A systematic examination of preoperative surgery warm-up routines

Recent evidence indicates that a preoperative warm-up is a potentially useful tool in facilitating performance. But what factors drive such improvements and how should a warm-up be implemented?In order to address these issues, we adopted a two-pronged approach: (1) we conducted a systematic review of the literature to identify existing studies utilising preoperative simulation techniques; (2) we performed task analysis to identify the constituent parts of effective warm-ups. We identified five randomised control trials, four randomised cross-over trials and four case series. The majority of these studies reviewed surgical performance following preoperative simulation relative to performance without simulation.Four studies reported outcome measures in real patients and the remainder reported simulated outcome measures. All but one of the studies found that preoperative simulation improves operative outcomes-but this improvement was not found across all measured parameters. While the reviewed studies had a number of methodological issues, the global data indicate that preoperative simulation has substantial potential to improve surgical performance. Analysis of the task characteristics of successful interventions indicated that the majority of these studies employed warm-ups that focused on the visual motor elements of surgery. However, there was no theoretical or empirical basis to inform the design of the intervention in any of these studies.There is an urgent need for a more rigorous approach to the development of "warm-up" routines if the potential value of preoperative simulation is to be understood and realised. We propose that such interventions need to be grounded in theory and empirical evidence on human motor performance

Enhancing surgical training by audio-visual simulation with hazard cognitive training and reflection tools: a design-based study in laparoscopic cholecystectomy

Abstract Background Surgical training has become more challenging in the UK with the reduction in training time and the reduced training opportunities, making every training opportunity precious. This study aims to address this curriculum challenge by enhancing surgical training and assessment in the surgical training environment. Methodology Using a design-based approach a two-step design was created. Step One involved creating an online, standalone, Cognitive Hazard Training module. It uses videos of real operations to mentally train candidates to recognise, anticipate and avoid hazards during the operation. An online example of this Module was created for laparoscopic cholecystectomy. The second design step was a Reflective Formative Assessment. The trainee and supervisor reviewed the trainee’s video-recording of a supervised-operation which involved reassessing the trainee’s performance to enhance feedback and reflection. Design feasibility was tested in the Northern Deanery training environment and the feasibility study was complemented by a theatre observation study to capture the details of the complex surgical training environment. Results The feasibility of this two-step design was tested with 2 experts, 32 trainees and 15 trainers. Trainee and trainer qualitative feedback was collected, via semi-structured interviews. Users’ feedback along with multiple additional data from the operation-recordings and video-review session were analysed and triangulated to improve the design and establish the feasibility and role of this style of video-review in the current surgical training. Observational data was also collected during live surgery in theatre to identify any factors affecting safety and training. Discussion This study has developed a novel approach to enhance surgical training, which has been tested and has received overwhelming support from both supervisors and their trainees. Cognitive Hazards Training steepened the learning curve and increased adherence to safety. The videoed operations were found to be an excellent teaching tool, which enhanced feedback and reflection. It increased trainees’ confidence and competence by tailoring the training to their individual needs. The success of this work forms the foundation for future development and testing of this new approach to surgical skills training in the UK

Designing for tacit learning: an investigation of design strategies for multimedia supported learning in the crafts

There is an increasing interest and activity in the design of interactive multimedia to support learning in all fields of education and training. However, most of the theory to support such developments is concerned with learning explicit knowledge and there is little guidance available to designers of material for learning in areas with an element of tacit knowledge such as craft skills. This paper describes the foundation work for a long-term project concerned with learning in traditional rural crafts but with the intention to provide a methodological framework for the design of multimedia-based learning in all areas of craft knowledge. A review of established theory of learning and the use of multimedia for learning in areas of explicit knowledge indicates some important basic principles, for example the need to understand the interaction between the teacher and learner in the context of the subject being taught and the need for clear narrative structures to avoid students becoming "lost" in the multiple pathways of interactive media. Observational studies of learning using educational video in a craft context and a study of an experienced craftsman/teacher teaching a group of learners, complemented by study of learning in related contexts, have allowed problems and issues to be identified and design strategies to be developed. While these are provisional they provide an overview of the design problems and have been used to plan a programme of experimental design and evaluation to test and develop principles of effective multimedia design for craft learning. </p

