1
|
McCarrick CA, Moynihan A, Khan MF, Lennon F, Stokes M, Donnelly S, Heneghan H, Cahill RA. Impact of Simulation Training on Core Skill Competency of Undergraduate Medical Students. JOURNAL OF SURGICAL EDUCATION 2024; 81:1222-1228. [PMID: 38981819 DOI: 10.1016/j.jsurg.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Simulation based medical training (SBMT) is gaining traction for undergraduate learning and development. We designed, implemented, and independently assessed the impact of an SBMT programme on competency in surgical history taking and clinical examination for senior clinical students. METHODS With institutional ethical approval and initial pilot study of student volunteers that ensured format appropriateness, we implemented an SBMT programme weekly for ten weeks during the core surgery module of our Medicine degree programme. Groups of 5 students collaboratively undertook an observed focused history and physical examination while simultaneously directing care on a simulated surgical patient (actor) with acute abdominal pain. This was conducted in a nonclinical, standardised, tutor-supervised environment and followed by a group debriefing led by both the simulated patient and tutor discussing student interaction and competency. All students undertook Southampton Medical Assessment Tool (SMAT) on a surgical inpatient prior to (baseline) and within 2 weeks after SBMT. Students without simulation training functioned as a control group and randomized cluster sampling was utilised for group selection. Second assessments were by independent surgical academics blinded to student group. Feedback was collected via anonymous questionnaire from those who undertook SBMT. RESULTS One hundred students took part, fifty of whom undertook SBMT. Global mean SMAT scores were similar between the control and intervention group at baseline (p > 0.05). Scores on the second assessment were significantly higher (p = 0.0006) for those who had undertaken SBMT vs. controls; 94% of students taking SBMT reported benefit via questionnaire with 85% stating increased confidence in history-taking and 78% reporting improved abdominal examination. CONCLUSIONS Undergraduate simulation training at scale is feasible and positively impacts undergraduate student core task competency.
Collapse
Affiliation(s)
- Cathleen A McCarrick
- Department of Surgery, School of Medicine, University College Dublin; Department of Surgery, Mater Misericordiae University Hospital
| | - Alice Moynihan
- Department of Surgery, School of Medicine, University College Dublin; Department of Surgery, Mater Misericordiae University Hospital
| | - Mohammad Faraz Khan
- Department of Surgery, School of Medicine, University College Dublin; Department of Surgery, Mater Misericordiae University Hospital
| | - Finbar Lennon
- Department of Surgery, School of Medicine, University College Dublin
| | - Maurice Stokes
- Department of Surgery, School of Medicine, University College Dublin; Department of Surgery, Mater Misericordiae University Hospital
| | - Suzanne Donnelly
- Department of Surgery, School of Medicine, University College Dublin; Department of Surgery, Mater Misericordiae University Hospital
| | - Helen Heneghan
- Department of Surgery, School of Medicine, University College Dublin
| | - Ronan A Cahill
- Department of Surgery, School of Medicine, University College Dublin; Department of Surgery, Mater Misericordiae University Hospital.
| |
Collapse
|
2
|
Graef SE, Karimi N, Xu M, Petropoulos JA, Ngo QN, Bilgic E. What is the impact of simulation-based training for paediatric procedures on patient outcomes, cost and latent safety threats? CLINICAL TEACHER 2024:e13786. [PMID: 38812076 DOI: 10.1111/tct.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Simulation-based training (SBT) provides a safe space for medical trainees to experience realistic scenarios. SBT has been found to improve trainee performance in paediatric procedures. However, limited evidence exists regarding its effects on higher-level outcomes. This scoping review aims to identify studies that investigate the impact of SBT for procedural skills on T3 (patient outcomes) and T4 level outcomes (latent safety threats [LSTs], and hospital level costs) in paediatrics. METHODS Full-text articles were included if they focused on medical trainees, used simulation training for paediatric procedures and reported T3/T4 level outcomes. Six databases were searched from January 2011 to September 2022. Search strategies were developed with the assistance of a librarian. Three independent reviewers performed pilot screenings before title/abstract and full-text screenings. A data extraction sheet was created to gather information on interventions, outcomes, research design, and other study characteristics. FINDINGS After title/abstract screening of 4,076 sources, 50 were included for full-text review, with 15 articles selected for data extraction. Four were randomised control studies (RCTs), fourteen focused on T3 level outcomes including mortality rates, and one measured LSTs. There were no studies reporting cost-related data. Three of the studies focused on bag-and-mask ventilation, and eight mentioned the use of mannequins. DISCUSSION We highlight the potential effectiveness of simulation-based training of paediatric procedural skills in improving patient outcomes, such as reduced mortality rates and incidence of illness/injury. CONCLUSION Though the quality of research designs was low, researchers used different simulation modalities and outcome measures and showed a positive impact of SBT(e.g., decreased mortality rates).
Collapse
Affiliation(s)
- Samuel E Graef
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nima Karimi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maggie Xu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Quang N Ngo
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elif Bilgic
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- McMaster Education Research, Innovation and Theory (MERIT) Program, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Kshetrapal A, McBride ME, Mannarino C. Taking the Pulse of the Current State of Simulation. Crit Care Clin 2023; 39:373-384. [PMID: 36898780 DOI: 10.1016/j.ccc.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Simulation in health-care professions has grown in the last few decades. We provide an overview of the history of simulation in other fields, the trajectory of simulation in health professions education, and research in medical education, including the learning theories and tools to assess and evaluate simulation programs. We also propose future directions for simulation and research in health professions education.
