Introduction
There was a total of 14.4 million surgical procedures performed across the United States in hospital operating rooms within inpatient stays in 2018 (Healthcare Cost and Utilization Project, 2021). Annually, on average, one out of 25 people is admitted for surgery of some type. Focused training needed to be acquainted with the current technological trends relevant to their specific surgical fields. This study’s focus was to develop an in-depth knowledge of the experiences of surgical staff regarding training and education in advanced surgical technology.
Findings of this study were consistent with Allsbrook and Quiros (2021); surgical personnel and other clinicians depend on on-the-job training to advance their knowledge and skills in the field. On-the-job training varies, depending on the proficiency and knowledge level of the trainers (Chandler et al., 2020). Sachdeva (2019) suggested that on-the-job training should follow a structured list of activities, the areas to be covered, the total time required to complete the training, and the performance standards to be achieved
This study was consistent with Pradarelli et al. (2020), who shared that the connection between performance and individual development is essential among surgical personnel. Training should not be limited to recruits; making cross-function training a standard healthcare practice will enhance clinicians’ performance. Scholars and practitioners have addressed the need and value of modern technologies. The advancement in technology has resulted in increased need for medical attention and procedures. A deficiency in learning curves, among other reasons, has been studied to contribute to a lack of advanced education and training in operating room medical technologies (Namin et al., 2020). Knowledgeable, skilled, and competent operating room staff should be willing to try, use, and even recommend or approve new technologies (Mayol, 2021).
Studies by Augestad et al. (2017) conclude that surgical staff must engage in such practices to achieve efficiency and maintain patient safety. These outcomes can be achieved by standardized, anticipatory knowledge of operating room preparation, set-up, patient preparation, surgical procedure, and recovery plans. Surgical technology training and supports might maximize the efficiency of surgical procedures and assure or improve patient safety and satisfaction. Research is available on the need for ongoing education; however, there is little to no research on the experience of surgical staff attending training and in-service (Augestad et al., 2020). The advancement of medical and surgical technologies has brought forward the need for more effective training and education mechanisms to achieve competency for surgical staff. The research problem involved a lack of understanding of the experiences of surgical personnel attending in-services to learn new, advanced medical-surgical technology (Augestad et al., 2020). The deficiency exists due to learning curves (Abbott et al., 2019) and the delivery pattern used to train staff in surgical medical technology.
Research on the competencies of surgical staff exists, yet no specific research into the most effective education and training to accommodate different learning curves to achieve surgical competency using new surgical technologies are available (Epstein et al., 2019). Researchers should determine which education and training are most effective in attaining surgical staff competencies with new surgical support technologies. Maintaining a standard of excellence for graduating surgical residents requires a comprehensive and consistent pattern of surgical education (Geary et al., 2019). The same expectation applies to achieving and sustaining competency, efficiency, and knowledge-sharing efforts for all surgical staff using advanced surgical technologies.
Focusing on the population responsible for surgical care in accredited hospitals and ambulatory centers in the northeastern United States, the general population included surgeons, anesthesiologists, CRNAs, and surgical technologists. Eleven participants were used to obtain a manageable number of responses. According to the U.S. Bureau of Labor Statistics, in the year 2019, there are 7330 surgeons, 4340 anesthesiologists, 24320 surgical technologists, and 8550 CRNAs in the Northeastern United States. This study population is 44,540 health professionals engaging in surgical procedures in the northeastern part of the United States.
The study sample consisted of a total of 11 participants who met the inclusion criteria for the research. Inclusion criteria included:
- Experience working in a surgical center in the last three years;
- Attended in-services on new technologies for at least two different modalities;
- Could speak meaningfully about the advantages and disadvantages of face-to-face training or a technology-based form of delivery.
The information garnered from the responses of the operating room personnel based on their perceptions and experiences of various forms of educational delivery is critical in formulating the needed interventions. This study may add clarifying insights into the learning experience. The results might also provide insights necessary to develop guidelines for curriculum development for medical training and aid in educational efforts to assist the surgical team in maintaining advanced technology competency.
Methods
Use of the qualitative method enables the researcher to interpret the construct, or phenomenon, of focus—training approaches for operating room staff competency of new medical-surgical technologies—through the perspective of a holistic group who experiences the phenomenon—anesthesiologists, CRNAs, and surgical technologists. A qualitative method permits the understanding of complex phenomena from the perspective of the participants’ experiences rather than fixed categories and quantities, characteristic of quantitative methodology (Silverman, 2020).