Applying psychological science to the CCTV review process: a review of cognitive and ergonomic literature

As CCTV cameras are used more and more often to increase security in communities, police are spending a larger proportion of their resources, including time, in processing CCTV images when investigating crimes that have occurred (Levesley &amp; Martin, 2005; Nichols, 2001). As with all tasks, there are ways to approach this task that will facilitate performance and other approaches that will degrade performance, either by increasing errors or by unnecessarily prolonging the process. A clearer understanding of psychological factors influencing the effectiveness of footage review will facilitate future training in best practice with respect to the review of CCTV footage. The goal of this report is to provide such understanding by reviewing research on footage review, research on related tasks that require similar skills, and experimental laboratory research about the cognitive skills underpinning the task. The report is organised to address five challenges to effectiveness of CCTV review: the effects of the degraded nature of CCTV footage, distractions and interrupts, the length of the task, inappropriate mindset, and variability in people’s abilities and experience. Recommendations for optimising CCTV footage review include (1) doing a cognitive task analysis to increase understanding of the ways in which performance might be limited, (2) exploiting technology advances to maximise the perceptual quality of the footage (3) training people to improve the flexibility of their mindset as they perceive and interpret the images seen, (4) monitoring performance either on an ongoing basis, by using psychophysiological measures of alertness, or periodically, by testing screeners’ ability to find evidence in footage developed for such testing, and (5) evaluating the relevance of possible selection tests to screen effective from ineffective screener

Des preuves récentes sur les habiletés visuo- spatiales pour la formation en chirurgie : revue exploratoire

Background: Understanding the relationships between structures is critical for surgical trainees. However, the heterogeneity of the literature on visual-spatial ability (VSA) in surgery makes it challenging for educators to make informed decisions on incorporating VSA into their programs. We conducted a scoping review of the literature on VSA in surgery to provide a map of the literature and identify where gaps still exist for future research. Methods: We searched databases until December 2019 using keywords related to VSA and surgery. The resulting articles were independently screened by two researchers for inclusion in our review. Results: We included 117 articles in the final review. Fifty-nine articles reported significant correlations between VSA tests and surgical performance, and this association is supported by neuroimaging studies. However, it remains unclear whether VSA should be incorporated into trainee selection and whether there is a benefit of three-dimensional (3D) over two-dimensional (2D) training. Conclusions: It appears that VSA correlates with surgical performance in the simulated environment, particularly for novice learners. Based on our findings, we make suggestions for how surgical educators may use VSA to support novice learners. Further research should determine whether VSA remains correlated to surgical performance when trainees move into the operative environment.Contexte&nbsp;:&nbsp; Il est fondamental pour les chirurgiens en formation de comprendre les liens qui unissent les diverses structures corporelles. Étant donné l’hétérogénéité de la littérature portant sur les habiletés visuo-spatiales (HVS) nécessaires en chirurgie, les éducateurs ont de la difficulté à prendre des décisions éclairées quant à l’enseignement des HVS dans leurs programmes. On a effectué une étude exploratoire de la littérature sur les HVS en chirurgie afin de répertorier la littérature et de cerner des lacunes pouvant faire l’objet de recherches ultérieures. Méthodologie&nbsp;: On a interrogé des bases de données jusqu’à décembre 2019 à l’aide de mots-clés reliés aux HVS et à la chirurgie.&nbsp; Les articles trouvés ont été évalués de façon indépendante par deux chercheurs pour déterminer leur inclusion à la revue. Résultats&nbsp;:&nbsp; Au total, 117 articles ont été inclus dans la revue finale. Cinquante-neuf faisaient état d’importantes corrélations entre les tests d’évaluation des HVS et la performance chirurgicale. Cette association est étayée par les résultats d’études en neuro-imagerie.&nbsp;&nbsp; Il n’est pas clair cependant si les HVS devraient faire partie des critères de sélection des résidents et si une formation sur les techniques de visualisation en trois dimensions (3D) est préférable à une formation sur les techniques de visualisation en deux dimensions (2D). Conclusions&nbsp;: Il semble exister un lien entre les HVS et la performance chirurgicale en contexte de simulation, particulièrement chez les apprenants novices. À la lumière de nos résultats, nous présentons des recommandations sur la façon dont les formateurs en chirurgie pourraient se servir des HVS pour aider les apprenants novices. D’autres travaux de recherche devraient permettre de savoir si les HVS restent reliés à la performance chirurgicale lorsque les stagiaires passent à un environnement opératoire réel

