scholarly journals Designing a synthetic simulator to teach open surgical skills for limb exploration in trauma: a qualitative study exploring the experiences and perspectives of educators and surgical trainees

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
L. Heskin ◽  
C. Simms ◽  
O. Traynor ◽  
R. Galvin
Keyword(s):  
Haptic Feedback ◽  
Surgical Simulation ◽  
Trauma Surgery ◽  
Surgical Skills ◽  
Surgical Trauma ◽  
Structured Interviews ◽  
Surgical Trainees ◽  
Limb Trauma ◽  
Trauma Curriculum ◽  
Set Up

Abstract Background Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to adequately enable trainees to learn, practice and be assessed in surgical skills need to be of the highest standards. This study investigates the perceived requirements of simulation and simulators used to acquire skills in limb exploratory procedures in trauma. Methods Semi-structured interviews were conducted with an international group of 11 surgical educators and 11 surgical trainees who had experience with surgical simulation. The interviews focused on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. Interviews were recorded, transcribed and underwent thematic analysis. Results Analysis of the perspectives of surgical educators and surgical trainees on simulated training in limb trauma surgery yielded three main themes: (1) Attitudes to simulation. (2) Implementing simulation. (3) Features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt simulation could be improved with increased accessibility and variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost effectiveness, easy set up and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement. Conclusion There is a clear positive appetite for the incorporation of simulation into limb trauma training. The findings of this will inform the optimal requirements for high quality implementation of simulation into a surgical trauma curriculum and a reference to optimal features desired in simulator or task trainer design.

scholarly journals 751 Improving Engagement with Home-Based Surgical Skills Simulation

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Falconer ◽  
C Semple ◽  
J Cleland ◽  
K Walker ◽  
A Watson
Keyword(s):  
Surgical Training ◽  
Skill Acquisition ◽  
Surgical Simulation ◽  
Surgical Skills ◽  
Learning Needs ◽  
Structured Interviews ◽  
Training Requirements ◽  
Mandatory Training ◽  
Surgical Trainees ◽  
Home Based

Abstract Introduction Surgical simulation has been repeatedly shown to facilitate technical skill acquisition. However, trainee engagement with self-directed practice remains variable, despite access to resources. Understanding the motivators and barriers to participation is crucial to develop modules which can effectively meet the learning needs of current, and future, surgical trainees. The aim of this qualitative study was to examine factors which influence trainee engagement with home-based surgical skills simulation. Method A series of one-to-one semi-structured interviews were conducted remotely with ST3 vascular trainees who had previously consented to take part in a national programme of home-based technical skills simulation. Interview data was transcribed and thematically analysed. Results 12 trainees were interviewed during a 4-week period. Overall, trainees valued simulation but found it difficult to balance against clinical commitments and mandatory training requirements, particularly if there were limited opportunities for skill transfer to the real-world environment. Although simulation was acknowledged to be a safe environment for experiential learning, trainees alluded to an underlying culture of perfection which limited willingness to learn from mistakes, even within a simulated setting. In addition, traditional attitudes about the apprenticeship model of surgical training prevail, with simulation often viewed as inferior to learning “on the job” in theatre. Conclusions Trainee engagement with home-based surgical skills simulation may be influenced by a range of systemic factors. In future, formal certification of simulation modules, mandating simulated competencies and curricular integration may help improve participation, as well as supporting cultural shift towards recognition of simulation as a vital component of modern surgical training.

scholarly journals Military General Surgical Training Opportunities on Operations in Afghanistan

2009 ◽  
Vol 91 (5) ◽  
pp. 417-419 ◽  
Author(s):  
Adam J Brooks ◽  
Arul Ramasamy ◽  
David Hinsley ◽  
Mark Midwinter
Keyword(s):  
Surgical Management ◽  
Surgical Training ◽  
Trauma Surgery ◽  
Organ Injury ◽  
Surgical Trauma ◽  
Training Opportunity ◽  
Injury Management ◽  
Surgical Trainees ◽  
Specific Organ ◽  
The Uk

