The Pedagogy Of The Operating Theatre

This thesis outlines the findings of a large body of research work undertaken during 3 years of full-time study. The findings have already provided the author with helpful anchors for structuring formative feedback to surgical trainees within a simulation program, as well as helpful insights into her own learning. This thesis explores the operating theatre as a teaching and learning environment for postgraduate surgical trainees. The work crosses paradigms and uses contrasting methodologies to provide rich insights into surgical pedagogic practice. The first chapter is an introduction to the subject material, outlining the thesis aims and research questions, making clear why the research is important. The perspectives of the researcher are explained, in the first person, to make explicit her background and epistemological stance. The next chapter presents a narrative review of the literature, providing a background to the subject and a theoretical framework. Chapters three to six constitute empirical work. The third and fourth chapters use a grounded theory method to explore surgeons’ perceptions of the content and process of learning in the operating theatre. Chapter five uses case study methodology to illustrate teaching and learning in the operating theatre with concrete examples of pedagogic practice. The sixth chapter is a quasi-experimental study of learning which makes comparison between different pedagogic styles. The final chapter of the thesis draws together the findings from the empirical investigations. The personal development of the researcher is discussed in the first person and the body of research work is critically examined in view of its contribution to the field and its implications for future educational innovation.Open Acces

Haptics: Science, Technology, Applications

This open access book constitutes the proceedings of the 12th International Conference on Human Haptic Sensing and Touch Enabled Computer Applications, EuroHaptics 2020, held in Leiden, The Netherlands, in September 2020. The 60 papers presented in this volume were carefully reviewed and selected from 111 submissions. The were organized in topical sections on haptic science, haptic technology, and haptic applications. This year's focus is on accessibility

Design, validation and implementation of a virtual reality high fidelity laparoscopic appendicectomy curriculum

INTRODUCTION: The treatment for acute appendicitis is laparoscopic appendicectomy (LA), usually performed by trainees who face significant challenges to training. Simulation curricula are being increasingly utilised and optimised to accelerate learning and improve skill retention in a safe environment. The aim of this study is to produce and implement a virtual reality (VR) curriculum for laparoscopic appendicectomy (LA) on the high-fidelity LAP Mentor VR simulator. METHODOLOGY: Performance data of randomised experts and novices were compared to assess the construct validity of the LAP Mentor basic skills (BS) and LA modules. Face validity of the simulator and module was assessed by questionnaire. These results informed the construction of a VR LA curriculum on an evidence-based theoretical framework. The curriculum was implemented and evaluated by analysis of participant diaries. RESULTS: Thirty-five novices and 25 experienced surgeons performed either BS, five LA procedural tasks or the LA full procedure. Both modules demonstrated construct validity. The LA module was deemed moderately realistic and useful for developing laparoscopic psychomotor skills. Seven novice trainees completed the new LA curriculum (three others dropped out). Analysis of participants diaries revealed the presence of frustration, the benefits of feedback sessions and the advantages and pitfalls of open access. DISCUSSION: Evaluations of the implementation of similar curricula are rare and participant diaries led to critical insights. The curriculum was difficult and sometimes frustrating, mitigated by rewarding experiences and coaching. The latter facilitated deliberate practice. Scheduling issues were mitigated by open access. Limitations of the curricula include the invariability in the presentation of appendicitis, and the reason for dropouts are not known. CONCLUSION: Several BS and all LA tasks are construct-valid. A new VR LA curriculum was implemented and analysis of participant diaries yielded critical insights into real-world implementation. Future study should investigate its effect on real-world performance and patient outcomes