Ergonomics of the Operative Field in Paediatric Minimal Access Surgery

Imperial Users onl

Analytical Study of the Effects of Stress on Surgeons and Surgical Performance

This study aimed at exploring the effects of stress on surgeons and surgical performance, as the researchers adopted the methodology of descriptive analytical statistics by conducting a semi structured interviews on fourteen surgeons in Jordan. The aim of this study also was to investigate surgeons’ perceptions of surgical stress, highlight key stressors and their impact on performance, and identify coping strategies. Stress poses a serious risk for training surgeons since their performance and well‐being in reflected in patients' health. This study focuses on measuring the stress on surgeons and at the same time evaluates prospectively the results of practices that uses alternative techniques to combat the effects of stress. The study concluded that these interviews provided valuable insights into stressors, stress responses, and coping strategies used by surgeons and allowed us to categorize sources of stress. Although surgeons characteristically enjoy the stimulating features of their work, high levels of stress can affect performance adversely

Automated task load detection with electroencephalography: towards passive brain–computer interfacing in robotic surgery

Automatic detection of the current task load of a surgeon in the theatre in real time could provide helpful information, to be used in supportive systems. For example, such information may enable the system to automatically support the surgeon when critical or stressful periods are detected, or to communicate to others when a surgeon is engaged in a complex maneuver and should not be disturbed. Passive brain–computer interfaces (BCI) infer changes in cognitive and affective state by monitoring and interpreting ongoing brain activity recorded via an electroencephalogram. The resulting information can then be used to automatically adapt a technological system to the human user. So far, passive BCI have mostly been investigated in laboratory settings, even though they are intended to be applied in real-world settings. In this study, a passive BCI was used to assess changes in task load of skilled surgeons performing both simple and complex surgical training tasks. Results indicate that the introduced methodology can reliably and continuously detect changes in task load in this realistic environment

Motor learning induced neuroplasticity in minimally invasive surgery

Technical skills in surgery have become more complex and challenging to acquire since the introduction of technological aids, particularly in the arena of Minimally Invasive Surgery. Additional challenges posed by reforms to surgical careers and increased public scrutiny, have propelled identification of methods to assess and acquire MIS technical skills. Although validated objective assessments have been developed to assess motor skills requisite for MIS, they poorly understand the development of expertise. Motor skills learning, is indirectly observable, an internal process leading to relative permanent changes in the central nervous system. Advances in functional neuroimaging permit direct interrogation of evolving patterns of brain function associated with motor learning due to the property of neuroplasticity and has been used on surgeons to identify the neural correlates for technical skills acquisition and the impact of new technology. However significant gaps exist in understanding neuroplasticity underlying learning complex bimanual MIS skills. In this thesis the available evidence on applying functional neuroimaging towards assessment and enhancing operative performance in the field of surgery has been synthesized. The purpose of this thesis was to evaluate frontal lobe neuroplasticity associated with learning a complex bimanual MIS skill using functional near-infrared spectroscopy an indirect neuroimaging technique. Laparoscopic suturing and knot-tying a technically challenging bimanual skill is selected to demonstrate learning related reorganisation of cortical behaviour within the frontal lobe by shifts in activation from the prefrontal cortex (PFC) subserving attention to primary and secondary motor centres (premotor cortex, supplementary motor area and primary motor cortex) in which motor sequences are encoded and executed. In the cross-sectional study, participants of varying expertise demonstrate frontal lobe neuroplasticity commensurate with motor learning. The longitudinal study involves tracking evolution in cortical behaviour of novices in response to receipt of eight hours distributed training over a fortnight. Despite novices achieving expert like performance and stabilisation on the technical task, this study demonstrates that novices displayed persistent PFC activity. This study establishes for complex bimanual tasks, that improvements in technical performance do not accompany a reduced reliance in attention to support performance. Finally, least-squares support vector machine is used to classify expertise based on frontal lobe functional connectivity. Findings of this thesis demonstrate the value of interrogating cortical behaviour towards assessing MIS skills development and credentialing.Open Acces