Introduction
The purpose of this qualitative descriptive study was to understand the experiences of surgical personnel in ambulatory surgical centers in the northeastern part of the United States who learn new, advanced medical-surgical technology through in-services, on-the-job training, and the associated acquired level of skill competency. The aim was to learn how surgical personnel perceive their skill level or competency with medical-surgical technology following this type of training. The training approach addressed in the research is generally defined as operating room training which emphasized on the application of theoretical knowledge and the professional practice of operating room personnel.
Problem Statement
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 involves a lack of understanding of the experiences of surgical personnel attending in-services to learn new, advanced medical-surgical technology (Jaffe et al., 2017; Romeo, 2016). The deficiency exists due to learning curves (Acton, 2013b; Deutsch et al., 2015; Jaffe et al., 2017; Moore et al., 2015; Panait et al., 2014; Romeo, 2016; Stanford et al., 2015), and among other reasons, the delivery pattern used to train staff in surgical medical technology (Gallagher et al., 2014). Some researchers have determined that less than half (36%) of endoscopy trainees self-reported their skill level as proficient (Stanford et al., 2015). Reportedly, inexperienced trainees may perform more than 180 procedures before they can be considered competent (Ekkelenkamp et al., 2016). New surgical technologies require different skill sets than traditional open surgery once required (Stanford et al., 2015). Learning new skills and becoming competent with advanced technology is a necessary part of surgical success.
Significance of the Study
The information garnered from the responses of the operating room personnel and surgeons 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. This study’s results might also provide the insights necessary to develop guidelines for curriculum development for medical training. They can also aid in educational efforts to assist surgeons and operating room personnel in maintaining advanced technology competency.
Numerous researchers examined the effectiveness of training in the operating room or “the value of delivering a theater induction curriculum” (Patel et al., 2012, p. 266). Studies focusing on training in using the advanced equipment in the operating room in specific surgical procedures (Ekkelenkamp et al., 2016) are negligible. By extending the understanding of operational room personnel’s experiences regarding the continual learning of new technology, the current study aims to reduce the existing gap in the body of knowledge.
This study also sheds light on the means of enhancing knowledge and skill, as well as the associated hazards (Matern & Koneczny, 2007, p. 1965). The surgeons and the operating room team’s responses offer robust, informative insight on the effectiveness of training in advanced surgical technology for those who have experienced both types of training: in-service and on-the-job training. The research might also help leaders develop “a strong motivation” among the staff to use new technology (Christensen, 2013, p. 251). Gordon et al. (2012) also expected a rapid improvement in the use of new equipment and nontechnical skills as well as in the success of surgeries. This descriptive study’s findings can clearly understand the most efficient and effective means of training operating room personnel.
Research Questions
Research questions allow for rational analysis by guiding the development of the study. This study aimed to learn surgical staff’s experiences in using advanced surgical technologies in terms of settings and frequency of use. This study was also intended to describe staff willingness to use their knowledge and skill to contribute to operating room efficiency, staff knowledge-sharing willingness, staff job satisfaction, patient safety, and patient satisfaction. Under investigation was the participants’ overall commitment to contributing to the development of the healthcare facility by improving technology-associated policies and procedures. The purpose of the research study was to pursue and explore the following research questions:
- RQ 1: How do surgical personnel describe their experience of learning new, advanced medical-surgical technology through in-services at ambulatory surgical centers in the northeastern United States?
- RQ 2: How Do Surgical Personnel at Ambulatory Surgical Centers Experience On-the Job Training to Learn to Use New, Advanced Medical-Surgical Technology?
Conceptual Framework Foundations
The theoretical basis for this study is Knowles’ (2015) theory of andragogy. As adult education became more widespread in the 1980s in the United States, Knowles articulated the differences between teaching children and teaching adults. Definitely, Knowles was one of the first to discuss the factors influencing adult education, and ever-since, a host of theorists and practitioners have extended or refined the theory of andragogy to reflect the several forms of delivery found in adult education.
