Developing expertise in surgery

Alderson, David

doi:10.3109/01421591003695329

Cited by 38 publications

(20 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[26][27][28] This finding provides empirical support for the use of current theories of adaptive expertise 29 and naturalistic decision making 30 in the surgical education literature. 26,27,31,32 In these 2 theories, developing impressions of workplace-based experiences that can be intuitively applied to challenging situations is a critical element of expert practice. In contrast to traditional cognitive understandings of expertise, defined by acquisition and recall of abstract knowledge, adaptive expertise interprets problem solving as an intuitive and creative enterprise influenced by multiple complex factors such as organizational culture.…”

Section: Finding Clarity In Complexitymentioning

confidence: 99%

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

Apramian¹,

Cristancho²,

Watling³

et al. 2016

Journal of Surgical Education

View full text Add to dashboard Cite

OBJECTIVE-Clinical research increasingly acknowledges the existence of significant procedural variation in surgical practice. This study explored surgeons' perspectives regarding the influence of intersurgeon procedural variation on the teaching and learning of surgical residents.DESIGN AND SETTING-This qualitative study used a grounded theory-based analysis of observational and interview data. Observational data were collected in 3 tertiary care teaching hospitals in Ontario, Canada. Semistructured interviews explored potential procedural variations arising during the observations and prompts from an iteratively refined guide. Ongoing data analysis refined the theoretical framework and informed data collection strategies, as prescribed by the iterative nature of grounded theory research. RESULTS-Surgeons endorsed the use of intersurgeon procedural variations to teach residents about adapting to the complexity of surgical practice and the norms of surgical culture. Surgeons suggested that residents' efforts to identify thresholds of principle and preference are crucial to professional development. Principles that emerged from the study included the following: (1) knowing what comes next, (2) choosing the right plane, (3) handling tissue appropriately, (4) recognizing the abnormal, and (5) making safe progress. Surgeons suggested that learning to follow these principles while maintaining key aspects of surgical culture, like autonomy and individuality, are important social processes in surgical education. PARTICIPANTS-OurCONCLUSIONS-Acknowledging intersurgeon variation has important implications for curriculum development and workplace-based assessment in surgical education. Adapting to intersurgeon procedural variations may foster versatility in surgical residents. However, the existence of procedural variations and their active use in surgeons' teaching raises questions about the lack of attention to this form of complexity in current workplace-based assessment strategies. CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptFailure to recognize the role of such variations may threaten the implementation of competencybased medical education in surgery.

show abstract

Section: Finding Clarity In Complexitymentioning

confidence: 99%

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

Apramian¹,

Cristancho²,

Watling³

et al. 2016

Journal of Surgical Education

View full text Add to dashboard Cite

show abstract

“…Therefore, the internal air focuses the RF energy from an electrode onto a limited region. Thus the lung is more suitable for cauterization than breasts, livers, bones [1]. However, excessive ablation or non-ablation of tumors has been reported.We propose a method using numerical simulation to analyze the temperature distribution of the organ in order to overcome the current deficiencies.…”

Section: Resultsmentioning

confidence: 97%

“…Methods Endovascular aneurysm repair (EVAR) is a preferable option in most cases of AAA treatment, where a stent-graft, called endovascular graft (EVG), in a catheter is passed from the patient's leg artery to the aneurysm site and then released. Once secured in place, the EVG forms a new blood vessel, protecting the weakened AAA wall from the blood pressure and, hence, possible rupture [1]. EVAR is preferred over open surgery due to its advantages of minimal invasion, early recovery, reduced mortality and morbidity, though follow-up is still needed to determine whether these advantages are sustained [2].…”

