Role of Operative Reports in Surgical Learning and Memory: A Randomized Controlled Trial.

Abstract

To evaluate the effect of operative report documentation on surgeons' ability to remember procedural steps. We conducted a randomized controlled trial of obstetrician-gynecologist trainee and attending surgeons at University of Pittsburgh Magee-Womens Hospital. During the learning phase, participants were guided through a 50-step procedure that used a Montessori lockbox, lighted switchboard, and simple tools. After the procedure, participants were stratified by training level and block randomized to one of three writing exercises: control, templated operative report, and freestyle operative report. During the testing phase 1 week later, participants were asked to complete the procedure from memory. The primary outcome was the testing phase performance score (out of 100 possible points), and secondary outcomes include operative report accuracy, procedure time, predicted future performance, and perceived influence of documentation. Forty-eight participants were randomized to 16 participants per group, with 0% dropout. Completion of a templated or freestyle operative note resulted in significantly improved performance during the testing phase (control: mean 50.9, SD 13.6; template: mean 60.9, SD 11.9; freestyle: mean 62.1, SD 13.3; P <.05). In addition, participants who completed an operative report completed the procedure more quickly than those in the control group ( P <.05). Operative report accuracy during the learning phase was significantly correlated with testing day performance ( P <.005). Although the majority of participants who completed an operative report perceived that the documentation had a positive influence on their performance, this did not translate into differences in the perceived difficulty of the task or in their predictions for testing day performance. Operative report documentation significantly improved surgeons' procedural memory and task completion time 1 week after learning a new procedure. Trainee-written operative reports may be one means of promoting surgical memory and learning, and formal operative report education should be incorporated into surgical training programs.