery. Proficiency based virtual reality simulation training was used
as the intervention. Laparoscopic salpingectomy training was provided to the participants and the
controls were subjected to standard education. On measuring the technical performance, the
simulator trained group showed a better median score of 33 points while, the control group
reached a score of 23 points. This study established that virtual reality simulator training
increases proficiency in laparoscopic surgery (Larsen et al., 2012).
Another study compared the effect of OSATS (Objective Structured Assessment of
Technical Skills) on the performance of two gynecology and obstetrics resident groups. Some
postgraduate students who underwent focused and deliberate training in hysteroscope assembly
and operative hysteroscopic polypectomy performed better when compared to the untrained
residents. Their global skills cores, resection and assembly time scores significantly improved
(Rackow et al., 2012). The effect of virtual reality training on improvements of ear, nose and
throat surgery was demonstrated by a study that used computer generated imagery as the
simulated training environment. A randomized control trial included 210 participants and
showed that virtual reality group performance significantly increased and displayed better
psychomotor score (mean difference -1.66, 95% CI 0.52-2.81; 10-point scale) and shorter time to

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complete the operation (mean difference-5.50, 95% CI 9.97-1.03). One particular study showed
that medical students who acquire anatomical knowledge by virtual training perform better
during surgeries than those who participate in conventional training (mean difference- 4.3, 95%
CI 2.05-6.55) (Piromchai et al., 2012). A meta-analytic comparative review assessed the effect of
simulation-based medical education (SBME) and traditional clinical education on skill
acquisition. The results showed that SBME with deliberate practice is more consistent and
powerful. SBME proved superior when compared to traditional clinical education for acquiring a
wide variety of medical skills. The study proved that a laparoscopic surgery, advanced cardiac
life support, hemodialysis catheter insertion, cardiac auscultation, central venous catheter
insertion and thoracentesis improves when residents participate in deliberate practice (McGaghie
et al., 2014).
A study conducted by Yudkowsky et al., (2013) evaluated the impact of simulation-based
practices on virtual brains on the performance of neurosurgery residents in live and simulated
neurosurgical procedures like ventriculostomies. CT scans were used to prepare a library of 15
virtual brains for haptic simulator, ImmersiveTouch system and head and hand-tracked
augmented reality. Linear mixed model was used to analyze the performance of the residents on
novel brains in the simulator and before and after surgery following intervention was analyzed.
Live procedure outcomes and simulator cannulation rates showed an increase after intervention
and improved procedural skills. Improved performance among 4th year medical students
compared to senior surgery residents was displayed by a study that assessed the impact of
deliberate practice dedicated instruction coronary anastomosis proficiency using a porcine heart
model. The participants were compared to non-simulator trained senior surgery residents.
Deliberate practice methodology was used for 4 months and the respondents were filmed during

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anastomosis by three cardiac surgeons. The median combined final scores suggested focused
simulator training improves technical proficiency compared to real-time training (Nesbitt et al.,
2013). Improvement of subarachnoid block performance on simulation based deliberate practice
was measured by a study. Half of 21 residents were randomized to receive deliberate practice
that included expert guidance, repetition and real-time feedback. The subarachnoid performance
of residents was tested on the next three patients in the operation theatre. It was found that the
intervention group showed significant improvement benefits from the deliberate practice training
(Udani et al., 2014).
Drawing inferences from the literature search it can be stated that medical professionals
need to continuously learn to deliver superior quality of health care. Life long learning, involves
continuous scrutinizing and building of real-time practice, which helps doctors to improve their
skills. Medical schools do not prepare a resident doctor completely for the challenging tasks,
responsibilities and long work hours at operation theatres. The fittest doctors survive by learning
from deliberate practice and implementing the learned outcomes while performing surgeries. On
the other hand, doctors who are not exposed to simulation based training fail to learn new aspects
of medicine and often become mentally and physically exhausted. This causes dissatisfaction,
surgical errors and burn out. The current restrictions imposed on working hours, shorter hospital
stay, changes in organization of healthcare and breakdown of medical firms make the situation
even worse and necessitate efficient learning from practice (Macnamara, Hambrick & Oswald,
2014). Deliberate practice acts as a highly structured training. It explicitly directs improvement
of performance in particular surgical domains. Such practices involve rigorous assessment of
skills, repetitive performance related to psychomotor and cognitive skills, providing regular
feedback and their implications on better skill performance. The specific tasks are designed in

