Gathering Dust—Resistance to Simulator-based Deliberate Practice in Microsurgical Training

Abstract

Abstract Background Despite unrestricted access to a simulated microsurgery model, learners have not consistently self-regulated their learning by completing practice. This paper explores the lived experience of learners regarding how practice is perceived and why it is resisted. Methods A qualitative study was conducted, including recorded and transcribed focus groups and semistructured interviews. First and second pass coding was conducted by one reviewer, with feedback from another. Transcripts were analyzed with a constant comparative approach customary to thematic analysis. Theory was engaged to help explain and support the findings.The study was undertaken at the University of Calgary plastic surgery residency training program in Calgary, Alberta, Canada, involving 15 informants (9 residents and 6 surgeons). Results Four themes emerged: (1) barriers to practice, (2) motivation to practice, (3) owning learning/solutioning, and (4) expectations of practice. Competing priorities and time constraints were barriers. Motivation to practice ranged from extrinsic (gaining access to the next course) to intrinsic (providing optimal patient care). Learners described a range of ownership of learning and depth of effort at solutioning of practice opportunities. Learners expressed high expectations around model fidelity, ease of setup, and feedback. Learners self-regulating their learning, with surgeons acculturating practice at work, can overcome some barriers. As per self-determination theory (SDT), learners need explicit linkage to how the task aligns with their goals. Assessment may be required to motivate learners. In respect of adult learning theory, homework needs to be allocated by a respected trainer. Modeling simulation practice may encourage adult learners. Finally, the tenets of deliberate practice (DP) need to be explained in order that learners can optimize their practice time. Conclusion Microsurgical simulation practice is valued but barriers exist that invite resolution. Assisting residents to overcome barriers, maintain motivation, take ownership, and assimilate DP will help improve their microsurgery practice.