Collapse
Affiliation(s)
- Anisha Kshetrapal
- Department of Pediatrics, Division of Emergency Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA.
| | - Mary E McBride
- Depatment of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA
| | - Candace Mannarino
- Depatment of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA
| |
Collapse
|
4
|
Oliveira Silva G, Fonseca LMM, Siqueira KM, de Góes FDSN, Ribeiro LM, Aredes N. The simulation design in health and nursing: A scoping review. Nurs Open 2023; 10:1966-1984. [PMID: 36336777 PMCID: PMC10006602 DOI: 10.1002/nop2.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/01/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS The aims of this study were to map the components of the simulation design in health and nursing and to propose a classification based on their definitions to support the planning of simulation-based experiences. DESIGN Scoping review. METHOD Searches were performed in the databases LILACS, Embase, MEDLINE/PubMed, SCOPUS, Web of Science, Google Scholar and ProQuest Thesis and Dissertation were performed, without time limitation, to identify studies about simulation design. RESULTS This study mapped 19 components of the simulation design found in 26 studies included, which can contribute to the development of simulation-based experiences, classified into structural, methodological and theoretical-pedagogical components. The simulation design can be described according to its fundamental components: structural-define the basic formulation of a simulation in terms of infrastructure and conceptual framework; methodological-define the participants, roles and the instruction format; and theoretical-pedagogical-define the educational references used to support the simulation strategy.
Collapse
Affiliation(s)
| | - Luciana Mara Monti Fonseca
- Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Escola de Enfermagem de Ribeirão PretoUniversidade de São PauloSPRibeirão PretoBrazil
| | | | | | | | | |
Collapse
|
5
|
McBee MP, Agarwal A, Alexander LF, Bajaj G, Kelahan LC, Leake R, Richardson ML, Burns J. Teaching with Technology-Matching Pedagogy with Purpose in Radiology Education. Acad Radiol 2023; 30:359-369. [PMID: 35551855 DOI: 10.1016/j.acra.2022.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 01/11/2023]
Abstract
The response to pandemic-related teaching disruption has revealed dynamic levels of learning and teaching flexibility and rapid technology adoption of radiology educators and trainees. Shutdowns and distancing requirements accelerated the adoption of technology as an educational tool, in some instances supplanting in-person education entirely. Despite the limitations of remote interaction, many educational advantages were recognized that can be leveraged in developing distance learning paradigms. The specific strategies employed should match modern learning science, enabling both students and educators to mutually grow as lifelong learners. As panel members of the "COVID: Faculty perspective" Task Force of the Association of University Radiologists Radiology Research Alliance, we present a review of key learning principles which educators can use to identify techniques that enhance resident learning and present an organized framework for applying technology-aided techniques aligned with modern learning principles. Our aim is to facilitate the purposeful integration of learning tools into the training environment by matching these tools to established educational frameworks. With these frameworks in mind, radiology educators have the opportunity to re-think the balance between traditional curricular design and modern digital teaching tools and models.
Collapse
Affiliation(s)
- Morgan P McBee
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
| | - Atul Agarwal
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Gitanjali Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Linda C Kelahan
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Richard Leake
- Department of Radiology, University of Utah, Salt Lake City, Utah
| | | | - Judah Burns
- Department of Radiology, Montefiore Medical Center, New York, New York
| |
Collapse
|
6
|
Yu K, Wu L, Zhou L. Research on the Mixed Education Mode for the Safety Engineering Major during the Coronavirus (COVID-19) Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1967. [PMID: 35206154 PMCID: PMC8872460 DOI: 10.3390/ijerph19041967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
Abstract
During the COVID-19 epidemic, many countries faced a critical situation in terms of the global economy and human social activities, including education. In China, the coronavirus is better controlled. Chinese university students have returned to school to study. Despite previous research on online education and learning, the readiness of students for the online and offline learning models implemented at this particular time is not well understood. This paper discusses a hybrid education model for undergraduate students in the safety engineering major. Questionnaires are administered to faculty and students from different colleges and universities in the same major to statistically summarize the influencing factors of mixed or hybrid education. The system dynamics (SD) model is constructed and simulated to determine that using online in the tenth to fifteenth, twenty-fifth to thirtieth, and fortieth to forty-fifth min of classroom teaching (50 min in total) can effectively increase students' interest and engagement in learning. More hands-on activities should also be considered to enhance students' motivation to acquire knowledge, and consideration could be given to encourage interaction among students. This study will be continuously improved by a follow-up study of undergraduate student performance. This study has important implications for educators implementing online and offline blended instruction.
Collapse
Affiliation(s)
- Kai Yu
- College of Mining and Safety Engineering, Shandong University of Science and Technology, Qingdao 266590, China; (L.W.); (L.Z.)
- Min an Institute of Emergency and Safety Management of Qingdao West Coast New Area, Qingdao 266590, China
| | - Lirong Wu
- College of Mining and Safety Engineering, Shandong University of Science and Technology, Qingdao 266590, China; (L.W.); (L.Z.)
| | - Lujie Zhou
- College of Mining and Safety Engineering, Shandong University of Science and Technology, Qingdao 266590, China; (L.W.); (L.Z.)
| |
Collapse
|
7
|
Wong HJ, Su B, Attaar M, Kuchta K, Linn JG, Haggerty SP, Denham W, Ujiki MB. Teaching EndoFLIP Impedance Planimetry to Practicing Endoscopists: An "Into the Fire" Approach to Simulation. Surg Innov 2021; 29:241-248. [PMID: 34403287 DOI: 10.1177/15533506211038088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background. There are growing interests from practicing endoscopists to implement the functional lumen imaging probe (FLIP) impedance planimetry system. We present a simulation-based curriculum using an "into the fire" approach with hands-on pre- and post-tests to teach the use of this technology. Methods. The curriculum consists of a series of pre-tests, didactic content, mentored hands-on instructions, and post-tests. Pre- and post-testing included a knowledge-based written test, a confidence survey, and an assessment form specific to the hands-on performance of FLIP. Result. Twenty-two practicing physicians completed the curriculum. After course completion, participants had improved knowledge-based written test scores from 6.8±1.7 to 8.9±0.9 (P<0.001), confidence scores from 10.0±5.9 to 22.1±2.6 (P<0.001), and hands-on performance score from 11.4±3.4 to 23.1±2.0 (P<0.001) with significant improvement in all components of the hands-on skills. Conclusion. Our simulation curriculum is effective in improving confidence, knowledge, and technical proficiency when teaching the use of FLIP to practicing physicians.