INTRODUCTION In the UK, general surgical specialist trainees have limited exposure to general surgical trauma. Previous work has shown that trainees are involved in only two blunt and one penetrating trauma laparotomies per annum. During their training, nearly half of trainees will not be involved in the surgical management of liver injury, 20% will not undertake a trauma splenectomy and only a quarter will see a trauma thoracotomy. Military general surgical trainees require training in, and exposure to, the surgical management of trauma and specifically military wounding patterns that is not available in the UK. The objective of this study was to determine whether operative workload in the sole British surgical unit in Helmand Province, Afghanistan (Operation HERRICK) would provide a training opportunity for military general surgical trainees. PATIENTS AND METHODS A retrospective theatre log-book review of all surgical cases performed at the Role 2 (Enhanced) treatment facility at Camp Bastion, Helmand Province on Operation HERRICK between October 2006 and October 2007, inclusive. Operative cases were analysed for general surgical trauma, laparotomy, thoracotomy, vascular trauma and specific organ injury management where available. RESULTS A total of 968 operative cases were performed during the study period. General surgical procedures included 51 laparotomies, 17 thoracotomies and 11 vascular repairs. There were a further 70 debridements of general surgical wounds. Specific organ management included five cases of liver packing for trauma, five trauma splenectomies and four nephrectomies. CONCLUSIONS A training opportunity currently exists on Operation HERRICK for military general surgical specialist trainees. If the tempo of the last 12 months is maintained, a 2-month deployment would essentially provide trainees with the equivalent trauma surgery experience to the whole of their surgical training in the UK NHS. Trainees would gain experience in military trauma as well as specific organ injury management.

EP.TU.713A review of mobile device stands to facilitate virtual surgical skills teaching

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Radheswari Measuria ◽  
Jih Dar Yau ◽  
Professor Mahmoud Loubani
Keyword(s):  
Mobile Device ◽  
Video Camera ◽  
Surgical Skills ◽  
Maximum Height ◽  
Surgical Trainees ◽  
Reasonable Cost ◽  
Fit For Purpose ◽  
Design Characteristics ◽  
Set Up ◽  
The Ideal

Abstract Aims To assess optimal overhead video camera stand for virtual surgical skills teaching. Methodology Based on the assumption that most surgical trainees have an internet-enabled mobile device with a camera, an overhead device mounted on a phone stand is a ubiquitous set-up for trainers and trainees to demonstrate surgical skills to each other virtually. On 4th December 2020, to reflect affordability and accessibility, phone stands under £15 were purchased from an online retailer, Amazon. Data regarding their design characteristics were collected and studied. Each product was independently reviewed in a simulated setting by two investigators. Results 11 stands were identified with prices ranging from £5.99 to £14.99, with an average of £9.20. Clamp phone holders were the most secure in camera stability but were less adaptable to a variety of device sizes. Table-clamp and broad-based phone stands were sturdier than tripod-based holders. Fit-for-purpose phone stand designs were linked with smaller space occupied at set-up, greater maximum height for camera and more intuitive set-up. Products with smaller box dimensions, which were associated with storability, allowed them to be portable and have lower costs of delivery. Conclusion The ideal features for a phone stand are a clamp or stand for the base and a clamp phone holder, with reasonable cost and storability. Phone stand 4 was the most favourable candidate based on this review; however, further user feedback is required from trainees and trainers to select an ideal design suited for virtual surgical skills teaching.

scholarly journals New Age Teaching: Beyond Didactics

2006 ◽  
Vol 6 ◽  
pp. 2370-2380 ◽  
Author(s):  
Peter D. Vlaovic ◽  
Elspeth M. McDougall
Keyword(s):  
Operating Room ◽  
Surgical Simulation ◽  
Public Awareness ◽  
Skills Training ◽  
Surgical Skills ◽  
Surgical Simulators ◽  
Surgical Trainees ◽  
Surgical Skills Training ◽  
Increasing Demand

Widespread acceptance of laparoscopic urology techniques has posed many challenges to training urology residents and allowing postgraduate urologists to acquire often difficult new surgical skills. Several factors in surgical training programs are limiting the ability to train residents in the operating room, including limited-hours work weeks, increasing demand for operating room productivity, and general public awareness of medical errors. As such, surgical simulation may provide an opportunity to enhance residency experience and training, and optimize post-graduate acquisition of new skills and maintenance of competency. This review article explains and defines the various levels of validity as it pertains to surgical simulators. The most recently and comprehensively validity tested simulators are outlined and summarized. The potential role of surgical simulation in the formative and summative assessment of surgical trainees, as well as, the certification and recertification process of postgraduate surgeons will be delineated. Surgical simulation will be an important adjunct to the traditional methods of surgical skills training and will allow surgeons to maintain their proficiency in the technically challenging aspects of minimally invasive urologic surgery.

