Introduction See one. Do one. Teach one.* * Halsted WS. The training of the surgeon. Bull Johns Hopkins Hosp, 1904 * Halsted WS. The training of the surgeon. Bull Johns Hopkins Hosp, 1904
The problem… Pressures to change the classical teaching system –Pathologies –Explosion of the surgical armamentarium –Medico-legal issues efficacy efficiency safety cost –Requirement for standardization by accreditation bodies (ACGME. AB) –Attrition of knowledge
Hypothesis The use of - cognitive task analysis - kinesiology - mental imagery in the teaching of rarely performed emergency procedures like cricothyrotomy will improve its acquisition and long-term retention compared to standard teaching
Method 44 first-year medical students Teaching session –45-minute timed teaching session –Surgical anatomy –Short lecture on the handling of surgical instruments –Practice on rubber neck model
Method Randomized in three groups –Kinesiology alone (KG) –Kinesiology+mental practice (KG+MI) –Control group ATLS
Method STEPS 16 marks TIME 7 marks FLUIDITY 2 marks TOTAL 25 marks ∗ Evaluation at 2 weeks; 6 months and 12 months (2 years is planned)
Conclusions Educating residents is evolving faster and faster… Cognitive task analysis, kinesiology and mental imagery are new approaches that improve the teaching of rarely performed surgical skills. Applications for these new tools are yet to be explored and will require more work.
Conclusions More specifically regarding mental imagery, –How should it be taught? –Who should we teach it to? –Can it be used to select residents? Lots of work is yet to be done…
Thanks Dr Marcel Martin Nicolas Fontaine Isabelle and Marie-Eve
Potential applications of imaginary practice Early stages of learning a basic skill Diminishing the learning curve for a new procedure Transferring skills from an established technique Hindering the decay of skills Pre-op preparation for a complex procedure Hall, American Journal of Surgery, 2002
Mental imagery techniques External imagery –The person views himself from the perspective of an external observer (much like in home movies). Internal imagery –approximation of the real life phenomenology –the person actually imagines being inside his/her body –experiencing those sensations which might be expected in the actual situation. MAHONEY and al. Cognit. Ther; 1977
Yerkes-Dodson rule Learning potential vs stress
Experts Nicolas Fontaine Alain Prost Jacques Laffite Annie Pelletier Sylvie Bernier Eric Lucas Mélanie Turgeon
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