Collapse
Affiliation(s)
- Harry J Wong
- Department of Surgery, 3271NorthShore University HealthSystem, Evanston, IL, USA.,Department of Surgery, 21727University of Chicago Medicine, Chicago, IL, USA
| | - Bailey Su
- Department of Surgery, 3271NorthShore University HealthSystem, Evanston, IL, USA.,Department of Surgery, 21727University of Chicago Medicine, Chicago, IL, USA
| | - Mikhail Attaar
- Department of Surgery, 3271NorthShore University HealthSystem, Evanston, IL, USA.,Department of Surgery, 21727University of Chicago Medicine, Chicago, IL, USA
| | - Kristine Kuchta
- Department of Surgery, 3271NorthShore University HealthSystem, Evanston, IL, USA
| | - John G Linn
- Department of Surgery, 3271NorthShore University HealthSystem, Evanston, IL, USA
| | - Stephen P Haggerty
- Department of Surgery, 3271NorthShore University HealthSystem, Evanston, IL, USA
| | - Woody Denham
- Department of Surgery, 3271NorthShore University HealthSystem, Evanston, IL, USA
| | - Michael B Ujiki
- Department of Surgery, 3271NorthShore University HealthSystem, Evanston, IL, USA
| |
Collapse
|
8
|
Karamchandani U, Bhattacharyya R, Patel R, Oussedik S, Bhattacharya R, Gupte C. Training Surgeons to Perform Arthroscopic All-Inside Meniscal Repair: A Randomized Controlled Trial Evaluating the Effectiveness of a Novel Cognitive Task Analysis Teaching Tool, Imperial College London/University College London Meniscus Repair Cognitive Task Analysis (IUMeRCTA). Am J Sports Med 2021; 49:2341-2350. [PMID: 34166100 PMCID: PMC8283189 DOI: 10.1177/03635465211021652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND All-inside meniscal repair is an increasingly common technique for the surgical treatment of meniscal tears. There are currently no standardized techniques for training residents in this procedure. Cognitive task analysis (CTA) is a method of analyzing and standardizing key steps in a procedure that allows training to be conducted in a validated and reproducible manner. PURPOSE (1) To design a digital CTA teaching tool for a standardized all-inside meniscal repair. (2) To evaluate whether CTA-trained residents would perform better in a meniscal repair task compared with a control group who underwent traditional apprenticeship methods of training. STUDY DESIGN Controlled laboratory study. METHODS Three expert knee surgeons were interviewed using a modified Delphi method to generate a consensus among the ideal technical steps, cognitive decision points, and common errors and solutions for an all-inside meniscal repair. This written information was then combined with visual and audio components and integrated onto a digital platform to create the Imperial College London/University College London Meniscus Repair Cognitive Task Analysis (IUMeRCTA) tool. Eighteen novice residents were randomized into an intervention group (digital CTA tool) and control group (equipment instruction manual). Both groups performed an all-inside meniscal repair on high-fidelity, phantom knee models and were assessed by expert surgeons, blinded to the interventions, using a validated global rating scale (GRS). After a power calculation, median GRS scores were compared between groups using the Mann-Whitney U test; significance was set at P < .05. RESULTS For the IUMeRCTA tool design, the procedure was divided into 55 steps across 9 phases: (1) preoperative planning, (2) theater and patient setup, (3) portal placement, (4) meniscal examination, (5) tear reduction, (6) suture planning, (7) suture insertion, (8) repair completion, and (9) postoperative care and rehabilitation. For the trial, the intervention group (mean ± SD GRS, 32 ± 2.9) performed significantly better than did the control group (GRS, 24 ± 3.3; P < .001). CONCLUSION This is the first CTA tool to demonstrate objective benefits in training novices to perform an arthroscopic all-inside meniscal repair. CLINICAL RELEVANCE The IUMeRCTA tool is an easily accessible and effective adjunct to traditional teaching that enhances learning the all-inside meniscal repair for novice surgeons.
Collapse
Affiliation(s)
- Urvi Karamchandani
- Department of Surgery and Cancer, Imperial College London, London, UK,Department of Orthopaedics, Imperial College NHS Trust, UK
| | - Rahul Bhattacharyya
- Department of Surgery and Cancer, Imperial College London, London, UK,Department of Orthopaedics, Imperial College NHS Trust, UK
| | - Rahul Patel
- Department of Orthopaedics, University College London Hospitals NHS Trust, UK,Wellington Knee Unit, London, UK
| | - Sam Oussedik
- Department of Orthopaedics, University College London Hospitals NHS Trust, UK,Wellington Knee Unit, London, UK
| | - Rajarshi Bhattacharya
- Department of Surgery and Cancer, Imperial College London, London, UK,Department of Orthopaedics, Imperial College NHS Trust, UK
| | - Chinmay Gupte
- Department of Surgery and Cancer, Imperial College London, London, UK,Department of Orthopaedics, Imperial College NHS Trust, UK,Wellington Knee Unit, London, UK,Chinmay Gupte, PhD, MA, BM BCh, MSk Lab, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK ()
| |
Collapse
|
9
|
Consorti F, Panzera G. Low versus high level of physical resemblance in simulation for the acquisition of basic surgical skill: a meta-analysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:422-427. [PMID: 35515747 PMCID: PMC8936611 DOI: 10.1136/bmjstel-2020-000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/14/2021] [Indexed: 11/22/2022]
Abstract
Background Many studies explored the use of simulation in basic surgical education, with a variety of devices, contexts and outcomes, with sometimes contradictory results. Objectives The objectives of this meta-analysis were to focus the effect that the level of physical resemblance in a simulation has on the development of basic surgical skill in undergraduate medical students and to provide a foundation for the design and implementation of a simulation, with respect to its effectiveness and alignment with the learning outcomes. Study selection We searched PubMed and Scopus database for comparative randomised studies between simulations with a different level of resemblance. The result was synthesised as the standardised mean difference, under a random effect model. Findings We selected 12 out of 2091 retrieved studies, reporting on 373 undergraduate students (mean of subjects 15.54±6.89). The outcomes were the performance of simple skills and the time to complete a task. Two studies reported a scoring system; seven studies reported time for a task; and three studies reported both. The total number of measures included in the meta-analysis was 456 for score and 504 for time. The pooled effect size did not show any significant advantage in a simulation of a high level of physical resemblance over a lower level, both for the scoring system (−0.19, 95% CI −0.44 to 0.06) and for time (−0.14, 95% CI −0.54 to 0.27). Conclusion Simulations with a low level of physical resemblance showed the same effect as the simulation using a higher level of resemblance on the development of basic surgical skills in undergraduate students.