Getting the point: tracing worked examples enhances learning

Embodied cognition perspectives suggest that pointing and tracing with the index finger may support learning, with basic laboratory research indicating such gestures have considerable effects on information processing in working memory. The present thesis examined whether tracing worked examples could enhance learning through decreased intrinsic cognitive load. In Experiment 1, 56 Year 6 students (mean age = 11.20, SD = .44) were presented with either tracing or no-tracing instructions on parallel lines relationships. The tracing group solved more acquisition phase practice questions and made fewer test phase errors, but otherwise test results were limited by ceiling effects. 42 Year 5 students (mean age = 10.50, SD = .51) were recruited in Experiment 2 to better align the materials with students’ knowledge levels. The tracing group outperformed the non-tracing group at the test and reported lower levels of test difficulty, interpreted as lower levels of intrinsic cognitive load. Experiment 3 recruited 52 Year 6 and Year 7 students (mean age = 12.04, SD = .59) presented with materials on angle relationships of a triangle; the tracing effect was replicated on test scores and errors, but not test difficulty. Experiment 4 used the parallel lines materials to test hypothesized gradients across experimental conditions with 72 Year 5 students (mean age = 9.94, SD = .33), predicting the tracing on the paper group would outperform the tracing above the paper group, who in turn would outperform the non-tracing group. The hypothesized gradient was established across practice questions correctly answered, practice question errors, test questions correctly answered, test question time to solution, and test difficulty self-reports. The results establish that incorporating the haptic input into worked example-based instruction design enhances the worked example effect and that tracing worked examples is a natural, simple yet effective way to enhance novices’ mathematics learning

Haptics: Science, Technology, Applications

This open access book constitutes the proceedings of the 12th International Conference on Human Haptic Sensing and Touch Enabled Computer Applications, EuroHaptics 2020, held in Leiden, The Netherlands, in September 2020. The 60 papers presented in this volume were carefully reviewed and selected from 111 submissions. The were organized in topical sections on haptic science, haptic technology, and haptic applications. This year's focus is on accessibility

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Validation of the Haptic Cow: A simulator for training veterinary students

A virtual reality simulator, the Haptic Cow, has been developed using touch feedback technology for training veterinary students to perform bovine rectal palpation of the reproductive tract. The simulator was designed to supplement existing training and address some of the difficulties associated with teaching palpation-based skills. Students need to achieve a certain level of proficiency by graduation but this has become increasingly difficult because of problems with current training methods and a reduction in the number of opportunities to practice. A simulator- based teaching tool was developed as a potential solution. The first step involved designing a simulator on the basis of requirements established through consultation with both veterinary surgeons, as teachers, and students, as learners. Research was then undertaken to validate the simulator by following a set of established criteria described for the evaluation of new technologies used in medical education. The virtual models were assessed by experts as realistic enough representations of the same structures in the cow. An experiment to assess the effect of simulator training compared the performance of one group of students, whose training was supplemented with a simulator session, with another group of traditionally trained students. The subsequent performance for finding and identifying the uterus when examining cows for the first time, was significantly better for the simulator trained group, indicating that skills learned in the simulator environment transferred to the real task. A project was also undertaken to integrate the simulator into a curriculum, with training included as part of the farm animal course at the University of Glasgow Veterinary School. The training was well received by students, useful feedback was gathered and the simulator continues to be used as part of the course. Further developments were undertaken with the aim of creating a more versatile teaching tool and addressing some of the questions and issues raised. An automated version of the Haptic Cow was designed for students to use on their own, with computer guidance replacing the instructor's role. An evaluation found that the new version of the teaching tool was both usable and an effective way of equipping students with the skills required to find and identify the uterus. The potential to use haptic technology to investigate various aspects of performance was also explored in relation to the question of hand choice for certain palpation-based skills: differentiating between objects on the basis of softness and size. Ongoing research and development options are discussed, with the aim of building on the current work by expanding the role of haptic technology in veterinary education in the future

Distributed Sensing and Stimulation Systems Towards Sense of Touch Restoration in Prosthetics