Applying the Knowles theory of andragogy to the present study aids in understanding how the surgical staff is experiencing surgical education to increase comprehension and skill in the use of advanced technological instrumentation in the operating room. Correspondingly, the current study aimed to address the following research problem: Lack of understanding of the experience of surgical personnel in ambulatory surgical centers in the northeastern United States attending in-services training to learn new medical-surgical technology. In-services training can assume multiple and disparate forms from seminars and workshops to on-the-job training. Irrespective of the form of training, the principles of andragogy were applied to the study construct. To conduct this study, the researcher needed to consider and address a multidimensional paradigm and gather relevant descriptions from a sample of surgeons and surgical staff. The study framework is based on Knowles’ (2015) theory of andragogy.
Definition of Terms
The following operational definitions have been used interchangeably throughout the study:
- Andragogy. The sibling philosophy (and practice) to pedagogy, andragogy is the philosophy and practice of teaching and learning for adults (Knowles, 2015).
- Competence/competency. Competence was and to some extent still is defined by the achievement of a specified number of procedures as determined, measured, and assessed by experts (Dubé & Rostom, 2016; Tassios et al., 1999).
- Effective. While effective is a highly subjective adjective, a procedure is considered effective when it results in the intended optimum outcome—when it is efficient, safe, and satisfactory for both surgical staff and patients (Tomlin et al., 1999).
- Efficiency. Efficiency in surgical contexts involves the extent to which the work performed is most useful and least wasteful given the time spent and the effort expended (Alfredson & Isaksson, 2014; Deutsch et al., 2015; McLaughlin, 2012
- Learning curve. The learning curve is the time and number of repetitions required to achieve an acceptable (proficient) outcome of the given task (Moore et al., 2015; Sood et al., 2015; WHO, 2010).
Results
The presentation of the results is organized by research questions with the presentation of results related to each research question, and the results from the analysis of the open-ended questionnaire items are organized by theme. In details and simply arranged, the results from close-ended questionnaire items are presented separately under the related research questions.
RQ1: How Do Surgical Personnel Describe Their Experience of Learning New, Advanced Medical-Surgical Technology Through In-Services at Ambulatory Surgical Centers in the Northeastern United States? The results are presented terms of the research questions, which results in different themes. The essence of using both research questions and themes was to explore the findings from each question which provides a better focused study outcome.
Surgical professionals were asked to describe how their in-service training regarding advanced medical technology. The results were entered in table 3, which shows that lack of follow-up was the most frequently cited shortcoming of in-service training. Lack of motivation, inappropriate methods, and inappropriate curriculum were cited by fewer than half of the participants. Participants’ open-ended responses provided clarifications on the close-ended responses.
Table 3. Response Frequencies for Shortcomings and Drawbacks of In-Service Training.
Lack of follow-up was the most frequently cited shortcoming of in-service training. Lack of motivation, inappropriate methods, and inappropriate curriculum were each cited by fewer than half of the participants. Participants’ open-ended responses provided some clarification of the close-ended responses.
All 11 participants provided responses to this questionnaire item. One theme was identified in the responses to the item.
In-Service Training Should Be Focused and Reinforced
Participants’ responses to the open-ended item were consistent with their responses to the close-ended item presented in Table 4. Overall, the seven participants who recommended follow-ups for trainees indicated that the follow-ups should be scheduled in advance by the manufacturers’ training representatives, should be conducted in person at the hospital, and should have the purpose of assessing trainee competence with the equipment in order to retrain if necessary. P3 described this area for improvement in stating: “Follow-up will help increase competence. The company or manufacturer can schedule follow-up after each training as continuing education for better outcome.” P10 stated, “There should be scheduled dates for the reps [training representatives] from the manufacturers to come in for follow-ups and possible retraining.” P6 recommended that responsibility for arranging follow-up lie with the equipment manufacturer and that the purpose of follow-ups be to ensure training effectiveness, stating, “The manufacturer should always schedule follow up training to ensure efficiency of the staff in handling the equipment.”