Collapse
Affiliation(s)
- Fabrizio Consorti
- Surgical Sciences, University of Rome La Sapienza Sapienza Faculty of Medicine and Dentistry, Roma, Italy
| | - Gianmarco Panzera
- Surgical Sciences, University of Rome La Sapienza Sapienza Faculty of Medicine and Dentistry, Roma, Italy
| |
Collapse
|
10
|
Zala A, Tang AYY, Patel K, Hunukumbure AD. COVID-19: experience and development of simulation for training in a London
District General Hospital. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:167-168. [PMID: 35518565 PMCID: PMC8769161 DOI: 10.1136/bmjstel-2020-000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/30/2020] [Accepted: 10/04/2020] [Indexed: 11/08/2022]
Abstract
The world is facing an unprecedented crisis in the form of the coronavirus disease-2019 (COVID-19) pandemic. Clinicians and their working environments are under considerable pressures that have not previously been encountered. Consequently, clinicians have had to change their practice significantly to enable safe care for their patients, whilst ensuring their own safety. The majority of COVID-19 simulation to date has been either virtual or in-situ, with the aim of training specific departments. With this in mind, as the Hillingdon Hospital Education Team, we developed a simulation that would provide generic training on COVID-19 for staff across our Trust in various departments and roles. Our aim was to teach staff how to manage patients whilst protecting themselves during this pandemic.
Collapse
Affiliation(s)
- Ashik Zala
- Education Department, Hillingdon Hospital NHS Trust, Uxbridge, UK
| | | | - Kirtan Patel
- Education Department, Hillingdon Hospital NHS Trust, Uxbridge, UK
| | | |
Collapse
|
11
|
Wong HJ, Su B, Attaar M, Kuchta K, Linn JG, Denham W, Haggerty SP, Ujiki MB. Teaching peroral endoscopic pyloromyotomy (POP) to practicing endoscopists: An "into-the-fire" approach to simulation. Surgery 2020; 169:502-507. [PMID: 33023755 DOI: 10.1016/j.surg.2020.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peroral endoscopic pyloromyotomy, or gastric peroral endoscopic myotomy, is a novel endoscopic procedure for the treatment of refractory gastroparesis. We present a simulation-based curriculum using an "into-the-fire" approach with hands-on pre- and post-tests to teach this procedure. METHODS Six, 1-day peroral endoscopic pyloromyotomy courses were taught by an expert surgical endoscopist in 2018 to 2019. The curriculum is composed of a series of pretraining tests, lectures, mentored hands-on instruction, and post-training tests using porcine models. Both pre- and post-testing included a confidence survey, a knowledge-based written test, and a specific assessment form for the peroral endoscopic pyloromyotomy procedure. Participants' scores were analyzed using paired t tests. RESULTS Twenty-eight practicing physicians participated. After completing the curriculum, participants had improved confidence scores (10.5 ± 5.2 vs 19.4 ± 3.6; P < .001), written test scores (6.8 ± 1.6 vs 8.0 ± 1.1; P < .001), and hands-on performance scores (23.6 ± 3.4 vs 29.3 ± 1.4; P < .001) with marked improvement in all components of the peroral endoscopic pyloromyotomy procedure. Postcourse surveys showed 93% of participants had performed or intended to perform the peroral endoscopic pyloromyotomy procedure within the next year. CONCLUSION Our simulation curriculum with an into-the-fire approach to teach peroral endoscopic pyloromyotomy is effective in improving practitioner knowledge, confidence, and technical skills, leading to an increase in the adoption of this procedure.
Collapse
Affiliation(s)
- Harry J Wong
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL; Department of Surgery, University of Chicago Medicine, IL.
| | - Bailey Su
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL; Department of Surgery, University of Chicago Medicine, IL
| | - Mikhail Attaar
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL; Department of Surgery, University of Chicago Medicine, IL
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - John G Linn
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Woody Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | | | - Michael B Ujiki
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| |
Collapse
|
12
|
Hilburg R, Patel N, Ambruso S, Biewald MA, Farouk SS. Medical Education During the Coronavirus Disease-2019 Pandemic: Learning From a Distance. Adv Chronic Kidney Dis 2020; 27:412-417. [PMID: 33308507 PMCID: PMC7309716 DOI: 10.1053/j.ackd.2020.05.017] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022]
Abstract
As paradigms of clinical care delivery have been significantly impacted by the novel coronavirus disease-2019 pandemic, so has the structure, delivery, and future of medical education. Both undergraduate and graduate medical education have seen disruptions ranging from fully virtual delivery of educational content and limited clinical care for medical students to increased clinical demands with redeployment for residents and fellows. Adherence to social distancing has led to the adoption and implementation of already available technologies in medical education, including video conferencing softwares and social media platforms. Efficient and effective use of these technologies requires an understanding not only of these platforms and their features but also of their inherent limitations. During a time of uncertainty and increased clinical demands, the approach to medical education must be thoughtful with attention to wellness of both the educator and learner. In this review, we discuss the influence of the pandemic on the existing medical education landscape, outline existing and proposed adaptations to social distancing, and describe challenges that lie ahead.