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such a way that they assist in overcoming weaknesses. The performances after the training
carefully monitored, generally using video recordings. This provides cues to the doctors to
identify their drawbacks and achieve further improvement.
Thus, it can be stated that deliberate practice is not just a mindless repetition of certain
medical tasks. However, they associate training to a focused approach and motivate the
participants to reach a well-defined goal. Results from several research studies indicate that high
fidelity simulation mechanisms contribute to the development of novice junior medical
practitioners to experts during their undergraduate training in medicine. This leads to effective
performance. Real world exposure to wide range of surgical procedures may give the doctors an
idea of the events and challenges that might occur inside an operation theatre (Ericsson, 2015).
However, inadequate training may affect patient safety while participating in complicated
surgeries. Virtual simulation based environment therefore serve as an effective tool for training.
They reduce chances of failure or life-threatening risks. It can be deduced from the study results
that such practice trainings reduce the number of surgical errors and enhance the rate of skill
acquisition. Moreover, it helps healthcare practitioners to improve their planning strategies based
on the experiences and shortcomings they encountering while practicing surgery in a simulated
environment.
It not only helps novices and trainees who lack adequate experience in real-time surgical
context, but also assists experienced and professional surgeons to acquire more exposure to new
surgical procedures and become adept at learning new technologies before they can be
implemented on a patient in an operation theatre. It can be deciphered from the research studies
that have been conducted that practicing surgical activities attributes to an increase in focus and
awareness among students on the desired outcomes of the surgical intervention. This

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significantly enhances effectiveness of the practice (Weller et al., 2012). Thus, the medical
surgeons are able to refine their performance by utilizing these aspects of deliberate practice. On
interpreting the results if the research studies it can be concluded that the junior surgeons
gradually learn to make efficient use of their time, resources and energy while practicing in a
virtual hospital setting.
Routine practice is not just enough to enable the surgeons to gain better expertise. The
progress of surgeons also depends on their sustained efforts to enhance their performance by
identifying the specific targets that need improvement. Though, construction of a fully
immersive virtual operation theatre environment can be expensive, the advancements that they
produce in learning of surgical techniques are quite significant when compared to common
training methods. Hence, it can be concluded that clinical skill development can be facilitated by
making junior surgeons equipped with surgical skills through deliberate practice and not just by
experience.

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References
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(2014). Deliberate practice: Is that all it takes to become an expert?. Intelligence, 45, 34-
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Hashimoto, D. A., Sirimanna, P., Gomez, E. D., Beyer-Berjot, L., Ericsson, K. A., Williams, N.
N., ... & Aggarwal, R. (2015). Deliberate practice enhances quality of laparoscopic
surgical performance in a randomized controlled trial: from arrested development to
expert performance. Surgical endoscopy, 29(11), 3154-3162.
Larsen, C. R., Oestergaard, J., Ottesen, B. S., & Soerensen, J. L. (2012). The efficacy of virtual
reality simulation training in laparoscopy: a systematic review of randomized trials. Acta
obstetricia et gynecologica Scandinavica, 91(9), 1015-1028.
Macnamara, B. N., Hambrick, D. Z., & Oswald, F. L. (2014). Deliberate practice and performance in
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McGaghie, W. C., Issenberg, S. B., Barsuk, J. H., & Wayne, D. B. (2014). A critical review of
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Nesbitt, J. C., St Julien, J., Absi, T. S., Ahmad, R. M., Grogan, E. L., Balaguer, J. M., ... &
Putnam, J. B. (2013). Tissue-based coronary surgery simulation: medical student
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