Informed consent: Towards improved lay-friendliness of patient information sheets

2014 ◽  
Vol 10 (3) ◽  
pp. 201-211
Author(s):  
Morten Pilegaard ◽  
Hanne Berg Ravn
Keyword(s):  
Informed Consent ◽  
Information Structure ◽  
Language Use ◽  
Ethical Standards ◽  
Structured Interviews ◽  
Explorative Study ◽  
Microsoft Word ◽  
Text Production ◽  
Linguistic Intervention ◽  
Set Up

Regional research ethics committee (REC) members have voiced a need for the linguistic improvement of informed consent documents to ensure duly informed consent and to ease committee deliberation. We have little knowledge of what elements of language use hamper comprehension, or of the extent of medical researchers’ appreciation of this problem and their willingness to accept intervention. This qualitative, explorative study proposes an intervention design and tests its feasibility and acceptability. Semi-structured interviews with potential REC applicants informed a linguistic intervention benchmarked against existing guidelines, mandated locally and nationally, and then evaluated quantitatively in a semi-controlled set-up and qualitatively via questionnaires. Potential applicants professed the psychological acceptability of linguistic intervention. The intervention comprised a downloadable Microsoft Word template outlining information structure, a detailed guideline offering advice for each move and self-selected linguistic screening. It was used by 14 applicants and had a measurable effect on REC deliberation time and approval rates. The intervention instruments overall made it easier for applicants to produce informed consent documents meeting prescribed ethical standards concerning lay-friendliness. In conclusion, it was found that linguistic intervention is relevant, feasible and psychologically acceptable to REC applicants; it aids their text production process and seems to enhance the lay-friendliness of these texts.

scholarly journals Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training

2015 ◽  
Vol 123 (5) ◽  
pp. 1331-1338 ◽  
Author(s):  
James K. C. Liu ◽  
Varun R. Kshettry ◽  
Pablo F. Recinos ◽  
Kambiz Kamian ◽  
Richard P. Schlenk ◽  
...  
Keyword(s):  
Surgical Training ◽  
Training Programs ◽  
Core Competencies ◽  
Technical Skills ◽  
Surgical Skills ◽  
Training Experience ◽  
Surgical Trainees ◽  
Modern Health Care ◽  
External Pressures ◽  
Skills Laboratory

Surgical education has been forced to evolve from the principles of its initial inception, in part due to external pressures brought about through changes in modern health care. Despite these pressures that can limit the surgical training experience, training programs are being held to higher standards of education to demonstrate and document trainee competency through core competencies and milestones. One of the methods used to augment the surgical training experience and to demonstrate trainee proficiency in technical skills is through a surgical skills laboratory. The authors have established a surgical skills laboratory by acquiring equipment and funding from nondepartmental resources, through institutional and private educational grants, along with product donations from industry. A separate educational curriculum for junior- and senior-level residents was devised and incorporated into the neurosurgical residency curriculum. The initial dissection curriculum focused on cranial approaches, with spine and peripheral nerve approaches added in subsequent years. The dissections were scheduled to maximize the use of cadaveric specimens, experimenting with techniques to best preserve the tissue for repeated uses. A survey of residents who participated in at least 1 year of the curriculum indicated that participation in the surgical skills laboratory translated into improved understanding of anatomical relationships and the development of technical skills that can be applied in the operating room. In addition to supplementing the technical training of surgical residents, a surgical skills laboratory with a dissection curriculum may be able to help provide uniformity of education across different neurosurgical training programs, as well as provide a tool to assess the progression of skills in surgical trainees.

scholarly journals Teachers’ Perception about English as a Medium of Instructions: Evidence from the Government Higher Secondary Schools of Sindh, Pakistan

2021 ◽  
Vol 11 (4) ◽  
pp. 362-371
Author(s):  
Abul Ala Mukhtar ◽  
Zafarullah Sahito ◽  
Abida Siddiqui
Keyword(s):  
Secondary Schools ◽  
English Language ◽  
Mother Tongue ◽  
Social Institutions ◽  
Medium Of Instruction ◽  
Structured Interviews ◽  
Common People ◽  
British Rule ◽  
The Government ◽  
Set Up

This case study inquires the perceptions and experiences of teachers about the English as a medium of instructions at government higher secondary schools of Warah city of Sindh, Pakistan. It witnesses that a large chunk of the population is diversified to use their provincial or regional languages as destined by socio-political heritage. Because English was remained a paramount part of educational context in Pakistan during British rule. In Sindh, students learn English from their teachers at their schools, who by no means really acquire the required proficiency in the English language. The research design undertaken was qualitative in nature and revolved around the semi structured interviews. English as a medium of instruction has a daunting and remarkable role to set to be set up across the globe. The mother tongue has the supreme role to play in the organized system of social institutions, which has massive resources of linguistics pouring down to the common people in the forms of superb streams of dialects with definite code of syntax, semantics and pragmatism. The extra reading materials with the support of technology, the English lessons can play a pivotal role to give internalization and adaptation of English language as a medium of instruction.

scholarly journals Development of a High-Fidelity, 3D Printed Otoplasty Surgical Simulator

