Development and Evaluation of a Proficiency-based and Simulation-based Surgical Skills Training for Technical Medicine Students

Objective: Surgical graduate training to achieve practice-ready students is needed, yet is often lacking. This study developed and evaluated a proficiency-based, simulation-based course for basic surgical skills at graduate level. Learning outcomes were measured at the level of knowledge and skills and evaluated with a post-course questionnaire after students’ clinical rotations.Methods: The surgical skills course was anchored to surgical patient flow and covered topics and skills related to pre-, intra-, and post-operative care, including case-based medical reasoning, patient safety, infection management, operating theatre etiquette, scrubbing and donning, instrument handling, local anaesthesia, excision of tissue, and suturing. Students were assessed on knowledge and procedural skills.Results: 155 graduate Technical Medicine students from academic years 2015-2016 and 2016-2017 entered this 10-week, 3 ECTS credits graduate Surgical Skills course. Pass rates of the knowledge test were 78%, and 87% for the procedural skill assessment. Graduate students reached proficiency level in a simulation-based basic surgical skills course. Students stated to go with confidence to the operating room and felt competent in performing four basic surgical skills.Conclusion: Based on this study, we recommend that proficiency-based training using simulation should be standard in surgical curricula before students are allowed to practice on patients

Motion tracking to support surgical skill feedback and evaluation

Introduction & Aims Performance evaluation of technical surgical skill is done by direct observation by expert surgeons. This is time intensive, costly, and requires training of assessors. Motion tracking could complement direct observation to provide immediate feedback during training and to support objective performance assessment. A recent study by Ahmed et al. (2017) showed that expert feedback combined with validated metrics resulted in greater performance improvement for novices. However, current motion tracking methods are expensive, non-portable, or very sensitive to disturbances from the environment. We hypothesize that combining technologies solves these limitations. The goal of the current study was to design a wireless, low-cost motion tracking system to support 1) real-time individual performance feedback and 2) objective assessment of technical surgical skills. Description An iterative, research-based design process with rapid prototyping was followed. First, we performed a needs assessment with a literature review and survey to a broad range of surgeons to identify relevant motion parameters. Second, various prototypes using an Inertial Measurement Unit (IMU) and a Leap motion sensor were tested in an authentic surgical environment for 1) robustness and 2) accuracy. Outcomes Twelve surgeons (experience range = 2 - 27 years) from five different hospitals and a range of surgical specialties completed the survey and rated ‘precision of movement’ and ‘minimizing unnecessary movements’ as most important motion parameters of surgical skill. Furthermore, unnecessary or excessive movements and secondary tissue damage were reported as most common errors. The final prototype can be seen in Figure 1. The IMU is embedded in a sleeve and detects fine motor skills such as small hand movements, tremors, and strokes. The Leap Motion sensors complement this with infrared tracking of the hand in 3D space and time. The devices proved robust under changing lighting and gowning conditions. Accuracy of motion tracking was however influenced by instrument use. Discussion Our device offers the possibility for immediate performance feedback aiding trainees’ self-assessment during training. By discriminating good from poor performers in training early on, training can be adapted to an individual trainee’s needs and facilitate deliberate practice. Future research includes expert benchmarking and parameter selection. Motion tracking analysis complements subjective assessment that is prone to bias and reduces assessors’ workload. Novelty of methodology Motion tracking to support surgical skill assessment is not yet common practice. The device offers a robust, affordable, and wearable alternative to current motion tracking devices

Technical Medicine: Designing Medical Technological Solutions for Improved Health Care

Introduction Complex medical technology is rapidly being introduced in health care, aimed at improving diagnosis and treatment. However, mistakes in the use of medical technology show that adequate expertise to apply it safely is often lacking, let alone to improve patient care through innovative technology use. We argue that a new health care professional, the Technical Physician, should be trained to have the expertise to translate medical technology use into improved patient-specific procedures. Method An educational design model was followed, consisting of analysis, design, construction, implementation, and formative evaluation. Analysis of technology use in health care and the required expertise was conducted to derive the professional profile and core competencies. Adaptive expertise theory and research-based design form the foundation of the professional profile. Cognitive integration, self-directed learning, and technical medical design projects were selected as leading instructional principles. Evaluation The curriculum was implemented in 2003 in the Netherlands. Over 300 Technical Physicians have graduated since 2009. Internal evaluations showed that curriculum changes were necessary to (1) address the application of mathematical principles, (2) enhance reflection by increasing experience-based learning, (3) support development of adaptive expertise related to basic technical skills, and (4) aid faculty in translating their knowledge and skills to the Technical Medicine domain. Discussion We recommend a strong focus on supporting both faculty within the Technical Medicine program and the Technical Physicians in clinical practice with the translation of knowledge and skills between the technical and medical domains. Future research should systematically evaluate the design and effects of the Technical Medicine curriculum

