Redefining Surgical Skill Acquisition

There have been reduced opportunities for surgical skill acquisition due to the COVID-19 pandemic and the regulated training hours. Despite these challenges, self-regulated learning allows trainees to learn continuously, and motor skills development can be augmented through mental practice and motor imagery. The aim of this chapter is to introduce the theoretical concepts in skill acquisition and the role of mental and deliberate practice as an alternative for skill training. A case study is presented using a design and development framework for producing an online basic micro suturing training resource based on self-regulated learning. This case study demonstrates the use of the ADDIE instructional design model and Mayer’s multimedia theory guidelines, for creating online instructional resources. The methodological approach of a design and developmental framework to create an educationally sound online training module for micro suturing which has significant utility in hand surgery is discussed in this chapter. The tools described in this chapter are translatable to any psychomotor skills development in medical education

High Median Nerve Paralysis:Is the Hand of Benediction or Preacher's Hand A Correct Sign?

High median nerve injuries are commonly presented in textbooks as adopting the typical posture of hand of benediction or preacher’s hand. This study aimed to show that the hand of benediction or preacher’s hand is incorrectly associated with a high median nerve paralysis. METHODS: A retrospective review of four cases with a high median nerve injury is presented. Diagnosis of a high median nerve injury was performed by means of intraoperative findings, electrodiagnostic studies, or ultrasound imaging. None of the patients presented in this study had a hand of benediction on physical examination despite the presence of a high median nerve lesion. RESULTS: All four patients with high median nerve injuries showed a similar hand posture when attempting to make a fist. Firstly, the index finger still flexed at the metacarpophalangeal joint because of the ulnar innervated interossei muscles. Secondly the thumb is completely abducted at the carpometocarpal joint and extended at the interphalangeal joint. Lastly, middle finger flexion is possible due to dual innervation of its flexor digitorum profundus by the ulnar nerve as well as due to the quadriga phenomenon. CONCLUSIONS: The clinical appearance of a high median nerve palsy is different from the classical hand of benediction or preacher’s hand posture pointing finger. We have shown that this incorrect association can result in delayed referral of patients with high median nerve injuries

A Metaknowledge Framework for the Training of Trainers Using Smart Mobile Learning Applications

Smart mobile learning (SML) is evolving due to the availability of devices, advancement in technologies (artificial intelligence and big data analytics), and a pressing need from users for a change in their learning environment. SML has impacted many facets of learning and one of it is the training of trainers (ToT). This chapter presents a state-of-the-art SML framework for the training of trainers - called the SCALED framework. The SCALED framework allows trainers to plan their training based on metaknowledge related to stakeholders, competencies, affordances, learners, evaluation and design intentions. The chapter presents two case studies, one related to SDG4 and the other to SDG3, both addressing the needs of developing countries in the ToT and how the trainers collaborate with their partners in reaching the goals of their programs. The case studies provide excellent instances of how metaknowledge surfaced using the SCALED framework

Conduit-based Nerve Repairs Provide Greater Resistance to Tension Compared with Primary Repairs: A Biomechanical Analysis on Large Animal Samples

Background:. When primary repair of transected peripheral nerves is not possible due to large gaps, nerve grafts or repair using conduits are other options to bridge the gap such that the nerve is repaired without tension. When nerve gaps are repaired primarily, there is a worry about tension, failure, and poor healing. In this biomechanical study comparing nerves repaired primarily versus those repaired with conduits, we hypothesized that conduit repair provided greater mechanical breaking strength. Methods:. We dissected fresh cadaveric sheep hooves and transacted their peripheral nerves. Subsequently, we divided these transacted nerves into 2 groups: primary repair versus repair using a nerve conduit. After repair using a standardized technique, we tensioned each of these repairs via a load tester and recorded the force required till repair failure occurred. Results:. Six nerves using primary nerve repair and 6 nerves repaired with a nerve conduit (10 mm length × 2.5 mm diameter) were studied. The average breaking strength of the nerves repaired with the nerve conduit was 0.92 N and that using the primary nerve repair technique was 0.46 N (P = 0.001). All the nerves repaired using nerve conduit repair had an additional 5 mm added to their total length as compared with the nerves in the other group. Conclusions:. Nerve repair using a nerve conduit ensures a higher breaking strength and potentially a greater tension-free repair as compared with primary nerve repairs in a sheep model. This study supports the use of conduits in the bridging of nerve gaps

Experiences of living with leprosy: A systematic review and qualitative evidence synthesis

OBJECTIVE: The objective of the review was to identify, appraise, and synthesise qualitative studies on the lived experience of individuals diagnosed with leprosy, the impact of the disease, and how they coped with the disease burden. INTRODUCTION: Leprosy is a chronic disease with long-term biopsychosocial impact and is a leading cause of preventable disabilities. It traps the individuals with leprosy in a vicious circle of disease, stigma, and poverty. The efforts to reduce stigma and discrimination and improve their quality of life have not kept pace with the success of the multidrug treatment. INCLUSION CRITERIA: This review considered published literature on the lived experience of individuals diagnosed with leprosy. There were no limitations on gender, background, or country. All qualitative or mixed-methods studies were accepted. METHODS: The review followed the JBI meta-aggregation approach for qualitative systematic reviews. A structured literature search was undertaken using multiple electronic databases: PubMed, Embase, Web of Science, and CINAHL. RESULTS: The search identified 723 publications, and there were 446 articles after deduplication. Forty-nine studies met the inclusion criteria. The final 173 findings were synthesised into ten categories and aggregated into four synthesised findings: biophysical impact, social impact, economic impact, and mental and emotional impact. These synthesised findings were consistent across the included studies from a patient's perspective. The way people coped with leprosy depended on their interpretation of the disease and its treatment. It affected their help-seeking behaviour and their adherence to treatment and self-care. The review has identified a multi-domain effect on the affected individuals, which goes beyond the biological and physical effects, looking at the social issues, specific difficulties, emotions, and economic hardships. CONCLUSIONS: The researchers, health professionals, and policymakers could use the synthesised findings to address the concerns and needs of the leprosy-affected individuals and offer appropriate support to manage their lives. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO Registration number: CRD42021243223