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Ivan Wong final assignment

Page history last edited by ivan.h.wong@gmail.com 7 years, 11 months ago

Class – Basic OR skills of arthroscopic surgery 3 month curriculum. This includes an initial 2 hour workshop, followed by a 3 month home-based curriculum, followed by a final 2hr workshop and an evaluation in the OR.


Competency – Patient Care


Learners – Orthopaedic residents at Dalhousie University – PGY 1-5.


Goals – to increase Orthopaedic resident basic OR arthroscopic skills with home-based simulator training and self-directed feedback.


Learning Objectives: By the end of this curriculum, residents will be better able to:

  1. Tie arthroscopic knots in the operating room
  2. Self evaluate skills of arthroscopic knot tying on a simulator using proficiency formula


Content to be included:

  • Initial workshop: This will include a video describing the equipment and technique of arthroscopic knot tying on an Arthroscopic (ArK) trainer. Step by step instruction has been created and validated previously. This video will serve as the basis to learn the skill. All residents will have their own ArK Trainer to practice on to try to replicate what is done on the video. Expert educators will facilitate this by answering questions and aiding in the learning of skill to tie an arthroscopic knot on the model. A proficiency formula has been validated to objectively measure the skill of tying an arthroscopic knot on a model. The application of this formula to each of the knots will be taught to the residents at this time. At the end of the workshop, all residents will be video-taped to know the initial skill level to tie an arthroscopic knot on the model.
  •  Home-Based curriculum: This home-based curriculum will consist of self-directed practice on the same ArK trainer as the workshop. A logbook will be provided to document self-assessment by means of scoring using the proficiency formula. A webcam that can attach to a USB port on a computer will be provided. Residents will be instructed to score each knot that they tie with emphasis that the scores have no reflection on any type of their evaluation. It is recommended to practice tying the knots by watching a monitor that is attached to the webcam that looks at the knot being tied in the ark trainer - to more closely simulate the process of tying the arthroscopic knot. If additional expert feedback is requested, residents can record their attempt to tie the knot and review this video with faculty at a mutually convenient time. Total time period of 3 months is allotted for this.
  • Final workshop: In this final workshop, residents will be asked to pros and cons of using this home-based curriculum with self-assessment scoring. Logbooks will be collected, and final skills assessed through video-taping on the ArK models.
  • OR Final assessment: Patient care skills will be assessed in the OR on an actual patient to tie one arthroscopic knot in a maximum time of 10 minutes under supervision. 


Teaching and learning strategies

  • Didactic teaching through standardized video of equipment and basic techniques. This standardizes what is taught to all residents. In addition, this video which has broken down all the steps and explains each of the pieces of equipment will be made available at all times to all residents via Moodle curriculum links (so it can be accessed at all times).
  • Workshop with expert instructors to provide instant feedback and helpful hints. During the 2 hour workshop individual and group feedback with instruction will be provided by multiple experts in the field. This will allow for individualized questions to be answered and more focused demonstrations and modifications of techniques.
  • Self assessment proficiency formula – A previously validated proficiency formula that only uses objective measures will be taught to each resident and be part of the logbook (described and explained in there as well). This will help to increase self-assessment skills as well as to help improve dedicated practice (the quality of the practice that they do in the home curriculum). This self-assessment proficiency formula will also be correlated with the final assessment proficiency formula to judge the accuracy of resident self-evaluation.
  • Webcam for recording of home-based practice for faculty feedback – for additional feedback residents may choose to record their knot tying attempts on their home ArK trainer for timely feedback from faculty. This can be reviewed together for suggestion of improvement in skill.
  • Home-based ArK trainer simulator – moving a skills center from a central learning location to a more convenient home location may increase the chance of practice. Combined with the self-evaluation and possibility for recorded feedback could increase the learning opportunities.