Collapse
Affiliation(s)
- Rachel Hilburg
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Niralee Patel
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sophia Ambruso
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - Mollie A Biewald
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samira S Farouk
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
13
|
Urdiales AIA, Struck GT, Guetter CR, Yaegashi CH, Temperly KS, Abreu P, Tomasich FS, Campos ACL. Surgical cricothyroidostomy. Analysis and comparison between teaching and validation models of simulator models. ACTA ACUST UNITED AC 2020; 47:e20202522. [PMID: 32520132 DOI: 10.1590/0100-6991e-20202522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE to compare the acquisition and retention of knowledge about surgical cricothyroidostomy by the rapid four-step technique (RFST), when taught by expository lecture, low fidelity and high-fidelity simulation models. METHODS ninety medical students at UFPR in the first years of training were randomized assigned into 3 groups, submitted to different teaching methods: 1) expository lectures, 2) low-fidelity simulator model, developed by the research team or 3) high-fidelity simulator model (commercial). The procedure chosen was surgical cricothyroidostomy using the RFST. Soon after lectures, the groups were submitted to a multiple-choice test with 20 questions (P1). Four months later, they underwent another test (P2) with similar content. Analysis of Variance was used to compare the grades of each group in P1 with their grades in P2, and the grades of the 3 groups 2 by 2 in P1 and P2. A multiple comparisons test (post-hoc) was used to check differences within each factor (test and group). Statistical significance was considered when p<0.05. Statistical analysis was performed in the statistical software R version 3.6.1. RESULTS each group was composed of 30 medical students, without demographic differences between them. The mean scores of the groups of the expositive lecture, of the simulator of low fidelity model and of high-fidelity simulator model in P1 were, respectively, 75.00, 76.09, and 68.79, (p<0.05). In P2 the grades were 69.84, 75.32, 69.46, respectively, (p>0.05). CONCLUSIONS the simulation of low fidelity model was more effective in learning and knowledge retention, being feasible for RFST cricothyroidostomy training in inexperienced students.
Collapse
Affiliation(s)
- Akihito Inca Atahualpa Urdiales
- - Hospital do Trabalhador/Federal University of Paraná, Department of Integrated Medicine - Curitiba - PR - Brazil.,- Hospital do Trabalhador/Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil.,- Federal University of Paraná, Postgraduate Program in Surgical Clinic - Curitiba - PR - Brazil
| | | | | | - Cecilia Hissai Yaegashi
- - Cajuru University Hospital- Pontifical Catholic University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| | - Kassio Silva Temperly
- - Pontifical Catholic University of Paraná, Course of Medicina - Curitiba - PR - Brazil
| | - Phillipe Abreu
- - Hospital do Trabalhador/Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| | - Flavio Saavedra Tomasich
- - Hospital do Trabalhador/Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil.,- Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| | - Antônio Carlos Ligocki Campos
- - Federal University of Paraná, Postgraduate Program in Surgical Clinic - Curitiba - PR - Brazil.,- Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| |
Collapse
|
14
|
Lap Nicholas Tsang C, Cao J, Sugand K, Chiu J, Casper Pretorius F. Face, content, construct validity and training effect of touch surgery™ as a surgical decision-making trainer for novices in open appendicectomy. Int J Surg Protoc 2020; 22:19-23. [PMID: 32671311 PMCID: PMC7348480 DOI: 10.1016/j.isjp.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/25/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Laparoscopic surgery has become the gold standard for many operations with significant benefits in morbidity and hospital recovery time. One such procedure is appendicectomy, which is overwhelmingly performed using the laparoscopic approach in the modern era. This has also meant that the number of cases involving traditional open appendicectomy has declined despite surgeons being expected to be able to convert to the open technique if required. One method to rehearse for theatre is the use of software applications. This paper investigates the validity of Touch Surgery™ as an education tool for surgical decision-making for novices, as well as its training effect in open appendicectomy. METHOD 70 participants will be recruited, consisting of 60 medical students (novices) and 10 surgical consultants (experts). For face, content, and construct validity, first attempt scores on the Touch Surgery™ Open Appendicectomy Test Module will be compared between novices and experts. For the training effect and knowledge decline elements of the study, novices will be further randomised into either the low intervention (control) group who will complete the simulation once, or to the high intervention group who will complete the simulation six times, with both novice groups asked to repeat the test one week later. All participants will also be requested to complete questionnaires regarding the stimulation.
Collapse
Affiliation(s)
| | - Jerry Cao
- Department of Surgery, Wollongong Hospital, NSW, Australia
| | - Kapil Sugand
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, United Kingdom
| | - Jacqui Chiu
- Faculty of Medicine, University of Queensland, QLD, Australia
| | | |
Collapse
|
15
|
Miranda SP, Glauser G, Wathen C, Blue R, Dimentberg R, Welch WC, Grady MS, Schuster JM, Malhotra NR. Letter to the Editor "Incorporating Telehealth to Improve Neurosurgical Training During the COVID-19 Pandemic". World Neurosurg 2020; 139:728-731. [PMID: 32426069 PMCID: PMC7231482 DOI: 10.1016/j.wneu.2020.05.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen P Miranda
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Blue
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Dimentberg
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Sean Grady
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James M Schuster
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
16
|
Sachdeva AK. Acquiring and maintaining lifelong expertise in surgery. Surgery 2020; 167:787-792. [DOI: 10.1016/j.surg.2019.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 11/24/2022]
|
17
|
Logishetty K, Gofton WT, Rudran B, Beaulé PE, Gupte CM, Cobb JP. A Multicenter Randomized Controlled Trial Evaluating the Effectiveness of Cognitive Training for Anterior Approach Total Hip Arthroplasty. J Bone Joint Surg Am 2020; 102:e7. [PMID: 31567674 DOI: 10.2106/jbjs.19.00121] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For total hip arthroplasty (THA), cognitive training prior to performing real surgery may be an effective adjunct alongside simulation to shorten the learning curve. This study sought to create a cognitive training tool (CTT) to perform anterior approach (AA)-THA, which was validated by expert surgeons, and test its use as a training tool compared with conventional material. METHODS We employed a modified Delphi method with 4 expert surgeons from 3 international centers of excellence. Surgeons were independently observed performing THA before undergoing semistructured cognitive task analysis (CTA) and before completing successive rounds of surveys until a consensus was reached. Thirty-six surgical residents (postgraduate year [PGY]-1 through PGY-4) were randomized to cognitive training or training with a standard operation manual with surgical videos before performing a simulated AA-THA. RESULTS The consensus CTA defined THA in 11 phases, in which were embedded 46 basic steps, 36 decision points, and 42 critical errors and linked strategies. This CTA was mapped onto an open-access web-based CTT. Surgeons who prepared with the CTT performed a simulated THA 35% more quickly (time, mean 28 versus 38 minutes) with 69% fewer errors in instrument selection (mean 29 versus 49 instances), and required 92% fewer prompts (mean 13 versus 25 instances). They were more accurate in acetabular cup orientation (inclination error, mean 8° versus 10°; anteversion error, mean 14° versus 22°). CONCLUSIONS This validated CTT for arthroplasty provides structure for competency-based learning. It is more effective at preparing orthopaedic trainees for a complex procedure than conventional materials, as well as for learning sequence, instrumentation utilization, and motor skills. CLINICAL RELEVANCE Cognitive training combines education on decision-making, knowledge, and technical skill. It is an inexpensive technique to teach surgeons to perform hip arthroplasty and is more effective than current preparation methods.
