Expanding the use of simulation to address different audiences and existing audiences in different ways by A.M. https://padlet.com/asifmac/d5sv5zrhhgmrwbqi CID: 00506910 Module 4 Summative Assignment en-us 2020-04-26 10:22:52 UTC 2025-05-17 17:38:39 UTC hello@padlet.com The purpose of this essay is to explore the rationale for surgical educators to expand simulation to other and existing audiences. This discussion addresses methods by which to expand simulation using a multimedia approach. However, It is useful first to define simulation in order to understand its requirement. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534842626 2020-04-27 22:28:15 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534842626 To provide some context for simulation, Kneebone (2003) describes a trainee surgeon, gradually building necessary skillsets for independent practice through the fusion of factual knowledge, clinical judgement and operative skill. The influential learning theories relevant to simulation that Kneebone (2003, pp. 268-269) summarises is in Table 1. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534850194 2020-04-27 22:34:38 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534850194 Ker and Bradley (2010, pp. 176) summarise some of the societal, political, clinical and educational influences that are driving simulation development over the last 40 years in Figure 1. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534850814 2020-04-27 22:35:10 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534850814 Table 1. Kneebone’s (2003) summary of influential theories of adult learning. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534851773 2020-04-27 22:35:58 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534851773 Figure 1. Ker and Bradley’s drivers for simulation development (2010, pp. 176) asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534855467 2020-04-27 22:39:23 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534855467 As the learning requirements of the trainee are secondary to the clinical needs of the patient, there is an increasing expectation from simulation to facilitate learning. Simulation must buffer the deficit in learning as educators move away from the apprenticeship model and to meet the requirements from the various stakeholders. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534855920 2020-04-27 22:39:49 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534855920 We are now in an era of transparency involving not only the accountability of a doctor but also reliability and validity of performance monitoring data. Another driver of simulation has been the challenges the surgical profession faces as a result of the European Work Time Directive. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534856219 2020-04-27 22:40:05 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534856219 The Royal College of Surgeons (RCS) (2014) outlines a range of domains and subdomains of good surgical practise (Table 2) to help guide trainee development in the context of stakeholder expectation. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534856644 2020-04-27 22:40:28 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534856644 Table 2. Royal College of Surgeons of England (2014) Domains of good surgical practice. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534856911 2020-04-27 22:40:43 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534856911 Renwick et al. (2005), Itani et al. (2005) and Kanakala et al. (2010) all report that patient outcomes of those operated on during training courses were not significantly different. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534858295 2020-04-27 22:41:52 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534858295 Expanding into the other domains of good practice, surgical educators can also optimise patient safety by applying the use of simulation further to clinical decision-making. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534858610 2020-04-27 22:42:09 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534858610 Septris: Click on link to play asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534859999 https://med.stanford.edu/septris/game/SeptrisTitle.html]]> 2020-04-27 22:43:24 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534859999 Another example is the surgical environment of clinical knowledge ops (SICKO) created by Lin et al. (2015). asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534860689 2020-04-27 22:44:00 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534860689 SICKO: Click on link to play asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534860912 http://med.stanford.edu/sm/archive/sicko/game/SICKO.html]]> 2020-04-27 22:44:11 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534860912 Surgical educators could expand the use of these to all junior levels. Simulations such as these are relatively cost-effective once designed and have invaluable use in training and re-training surgeons of all levels. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534864857 2020-04-27 22:47:42 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534864857 The necessity for simulation in all domains asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534865204 2020-04-27 22:48:01 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534865204 Accessibility is key asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534865390 2020-04-27 22:48:12 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534865390 In addition to optimising patient safety, simulation also has a role in facilitating communication and teamwork, an integral component for delivering safe, high-quality patient care. Leonard et al. (2004) report communication failures as a widespread cause of avoidable patient harm. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534865551 2020-04-27 22:48:21 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534865551 Figure 2. Kneebone et al. (2010) distributable simulation theatre asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534866386 2020-04-27 22:49:06 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534866386 By being easily transportable, it can deliver high fidelity contextualised simulation at a fraction of the cost typical of static centres. There is also the added flexibility of recreating a variety of clinical scenarios to meet user need. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534867463 2020-04-27 22:50:11 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534867463 Figure 3. Kneebone et al. (2010) hybrid simulation asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534868126 2020-04-27 22:50:48 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534868126 Examining with simulation asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534868736 2020-04-27 22:51:18 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534868736 As surgical educators increasingly utilise simulation to facilitate learning, surgeons of all levels are developing a new form of literacy. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534868942 2020-04-27 22:51:29 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534868942 Platforms similar to Septris and SICKO have the potential to be used in surgical membership examinations, should multiple-choice questions become computerised in the future. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534869164 2020-04-27 22:51:41 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534869164 Other considerations when expanding the use of simulation asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534869294 2020-04-27 22:51:49 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534869294 However, Badash et al. (2016) highlight the importance of accountability of surgical educators for the efficacy of the surgical training and requires educators to have a methodical approach when it comes to verifying if the designed standard of training is effective. