Teaching methods for surgical education in the Residency...
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Teaching methods for surgical education in the Residency Program
Transcript of Teaching methods for surgical education in the Residency...
Teaching methods for surgical education in the Residency Program
LEARNING OBJECTIVES
SurgTTT Project – Cross national survey
Surgical education in Ireland - Surgical bootcamp
in Dublin
Usage of standardized patient simulation in general
surgery
Surgical residency program in Hungary
Surgical skill training program in Hungary(example)
DOCTOR IN THE HOUSE
A NEW SITUATION The practice of general surgery is undergoing significant change. The rapid adoption of new technologies, the integration of traditional and minimally invasive operations and the exponential expansion of the knowledge and variety of procedures the that trainees must learn dramatically alter the landscape of surgery. Ever – increasing complexity of procedures and the pronounced decrease in transferability require changes in training of residents.
SurgTTT Project - Cross national survey
COUNTRY PARTICIPANTS NOT COMPLETED Germany 49 4 Spain 130 38 Hungary 101 0 Romania 72 0
Questionnary filled by surgical trainers of four countries
Altogether: 352
Question analysis – I. Do you agree: a lecture/presentation is the disciplinary heart of surgical education?
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In the residency program ithas only secondaryimportanceLecture/presentation andpresence in the OR areequally importantNo, presence in the OR ismore important
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Question analysis – II. What do you prefer personally: lectures/presentations to pass surgical knowledge or education in the OR?
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Being a surgeon and educatorat the same time I enjoy botharea
I prefer lectures, I canconcentrate solely to thescientific topic, not necessaryto share my activity betweenoperation and oral educationI prefer the OR, this representsreality, consequently the bestplace for education
Question analysis – III. Do you analyze surgical procedures seen in the OR, in connection with the previously educated standard methods, together with your residents?
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Only if it was performed by another,special methodOnly if the procedure hadcomplicationsYes, always
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Question analysis – IV. Do you think: the operative technical skills of the surgeon observed in the OR has the most important, enthusiastic role in surgical residents’ education?
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It is only a part of the successfuleducation
No, the surgeon’s activity at the outpatient department or at the ward is just as important Yes, obviously
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Question analysis – V. Do you think that surgical mastering is the most important part of being surgeon as a role model?
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Other characteristics of the surgeon – to be patient, determined, quick, excellent scholar and scientist etc. – are equally important factors of a role model Personal characteristics of thesurgeon are not important factorsat all
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Question analysis – VI. Do you consider personal surgical skills are more important than team work skills?
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Both are equally important
More important, but cannot workwithout agreement in the surgical team
Obviously
Team work is more important
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Question analysis – VII. Are surgical skills, communication skills and team-work skills essential to be a good surgeon?
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Surgical skills is the most importantfactorTeam work is more important
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Question analysis – VIII. Do you analyze surgical procedures seen in the OR, in connection with the previously educated standard methods, together with your residents?
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Only if it was performed by another,special methodOnly if the procedure hadcomplicationsYes, always
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SURGICAL BOOTCAMP IN DUBLIN
SURGICAL BOOTCAMP IN DUBLIN, IRELAND
SURGICAL BOOTCAMP – I.
Interactive lectures Laparoscopic Equipment
Surgeons in the 21 Century
Electrocautery Deices
Caring for your body (Physioterapist)
Caring for your mind (Phychologist)
Trauma
Endoscopy
SURGICAL BOOTCAMP – II.
Skills trainig
Interactive lectures Knot Tying
Suturing
Ingrown Toenail
Laparotomy
Sebaceous Cysts
Skin Lesions
Bowel Anastomosis
Vessel Ligation
Laparoscopic Exercises: Dissection
Laparoscopic Exercises: Beads
Laparoscopic Exercises:Appendectomy
SURGICAL BOOTCAMP – III.
