Search

Background Simulation-based programs allow trainees to be progressively challenged in a systematic, learner-centered and patient-focused fashion. The design of these programs requires an understanding of the individual steps that comprise the entire surgical procedure and our ability to assess the progress of the learner. We present the results of the design and validation of performance assessment checklists for a progressive simulation-based program in cardiac surgery. Methodology Using a case study design, we videotaped 10 off-pump coronary artery bypass procedures and applied a new methodological framework to deconstruct the procedure into teachable components for which 6 simulation scenarios were developed. Individual checklists were designed and validated using the Delphi technique. An expert panel of 11 cardiac surgeons rated each checklist item by using a 5-point Likert-type scale and provided comments on the rating choice. The consistency of the experts' ratings were interpreted as consensus achieved when 70% of experts rated 3.5 or greater on the 5-point Likert-type scale for each assessment item. Results An in vivo workflow diagram was developed, and 6 simulation modules with progressive difficulty were selected to design an off-pump coronary artery bypass simulation-based program. The corresponding 6 assessment checklists were designed and validated. After 2 Delphi rounds, the overall average score across all checklists was 4.0, and all items were greater 3.5. The final checklists comprise between 12 and 23 items. Conclusion We have demonstrated the feasibility of designing simulation-based program for complex operative procedures in a progressive fashion. The complexity at each level was given by the predefined training objectives and assessment checklists were designed and validated as content-specific assessment tools for each simulation scenario.

The ever changing needs of society have created a much needed shift in health care delivery from that of hospital to community. However, the role and process of community health nursing is foreign to most nursing students as the majority of nursing curricula continue to relate experiences and examples of nursing to the more familiar role of “nurse clinician.” In contrast to undergraduate nursing programs where the use of simulation and technology has been widely adopted to emphasize the role of the nurse clinician, the use of such technology hasn’t been widely used to address the learning needs of community health nursing students. Here, we present a descriptive paper on the development of an interactive, virtual learning environment (serious game) for acquisition of community health nursing skills. The serious game primarily presents a learner-centered, experiential learning and problem-based learning approach, addressing the learning needs of today’s students.

We have begun development of an interactive, multi-player serious game for the purpose of training cardiac surgeons, fellows, and residents the series of steps comprising the Off-Pump Coronary Artery Bypass grafting (OPCAB) surgical procedure. It is hypothesized that by learning the OPCAB procedure in a "first-person-shooter gaming environment", trainees will have a much better understanding of the procedure than by traditional learning modalities. The serious game will allow for simulation parameters related to levels of fidelity to be easily adjusted so that the effect of fidelity on knowledge transfer can be examined.

The construct validity of a surgical bench-top simulator with built-in computer acquired assessments was examined. It features two parallel elastic tubes instrumented with flexion sensors that simulate the walls of a wound. Participants from three groups (9 novices, 7 intermediates, 9 experts) performed 10 two-handed, double square knots. The peak tensions at the initiation of the first knot, the completion of the first knot and the completion of the second knot, as well as measures of movement economy indicated technical performance. Product quality was indicated by knot stability defined as the amount of slippage of the knot under the tension. There were significant differences between experts and novices for peak tension on first knot (p=.03), movement economy (p=.02), and knot stability (p=.002). The results support the construct validity of these objective measures.

Serious games, or video game-based technology applied to training, learning applications, provide a high fidelity simulation of particular environments and situations that focus on high level skills that are required in the field. Given the popularity of video games, particularly with today's generation of learners, and the growing trend of restricted resident work hours and diminished operating room exposure due to limited budgets increased case complexity and medicolegal concerns, serious games provide a cost-effective viable training option. To develop effective serious games, the views and perceptions of both the end users (learners) and educators regarding their use "in the classroom" must be assessed and accounted for. Here we present the results of a survey that was designed to assess students' perceptions of serious games.

Off Pump Coronary Artery Bypass (OPCAB) surgery is a strategy for revascularizing diseased coronary arteries without cardiopulmonary bypass. The complete operation can be deconstructed into individual tasks and subtasks that are ideal for creating simulation modules. Recently, we have developed a modular mechanical beating-heart OPCAB simulator for use in learner-centered training. In the present study, we describe the design of a progressive, simulation-augmented training program for OPCAB surgery. In particular, we a) define need-driven education and training goals, b) create simulation scenarios with progressive difficulty to specifically address these goals, and c) design corresponding assessment tools for both formative and summative purposes.