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534880885 2020-04-27 23:01:58 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534880885 Ker and Bradley describe simulation as “a technique which can be used to facilitate any learning, whether in the cognitive, psychomotor or affective domains” (2010, pp. 175). It is “not defined in terms of either high (or low) technology, nor is it confined to interactions with people or models, physical or virtual” (2010, pp. 176). asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534888625 2020-04-27 23:08:43 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534888625 In the wake of scandalous events such as the Bristol heart scandal, Smith (1998) identifies the consequential transformations in assessment and evaluation of competences and technical expertise. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534889947 2020-04-27 23:09:53 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534889947 Cresswell (2009) reports the significant difficulty in training surgeons within newly imposed time constraints and the need for more efficient ways of learning. Again, surgical educators must use simulation to compensate for fewer opportunities to attend theatre for shift workers. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534890675 2020-04-27 23:10:31 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534890675 However, it is debatable that these data may not necessarily be representative given consultants on training courses may have formal training on teaching. They are also more likely to be experienced with teaching and supervising when compared to the average operating consultant. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534891968 2020-04-27 23:11:43 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534891968 Kneebone et al. (2010) introduce the concept of distributed simulation as a solution; a self-contained ‘set’ for creating simulation environments within an inflatable enclosure, known as the distributed simulation theatre (Figure 2). asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534896228 2020-04-27 23:15:18 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534896228 In a feasibility study by Harris et al. (2013), the use of an inflatable enclosure is adequately intuitive for a researcher naïve to distributed simulation in areas outside of regular simulation use and high acceptability. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534896885 2020-04-27 23:15:56 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534896885 However, the use of simulation is concentrated at large centres with funding to sustain high fidelity models. Solutions such as distributed and hybrid simulation have the potential to have widespread and standardised use, as do existing technologies as they become cheaper to reproduce. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534898731 2020-04-27 23:17:46 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534898731 Automated methods of assessment within simulation may provide the added theoretical benefit of performance measurement free from assessor subjectivity. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534899475 2020-04-27 23:18:28 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534899475 Distributed simulation in action: Click video to play asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534905584 2020-04-27 23:24:12 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534905584 A Health Quality (2017) report, for example, demonstrated no high-quality evidence that robot-assisted radical prostatectomy improves functional and oncological outcomes compared with open and laparoscopic approaches for prostatectomy. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534917331 2020-04-27 23:35:18 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534917331 It is also essential to establish an appropriate target audience. Alaker et al. (2016) have not been able to identify who exactly benefits the most from the simulation in a systematic review. Surgical educators must, therefore, take a careful, pragmatic approach. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534917762 2020-04-27 23:35:36 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534917762 Conclusion asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534918321 2020-04-27 23:36:11 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534918321 Background Image Credits: NASA, ESA, P. Oesch (University of Geneva), and M. Montes (University of New South Wales) asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534929474 2020-04-27 23:46:36 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534929474 If this were to become the case, the next organic step in expanding the use of simulation would be in examination. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534935905 2020-04-27 23:52:28 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534935905 It is easy to become blind to the futility of technological leaps at disproportionate costs to the National Health Service or of little benefit to patient outcomes. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534937819 2020-04-27 23:54:15 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534937819 The surgical trainees of today are subject to a much harsher socio-political landscape than their predecessors. In the effort to comply with demands or restrictions influenced by multiple stakeholders, surgical educators must devise ways to buffer the lack of hands-on or experiential learning previously obtained from direct patient contact. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534938785 2020-04-27 23:55:12 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534938785 Surgical educators, however, are fortunate in that there are currently multiple solutions rapidly in development aimed at facilitating learning and development in all domains of good surgical practice. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534939186 2020-04-27 23:55:28 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534939186 However, educators must be careful to maintain a sensible financial perspective. Septris and SICKO are platforms that are free, accessible, and quickly disseminated, including throughout the developing world. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534939861 2020-04-27 23:56:06 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534939861 The distributed simulation theatre is a cost-effective solution that may foster the widespread use of simulation in the United Kingdom and may also have global applications. Indeed, there may be a point in time where the use of simulation has become widespread and standardised. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534940235 2020-04-27 23:56:29 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534940235 All participants in, or related to, the field of surgery may become simulation literate. Surgical educators must also, therefore, explore the role of simulation as a minimally fragmented contextualised solution that could theoretically be free of subjectivity with automation. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534940428 2020-04-27 23:56:41 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534940428 References asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534941222 ALAKER, M., WYNN, G. R. & ARULAMPALAM, T. 2016. Virtual reality training in laparoscopic surgery: A systematic review & meta-analysis. Int J Surg, 29, 85-94.