Collapse
Affiliation(s)
- Kartik Logishetty
- The MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Wade T Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Branavan Rudran
- The MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Chinmay M Gupte
- The MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Justin P Cobb
- The MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| |
Collapse
|
18
|
Winkler-Schwartz A, Bissonnette V, Mirchi N, Ponnudurai N, Yilmaz R, Ledwos N, Siyar S, Azarnoush H, Karlik B, Del Maestro RF. Artificial Intelligence in Medical Education: Best Practices Using Machine Learning to Assess Surgical Expertise in Virtual Reality Simulation. JOURNAL OF SURGICAL EDUCATION 2019; 76:1681-1690. [PMID: 31202633 DOI: 10.1016/j.jsurg.2019.05.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Virtual reality simulators track all movements and forces of simulated instruments, generating enormous datasets which can be further analyzed with machine learning algorithms. These advancements may increase the understanding, assessment and training of psychomotor performance. Consequently, the application of machine learning techniques to evaluate performance on virtual reality simulators has led to an increase in the volume and complexity of publications which bridge the fields of computer science, medicine, and education. Although all disciplines stand to gain from research in this field, important differences in reporting exist, limiting interdisciplinary communication and knowledge transfer. Thus, our objective was to develop a checklist to provide a general framework when reporting or analyzing studies involving virtual reality surgical simulation and machine learning algorithms. By including a total score as well as clear subsections of the checklist, authors and reviewers can both easily assess the overall quality and specific deficiencies of a manuscript. DESIGN The Machine Learning to Assess Surgical Expertise (MLASE) checklist was developed to help computer science, medicine, and education researchers ensure quality when producing and reviewing virtual reality manuscripts involving machine learning to assess surgical expertise. SETTING This study was carried out at the McGill Neurosurgical Simulation and Artificial Intelligence Learning Centre. PARTICIPANTS The authors applied the checklist to 12 articles using machine learning to assess surgical expertise in virtual reality simulation, obtained through a systematic literature review. RESULTS Important differences in reporting were found between medical and computer science journals. The medical journals proved stronger in discussion quality and weaker in areas related to study design. The opposite trends were observed in computer science journals. CONCLUSIONS This checklist will aid in narrowing the knowledge divide between computer science, medicine, and education: helping facilitate the burgeoning field of machine learning assisted surgical education.
Collapse
Affiliation(s)
- Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - Vincent Bissonnette
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Division of Orthopedic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nykan Mirchi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Nirros Ponnudurai
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Samaneh Siyar
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Hamed Azarnoush
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Bekir Karlik
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Rolando F Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
19
|
Green CA, Mahuron KM, Harris HW, O'Sullivan PS. Integrating Robotic Technology Into Resident Training: Challenges and Recommendations From the Front Lines. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1532-1538. [PMID: 30998574 PMCID: PMC6768698 DOI: 10.1097/acm.0000000000002751] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE To develop recommendations for improving the integration of robotic technology into today's apprentice-based resident training. METHOD During a national meeting in 2017, 24 robotic surgeons were interviewed about their experiences integrating robotic technology into resident training. Qualitative thematic analysis of interview notes and recordings revealed themes related to challenges and recommendations. RESULTS Four themes emerged, each corresponding to a general recommendation for integrating robotic technology into training. The first, surgical techniques versus tools, contrasts faculty's sequential mastery-surgical techniques first, then the robotic tool-with residents' simultaneous learning. The recommendation is to create separate learning opportunities for focused skill acquisition. The second theme, timing of exposure to the robotic tool, describes trainees' initial focus on tool use for basic surgical steps. The recommendation is to increase access to basic robotic cases. The third theme covers the relationship of laparoscopic and robotic surgery. The recommendation is to emphasize similar and dissimilar features during all minimally invasive surgical cases. The fourth theme, use of the dual console (which enables two consoles to operate the robot, the primary determines the secondary's functionality), highlights the unique teaching opportunities this console creates. The recommendation is for surgeons to give verbal guidance so residents completely understand surgical techniques. CONCLUSIONS Surgical educators should consider technique versus tool, timing of exposure to the tool, overlapping and varying features of robotic and laparoscopic surgery, and use of the dual console as they develop curricula to ensure thorough acquisition and synthesis of all elements of robotic surgery.
Collapse
Affiliation(s)
- Courtney A Green
- C.A. Green is a general surgery resident, University of California, San Francisco, San Francisco, California. K.M. Mahuron is a general surgery resident, University of California, San Francisco, San Francisco, California. H.W. Harris is professor and chief, Division of General Surgery, J. Engelbert Dunphy Endowed Chair in Surgery, and program director, National Institutes of Health T32 Training Program in Gastrointestinal Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California. P.S. O'Sullivan is professor, Departments of Medicine and Surgery, and director of research and development in medical education, Center for Faculty Educators, University of California, San Francisco School of Medicine. She is also endowed chair of surgical education, Department of Surgery, University of California, San Francisco, San Francisco, California
| | | | | | | |
Collapse
|
20
|
Abstract
Maxillary all-on-four implant reconstruction requires training beyond normal dental implant training. It conjoins technical surgical acumen, anatomic and complex spatial relationship understanding, thorough awareness of dental prosthodontic principles, and excellent patient management skills. Acquisition of appropriate training to the level of competence in an era of greater patient expectations and increased vigilance for patient safety and overall quality of care is limited. Repeated purposeful practice in performing complex psychomotor tasks is of paramount importance in achieving competence. Surgical simulation may assist surgical learners to acquire familiarity with relevant anatomic variations, instrumentation, surgical techniques, and management of intraoperative and postoperative complications.