Modern prostheses aim at restoring the functional and aesthetic characteristics of the lost limb. To foster prosthesis embodiment and functionality, it is necessary to restitute both volitional control and sensory feedback. Contemporary feedback interfaces presented in research use few sensors and stimulation units to feedback at most two discrete feedback variables (e.g. grasping force and aperture), whereas the human sense of touch relies on a distributed network of mechanoreceptors providing high-fidelity spatial information. To provide this type of feedback in prosthetics, it is necessary to sense tactile information from artificial skin placed on the prosthesis and transmit tactile feedback above the amputation in order to map the interaction between the prosthesis and the environment. This thesis proposes the integration of distributed sensing systems (e-skin) to acquire tactile sensation, and non-invasive multichannel electrotactile feedback and virtual reality to deliver high-bandwidth information to the user. Its core focus addresses the development and testing of close-loop sensory feedback human-machine interface, based on the latest distributed sensing and stimulation techniques for restoring the sense of touch in prosthetics. To this end, the thesis is comprised of two introductory chapters that describe the state of art in the field, the objectives and the used methodology and contributions; as well as three studies distributed over stimulation system level and sensing system level. The first study presents the development of close-loop compensatory tracking system to evaluate the usability and effectiveness of electrotactile sensory feedback in enabling real-time close-loop control in prosthetics. It examines and compares the subject\u2019s adaptive performance and tolerance to random latencies while performing the dynamic control task (i.e. position control) and simultaneously receiving either visual feedback or electrotactile feedback for communicating the momentary tracking error. Moreover, it reported the minimum time delay needed for an abrupt impairment of users\u2019 performance. The experimental results have shown that electrotactile feedback performance is less prone to changes with longer delays. However, visual feedback drops faster than electrotactile with increased time delays. This is a good indication for the effectiveness of electrotactile feedback in enabling close- loop control in prosthetics, since some delays are inevitable. The second study describes the development of a novel non-invasive compact multichannel interface for electrotactile feedback, containing 24 pads electrode matrix, with fully programmable stimulation unit, that investigates the ability of able-bodied human subjects to localize the electrotactile stimulus delivered through the electrode matrix. Furthermore, it designed a novel dual parameter -modulation (interleaved frequency and intensity) and compared it to conventional stimulation (same frequency for all pads). In addition and for the first time, it compared the electrotactile stimulation to mechanical stimulation. More, it exposes the integration of virtual prosthesis with the developed system in order to achieve better user experience and object manipulation through mapping the acquired real-time collected tactile data and feedback it simultaneously to the user. The experimental results demonstrated that the proposed interleaved coding substantially improved the spatial localization compared to same-frequency stimulation. Furthermore, it showed that same-frequency stimulation was equivalent to mechanical stimulation, whereas the performance with dual-parameter modulation was significantly better. The third study presents the realization of a novel, flexible, screen- printed e-skin based on P(VDF-TrFE) piezoelectric polymers, that would cover the fingertips and the palm of the prosthetic hand (particularly the Michelangelo hand by Ottobock) and an assistive sensorized glove for stroke patients. Moreover, it developed a new validation methodology to examine the sensors behavior while being solicited. The characterization results showed compatibility between the expected (modeled) behavior of the electrical response of each sensor to measured mechanical (normal) force at the skin surface, which in turn proved the combination of both fabrication and assembly processes was successful. This paves the way to define a practical, simplified and reproducible characterization protocol for e-skin patches In conclusion, by adopting innovative methodologies in sensing and stimulation systems, this thesis advances the overall development of close-loop sensory feedback human-machine interface used for restoration of sense of touch in prosthetics. Moreover, this research could lead to high-bandwidth high-fidelity transmission of tactile information for modern dexterous prostheses that could ameliorate the end user experience and facilitate it acceptance in the daily life

Impact of Ear Occlusion on In-Ear Sounds Generated by Intra-oral Behaviors

We conducted a case study with one volunteer and a recording setup to detect sounds induced by the actions: jaw clenching, tooth grinding, reading, eating, and drinking. The setup consisted of two in-ear microphones, where the left ear was semi-occluded with a commercially available earpiece and the right ear was occluded with a mouldable silicon ear piece. Investigations in the time and frequency domains demonstrated that for behaviors such as eating, tooth grinding, and reading, sounds could be recorded with both sensors. For jaw clenching, however, occluding the ear with a mouldable piece was necessary to enable its detection. This can be attributed to the fact that the mouldable ear piece sealed the ear canal and isolated it from the environment, resulting in a detectable change in pressure. In conclusion, our work suggests that detecting behaviors such as eating, grinding, reading with a semi-occluded ear is possible, whereas, behaviors such as clenching require the complete occlusion of the ear if the activity should be easily detectable. Nevertheless, the latter approach may limit real-world applicability because it hinders the hearing capabilities.</p