Interactive lectures
Skills trainig
Clinical scenarios Critical Care
Clinical Decision Making
Legal / Risk Management
Surgical Problems / Management
Trauma
1 2 3 4 5
Title
Learning Objectives
Assesment
Speakers
Other
Open Surgery Part B
Lap. Surgery Part A
Lap. Surgery Part B Endoscopy
Anatomy Anatomy
Anatomy Anatomy
Open Surgery
Part A
Day
Anatomy
Endoscopy Equipment
(Storz)
Fundamentals of open surgery and tissue handling
Principles of bowel anastomosis & wound management
Fundamental of Laparoscopic surgery
Development of applied laparoscopic skills
Understanding the fundamentals of endos- copy. Principles of vascular surgery
RCSI TEACHING
SURGICAL BOOTCAMP
Technical Skills: Knot tying Suturing Wound closure Anastomosis Surgical Technique/theatre skills Drain/catheters Minor surgical procedures Laparoscopy/Endoscopy Brian Lane Medal
SURGICAL TRAINING SELECTION ISSUES
Aptitude based selection Fit for purpose selection Selection panel training Quality assurance Appeals process
RCSI
APPTITUDE TESTING IN SURGICAL TRAINING
Aptitude DOES matter Aptitude DOES matter
And it WILL matter more!
RCSI
STANDARDIZED PATIENT SIMULATION FOR GENERAL SUERGERY MILESTONES ASSESMENT
Certain Milestones are difficult to assess in traditional resident activities • Practice-based learning and improvement
• Interpersonal and communication skill
• Professionalism
• Systems-based practice
RCSI
SIMULATION MODULE DISLOSURE AND APOLOGY
• Patient comes back to office for follow-up of seemingly uncomplicated operation
• Resident discloses that during the operation, enterotomy was actually created by trocar and this had to be repaired
RCSI
ORGANIZED SURGICAL RESIDENCY PROGRAM IN HUNGARY
Time for the training: 72 months ( 6 years ) Resident gets full informationat the beginning of the program Every stage of education is checked in the Index booklet
24 MONTH BASIC PROGRAM 6 months emergency surgery practice 1 month course basic knowledge 6 months basic knowledge of surgery including 3 months ambulatory surgery practice 3 months practice in traumatology 3 monthsi ntensive care practice 1 month diagnostic radiology (CT,ultrasound) 1 month endoscopy practice 1 month oncology practice 1 month pathology practice 1 months surgical skill training course
EDUCATION AT WARD
42 MONTHS GENERAL SURGERY PRACTICE
including 6 months of optional endoscopic-, hand-,neuro-,plastic-, gynecologic-, urologic-surgery, oxyology 3 months vascular surgery practice 2 months thoracic surgery practice 1 month pediatric surgery practice
EDUCATION AT OUTPATIENT DEPARTMENT
EDUCATION OF DUCUMENTATION
COMPULSORY COURSES DURING THE RESIDENCY PROGRAM
Surgical infectology Surgical oncology Laparoscopy Oxyology Transfusion 2 weeks course to prepare for Board Exam 2 weeks for preparation for practical Board Exam
EDUCATION OF ENDOSCOPY
ULTRASOUND EDUCATION
COMPULSORY COURSES DURING THE BASIC PROGRAM (1)
HEALTH CARE MANAGEMENT: Economy Quality management in Health Care Ethical knowledge Legal knowledge Team work Directing knowledge
COMPULSORY COURSES DURING THE BASIC PROGRAM (2)
MEDICAL COMMUNICATION, STRESS SITUATIONS Patient-doctor communication How to handle difficult emotional situations Special communication situations (Handicapped patients) Time consumption, decision making How to overcome stress situations Socialization of medical profession
ACUT AND CHRONIC PAIN RELIEF, PALLIATIVE TREATMENT Basics of palliative treatment Symptomatic treatment Communication at palliative treatment Ethical dilemma at the premortal periode Mourning Religional, cultural, spriritual aspects at treatment
COMPULSORY COURSES DURING THE BASIC PROGRAM (3)
Surgical procedures residents have to perform during the Residency Program
Surgical procedures residents have to assist during the Residency Program
BOARD EXAMINATION COMMITTEE
Mentor
Tutor
Resident
Mentor has to inform the Board of Residency Program every three months
Mentor Resident Tutor
SURGICAL SKILL TRAINING PROGRAM IN HUNGARY