The six participants indicating that in-service methods and curriculum were inappropriate conflated the intended curriculum with the method of teaching it. Overall, the six participants indicated that should be made to convey the relevant curriculum more clearly rather than to change the intended training content. P1 suggested that training presentations were often unfocused and off-topic in stating that needed improvements were, “Go to the point, talk about the focus instrument or the equipment only. Teach with the right media.” P4 also alluded to experiences of unfocused training in stating, “Sometimes the equipment is not discussed in the training session.” P2 alluded to experiences of unclear presentations resulting from inadequate media in recommending that future in-service training should, “Always use media that will have clear visual and audio.”
RQ2: How Do Surgical Personnel at Ambulatory Surgical Centers Experience On-the-Job Training to Learn to Use New, Advanced Medical-Surgical Technology?
Two questionnaire items were relevant to answering the second research question. Table 4 indicates the response frequencies for the research question.
Table 4. Response Frequencies for Shortcomings and Drawbacks of On-the-Job Training.
Team disturbances and rushed training were the most frequently cited drawbacks of on-the-job training. Ineffective trainers and low productivity were each cited by fewer than half of the participants. Participants’ open-ended responses included some elaboration of the close-ended responses.
Experienced Teaching and Learner Attentiveness Should Be Promoted in On-the-Job Training
Six out of 11 participants indicated that a needed improvement for more effective on-the-job training strategies was to provide adequate time for the training. The responses related to the need for adequate time complemented the response “rushed training” in the drawbacks to on-the-job training strategies listed in Table 5. P3 referred to a need for adequate training time in stating, “They should allocate more time.” P7 expressed the same perception in recommending, “They should give more time for training.” P10 stated, “There should be enough time allocated for the training.”
Six out of 11 participants indicated that a needed improvement for more effective on-the-job training strategies was to maintain trainee focus on the curriculum. The responses related to the need for adequate time complemented the response “team disturbances” in the drawbacks to on-the-job training strategies listed in Table 5. P5 indicated a need to prevent team disturbances during training in stating, “All staff members must take training seriously and not try to socialize during training.” P2 indicated that trainees’ personal communications were also a source of disturbance in stating, “All employees participating in the training must be cautioned about cell phone use.” P8 indicated that trainers should take active steps to encourage trainee attentiveness: “All team members must be discouraged from socializing during training.” P6 suggested that strict enforcement of prohibitions against socializing during on-the-job training would be needed in recommending, “Strict handling of training time and participants.”
Four out of 11 participants indicated that a needed improvement for more effective on-the-job training strategies was to use more experienced trainers. The responses related to the need for adequate time complemented the response “ineffective trainer” in the drawbacks to on-the-job training strategies listed in Table 5. P2 recommended, “The on-the-job training team must deliver the training using a well-experienced employee.” P10 expressed a similar recommendation in stating, “The training should be conducted by the most experienced staff member.” P9 referred to experienced trainers as “well-versed” in recommending, “Personnel providing on-the-job training should be well-versed and show complete competence.”
RQ3: How Do Surgical Personnel Describe the Effect of Learning New, Advanced Medical-Surgical Technology Through In-Services and/or On-the-Job Training with Respect to Their Self-Described Confidence in Their Skill?
Five questionnaire items were relevant to answering the third research question. Three themes were identified in the responses to the three open-ended questions. Responses to the two close-ended items are presented at the end of the discussion of the third research question because both items asked participants to reference responses presented in this chapter under Theme 5.
Multiple Training Formats Are Effective in Building Confidence
Participants cited four training formats that they believed would be effective in increasing operating room staff’s confidence in their skill. Four participants (P2, P3, P4 and P7) recommended daily in-service training before procedures in responses that included, “Daily in-service prior to procedures” (P5) and “Daily reminder training before procedures” (P7). Three participants (P1, P5, and P6) recommended “online training,” with P5 specifying, “Online live training.” Three participants (P1, P10, and P11) recommended prerecorded video training, with responses including “Prerecorded video is always useful for playbacks” (P11) and “Prerecorded training will work” (P10). Two participants (P8 and P9) recommended training involving and reinforcing teamwork, with the responses including “Teamwork and trust-building activities” (P9) and “Peer training” (P8).