Collapse
|
21
|
Babla K, Lipton J, Williams S, Chopra P, Thenabadu S. Simprovisation: A model for student-led simulation. CLINICAL TEACHER 2019; 17:64-69. [PMID: 31012260 DOI: 10.1111/tct.13021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Simulation is well established in medical education, with scenarios designed by faculty members to elicit specific learning outcomes. We describe and evaluate a learner-led style of simulation-based education that puts learners in control of the day. Simprovisation harnesses the principles of socially constructed learning and andragogy, encouraging learners to address their own learning requirements. Participants are divided into two groups. They are asked to consider their learning needs and are provided with resources and faculty member support to write two simulation scenarios. Faculty members remain available to guide scenario writing and offer 'micro-teaching' on required topics. The groups then swap and participate in the scenarios written for them by the opposite group. Each scenario is followed by a structured debriefing, providing opportunities for participants to share their learning from the scenarios. Simprovisation harnesses the principles of socially constructed learning and andragogy, encouraging learners to address their own learning requirements METHODS: We delivered Simprovisation to 62 participants ranging from fourth-year medical students to junior doctors. We conducted pre- and post-course questionnaire surveys and invited participants to focus groups to discuss their experiences. RESULTS Our feedback questionnaire shows 100% of 58 respondents found Simprovisation useful, and 95% were able to meet at least two out of three self-determined learning outcomes. Thematic analysis of focus group transcriptions showed that participants valued group-based work and setting their own learning objectives. They found writing simulation scenarios to be challenging, but a valuable source of learning, and reported being more engaged compared with previous simulation study days. CONCLUSIONS Simprovisation is an innovative style of simulation-based education that allows learners to effectively define and address their own learning needs.
Collapse
Affiliation(s)
- Kunal Babla
- Department of Postgraduate Medical and Dental Education, King's College Hospital NHS Foundation Trust, London, UK.,GKT School of Medical Education, King's College London, London, UK
| | - Joseph Lipton
- Department of Postgraduate Medical and Dental Education, King's College Hospital NHS Foundation Trust, London, UK.,GKT School of Medical Education, King's College London, London, UK
| | - Sophie Williams
- Department of Postgraduate Medical and Dental Education, King's College Hospital NHS Foundation Trust, London, UK
| | - Preeti Chopra
- Department of Postgraduate Medical and Dental Education, King's College Hospital NHS Foundation Trust, London, UK
| | - Sam Thenabadu
- Department of Postgraduate Medical and Dental Education, King's College Hospital NHS Foundation Trust, London, UK.,GKT School of Medical Education, King's College London, London, UK
| |
Collapse
|
22
|
How Educational Theory Can Inform the Training and Practice of Plastic Surgeons. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e2042. [PMID: 30656119 PMCID: PMC6326625 DOI: 10.1097/gox.0000000000002042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
It is important to optimize our current learning and teaching models, particularly in a climate of decreased clinical exposure. With technical advancements and clinical care now more accountable, traditional methods of skill acquisition need to be revisited. The past decade has seen changes in plastic surgery curricula. There has also been a shift toward competency-based training programs reflecting the growing emphasis on outcomes-based surgical education. This review explores the role of educational theory in promoting effective learning in practical skills teaching. Key models of educational theory are presented and their application to plastic surgery training to an expert level are highlighted. These models include (1) learning within communities of practice (Lave and Wenger’s theory); (2) the role of the zone of proximal development and importance of the availability of expert assistance (Vygotsky’s theory); (3) skill acquisition and retention (Dreyfus’ and Dreyfus’, and Fitts’ and Posner’s theories); (4) development of expertise after repeated practice and regular reinforcement (Ericsson’s theory); and (5) the assessment of competence (Miller’s triangle). Future plastic surgeons need to possess a thorough understanding of the technical and nontechnical skills required to manage patients effectively. Surgical educators are therefore compelled to develop practical training programs that can teach each of these skills in a safe, learner-centric manner. It is hoped that new approaches to surgical skills training are designed in light of our understanding of educational theory to optimize the training of the next generation of plastic surgeons.
Collapse
|
23
|
Cold KM, Konge L, Clementsen PF, Nayahangan LJ. Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion. Respiration 2018; 97:160-167. [PMID: 30391958 DOI: 10.1159/000493431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies have shown the beneficial effects of mastery learning of a simulation-based course, but not all trainees complete it. OBJECTIVES The purpose of this study was to find deciding factors for the completion of a simulation-based mastery learning course with distributive practice in flexible bronchoscopy. METHODS Seventy-seven trainees who signed up for the course were invited to a survey for deciding factors of completing the course. Sixty-two (81%) trainees answered the survey. RESULTS Male trainees were more likely to complete the course. The most important factor for completion was clinical relevance, and the most important factor for not completing the course was being "too busy." CONCLUSION Several deciding factors for completing the course were identified. Successful simulation-based mastery learning courses should be clinically relevant, and the trainees should be provided protected time to complete the training. The instructional design should also be adapted systematically for male and female trainees to achieve the necessary competencies.
