[Video-based self-control in surgical teaching. A new tool in a new concept]

Digital teaching and learning of surgical skills (not only) during the pandemic: a report on a blended learning project

Due to the COVID-19 pandemic, digital teaching approaches should be used wherever possible. In this article we report on our project for digital teaching and learning of surgical skills. The compulsory elective "Intensivkurs Chirurgische Techniken" for medical students starting with semester 5 was designed as a blended learning course. One week before the face-to-face class, the students receive the learning and teaching material online in a Moodle course. In the face-to-face class, live demos of procedures (e.g. performing skin and intestinal sutures) are presented by the teachers. The learners then perform the practical procedures and record themselves with the camera of an iPad. They publish their videos in the Moodle course via an Opencast plugin. The implementation of an annotation tool enables everyone in the Moodle course to add free-text comments to selected parts of the videos (video-assisted feedback and coaching). As a result of the pandemic, the face-to-face class is being moved to a digital learning environment. For this purpose, we are extending the existing system with a web conference tool (BigBlueButton).

Self-debriefing Model Based on an Integrated Video-Capture System: An Efficient Solution to Skill Degradation

OBJECTIVE

Video-based teaching is considered highly effective in debriefing, especially in minimally invasive surgeries. In this study, the benefits of using a new integrated video recording system, were investigated and compared to those of the standard basic skills robotic training procedure.

DESIGN

Fifty residents from the 2nd and 3rd year medical faculty without any experience of robot usage or laparoscopy were randomized into 2 groups: group A--a natural self-training group without a trainer, and group B--a self-training group assisted by an integrated video recording system during training. The training was divided into four 2-hour sessions, with a 72-hour delay between each session. Two tasks were selected for testing on the dV-Trainer, a virtual reality based robotic simulator: Match board 2 and Thread the Rings 1. After each session, the practice video recorded by the system of group B was transferred to the residents' smartphones for self-debriefing. At the end of each session, the performance score was evaluated automatically by using the simulator to plot learning curves A and B.

RESULTS

Group A showed a significant drop in performance score due to skill decay caused by the 72-hour delay. Group B exhibited a regular stepwise rising learning curve. At the end of the training, group B showed a significantly higher performance score both in Match board 2 and Thread the Rings 1. The autoanalysis and capture function, which selects only the critical errors and most valuable parts, could facilitate time saving.

CONCLUSIONS

The use of an integrated video recording system makes the self-manipulated protocol with own smartphone feasible to improve training efficiency and overcome the skill decay during robotic surgical training.

Recommendations to enhance constructivist-based learning in Interprofessional Education using video-based self-assessment

INTRODUCTION

Interprofessional collaboration is crucial to the optimization of patient care.

AIM

This paper aims to provide recommendations for implementing an innovative constructivist educational concept with the core element of video-based self-assessment.

METHODOLOGY

A course for students in medicine, physiotherapy, and nursing was developed through interprofessional, cross-institutional collaboration. The course consisted of drawing on prior knowledge about the work done by each professional group in regard to a specific clinical scenario and an interprofessional treatment situation, filming a role play of this treatment situation, and a structured self-assessment of the role play. We evaluated the preparation and implementation of the three courses conducted thus far. Concrete recommendations for implementation were made based on evaluation sheets (students), open discussions (tutors, instructors, institutions) and recorded meeting minutes (project managers, project participants).

RESULTS

Basic recommendations for implementation include: selecting appropriate criteria for self-assessment and a simulated situation that offers members of each professional group an equal opportunity to act in the role play. In terms of administrative implementation we recommend early coordination among the professions and educational institutions regarding the target groups, scheduling and attendance policy to ensure participant recruitment across all professions. Procedural planning should include developing teaching materials, such as the case vignette and treatment scenario, and providing technical equipment that can be operated intuitively in order to ensure efficient recording.

CONCLUSION

These recommendations serve as an aid for implementing an innovative constructivist educational concept with video-based self-assessment at its core.

A basic model for training of microscopic and endoscopic transsphenoidal pituitary surgery: the Egghead

BACKGROUND

Transsphenoidal endoscopic surgery has gained popularity in the last 2 decades and is becoming a standard technique for resection of pituitary adenomas. In contrast to their ENT colleagues, neurosurgical residents have practically no endoscopic experience when they reach the training stage for transsphenoidal procedures. We have developed an affordable method for repetitive training in endoscopic (and microscopic) work in a narrow channel, allowing training of the basic movements needed for resection of pituitary adenoma.

METHODS

In collaboration with colleagues in the ENT Department, Cantonal Hospital St. Gall, and the Technical University of Zurich, a three-dimensional model of the nasal cavity was developed and patented. The Egghead model consists of a 3D synthetic reconstruction of the head nasal cavity and sphenoid sinus. A boiled egg represents the sella. For validation, 17 neurosurgical residents from the Department of Neurosurgery, University Hospital of Basel, and Department of Neurosurgery, Cantonal Hospital of St. Gall, St. Gall, Switzerland, and two experts performed a standardized procedure mimicking a transsphenoidal pituitary procedure by dissecting a corridor to the egg yolk and resecting it, respecting the surrounding egg white. This procedure was performed under both microscopic and video-endoscopic visualization. A score for the precision and speed of the surgical performance was developed and used.

RESULTS

The model allows repetitive training of the resection of the egg yolk under sparing of the egg white after careful opening of the shell. The validation data showed a steeper learning curve using the endoscopic technique than performing the same task using the microscope. After three repetitions, the quality of resection was better with the endoscopic technique.

CONCLUSIONS

Our model, the Egghead, is affordable, offers tactile feedback and allows infinite repetitions in basic training for pituitary surgery. It can be used for training of advanced neurosurgical residents, who thus far have very few possibilities of acquiring endoscopic experience.