Semmelweis University Hungarian Surgical Society
4 WEEKS
1st week GENERAL SURGERY LECTURES: OR structure and staff Asepsis-antisepsis, up-to-date sterilization methods, dezinfection, scrubbing Wound healing, wound care, complications Bleeding control Electric devices, safety in OR Surgical tools Surgical incisions, dissecting technics Wound closure Checklist, Never events, Foreign bodies Experimental research on animals: ethical and legal issues
1st week PRACTICE Preparation for surgical procedures, scrubbing Different methods of knot-tying How to use electric devices – practice on ex vivo animal tissues Different suturing methods – practice on ex vivo animal tissues Surgical suture materials, needles Practical use of surgical devices Evaluation of residents’ work at the end of the first week
2nd week
GENERAL SURGERY LECTURES Principles of vascular surgery Anastomosis technics of the gastro-intestinal tract Open cholecystectomy, closure of gastric and small intestine perforations Surgical implantatum, stents Surgical staplers Functional anatomy of experimental animal (pig) Pneumothorax, thoracotomy, thoracic drainage, lung resection Legal aspects of surgical interventions Surgical lasers Future of surgery, Robotic surgery
2nd week PRACTICE Closure of longitudinal arteriotomy, patch-plastic, vascular anastomosis Practice on ex vivo animal arteries and on aorta segments Sutures on ex vivo animal gastric, small intestine and colon tissues End-to-end and side-to-side anastomosis on ex vivo animal intestines Transverse laparotomy, sutures on stomach, open cholecystectomy, Intestinal anastomosis, splenectomy, closure of abdominal wall, incisions on narcotized animals Dissection at the infra-renal segment of the aorta, arteriotomy, patch-plastic, Sutures on aorta and arteries on narcotized animals Thoracotomy, lung resection, lobectomy, tracheostomy, thoracic drainage, pericardial fenestration, closure of thoracotomy on narcotized animals Evaluation of residents’work at the end of the second week
3rd week
LAPAROSCOPIC SURGERY LECTURES Laparoscopic surgery Basic principles of sutures and knot-tying at laparoscopic procedures Laparoscopic cholecystectomy Laparoscopic hernia operations Laparoscopic procedures of liver, suprarenal glands and at the cardia-region Laparoscopic colo-rectal surgery New technics in laparoscopic surgery Laparoscopic procedures in urology and gynecology
3rd week
PRACTICE Laparoscopic tasks in pelvitrainer (peg-transfer, sutures, knot-tying) on ex vivo animal tissues Laparoscopic cholecystectomy, gastric sutures on narcotized animals Laparoscopic pelvic procedures on tuba, uterus, bladder on narcotized animals Laparoscopic GERD, liver, supra renal gland, colon procedures on narcotized animals Residents’ laparoscopic competition (peg-transfer, suture techniques) Evaluation of residents’ work at the end of the third week
4th week
MICRO_SURGERY LECTURES Introduction to Micro-surgery Microsurgical devices and suture materials Micro-vascular suture techniques, anastomosis Functional anatomy of experimental animal (rat) Principles of sutures of nerves
4th week
PRACTICE Microtechnical suture technics performed in vitro model (silicon tube) (2mm silicon tube, 8/0 suture material) byoperativ microscope and magnifier Neurovascular microsurgical dissection on fresh ex vivo animal tissue End-to-end microsurgical anastomosis on 2mm diameter artery on fresh ex vivo animal tissue Suture of Ischiadicus nerve on narcotized rat Evaluation of residents’ workat the end of the fourth week Evaluation of the personal achievement of residents at the end of the SURGICAL SKILL TRAINING PROGRAM
TAKE HOME MESSAGE
Challenges of new surgical technologies
Shorter time for education surgical residents REQUIRE •New methods for practical training
•Practice outside from OR
•Structured program with continuous feedback
"The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein."
Thank you!
www.surgttt.eu
Project reference no.: 2014-1-DE02-KA202-001474