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Chelsey Wallace, M.S. ◽  
Zahra Nourmohammadi, Ph.D. ◽  
David A. Zopf, M.D., M.S.
Keyword(s):  
Surgical Simulation ◽  
Low Cost ◽  
Cost Effective ◽  
Occurrence Rate ◽  
Surgical Simulator ◽  
Risk Environment ◽  
Surgical Simulators ◽  
Protruding Ears ◽  
Surgical Trainees ◽  
Ear Cartilage

Background and Hypothesis: Protruding ears, also known as prominauris, are prevalent worldwide at an occurrence rate of about 5%. Children with prominauris report lower self-esteem and experience increased teasing and social isolation at school. From a functional standpoint, protruding ears can make wearing prescription glasses difficult. This increased stress and anxiety and impaired functionality lead children and families to seek treatment. One of the most effective treatments for protruding ears is otoplasty. This procedure involves an incision in the back of the ear and the placement of non-resorbable sutures to reform the ear. Alternatively, the procedure can be performed using an incisionless technique. As this is an elective procedure done commonly in children, adequate education of medical trainees is critical to ensure the proper level of skill is attained and patient satisfaction is maximized. Currently, teaching otoplasty is done with cadavers and supervised procedures with an attending. Surgical simulators are employed in the instruction of a variety of surgical procedures and allow residents to practice in a zero-risk environment. In addition, 3D printing has facilitated the development of surgical simulators allowing for a more cost-effective, consistent, and anatomically correct simulator. We developed an ear model made from silicone for trainees to practice traditional and incisionless otoplasty. Project Methods: The otoplasty surgical simulator was developed by isolating an ear from a computed-tomography scan in the Materialise software to create a 3D model. This model was then altered to create a negative mold. The mold was printed using fusion deposition printing with 1.75 MM polylactic acid filament. After printing, the mold was filled with Dragon Skin Silicone Shore 20 to simulate ear cartilage. The model was then coated in a layer of Dragon Skin Silicone Shore 10 to simulate a layer of skin. Conclusion and Potential Impact: This otoplasty simulator will next be validated by expert surgeons and then used in a surgical simulation workshop for surgical trainees. Because of the low-cost of the surgical simulator and the ease of manufacturing, this simulator can also be used to train surgeons abroad where access to surgical training may not be readily available. 

scholarly journals Consenting Operative Orthopaedic Trauma Patients: Challenges and Solutions

ISRN Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Amin Kheiran ◽  
Purnajyoti Banerjee ◽  
Philip Stott
Keyword(s):  
Phase 1 ◽  
Operative Procedure ◽  
Trauma Surgery ◽  
National Standards ◽  
Junior Doctors ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Phase 2 ◽  
Consent Forms ◽  
Surgical Trainees

Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced (P=0.03) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient’s copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards.

How does the evolution of an organization's multiple-dominant-logic system affect its ambidextrous innovation?

2021 ◽  
Vol 34 (3) ◽  
pp. 545-569
Author(s):  
Haifen Lin ◽  
Tingchen Qu
Keyword(s):  
Structured Interviews ◽  
Content Type ◽  
Internal Resources ◽  
Dominant Logic ◽  
Influence Mechanism ◽  
Entrepreneurial Bricolage ◽  
Set Up ◽  
Logic System ◽  
The Way

PurposeThis paper aims to address how an organization's multiple-dominant-logic system evolves as it grows and how does this evolution affect the way managers choose to balance ambidextrous innovation.Design/methodology/approachThis paper adopts an interpretive and exploratory case study on the mechanism of how the multiple-dominant-logic system influences the decision of balanced ambidextrous innovation. Considering that the multiple-dominant-logic system will change with the development of a firm, this paper focuses on exploring how the evolution of multiple-dominant-logic system affects the way managers choose to balance ambidextrous innovation. The authors spent almost two years collecting data from M-grass Ecology and following the evolution and innovation through semi-structured interviews, archival data and observation. Then they set up a framework showing the influence mechanism by analyzing the data through a four-step process.FindingsThis research points out that an organization's multiple-dominant-logic system may change for several times in its growth. It provides a model for the evolution of a multiple-dominant-logic system. It confirms that firms' multiple-dominant-logic system is not immutable, but evolves with the change of the firm's internal resources and external environment. Also, it finds that under the influence of different multiple-dominant-logic architectures, mangers choose different ways to balance ambidextrous innovation. In this process, appropriate entrepreneurial bricolage plays a significant role in balancing ambidextrous innovation.Originality/valueThe findings offer some valuable insights for further research on dominant logics and ambidextrous innovation and hold important implications for managers making a decision.

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