Learning Theory Foundations of Simulation-Based Mastery Learning

Computer Simulation Training for Mandibular All-on-Four/All-on-Three Surgery

Mandibular all-on-4 implant reconstruction techniques are less complex than maxillary but more complex than routine dental implant surgery, requiring advanced technical skills, deeper understanding of prosthodontic principles, and more complex surgical planning. Surgical simulation may assist experienced surgeons seeking to acquire new skills through increased planning ability, improved intraspecialty communication, and enhanced technical competence. Achieving competence is different for the trainee devoted to the learning process and the practicing surgeon with limited time and balancing other roles and responsibilities. Well-constructed continuing education incorporating simulation, 3-dimensional printed models, and computer-assisted planning may offer the most efficient path to competence.

Ensuring basic competency in chest tube insertion using a simulated scenario: an international validation study

Introduction

Chest tube insertion can be associated with serious complications. A structured training programme is needed to minimise complications and enhance patient safety. Novices should pass a reliable test with solid evidence of validity before performing the procedure supervised on patients. The aim of this study was to establish a credible pass/fail standard.

Methods

We used an established assessment tool the Chest Tube Insertion Competency Test (TUBE-iCOMPT). Validity evidence was explored according to Messick’s five sources of validity. Two methods were used to establish a credible pass/fail standard. Contrasting groups’ method: 34 doctors (23 novices and 11 experienced surgeons) performed the procedure twice and all procedures were video recorded, edited, blinded and rated by two independent, international raters. Modified Angoff method: seven thoracic surgeons individually determined the scores that defined the pass/fail criteria. The data was gathered in Copenhagen, Denmark and Riyadh, Saudi Arabia.

Results

Internal consistency reliability was calculated as Cronbach’s alpha to 0.94. The generalisability coefficient with two raters and two procedures was 0.91. Mean scores were 50.7 (SD±13.2) and 74.7 (SD±4.8) for novices and experienced surgeons, respectively (p<0.001). The pass/fail score of 62 points resulted in zero false negatives and only three false positives.

Discussion

We have gathered valuable additional validity evidence for the assessment tool TUBE-iCOMPT including establishment of a credible pass/fail score. The TUBE-iCOMPT can now be integrated in mastery learning programmes to ensure competency before independent practice.

Problem-based learning for anesthesia resident operating room crisis management training

BACKGROUND

Senior anesthesia residents must acquire competency in crisis management for operating room (OR) emergencies. We conducted problem based learning (PBL) OR emergency scenarios for anesthesia residents, focused on emergencies in 'Airway', 'Circulation', 'Central venous catheter', and 'Pain management complications'. Non-technical skills are an integral component of team-based OR emergency management.

METHODS

Prior to integrated OR emergency clinical and non-technical skills PBL training, participating 35 anesthesia residents completed two 5-point scale surveys regarding frequency of emergency experiences in the operating room, and self-confidence for anesthesia-related crisis management. Repeat administration of the self-confidence survey was completed immediately following PBL training.

RESULTS

Post-PBL resident clinical management self- confidence improved (P<0.05) in all scenarios on Circulation, Central venous catheter, and Pain treatment related complication topics. Impossible intubation, impossible oxygenation, and awake intubation did not show significant difference following PBL.

CONCLUSION

Our findings suggest that PBL for OR emergency management can improve resident self- confidence in anesthesia residents.