The purpose of adopting a qualitative descriptive study was to understand the experience of surgical personnel in the northeastern part of the United States who learn the most current, advanced medical-surgical technology as a result of in-services and on-the-job training to acquire skill competency for successful outcomes. The research problem was the lack of knowledge and procedural skills that existed with the use of new operating room medical technology (Zhao et al., 2019). This study has been conducted to narrow the existing gap in training on advancing medical technology.
Literature Review
Technology in Surgical Training
Recent literature on the use of technology in surgeon training has focused on the potential benefits of integrating new and advanced technology into training programs. Advancements in technology and restriction of surgical work hours have made the use of simulations, virtual reality, robotics, telemedicine, and gaming much more common in surgical training (Mao et al., 2021). Simulation technology, the most frequently discussed technology, has been shown to have benefits for both robotic-assisted and non-robotic surgical training. Other technologies, such as telecollaboration and video game technologies, have also been shown to be beneficial.
With advances in surgical technologies, such as minimally invasive surgical procedures including colonoscopies, endoscopies, laparoscopies, and laser surgery, steeper or more significant learning curves require additional or diverse training approaches to meet the needs of operating room staff. The learning curve refers to the time and number of repetitions required to achieve an acceptable outcome of the given task (Mayol, 2021). Education and training necessary for surgical technological advancements have also advanced to shorten or support the steep learning curves towards maintaining efficiency and patient safety concurrently. Such instruction includes training devices for surgeons to use robotic operating systems, surgical simulators, such as box trainers for laparoscopic surgery, animal models, virtual reality surgical simulators, and full procedural simulators.
Minimally invasive surgical methods and technology development in health care have become intermixed, as the two factors often proceed together. While a standardized form of surgical training does not yet exist, surgical activity that integrates technology is becoming one of the more sought-after learning methods (Jackson, 2020). The presence of traditional surgical training, coupled with e-learning, may provide an experience that improves the overall surgical training process. Consequently, surgeons and the health care industry alike are constantly seeking innovative technologies that may improve the dynamic of the operating room (Haddad & Horriat, 2019).
Discussion and Implications
Surgical Team Training
On policy, during the first decade of the 21st century, residency work-hour limits and the rise of competency-based assessment have transformed the way surgeons are trained (Gauvin et al., 2021). Assessment of surgeons includes using a more stringent admissions process to select the best-qualified applicants for patient care (Association of American Medical Colleges, 2021). This transformation to a stricter assessment process aimed to prepare medical professionals who understand the dynamic nature of the health care industry and are prepared to respond to the fluid and diverse demands of health care positively. The health care industry’s focus on bolstering nationwide surgical training methods has progressed explicitly over the first two decades of the 21st century (Pottle, 2019).
Between 2000 and 2020, many residents studying surgery had decided to further their studies by partaking in subspecialty training following their residency period for general surgery (Marcadis et al., 2020). Despite the ongoing trend, some directors of fellowship programs have vocalized feelings regarding the unpreparedness of their students for the fellowship experience. Adding, surgical professionals must undergo training to adapt to the ever-changing nature of the health care industry. These changes include the maintenance and care of disease, the move toward minimally invasive surgery and nonsurgical procedures, and a cap on work hours.
Despite demonstrated benefits of advanced surgical technologies, operating room medical technology frequently does not meet the needs of health care providers and patients (Bedoll et al., 2021). Such technology has become insufficient to address the requirements of patients and doctors solely, as financial restrictions deem implausible for some institutions, particularly those with low economic status, to obtain specific medical devices (Moro Visconti & Morea, 2020). A need exists for new educational approaches to address training operating room staff on advanced surgical technology to ensure that health care providers maximize the benefits of these devices when applicable, leading to improved provider and patient satisfaction (Kyaw et al., 2019).
Educational Benefits of Surgical Training Programs
Advancement in surgical technology, such as robotically assisted surgical devices, has necessitated new surgical competency measures that allow physicians evaluation for preparedness in evolving operating room environments (U.S. Food and Drug Administration, 2021). Surgical training programs mitigate learning curves for surgeons using both non-robotically assisted and robotically assisted surgical technologies. The emergence of global surgery has led to residency programs that integrate international surgical knowledge into students’ training, particularly concerning clinical setting with inadequate resources (Glynn et al., 2020). The evident and lack of fundamental training for surgeons in the rapidly developing industry calls for significant concern and the need for more profound research in surgical technologies.