Evaluation of learners and of the course:

  • Initial assessment of residents at the end of the initial workshop. This is done by video-recording the process of each resident tying an arthroscopic knot on an ArK trainer. A blinded expert evaluator will grade the technique using multiple outcome measures including Global Rating Scale (GRS), Checklist, and Proficiency Formula.
  • Logbook to monitor self practice (amount of practice) and proficiency score (quality of practice)
  • Final assessment of learners in final workshop to video-record increases in learning on simulation model – Evaluated using GRS, checklist, and proficiency scoring. This is to be compared with each residents’ own measures of proficiency score (evaluation of self-assessment techniques)
  • OR assessment of learners to tie a knot arthroscopically. 10 minutes allotted during a case of arthroscopic knot tying that is video taped to determine skills of tying a knot in the OR. – evaluated using GRS, Checklist and proficiency scoring.
  • Final survey – resident satisfaction with curriculum. Open ended questions for strengths, weaknesses, and areas for improvement.


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  2. Moulton CA, Dubrowski A, Macrae H, Graham B, Grober E, Reznick R. Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial. Ann Surg 2006;244:400-409.
  3. Scott DJ, Cendan JC, Pugh CM, Minter RM, Dunnington GL, Kozar RA. The changing face of surgical education: simulation as the new paradigm. J Surg Res 2008;142(2):189-193.
  4. Reznick RK, MacRae H. Teaching surgical skills  - changes in the wind. N Engl J Med 2006;355:2664-2669.
  5. McDougall EM. Validation of surgical simulators. J Endourol 2007;21:244-247.
  6. Kneebone R. Simulation in surgical training: educational issues and practical implications. Med Educ 2003;37:267-277.
  7. Tovakol M, Mohagheghi MA, Dennick R. Assessing the skills of surgical residents using simulation. J Surg Educ 2008;65(2):77-83.
  8. Choy I, Okrainec A. Simulation in surgery: perfecting the practice. Surg Clin North Am 2010;90(3):457-473.
  9.  Cristancho SM, Moussa F, Dubrowski A. A framework-based approach to designing simulation-augmented surgical education and training programs. Am J Surg 2011;202:344-351.
  10. Downing SM. Validity: on meaningful interpretation of assessment data. Med Educ 2003;37:830-837.
  11. Kern DE, Thomas PA, Hughes MT. Step 6: Evaluation and Feedback. In: Curriculum development for medical education: a six-step approach. Baltimore: The Johns Hopkins University Press, 2009. 


Comments (3)

Lavjay Butani said

at 11:28 am on Mar 19, 2012

Lavjay overall feedback-This is so high on the cool and innovation factor...I love it! High fidelity simulation, opportunity for feedback are additional strengths
1) very clear goals and objectives (even for a non-surgeon). I especially like the self-evaluation objective since it highlights the value of self-regulation and life long learning
2) Content is self-paced and can be individualized by learner based on learner needs which is a great way to increase motivation, and also is in tune with with Knowles learning theory principles
3) Very interactive teaching techniques and excellent creation of a safe learning environment by not tying feedback to evaluation
Stretching feedback/questions:
1) Is there an optimal/ideal proficiency score that is being targeted? Knowing that target may help motivate learners even more as they see their progress. How many times can they practice (or are they expected to practice)? Is there a minimum that should be set since mastery comes with practice, even if they achieve a high score early on.
2) Does the simulator change the environment/context from time to time? If possible, that may help improve skills in varying situations in the OR and make learners better prepared. May also encourage them to keep practicing.
3) The OR experience is time limited to 10 minutes. Could one better prepare learners for this by also having a 10 minute time limit for some of the simulations? Perhaps by slowly decreasing time given to tie the knots with each practice?
4) May be cool to have learners reflect at the end on the self-assessment part and how helped/hindered self-efficacy and progress?

Bev Wood said

at 8:11 am on Mar 27, 2012

Like the initial video for orientation. Might be good to accompany it with a list, in order, of actions. Also good to debrief the video and what people correlated with their "task analysis".
You are clearly focusing nicely on development of skills. Maybe show the same video later, to see if people pick up on any fine points they missed the first time and before they tried it themselves.
Like the practice sessions for participants.
Lavjay's last comment is interesting. Maybe if they identify the items they had the most difficulty with and how they approached those, it will be helpful to others also.

Win May said

at 11:07 pm on Apr 9, 2012

Strong focus on developing procedural skills using simulation. Very clear objectives. Liked the fact that they can have practice sessions at home, away from the lab. Very good idea to put the video o Moodle so that the residents will have access to the video as they practice at home. I like Lavjay's suggestion of a 10-minute limit so that they can be better prepared for the OR. Thank you for a well thought-out assignment.

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