Psychologists’ Diagnostic Processes during a Diagnostic Interview

In mental health care, psychologists assess clients’ complaints, analyze underlying problems, and identify causes for these problems, to make treatment decisions. We present a study on psychologists’ diagnostic processes, in which a mixed-method approach was employed. We aimed to identify a common structure in the diagnostic processes of different psychologists. We engaged an actor to simulate a client. Participants were asked to perform a diagnostic interview with this “client”. This interview was videotaped. Afterwards participants first wrote a report and then were asked to review their considerations during the interview. We found that psychologists were comprehensive in their diagnostic interviews. They addressed the client’s complaints, possible classifications, explanations, and treatments. They agreed about the classifications, more than about causal factors and treatment options. The content of the considerations differed between the interviews and the reports written afterwards. We conclude that psychologists continuously shifted between diagnostic activities and revised their decisions in line with the dynamics of the interview situatio

Using sensor technology to capture the structure and content of team interactions in medical emergency teams during stressful moments

In healthcare, action teams are carrying out complex medical procedures in intense and unpredictable situations to save lives. Previous research has shown that efficient communication, high-quality coordination, and coping with stress are particularly essential for high performance. However, precisely and objectively capturing these team interactions during stressful moments remains a challenge. In this study, we used a multimodal design to capture the structure and content of team interactions of medical teams at moments of high arousal during a simulated crisis situation. Sociometric badges were used to measure the structure of team interactions, including speaking time, overlapping speech and conversational imbalance. Video coding was used to reveal the content of the team interactions. Furthermore, the Empatica E4 was used to unobtrusively measure the team leader’s skin conductance to identify moments of high arousal. In total, 21 four-person teamsof technical medicine students in the Netherlands were monitored in a simulation environment while they diagnosed and managed a patient with cardiac arrest. Outcomes of this exploratory study revealed that more effective teams showed greater conversational imbalance than less effective teams, but during moments of high arousal the opposite was found. Also, a number of differences were found for the content of team interaction. Combining sensor technology with traditional measures can enhance our understanding of the complex interaction processes underlying effective team performance, but technological advances together with more knowledge about the simultaneous application of these methods are needed to tap into the full potential of wearable sensor technology in team research

How simulated patients contribute to student learning in an authentic way:An interview study

Introduction: Simulated patients (SPs) play an instrumental role in teaching communication skills and enhancing learning outcomes. Prior research mostly focused on the SP’s contribution to students’ learning outcomes by providing feedback afterwards. A detailed understanding of the contribution of the SP during SP-student encounters is currently lacking although the majority of the interaction between SPs and students occurs during the SP-student encounter. Therefore, this study focuses on how SPs see their contribution to meaningful student learning experiences during SP-student encounters. Methods: We interviewed fifteen simulated patients from one institution. We explored their perspectives on meaningful learning experiences during SP-student encounters through in-depth, semi-structured interviews and analyzed using thematic analysis. Results: SPs view their contribution to meaningful student learning during SP-student encounters from two perspectives. A collective perspective as a member of the community of SPs and an individual perspective. From the collective perspective, SPs believe that the fact that students deal with multiple varied SP-student encounters over time is of value for meaningful learning. From the individual perspective, we noticed that SPs think, act, and react from three different positions. First, as the patient in the role description, second, as a teaching aid and third, as an individual with personal experiences, beliefs, and values. SPs mentioned that the ratio between these different positions can vary within and between encounters. Conclusions: According to SPs, we should value the variation between SPs, thereby creating meaningful variation in authentic interactions in SP-student encounters. SPs should be allowed to act and react from different positions during SP-student encounters, including their role description, as teaching aid, and based on their own experiences. In this way, SP-student encounters are optimized to contribute to meaningful student learning through authenticity.</p

Oorzaken in het psychodiagnostisch proces, welke rol speelt klinische intuïtie?

Wat hebben psychologen eraan te weten wat de oorzaken van de problemen van hun cliënten zijn? Dit artikel gaat in op de rol van causaal redeneren in psychodiagnostiek en indicatiestelling. Cilia Witteman cum suis introduceren ook een tegenhanger: klinische intuïtie. Dat deze intuïtie een rol speelt in het diagnostische proces lijkt evident. De vraag is hoe, en of dat zinvol kan zijn