Sonal Arora PhD MBBS MRCS BSc(hons)

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Presentation transcript:

The Rule of 4s: A Theory-Driven Approach to Implementing Simulation into Surgical Training Sonal Arora PhD MBBS MRCS BSc(hons) Academic Clinical Lecturer/General Surgeon SpR

Simulation Works BUT…. Not always grounded in educational theory Ad-hoc & Expensive Disconnect from practice Failure to realise full potential

Simulator-based practice CLINICAL ENVIRONMENT Patients Clinical practice Clinical supervision Tutor support Simulator-based practice Simulators SIMULATED ENVIRONMENT

SIMULATED ENVIRONMENT CLINICAL ENVIRONMENT Patients Identify learning need Reapply skill Review Continue Clinical supervision Tutor support Simulator based practice Further practice as needed Simulators SIMULATED ENVIRONMENT

Aims To establish a 4-step training programme: Based upon sound educational principles Delivered according to Kolb’s cycle of experiential learning Incorporating simulation Demonstrating transfer at multiple iterations of programme

Kolb’s Learning Cycle: The Theory….. 2. Active Experimentation 3. Concrete Experience 4. Reflective Observation 1. Abstract Conceptualization

ABSTRACT CONCEPTUALIZATION ACTIVE EXPERIMENTATION REFLECTIVE OBSERVATION CONCRETE EXPERIENCE .

Setting Study Design Participants Test Procedures Outcome Measures Methods Single Community Hospital UK Setting Prospective cohort study Baseline skills assessment in OR Study Design Total n=16 residents (PGY2-4) Each iteration; 4 residents Participants Open Hernia Lap Chole Test Procedures OSATS (hernia) GOALS (lap chole) Outcome Measures

Rule of 4s Iterations Days Stages 4 Trainers 4 Trainees Mentoring & Feedback Distributed Learning Replication

Study Procedure: Each trainee-trainer pair completes…. CORE LAPAROSCOPY SKILLS, KNOWLEDGE & COGNITIVE SKILLS VIDEOS OF EXPERT PERFORMANCE Active Experimentation Concrete Experience Reflective Observation Abstract Conceptualization Day 1: Didactic & Video Day 2: Skills Lab* Day 4: Debriefing Day 3: Real OR Practice* * Video-based performance assessment

Results: Technical performance – Open Hernia (ICC = 0.74 -0.92) TRANSFER LEARNING P= 0.08 P= 0.001

Results consistent at all 4 Iterations of Programme TRANSFER LEARNING

Technical Performance Lap Chole (ICC=0.72-0.88) TRANSFER LEARNING P= 0.35 P= 0.01

Results consistent at all 4 Iterations of Programme

Discussion: Strengths, Limitations & Future Study Educational Theory into practice Single theory, technical skills Compare models, teamwork skills Immediate benefits of simulation Small Group, Single Centre Retention, Multi-Centre In-situ Training Costs Resources Transfer Effectiveness Ratio

Summary – Towards best practice with the Rule of 4s Developed a simulation-based training programme 4 trainees, 4 trainers, 4 stages, 4 days, 4 iterations Incorporated educational principles of mentoring, distributed learning Delivered according to Kolb’s cycle of experiential learning Blended learning with theory, skills lab training, debriefing and transfer Replication through multiple iterations of programme Sonal.Arora06@imperial.ac.uk