The goal of simulation-based medical education and training is to help trainees acquire and refine the technical and cognitive skills necessary to perform clinical procedures. When designers incorporate simulation into programs, their efforts should be in line with training needs, rather than technology. Designers of simulation-augmented surgical training programs, however, face particular problems related to identifying a framework that guides the curricular design activity to fulfill the particular requirements of such training programs. These problems include the lack of (1) an objective identification of training needs, (2) a systematic design methodology to match training objectives with simulation resources, (3) structured assessments of performance, and (4) a research-centered view to evaluate and validate systematically the educational effectiveness of the program. In this report, we present a process called "Aim - FineTune - FollowThrough" to enable the connection of the identified problems to solutions, using frameworks from psychology, motor learning, education and experimental design.

In medical education, we have tended to present problems as being singular, stable, and solvable. Problem solving has, therefore, drawn much of medical education researchers’ attention. This focus has been important but it is limited in terms of preparing clinicians to deal with the complexity of the 21st century healthcare system in which they will provide team-based care for patients with complex medical illness. In this paper, we use the Soft Systems Engineering principles to introduce the idea that in complex, team-based situations, problems usually involve divergent views and evolve with multiple solution iterations. As such we need to shift the conversation from (1) problem solving to problem definition, and (2) from a problem definition derived exclusively at the level of the individual to a definition derived at the level of the situation in which the problem is manifested. Embracing such a focus on problem definition will enable us to advocate for novel educational practices that will equip trainees to effectively manage the problems they will encounter in complex, team-based healthcare.

Historically, approaches to exploring complexity have mainly focused on the notion that complex problems must be deconstructed into simpler parts if we are to make sense of them; this is the so-called reductionist approach. When dealing with the complexity of human experience, however, deconstructing the experience without diminishing it is a daunting, perhaps impossible task. Researchers wishing to make sense of complex experiences often begin by interviewing the individuals at the centre of those experiences. But interviews can be frustratingly limited. Visual methods, such as drawings, are beginning to show promise for designing research that taps into the complexity of professional practice. The promise of visual methods may relate to a key notion in complexity research: ‘disruptions’. In this paper I introduce the notion of ‘disruptions’ as articulated by complexity approaches from ‘systems engineering’ and suggest ‘rich pictures’ as an effective visual method to describe and understand complex problems in medical education research.

Letter in response to: What people say ≠ what people do We write this letter as a response to the letter ‘What people say ≠ what people do’, in which Dr. van Merrienboer acknowledges the generic value of subjective data but argues that they are unreliable, misleading, and best combined with objective data in the study of behaviour and cognitive processes [1]. As a research group studying teaching and learning in naturalistic clinical settings, we would like to offer a rejoinder. First, we question the dichotomous characterization of data as either subjective or objective. We argue that a spectrum, rather than a dichotomy, exists between ‘subjectivity’ and ‘objectivity’ in research data. At one end of the spectrum are the research approaches Van Merrienboer refers to that ‘[ask] people their opinions’ using interviews, while at the other end are research approaches that attempt to purge all external human influence. Between these poles, degrees of ‘subjectivity’ and ‘objectivity’ exist. Van Merrienboer’s focus on interview techniques that seek opinions belies the richness and diversity of naturalistic data collection methods, which can employ photography, critical incident interview techniques and video-recording of human experiences. Such data are not straightforwardly ‘subjective’: they combine, often in nuanced ways, both more subjective (influenced by human interpretation) and more objective (unfiltered representation) dimensions. Furthermore, the most ‘objective’ research – such as eye tracking analyses or double-blind randomized controlled trials – has subjective dimensions: it is necessarily influenced by human interpretation, from the wording of the question asked, to the inclusion/exclusion criteria of the sampling and the selection of statistical tests [2]. Second, we respectfully disagree with Van Merrienboer’s marginalization of ‘subjective data’ in the study of cognition and behaviour. Calls for studying cognition and behaviour outside of the laboratory [3, 4] suggest that naturalistic research generally, and interview techniques in particular [5, 6] can offer meaningful insights into cognition and behaviour. Furthermore, many techniques exist for enhancing the rigour and authenticity of interview data regarding human cognition and behaviour [5, 6]. Interviews may be framed around clinical case presentations to elicit valuable insights into how clinicians work, [7] as in a recent study exploring faculty supervisory practices [8]. The ‘guided walk’ technique enriches interviews with authentic contextual details, as in a recent study of the lived experience of medical students in remote rural communities [9]. And interview protocols that incorporate workplace observations and visual methods can elicit tacit aspects of expert practice [10, 11]. Importantly, these techniques do not reduce subjectivity in the interview. Rather, they enrich interview data with more perspectives, more interpretive resources, more glimpses of the human participants’ implicit and explicit understandings of their work processes. In conclusion, we suggest putting aside the dichotomy between subjective and objective data. We advocate that medical education researchers draw from the full spectrum of approaches in the exploration of human cognition and behaviour. From our perspective, each methodology and the data it produces have something to contribute; none is intrinsically more valuable.