Collapse
Affiliation(s)
- Kristoffer Mazanti Cold
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark, .,University of Copenhagen, Copenhagen, Denmark,
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| |
Collapse
|
24
|
Qi X, Ding L, Zhai W, Li Q, Li Y, Li H, Wen B. A novel approach to assess clinical competence of postgraduate year 1 surgery residents. MEDICAL EDUCATION ONLINE 2017; 22:1342523. [PMID: 28670976 PMCID: PMC5508647 DOI: 10.1080/10872981.2017.1342523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND An increased demand for accountability and transparency in medicine have initiated a shift toward a more objective and standardized approach for postgraduate medical training. OBJECTIVE To develop and evaluate an objective method to assess clinical competence of postgraduate year 1 surgery residents. DESIGN Thirty-one postgraduate year 1 surgery residents, who had been trained in the Surgical School of Peking University First Hospital for one year, participated in an objective structured clinical examination as a final assessment of their clinical competence. A test station of irregular wound repair (debridement and suture) was specially designed to test the residents' surgical integrative competence in a complex-trauma treatment procedure. A modified global rating scale, in combination with wound area measurement, was applied to evaluate residents' surgical performance. The validity of the subjective global rating scale was evaluated by the objective measurement results from the software. RESULTS The global rating scale score had no obvious correlation with the area of the removed tissue and the residual wound area after the suture. There was significant difference in the debridement time and the residual wound area between 0-3 and >3 total stitches. There were significant differences in the area of the removed tissue between 0 and 1-2 grey stitches and 0 and 3-4 grey stitches, and in the residual wound area after suture between 0 and 3-4 grey stitches and 1-2 and 3-4 grey stitches. CONCLUSIONS An irregular wound repair procedure could be an effective method to assess the integrative competence of surgery residents. The training for surgical thinking in the early stage of junior residents needs to be strengthened. The entire measurement process was more complex and time-consuming than expected. The possibility of measurement by simply counting the numbers of the key spots might be explored in the future. ABBREVIATIONS ACS/APDS American College of Surgeons/Association of Program Directors in Surgery; GRS Global rating scale; LSD-T Least significant difference-test; OSATS Objective structured assessment of technical skills; OSCE Objective structured clinical examination; PBT Proficiency based training; PGY1 Postgraduate Year 1.
Collapse
Affiliation(s)
- Xin Qi
- Department of Plastic Surgery & Burns, Peking University First Hospital, Beijing, People’s Republic of China
| | - Lian Ding
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, People’s Republic of China
| | - Wei Zhai
- Department of Plastic Surgery & Burns, Peking University First Hospital, Beijing, People’s Republic of China
| | - Qiang Li
- Department of Plastic Surgery & Burns, Peking University First Hospital, Beijing, People’s Republic of China
| | - Yan Li
- Department of Cardiac Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Haichao Li
- Department of Respiratory Medicine, Peking University First Hospital, Beijing, People’s Republic of China
| | - Bing Wen
- Department of Plastic Surgery & Burns, Peking University First Hospital, Beijing, People’s Republic of China
| |
Collapse
|
25
|
Levy IM, Pryor KW, McKeon TR. Is Teaching Simple Surgical Skills Using an Operant Learning Program More Effective Than Teaching by Demonstration? Clin Orthop Relat Res 2016; 474:945-55. [PMID: 26369658 PMCID: PMC4773331 DOI: 10.1007/s11999-015-4555-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A surgical procedure is a complex behavior that can be constructed from foundation or component behaviors. Both the component and the composite behaviors built from them are much more likely to recur if it they are reinforced (operant learning). Behaviors in humans have been successfully reinforced using the acoustic stimulus from a mechanical clicker, where the clicker serves as a conditioned reinforcer that communicates in a way that is language- and judgment-free; however, to our knowledge, the use of operant-learning principles has not been formally evaluated for acquisition of surgical skills. QUESTIONS/PURPOSES Two surgical tasks were taught and compared using two teaching strategies: (1) an operant learning methodology using a conditioned, acoustic reinforcer (a clicker) for positive reinforcement; and (2) a more classical approach using demonstration alone. Our goal was to determine whether a group that is taught a surgical skill using an operant learning procedure would more precisely perform that skill than a group that is taught by demonstration alone. METHODS Two specific behaviors, "tying the locking, sliding knot" and "making a low-angle drill hole," were taught to the 2014 Postgraduate Year (PGY)-1 class and first- and second-year medical students, using an operant learning procedure incorporating precise scripts along with acoustic feedback. The control groups, composed of PGY-1 and -2 nonorthopaedic surgical residents and first- and second-year medical students, were taught using demonstration alone. The precision and speed of each behavior was recorded for each individual by a single experienced surgeon, skilled in operant learning. The groups were then compared. RESULTS The operant learning group achieved better precision tying the locking, sliding knot than did the control group. Twelve of the 12 test group learners tied the knot and precisely performed all six component steps, whereas only four of the 12 control group learners tied the knot and correctly performed all six component steps (the test group median was 10 [range, 10-10], the control group median was 0 [range, 0-10], p = 0.004). However, the median "time to tie the first knot" for the test group was longer than for the control group (test group median 271 seconds [range, 184-626 seconds], control group median 163 seconds [range 93-900 seconds], p = 0.017), whereas the "time to tie 10 of the locking, sliding knots" was the same for both groups (test group mean 95 seconds ± SD = 15 [range, 67-120 seconds], control group mean 95 seconds ± SD = 28 [range, 62-139 seconds], p = 0.996). For the low-angle drill hole test, the test group more consistently achieved the ideal six-step behavior for precisely drilling the low-angle hole compared with the control group (p = 0.006 for the median number of technique success comparison with an odds ratio [at the 95% confidence interval] of 82.3 [29.1-232.8]). The mean time to drill 10 low-angle holes was not different between the test group (mean 193 seconds ± SD = 26 [range, 153-222 seconds]) and the control group (mean 146 seconds ± SD = 63 [range, 114-294 seconds]) (p = 0.084). CONCLUSIONS Operant learning occurs as the behavior is constructed and is highly reinforced with the result measured, not in the time saved, but in the ultimate outcome of an accurately built complex behavior. LEVEL OF EVIDENCE Level II, therapeutic study.
Collapse
Affiliation(s)
- I Martin Levy
- Department of Orthopaedic Surgery, Montefiore Medical Center, 1250 Waters Place, 11th Floor, Bronx, NY, 10461, USA.
| | | | | |
Collapse
|