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Multimodel re-training
(Re-)Training concepts » Multimodel re-training
Last modified on Thu 10 Jul 2014

 

MULTIMODAL OPCAB RE-TRAINING

Improving continuing medical education for surgical techniques: applying the lessons learned in the first decade of minimal access surgery, Rogers David A, Elstein Arthur S, Bordage georges, Annals of Surgery 2001;233:159-166
1⁄ Due to the steep shape of the learning curve it can be concluded that a relatively small increase in the amount of practice, obtained during a CMEST, can substantially improve technical performance in a beginner.
2⁄ Operative time is a good marker for overall learning performance
3⁄ The shape of the learning curve varies for each learner and each task.  Courses therefore need to be individualised
4⁄ Teaching surgical skills is similar to teaching motor skills

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1. LEUVEN QUALIFICATION

The search for opportunities and the decision to proceed with a transfer inevitably occurs under some degrees of irreducible uncertainty or causal ambiguity. The source's mastery and ability to articulate a practice is often incomplete as the recipient's ability to specify the enviroment where new knowledge will be applied. measures of performance used to identify opportunities are often imprecise and subject to fluctuation. it becomes more difficult to assess the real merit of an pooortunity and to act uppon it. However this uncertainty is reduced when there is evidence that the knowledge to be transferred has proven robust in other enviroments and that the source is reputable. When the source is not perceived as relaible, trustworthy, or knowledgeable, initiating a transfer from the source will be more difficult and its advice and example are likely to be challenged and reisted.
The process of knowledge transfer: a diachronic analysis of stickiness. Szulanski Gabriel. organizational behaviour and human decision processes 2000;82:9-27

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1.1 OPCAB PERFORMANCE

1.2 OPCAB CMEST PERFORMANCE

1.3 OPCAB CMEST PERFORMANCE MODEL

Problem-solving strategies that occur before a new process is introduced in the final production enviroment (learning-before-doing) should be differentiated from the more conventional notion of learning-by-doing that takes place after a process is transfered to a production enviroment.  Under what conditions and for what type of problems can learning-before-doing be an effective problem-solving strategy ( bring down the learning curve before the start of commercial production) ?
Learning-before-doing in the development of new process technology, Pisano GP, Research Policy 1996;25:1097-1119

In reality, it is impossible to replicate exactly the future conditions. However, if problem-solvers understand how specific experimental conditions affect particular outcome they can use this knowledge to make predictions about performance under a future set of operating conditions.
In this case the performance observed under experimental conditions, called L(p I XL) would predict the performance of the process in the future operating enviroment, called C(p I Xc). konwledge takes the form C(p I Xc) = F[L(p I XL)], where the functional form of F could be as simple as a constant or a more complex relationship.
In a extreme case, the researcher might have complete knowledge of all the relevant experimental conditions, their impact on process parameters, and the first and second-order effects of all process parameters on performance.
Learning-before-doing in the development of new process technology, Pisano GP, Research Policy 1996;25:1097-1119

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2. TEAM QUALIFICATION


2.1 TEAM STRUCTURE

It promotes speed of learning when the adopting surgeon handpick the team based on their prior experience working together and their demonstrated ability to work well together. In contrary when a team that was sent to training was picked largely on the basis of availability and willingness to go, learning gets difficult.
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768

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2.2 CROSS-DEPARTMENT COMMUNICATION AND COOPERATION

Adopting a new technology requires more than mastering the surgical technique; it requires a significant degree of change in the way different members of the surgical team interact and communicate.
Organizational differences in rates of learning: evidence from the adoption of minimally invasive cardiac surgery.Pisano Gary P, Bohmer Richard MJ, Edmondson Amy C. Management Science 2001;47:752-768

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2.3 PRE-VISIT CABG AND OPCAB EXPERIENCE

2.4 TEAM COMMITMENT

The intent to change is not influenced by the signature of the commitment to change, but by the expression of the intent before the visit (the commitment to change model)
Effects of a signature on rates of change: a randomized controlled trial involving continuing education and the commitment-to-change model, Mazmanian Paul E, Johnson Robert E, Zhang Aixiu, Boothby John, Yeatts Elaine,Academic Medicine 2001;76:642-646
Requesting participants to give commitments to change adds little to the effectiveness of the CME course in producing behavioral change Validity of self-reports of behavior changes byparticipants after a CME course, Curry Lynn, Purkis Ian; Journal of medcial Education 1986;61:579-584

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2.5 PRE-VISIT ATTITUDE AND COMPLEXITY SCORE

2.6 PRE-VISIT TRAINING EXPECTATIONS

Bandura's social learning theory: clear specification of a behavioral goal facilitates its accomplishement.
Bandura A. Social learning theory, Englewood Cliffs, New Jersey: Prentice-Hall 1977

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2.7 PSYCHOMOTOR AND VISUAL-SPATIAL ABILITIES

Initial visual-spatial ability is related to initial competency in a spatially-complex surgical procedure. Trainees with the highest visual-spatial scores were able to transfer their skills to the more complex procedures more easily, whereas trainees with lowest visual-spatial scores improved their performance most after practice and fedback.
Effect of visual-spatial ability on learning of spatially-complex surgical skills. Wanzel KR, Hamstra SJ, Anastakis DJ, Matsumoto ED, Cusimano MD. Lancet 2002;359:230-231
A significant degree of predictability from initial to final proficiency will still remain after extensive training using a psychomotor skill test (rotary pursuit tracking) ), precluding complete convergence.
Acquisition of pursuit tracking skill under etxenbded training as a joint function of sex and initial ability. Noble Clyde E. Journal of Experimental Psychology 1970;86: 360-373

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3. CONVERSION


4. NUMBER OF CASES AND DAYS


5. TEAM ACTION


5.1 MULTIDISCIPLINARY INTERACTION (TO2)


 

5.2 ANESTHETIC OBSERVATION AND PARTICIPATION (TO3)


5.3 DEEP STITCH PLACEMENT (TO4)

 

5.4 CARDIAC ENUCLEATION (TO4)


5.5 SHUNT PLACEMENT (TO4)


 

5.6 BOX TRAINING(TO4)


6. INTERACTIVE DISCUSSION

6.1 MANAGEMENT OF CHANGE (TO1)

6.2 NEED AND PROCESS OF CHANGE(TO1)

6.3 MULTIDISCIPLINARY INTERACTION (TO2)

6.4 ANESTHETIC MANAGEMENT (TO3)

6.5 OUTCOME AND FINANCIAL DATA (TO5)

7. CD-ROM AND WEBSITE OPCAB-TRAINING.EU (TO 1-5)

8. EXIT IMPACT

Making a summary at the end of a learning experience moves the contents of the summary from short-term memory into long-term memory. (information processing theory)
Theories of learning, Hilgard E.R., Bower G.H., New York: Appleton-Century-Crofts 1966:381-425
There should be an impact on attitude and on complexity score.

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