BADASH, I., BURTT, K., SOLORZANO, C. A. & CAREY, J. N. 2016. Innovations in surgery simulation: a review of past, current and future techniques. Ann Transl Med, 4, 453.
CASEY, L. & BRUCE, B. C. 2011. The Practice Profile of Inquiry: connecting digital literacy and pedagogy. E–Learning and Digital Media, 8, 76-85.
CRESSWELL, B. M., C.; HAWKINS, W.; HARRISON, E.; FITZGERALD, E.; ROON, A.V. 2009. Optimising working hours to provide quality in training and patient safety. A position statement by The Association of Surgeons in Training. Available at: http://www.asit.org/assets/documents/ASiT_EWTD_Position_Statement.pdf [Accessed 26 April 2020].
EVANS, K. H., DAINES, W., TSUI, J., STREHLOW, M., MAGGIO, P. & SHIEH, L. 2015. Septris: a novel, mobile, online, simulation game that improves sepsis recognition and management. Acad Med, 90, 180-4.
GALLAGHER, A. G., RITTER, E. M., CHAMPION, H., HIGGINS, G., FRIED, M. P., MOSES, G., SMITH, C. D. & SATAVA, R. M. 2005. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg, 241, 364-72.
HARRIS, A., KASSAB, E., TUN, J. K. & KNEEBONE, R. 2013. Distributed Simulation in surgical training: an off-site feasibility study. Med Teach, 35, e1078-81.
HEALTH QUALITY, O. 2017. Robotic Surgical System for Radical Prostatectomy: A Health Technology Assessment. Ont Health Technol Assess Ser, 17, 1-172.
ITANI, K. M., DEPALMA, R. G., SCHIFFTNER, T., SANDERS, K. M., CHANG, B. K., HENDERSON, W. G. & KHURI, S. F. 2005. Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals. Am J Surg, 190, 725-31.
KANAKALA, V., BAWA, S., GALLAGHER, P., WOODCOCK, S., ATTWOOD, S. E., HORGAN, L. F. & SEYMOUR, K. 2010. Outcome of patients in laparoscopic training courses compared to standard patients. Surgeon, 8, 132-5.
KER, J. & BRADLEY, P. 2010. Simulation in Medical Education. In: SWANWICK, T. (ed.) Understanding Medical Education. Association for the Study of Medical Education.
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KNEEBONE, R., ARORA, S., KING, D., BELLO, F., SEVDALIS, N., KASSAB, E., AGGARWAL, R., DARZI, A. & NESTEL, D. 2010. Distributed simulation - accessible immersive training. Med Teach, 32, 65-70.
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LEONARD, M., GRAHAM, S. & BONACUM, D. 2004. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care, 13 Suppl 1, i85-90.
LIN, D. T., PARK, J., LIEBERT, C. A. & LAU, J. N. 2015. Validity evidence for Surgical Improvement of Clinical Knowledge Ops: a novel gaming platform to assess surgical decision making. Am J Surg, 209, 79-85.
RANGARAJAN, K., DAVIS, H. & PUCHER, P. H. 2020. Systematic Review of Virtual Haptics in Surgical Simulation: A Valid Educational Tool? J Surg Educ, 77, 337-347.
RENWICK, A. A., BOKEY, E. L., CHAPUIS, P. H., ZELAS, P., STEWART, P. J., RICKARD, M. J. & DENT, O. F. 2005. Effect of supervised surgical training on outcomes after resection of colorectal cancer. Br J Surg, 92, 631-6.
ROYAL COLLEGE OF SURGEONS 2020. Guidance for surgeons working during the COVID-19 pandemic. Available at: https://www.rcseng.ac.uk/-/media/files/rcs/coronavirus/joint-guidance--surgical-support-during-covid.pdf [Accessed 26 April 2020].
