Evidence-Based Effective Teaching Behaviors for Complex Psychomotor Skills Training

Introduction: Although the research to operating room teaching is extensive, evidence relating surgical teachers’ behaviors to trainees’ objective complex psychomotor skills acquisition is limited. We aimed to identify objectively evidence-based teaching behaviors in hands-on training associated with increased complex psychomotor skills in surgical and non-surgical trainees. Methods: The MEDLINE, PsycINFO and ERIC databases were searched for relevant papers. Due to comparable training characteristics to complex surgical skill acquisition, papers on sports and music training were also included. Paper screening took place after training sessions with the inclusion and exclusion criteria. Inter-rater reliability was determined. Data were extracted and the quality of studies was assessed with the Medical Education Research Study Quality Instrument (MERSQI) and the Newcastle-Ottawa Scale-Education (NOS-E). Results: 18,337 references were identified. Seven studies were included. Teaching behaviors shown to improve trainees’ objective skills acquisition included feedback, instruction, active trainee involvement and demonstrations. Feedback and instruction with an external focus on the task and effect were supported by the strongest evidence. There was significant evidence regarding negative effects of harshly criticizing and belittling teaching behaviors. The data quality and evidence for most teaching behaviors were weak with low impact levels. Discussion: Feedback, instruction, active trainee involvement and demonstrations are important for the hands-on teaching of complex psychomotor skills. However, strong evidence supporting their effectiveness is lacking. Future research should be directed on investigating the relationship between clearly defined teaching behaviors and the objective acquisition of complex skills in surgical trainees.