In-Service and On-the-Job Training Increase Staff Confidence and Competence
All 11 participants indicated that, when done correctly, in-service and on-the-job training were both effective in enhancing staff’s confidence and competence. P3 described both forms of training as effective when physicians applied themselves, stating, “Working hard both with on-the-job training and in-services makes one a competent physician.” P9 said of the combination of both forms of training, “It increases confidence and competency.” P5 stated that the combination of both forms of training was, “The best way to learn as you are handling human lives. It helps increase comfortability.”
Six participants referred specifically to the use of both in-service and on-the-job training as improving competence in the form of performance. P2 stated that both training strategies, “Help improve job performance.” P6 stated that the two training strategies both contributed to, “Better outcomes and quality service.” Two participants (P1 and P8) referred to productivity, a type of job performance, in stating that both training strategies contributed to, “Increased productivity.”
Hands-on, On-the-Job Training Is the Most Effective in Increasing Confidence and Competence
Eight out of 11 participants indicated that on-the-job training was more effective at increasing staff’s confidence in their skill than in-service training because it was hands-on and involved experienced instructors. P11 stated, “The most effective training in my experience is the on-the-job training.” P5 stated, “On the job daily training” was the most effective, and P1 stated, “On-the-job training is better.” P3 referred to instructor effectiveness in stating, “On-the-job training is very effective as it is taught by [an] experienced staffer.”
Three participants indicated that hands-on training was the most effective strategy, whether it was delivered in an in-service or on-the-job format. P10 expressed this perception in stating that the most effective strategy 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.” P6 expressed a similar perception to P10’s in stating that the most effective strategy was, “Hands-on training, during either on-the-job or in-services.”
Close-Ended Responses Complementing Theme 5
Two close-ended questionnaire items were relevant to the third research question, and specifically to complementing the responses assigned to Theme 5. The first of the two relevant close-ended items was: Do you believe that the aforementioned [in responses assigned to Theme 5] training process of in-services training available to the staff members are sufficient to prepare you for your role/s, especially as you often encounter crucial circumstances and manage complicated medical equipment in your daily tasks? All 11 participants selected the answer “Yes.”
The second of the two relevant close-ended items was: Do you believe that the aforementioned [in responses assigned to Theme 5] training process of on-the-job-training available to the staff members are sufficient to prepare you for your role/s, especially as you often encounter crucial circumstances and manage complicated medical equipment in your daily tasks? All 11 participants selected the answer “Yes.” The relevance of the affirmative responses to these two close-ended items was that all 11 participants perceived the training strategies they believed were optimal as sufficient to prepare them for their roles.
Chapter Summary
Three research questions were used to guide this study. The first research question was: How do surgical personnel describe their experience of learning new, advanced medical-surgical technology through in-services at ambulatory surgical centers in the northeastern United States? Findings indicated that participants experienced the drawbacks of in-service training as including, in descending order of frequency, lack of follow-up, lack of motivation, inappropriate methods, and inappropriate curriculum. Participants recommended that in-service training should be focused and reinforced, specifically by through the trainer’s focusing on the most relevant curriculum instead of digressing and through the trainer’s following up with trainees in person to assess training effectiveness and retrain if necessary.
The second research question was: How do surgical personnel at ambulatory surgical centers experience on-the-job training to learn to use new, advanced medical-surgical technology? Findings indicated that participants experienced the drawbacks of on-the-job training as including, in descending order of frequency, team disturbances, rushed training, ineffective trainers, and low productivity. In open-ended responses, participants recommended that a prohibition against socializing and cell-phone use during training be implemented and enforced, that adequate time be scheduled to cover the curriculum, and that only experienced trainers be used.
