Touch Surgery- Decision Making for Surgical Training
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Abstract
Background: Surgical training nationally and globally has been affected by several factors including: budget constraints, increased trainee numbers, reduction in working hours and patient safety concerns. These factors have compounded to reduce training opportunities making it difficult to obtain sufficient experience in surgical training programs in the UK and globally.
Surgical operative experience entails cognitive decision-making (based on procedural knowledge) and technical ability. Often it is the latter that is the focus of surgical training models. However, intra-operative decision-making is arguably more important than technical skill in the successful completion of a surgical procedure. Despite its importance procedural knowledge and decision-making is poorly taught in the current surgical curricula internationally. To address this we developed Touch Surgery- a platform on mobile touch screen devices - first cognitive task simulator.
Methods: The module laparoscopic cholecystectomy was developed using a validated cognitive task analysis (CTA) methodology with 3 local expert surgeons. Interviews were transcribed into individual cognitive task demands table (CDT). These were analysed, and a consensus meeting was organized between experts to develop a master CDT. This was then combined with video technology and a 3D- interactive simulation was developed for touch screen devices. To evaluate learning a test component of the program was developed to remove queues. This required an underlying decision engine to measure errors and times and thus produce a performance score.
Results: A combined total of 56 steps were identified for inclusion in the final CDT for the laparoscopic cholecystectomy module. A total of 5 key risks were identified at various stages of the procedure to avoid serious sequelae from surgical error. The module development turn over time was 4 weeks. When questioned, 10 experts rated the realism of Touch Surgery as high and the value of this framework for training as highly educational.
Conclusions: Touch Surgery represents the first cognitive task simulator for surgical and procedural training. Utilising CTA to deconstruct a procedure and identify the key components of a procedure, Touch Surgery houses this framework in an engaging and interactive format. The accessibility of the platform means that it will have global implications on training. Further, work is required to validate Touch Surgery.
Surgical operative experience entails cognitive decision-making (based on procedural knowledge) and technical ability. Often it is the latter that is the focus of surgical training models. However, intra-operative decision-making is arguably more important than technical skill in the successful completion of a surgical procedure. Despite its importance procedural knowledge and decision-making is poorly taught in the current surgical curricula internationally. To address this we developed Touch Surgery- a platform on mobile touch screen devices - first cognitive task simulator.
Methods: The module laparoscopic cholecystectomy was developed using a validated cognitive task analysis (CTA) methodology with 3 local expert surgeons. Interviews were transcribed into individual cognitive task demands table (CDT). These were analysed, and a consensus meeting was organized between experts to develop a master CDT. This was then combined with video technology and a 3D- interactive simulation was developed for touch screen devices. To evaluate learning a test component of the program was developed to remove queues. This required an underlying decision engine to measure errors and times and thus produce a performance score.
Results: A combined total of 56 steps were identified for inclusion in the final CDT for the laparoscopic cholecystectomy module. A total of 5 key risks were identified at various stages of the procedure to avoid serious sequelae from surgical error. The module development turn over time was 4 weeks. When questioned, 10 experts rated the realism of Touch Surgery as high and the value of this framework for training as highly educational.
Conclusions: Touch Surgery represents the first cognitive task simulator for surgical and procedural training. Utilising CTA to deconstruct a procedure and identify the key components of a procedure, Touch Surgery houses this framework in an engaging and interactive format. The accessibility of the platform means that it will have global implications on training. Further, work is required to validate Touch Surgery.
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