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Ward Simulation to Improve Surgical Ward Round Performance: A Randomized Controlled Trial of a Simulation-Based Curriculum

Pucher, Philip H. BSc, MRCS*; Aggarwal, Rajesh MA, PhD, FRCS*,†; Singh, Pritam MSc, MRCS*; Srisatkunam, Tharanny BSc*; Twaij, Ahmed BSc*; Darzi, Ara KBE, FRCS, FACS*

doi: 10.1097/SLA.0000000000000557
Randomized Controlled Trial

Objective: This study aimed to investigate the effects of a simulation-based curriculum for ward-based care on ward round (WR) performance.

Background: Variability in surgical outcomes does not relate to surgical skill alone. Prevention, diagnosis, and treatment of peri- and postoperative morbidity are dependent on provision of high-quality ward-based care. The focal point of this is the surgical WR. Although WR conduct is learned primarily through experience, a simulated environment and validated assessment tools may enable measurement and enhancement of WR quality.

Methods: Junior surgical residents were randomized either to a half-day educational intervention with lectures, structured feedback, and debriefing, or to standard practice (control). All conducted a standardized, validated, simulated WR of 3 patients. Surgical Ward Care Assessment Tool and W-NOTECHS rating scales were used for technical and nontechnical skills assessment, respectively, and compared between groups. Subjects completed pre- and posttest confidence questionnaires and feedback forms.

Results: Twenty-nine trainees were randomized to intervention (n = 14) or control (n = 15). Baseline confidence and demographics were equal between groups. Intervention group demonstrated better patient assessment: 63.5 ± 8.1% (control) versus 79.8 ± 11.9% (P = 0.002), management 56.0% ± 19.7% versus 72.2 ± 10.3% (P = 0.014), and nontechnical skills: W-NOTECHS 17.75 ± 2.06 versus 23.33 ± 1.21 (P < 0.001). Hundred percent of subjects felt that the curriculum improved their practice.

Conclusions: Conducting WRs is a crucial skill but not currently subject to formal training. Implementation of a comprehensive curriculum for surgical WRs led to significant improvement in quality of patient assessment, management, and nontechnical skills. Improved WR performance may lead to earlier identification and amelioration of complications and improve patient outcomes.

Surgical ward rounds are critical to the provision of surgical care, although not subject to formal training. Residents randomized to a simulation-based curriculum for ward-based care demonstrated improved ward rounds quality and nontechnical performance. This may lead to earlier identification and amelioration of complications and improved surgical outcomes.

*Department of Surgery and Cancer, Imperial College London, London, United Kingdom; and

Department of Gastrointestinal Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Reprints: Philip H. Pucher, BSc, MRCS, Department of Surgery and Cancer, St Mary's Hospital, 10th Floor QEQM Building, Praed St, London W2 1NY, United Kingdom. E-mail:

Supported by a grant from the Simulation Technology-enhanced Learning Initiative (STeLI), London Deanery, United Kingdom.

This study was presented at the Surgical Forum of the American College of Surgeons Clinical Congress, Washington, DC, October 2013.

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.