The third research question was: How do surgical personnel describe the effect of learning new, advanced medical-surgical technology through in-services and/or on-the-job training with respect to their self-described confidence in their skill? Findings indicated that multiple training formats are effective in building confidence, including daily in-service training prior to procedures, online training, prerecorded videos, and teamwork and trust-building activities with peers. Findings further indicated that both in-service and on-the-job training increase staff confidence and competence. Lastly, findings indicated that hands-on, on-the-job training is the most effective in increasing confidence and competence. All 11 participants indicated that training which was on-the-job and/or hands-on would adequately prepare them to perform their duties. Chapter five is the final chapter of the study, it comprises of the discussion of findings, the interpretation of results, and the implications of the outcomes, the conclusion and recommendations of the current research. The chapter includes discussion, interpretation, and implications of these findings.
Limitations
In order to complete the study within the scheduled time, this study used a small sample size thus making it difficult to generalize the results of the study to the larger population. The sampled participants’ diversity is not equitably distributed across the team roles. The participant numbers of CRNAs and occupational therapists were less in comparison to other team representatives. Also, the subjective nature of the study data might be considered a limitation. Since individual perceptions dominate in responses, the findings of the research are influenced by the subjective views of the personnel. Another limitation to this study is lack of reliable data available thus forcing the researcher to limit the scope of the study and sample size thus making it difficult to make quality conclusions regarding the research problem. Additionally, existing studies on the research problem are scares making it difficult to lay a foundation for the phenomenon under investigation.
Recommendations to Leaders and Practitioners
The problem addressed in this study is the lack of understanding of the experiences of medical personnel engaged in training for technology use. Several recommendations have been made basing on the results of this study. First, the leaders of healthcare facilities should create and implement quality on-the-job training sessions, as well as employ more qualified experts and trainers in order to enhance the knowledge and experience of surgical personnel. As identified by this study, effective training programs will improve patient outcomes and the incorporation of new technologies in the healthcare system. Since one of the reported challenges among the surgical personnel in this study was the lack of motivation, the second recommendation is for leaders to establish goals and establish rewards for progress towards the goals. The goal of healthcare organizations is to incorporate new technologies in their operations to improve the patient outcomes. Therefore, introducing rewards for clinicians who help organizations achieve this goal will improve the skills and experience of the healthcare providers. Healthcare leaders need to implement benefits for personnel who attend training and demonstrate positive results. As for the practitioners, multiple training formats are effective in building confidence. As found by this study, healthcare organizations have to implement multiple training methods which enhance the skills and experience of the practitioners. These methods include in-service training method, online training, and prerecorded training.
Recommendations for Future Research
This research project will serve as a solid ground for future research in the domain of technology-based training for surgical staff. Since the field of technology training in the surgical domain is relatively scarce, extensive investigation of the issues related to the topic is encouraged. This qualitative descriptive study has presented observational data concerning the most frequently observed problems in the effectiveness of training strategies. Basing on the findings of this study, it is recommended that future researchers to explore the same topic under study but using a larger sample size in order to increase the generalizability of the findings. During the progress of this study, two areas emerged which require further research in the future. These areas include new trends in the healthcare industry affecting surgical personnel and the most appropriate strategy of adopting technologies in healthcare. In-depth analysis of these areas will provide quality information that will improve the quality of training in medical-surgical settings.
Conclusions and Recommendations
The current study investigated the intersection between educational methods to train staff on medical technology in the surgical setting. The study has provided valuable evidence according to perceived effectiveness of the currently available training system for operating room professionals and the possible ways of eliminating problematic issues for improved experience and better patient outcomes. With the purpose of understanding the experiences of surgical personnel in ambulatory surgical centers in the northeastern part of the United States who learn new, advanced medical-surgical technology through in-services and on-the-job training their acquired level of skill competency was analyzed. In order to garner this understanding, the study explored how medical personnel involved in operating room performances perceive their skill level, in terms of technology usage. The research also sought to understand medical personnel’s perceptions of educational forms, techniques, and outcomes as used in modern health care facilities. This final chapter reiterate research questions to discuss how they have been answered during the research. The findings of this qualitative descriptive study are presented and followed by the discussion of the study’s limitations. Finally, recommendations for leaders and practitioners, as well as implications for future research are addressed.