Section: Resultsmentioning

confidence: 98%

See 1 more Smart Citation

Surgical modelling, simulation and education

2011

Int J CARS

View full text Add to dashboard Cite

Keywords Fetal surgery Á Soft tissue Á Modeling Á Viscoelasticity PurposeMinimally invasive fetal surgery is expected to improve therapeutic outcomes, and surgical robots are expected to aid the dexterous manipulation of fragile fetal tissues. Although robots are currently used for surgery on soft tissues, practical information concerning the viscoelastic characteristics of fetal tissues is lacking. Hence, the mechanical properties of fetal tissues should be quantified to design robotic devices that facilitate computer-assisted fetal surgery. Methods Shear creep tests were performed on abdominal wall tissues of rat fetuses, aged 16-20 days, and on the brain, lung, and liver tissues of adult rats. Viscoelastic properties of these tissues were evaluated using a rheometer. Histological sections of fetal rat tissues were stained with hematoxylin and eosin. ResultsThe viscoelastic properties of fetal tissues were quantified using models. Fetal tissues displayed 2 distinct phases of fragility, i.e., gelatinous characteristics with a markedly lower viscoelasticity before day 18 than after day 19. Concomitantly, skin morphology matured remarkably after day 19. As judged by the morphology, the gestation age of 19 days in rats corresponds to that of 23 weeks in human fetuses. From our data, we prepared artificial phantoms; phantoms made from 1.0% gelatin showed mechanical properties very similar to those of the fetuses before day 18. Figure 1 shows the estimated viscoelastic parameters of the tissues and phantoms measured in the experiment. ConclusionWe observed unique mechanical characteristics in fetal tissue, a previously unknown target for surgical robots. From the data obtained, we produced phantoms that have similar viscoelastic properties, aiming at designing surgical robots capable of handling early fetuses. Towards a rheological model for real-time simulation of endovascular repair of abdominal aortic aneurysmsKeywords Endovascular repair simulation Á Smoothed particle hydrodynamic Á Abdominal aortic aneurysms PurposeTo develop a novel rheological model based on smoothed particle hydrodynamics (SPH) in order to facilitate the development of interactive simulation system for training and planning of endovascular repair of abdominal aortic aneurysms (AAA). Methods Endovascular aneurysm repair (EVAR) is a preferable option in most cases of AAA treatment, where a stent-graft, called endovascular graft (EVG), in a catheter is passed from the patient's leg artery to the aneurysm site and then released. Once secured in place, the EVG forms a new blood vessel, protecting the weakened AAA wall from the blood pressure and, hence, possible rupture [1]. EVAR is preferred over open surgery due to its advantages of minimal invasion, early recovery, reduced mortality and morbidity, though follow-up is still needed to determine whether these advantages are sustained [2]. However, EVAR is a relatively complicated surgery; extensive training is therefore required for novices to acquire the related skills. In addition, currently, mo...

show abstract

“…A key focus of postgraduate healthcare and medical education is that of expertise development [18–28]. The study of clinical expertise in healthcare has often relied on the assumption of experience being a critical factor [29–31].…”

Section: Introductionmentioning

confidence: 99%

The effect of work-based mentoring on patient outcome in musculoskeletal physiotherapy: study protocol for a randomised controlled trial

Williams

Phillips

Watkins

et al. 2014

Trials

View full text Add to dashboard Cite

BackgroundDespite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of postgraduate clinical mentoring on physiotherapist performance have been assessed, but the impact of this mentoring on patient outcomes remains unknown. The objective of this trial is to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes in musculoskeletal physiotherapy.Methods/DesignA stepped wedge cluster randomised controlled trial (CRCT) has been designed to recruit a minimum of 12 senior physiotherapists who work in musculoskeletal outpatient departments of a large National Health Service (NHS) organization. Participating physiotherapists will be randomised by cluster to receive the intervention at three time periods. Patients will be blinded to whether their physiotherapist has received the intervention. The primary outcome measure will be the Patient-Specific Functional Scale; secondary outcome measures will include the EQ-5D, patient activation, patient satisfaction and physiotherapist performance. Sample size considerations used published methods describing stepped wedge designs, conventional values of 0.80 for statistical power and 0.05 for statistical significance, and pragmatic groupings of 12 participating physiotherapists in three clusters. Based on an intergroup difference of 1.0 on the PSFS with a standard deviation of 2.0, 10 patients are required to complete outcome measures per physiotherapist, at time period 1 (prior to intervention roll-out) and at each of time periods 2, 3 and 4, giving a sample size of 480 patients. To account for the potential loss to follow-up of 33%, 720 sets of patient outcomes will be collected.All physiotherapist participants will receive 150 hours of mentored clinical practice as the intervention and usual in-service training as control. Consecutive, consenting patients attending treatment by the participating physiotherapists during data collection periods will complete outcome measures at baseline, discharge and 12 months post-baseline. The lead researcher will be blinded to the allocation of the physiotherapist when analyzing outcome data; statistical analysis will involve classical linear models incorporating both an intervention effect and a random intercept term to reflect systematic differences among clusters.Trial registrationAssigned 31 July 2012: ISRCTN79599220.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-409) contains supplementary material, which is available to authorized users.

show abstract

Developing expertise in surgery

Cited by 38 publications

References 31 publications

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

“They Have to Adapt to Learn”: Surgeons’ Perspectives on the Role of Procedural Variation in Surgical Education

Surgical modelling, simulation and education

The effect of work-based mentoring on patient outcome in musculoskeletal physiotherapy: study protocol for a randomised controlled trial

Contact Info

Product

Resources

About