ROYAL COLLEGE OF SURGEONS OF ENGLAND 2014. Good surgical practice. Avilable at: https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/good-surgical-practice/ [Accessed 26 April 2020].
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]]> 2020-04-27 23:57:24 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534941222 Within the domain of knowledge, skills and performance, the RCS explicitly recommends the appropriate application of simulation to facilitate the learning of new procedures. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949183 2020-04-28 00:09:08 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949183 When patient safety is concerned, it would be reasonable from the behaviourist stance to assume ethically repetitive practice with simulation would allow for a safer but still supervised operation to proceed. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949420 2020-04-28 00:09:44 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949420 However, from the constructivist standpoint, given experiential learning has been globally limited due to sociopolitical and clinical restraints, it arguable that simulation has a role to play in facilitating development in all domains of good practice. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949535 2020-04-28 00:10:02 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949535 Gallagher et al. (2005) suggest simulation-based skills training can produce a ‘trained novice’ with pre-automation of basic technical aspects that in turn allows a narrower focus on learning the operational steps and how to manage unexpected events. Such a practice can have a significant measurable benefit. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949773 2020-04-28 00:10:43 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949773 Zevin et al. (2014) have shown that repetitive use of simulation reduces operation time, lowers the complication rates and improves clinical outcomes. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949853 2020-04-28 00:10:56 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534949853 Evans et al. (2015) describe ‘Septris’, a portmanteau of the words sepsis and Tetris, describing a mobile-accessible, case-based, online game that takes an innovative approach to teach early sepsis identification and evidence-based management. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534950272 2020-04-28 00:12:06 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534950272 SICKO is a novel gaming platform validated as a training and assessment platform with interactive modules that teach practising surgeons pre- and intraoperative decision-making skills for common surgical pathologies. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534950395 2020-04-28 00:12:29 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534950395 However, high fidelity simulators are of limited use outside centres of simulation due to the considerable costs. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534951422 2020-04-28 00:14:11 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534951422 High Fidelity VR in action: Click on video to play asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534958480 Full clip at https://www.youtube.com/watch?v=p4vO64Y27JE]]> 2020-04-28 00:22:36 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534958480 Amid the COVID-19 pandemic, this is of particular relevance given Royal College of Surgeons (2020) guidance emphasising adaptability to provide a service in alternate surgical and nonsurgical roles. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534984331 2020-04-28 00:45:21 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534984331 Physical or hybrid simulations (Figure 3) can give the added dimension for simulation of trauma without the need for complicated and costly mannikins. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534985621 2020-04-28 00:46:30 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534985621 Surgical educators can utilise distributed simulation in several ways. At an elementary level, medical students often have their first terrifying memories of theatre, desperate not obstruct or decontaminate equipment. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534987540 2020-04-28 00:48:13 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534987540 The inflatable enclosure could provide a transition step to teach theatre preparation and etiquette to a variety of students and trainees other than surgeons such as anaesthetists, scrub nurses and theatre assistants. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534987760 2020-04-28 00:48:25 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534987760 These also have a use in conjunction with high fidelity virtual reality (VR) simulations such as Lapsim and MIST-VR described in a systematic review by Alaker et al. (2016), shown to be more effective than video trainers, and parallel to box trainers. VR itself is a rapidly developing field and increasingly used in centres. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534988044 2020-04-28 00:48:40 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534988044 Rangarajan et al. (2020) describe augmentation with haptic feedback improving the fidelity, realism and in turn, the training effect of VR simulators. Surgical educators may develop the use of these for practising high stakes complex or seldom occurring operations. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534988351 2020-04-28 00:48:56 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534988351 There is also the potential for a role of distributed simulation in observed structured clinical examinations (OSCE) examinations at all levels allowing evaluation of clinical and professional competencies in a manner that is contextualised and less fragmented. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534989951 2020-04-28 00:50:22 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534989951 Surgical educators must justify how, where, when, which and frequency of simulations use in clinical training. asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534990527 2020-04-28 00:50:53 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/534990527 Case and Bruce describe literacy as “best understood through the concept of participation. Literacy enables participation, and new technologies give rise to new forms of participation, and hence new literacies” (2011, pp.76). asifmac https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/535002441 2020-04-28 01:01:14 UTC https://padlet.com/asifmac/d5sv5zrhhgmrwbqi/wish/535002441