Performance goals on simulators boost resident motivation and skills laboratory attendance

Abstract

Objective: To assess the impact of setting simulator training goals on resident motivation and skills laboratory attendance.

Design: Residents followed a proficiency-based laparoscopic curriculum on the 5 Fundamentals of Laparoscopic Surgery and 9 virtual reality tasks. Training goals consisted of the average expert performance on each task + 2 SD (mandatory) and best expert performance (optional). Residents rated the impact of the training goals on their motivation on a 20-point visual analog scale. Performance and attendance data were analyzed and correlated (Spearman's). Data are reported as medians (range).

Setting: General Surgery residency program at a regional referral Academic Medical Center.

Participants: General surgery residents (n = 15).

Results: During the first 5 months of the curriculum, weekly attendance rate was 51% (range, 8-96). After 153 (range, 21-412) repetitions, resident speed improved by 97% (range, 18-230), errors improved by 17% (range, 0-24), and motion efficiency by 59% (range, 26-114) compared with their baseline. Nine (60%) residents achieved proficiency in 7 (range, 3-14) and the best goals in 3.5 (range, 1-9) tasks; the other 6 residents had attendance rates <30%. Residents rated the impact of setting performance goals on their motivation as 15 (range, 1-18) and setting a best goal as 13 (range, 1-18). Motivation ratings correlated positively with attendance rates, number of repetitions, performance improvement, and achievement of proficiency and best goals (r = 0.59-0.75; p < 0.05) but negatively with postgraduate year (PGY) (-0.67; p = 0.02).

Conclusions: Setting training goals on simulators are associated with improved resident motivation to participate in a simulator curriculum. While more stringent goals may potentiate this effect, they have a limited impact on senior residents. Further research is needed to investigate ways to improve skills laboratory attendance.