Practice Makes Perfect? The Role of Simulation-Based Deliberate Practice and Script-Based Mental Rehearsal in the Acquisition and Maintenance of Operative Neurosurgical Skills
(Impact Factor: 3.62).
01/2013; 72:A124-A130. DOI: 10.1227/NEU.0b013e318270d010
Despite significant advances in technology and intraoperative techniques over the last century, operations on the brain and spinal cord continue to carry a significant risk of serious morbidity or mortality. Potentially avoidable technical errors are well recognized as contributing to poor surgical outcome. Surgical education is undergoing overwhelming change, in part as a result of changes in the economic, political, social, cultural, and technological climates in which it operates. Shortened training, reductions in the working week, economic difficulties, and increasing emphasis on patient safety have required educators to radically rethink the way in which surgical education is delivered. This has resulted in the development of simulation technology, mental script-based rehearsal, and simulation-based deliberate practice. Although these tools and techniques are garnering increasing evidence for their efficacy, the evidence for their use in neurosurgery is somewhat more limited. Here, we review the theory behind these tools and techniques and their application to neurosurgery. We conclude that further research into the utility of these tools and techniques is essential for determining their widespread adoption. If they ultimately prove to be successful, they may have a central role in neurosurgical training in the 21st century, improving the acquisition of technical skills in a specialty in which a technical error can result in grave consequences. ABBREVIATION: LC, laparoscopic cholecystectomy
Available from: Eileen Cormier
- "Without exception , these studies demonstrate consistent and robust improvements in clinical performance based on deliberate practice principles. Simulation-based deliberate practice studies in medicine versus nursing are also more likely to use research designs that include preintervention baseline measurement and comparison groups (Kessler, Auerbach, Pusic, Tunik, & Foltin, 2011; Marcus, Vakharia, Kirkman, Murphy, & Nandi, 2013; McGaghie et al., 2011). "
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ABSTRACT: The purpose of this study was to establish the efficacy of a deliberate practice intervention designed to enhance levels of clinical performance in senior baccalaureate nursing students.MethodA randomized control design was used. Forty participants were randomly assigned to control and intervention groups.ResultsThe deliberate practice-based intervention resulted in statistically significant improvements to key aspects of participants' efforts in each of the four scenarios.Conclusions
The deliberate practice protocol prompted participants to reconsider and act on salient stimuli present in the simulated task environment, resulting in substantive performance improvement.
Clinical Simulation in Nursing 11/2014; DOI:10.1016/j.ecns.2014.10.005
Available from: Fady T Charbel
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ABSTRACT: The purpose of this study was to evaluate the accuracy of ventriculostomy catheter placement on a head- and hand-tracked high-resolution and high-performance virtual reality and haptic technology workstation.
Seventy-eight fellows and residents performed simulated ventriculostomy catheter placement on an ImmersiveTouch system. The virtual catheter was placed into a virtual patient's head derived from a computed tomography data set. Participants were allowed one attempt each. The distance from the tip of the catheter to the Monro foramen was measured.
The mean distance (+/- standard deviation) from the final position of the catheter tip to the Monro foramen was 16.09 mm (+/- 7.85 mm).
The accuracy of virtual ventriculostomy catheter placement achieved by participants using the simulator is comparable to the accuracy reported in a recent retrospective evaluation of free-hand ventriculostomy placements in which the mean distance from the catheter tip to the Monro foramen was 16 mm (+/- 9.6 mm).
Journal of Neurosurgery 10/2007; 107(3):515-21. DOI:10.3171/JNS-07/09/0515 · 3.74 Impact Factor
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ABSTRACT: The past decade has seen significant changes to the face of neurosurgical training in the United Kingdom, driven in part by an increasing focus on patient safety and the introduction of Modernising Medical Careers and the European Working Time Directive (EWTD). Recent reforms to neurosurgical training over the past few years have resulted in creation of an 8-year 'run-through' training programme. In this programme, early years (ST1 and ST2) trainees often lack dedicated time for elective theatre lists and outpatient clinics. Further, any time spent in theatre and clinics is often with different teams. Here we describe a training model for early years trainees at the National Hospital for Neurology and Neurosurgery, who are given the responsibilities traditionally associated with a more senior trainee including dedicated weekly theatre and clinic time under the supervision of a single consultant, in addition to out of hours experience. The advantages and considerations for implementing this model are discussed, including the benefit of guidance under a single consultant in the early stages of training, along with key educational concepts necessary for understanding its utility. We feel that this is an effective model for junior neurosurgical training in the EWTD era, expediting the trainee's development of key technical and non-technical skills, with potentially significant rewards for patient, trainee and trainer. National implementation of this model should be considered.
British Journal of Neurosurgery 05/2013; 27(5). DOI:10.3109/02688697.2013.793290 · 0.96 Impact Factor
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