Are Live operative demonstrations desirable? Dr Vikesh Agrawal Associate Professor and Head Pediatric Surgery and PMAS Division NSCB Medical College, Jabalpur, India Deputy Registrar (Academics) Madhya Pradesh Medical Science University, Jabalpur

Introduction Efficacy as Educational Tool? Ethics? Patients Safety? Surgeons’ Stress level? Prohibition?

Educational Value Rodney Peyton 1 of the Royal College of Surgeons has popularised the four steps to effective learning of procedural skills: Demonstration: trainer demonstrates at normal speed, without commentary Deconstruction: trainer demonstrates while describing steps Comprehension: trainer demonstrates while learner describes steps Performance: learner demonstrates while learner describes steps J Toouli. What Is the role of “Live Surgical Demonstrations” at conferences? HPB (Oxford). 2006; 8(3): 163–164.

Educational Tools Independent of reasons that apply . . .  Cadavers are difficult to procure and tissue degrades  Anesthetized animals lack correct anatomy and are expensive  Real patients are getting smarter and don’t want to be used as practice material

Ethical issues: Patients!

Brigadier General William Mayo ‘‘the best interest of the patient is the only interest to be considered’’

Ethical issues: Surgeons!

Surgeons X-factor Skill or Thrill!

Art of Surgery vs Art of Surgeon

Are we heading to a Surgical Amphitheatre? J Endourol. 2014 Sep;28(9):1121-6. Performing in the surgical amphitheater of today: perception of urologists conducting live case demonstrations. Salami SS1, Elsamra SE, Motato H, Leavitt DA, Friedlander JI, Paoli MA, Duty B, Okeke Z, Smith AD.

Who else thought about this before? American Association of Thoracic Surgery American College of Surgeons American College of OG Royal College of surgeons European Association of Urology

IPEG Survey on Live Case Demonstrations in Pediatric Surgery JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 22, Number 0, 2012

Results…1

Statement of survey Surgeon Attendee 3 +/- 1.3 3+/- 1.4 2+/- 1.4 Essential for educational purposes 3 +/- 1.3 No other educational method can replace LCD 3+/- 1.4 2+/- 1.4 High impact on skills and everyday work by attendees ------ 4+/- 1.2 Beneficial for the individual patient who is operated on 2+/- 1.2 2+/- 1.3 LCD may be harmful for the patient 3+/- 1.2 Benefits of LCD in surgical education outweigh the possible disadvantage for the patient LCD should continue to be part of surgical meetings 4+/– 1.4 3+/– 1.4 LCD should generally be discontinued 2+/– 1.3 2+/– 1.4 LCD is ethically wrong ‘‘If my child required an operation, I would consent” 2+/- 1.7

........36% of surgeons and 52% of attendees would not agree to consent for LCD in their own child.......... ‘‘If my child required an operation, I would consent” 3+/- 1.4 2+/- 1.7 ??????

Observation is fruitful: Skill development? Beneficial for participants: Utilisation? Poses higher risk: Safety norms? Videos can serve well: Selective? Prohibition is in vogue: Moderation?

Educational Tools

Suggestions! Selective Live: Proffered opinion: Video workshop Selection of operative faculty should be stringent- Organizational scores based on feedback! Procedures should be straightforward! Ethical code of conduct! Liability and responsibility? Proffered opinion: Video workshop Include difficult and uncommon operations Edited videos for lectures Unedited videos for difficulties and complications Fails to attract audience? Use of Virtual Reality Simulators (VRS)/ Video kiosks Suggestions!

Organizers <---> Association

Live Live Live………Live shows!