Surgical training programs are designed to acclimatize surgical residents with the practice of procedures and operations under the guidance of a supervising surgeon (Rickard et al., 2019). Residents must undergo formal training that provides instructions based on skill acquisition and safety measures before conducting the procedures independently (Kawka et al., 2021). Proper training of residents is particularly relevant because the incidence of robotic surgery has proven to increase exponentially over the past ten years, and by 2018, robot-assisted operations take 15.1% of all general surgeries (Kelly, 2020). The more years of training that residents undergo, the greater the quality of performance. Surgeons with outstanding attributes have more autonomy in practice.
More than 1.7 million procedures were performed utilizing the da Vinci Surgical System – a specific surgical robot used to make minimal incisions–as of 2018 (Koh et al., 2018). The robotic surgery training process can be divided into patient-side training and console training (Wang & Ambani, 2021). Another venue for educating health professionals in advanced technological surgical equipment is virtual medical reality. Javaid and Haleem (2020) suggest introducing virtual medical reality can provide students and surgeons with scenarios as they prepare for the actual work. Not only does it signify the use of sophisticated medical equipment, but it also follows the ideas of the theory of andragogy in adult learning. The lack of operating room working knowledge and procedural skill(s) or procedurally based competency with medical technology and deficiency results from lengthy learning curves (Augestad et al., 2020). Insufficient advanced operating room medical technology education or training may yield negative results.
Lack of Knowledge about Effective Surgical Training Methods
Research has shown that surgeons lack self-awareness about how they learn (Augestad et al., 2020). Practicing surgeons use various training methods when learning new procedures and technologies, though there is an evident disconnect between commonly used training methods and those deemed most effective (Augestad et al., 2020). The disconnect is further enhanced by the transition from traditional surgical procedures to robotically assisted techniques. Tom et al. (2019) argued that surgeon-oriented training programs should integrate more educational concepts, such as adult learning theories, due to a lack of pedagogical attention in surgical training.
Benefits of Simulation on Surgeon Training
Simulators reproduce situations in a virtual setting that prospective surgeons will encounter in their vocational experience (Schmiederer et al., 2021). Students can benefit from exposure to surgical simulators designed to train laparoscopic motor skills necessary for successful outcomes. Substantial advantages have been witnessed in surgical residents who underwent training utilizing virtual reality simulators (Schmiederer et al., 2021). Surgical residents can utilize various virtual reality simulators in training, including box trainers, low-to-high fidelity systems, virtual reality systems, and systems using models of live animals. Virtual reality programs can provide an array of benefits, beginning with acquiring transferable skills to skills required in the operating room setting (Tom et al., 2019).
Simulation-based training for robotic-assisted surgery offers a range of benefits to trainees, including acquiring relevant skills needed to attain surgical competency, improved accuracy, and alternatives to older training methods. Simulation training provides surgical residents with practicing a surgical procedure repeatedly until they achieve precision (Tom et al., 2019). Simulation allows residents to often perform these surgical tasks in a virtual space where mistakes do not merit human harm.
Results
In-Service and On-the-Job Training Increase Staff Confidence and Competence
Surgical personnel increase their confidence through in-service and on-the-job training. This study has shown that on-the-job training addresses the weakness of the employees and strengthens the necessary skills to provide better performances. A development program helps surgical personnel to bring their skills and experiences to a higher level, thus reducing weak links in the organization (Nasser & Chung, 2020). Consistency in performances is always one of the essential elements of healthcare organizations’ policies and procedures. Surgical personnel need to understand the expectations of their organizations. The study was consistent with Epstein et al. (2019), stating that training creates a supportive environment, improves workers’ confidence, concluding that in-service and on-the-job training boost surgical employees job satisfaction.
On-the-job training gives individuals hands-on experience in their duties at the workplace (Sachdeva, 2019). Participants indicated that, when done correctly, in-service and on-the-job training effectively enhance staff’s confidence and competence. Participants indicated that hands-on training was the most effective strategy, whether delivered in an in-service or on-the-job format. Some participants expressed this perception, stating that the most effective method was “Hands-on training, which is mostly acquired with all types of training modes as long as staff members are allowed to work on the instruments and or equipment at the time of training.”
Drawbacks Impacting In-Service and On-the-Job Trainings
Surgical personnel use different techniques to enable surgical personnel to process and apply information (Yang, 2019). These techniques include clinical simulations, case-based learning, and feedback. Repetitive interventions improve learning outcomes and equip individuals with experience in handling patients in critical conditions. This study suggests that the choice of an effective in-service training technique improves the knowledge and skills of surgical personnel. Participants elicited the perceived methods of solving the detected problems. Addressing these shortcomings, the participants identified timely training by qualified staff and minimizing distractions as the most important. An accord with the minimization of distractions and resolving the issues since appropriately chosen time and place for training would facilitate the learning process.
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