Publications
232 results found
Kneebone RL, Nestel D, Bello F, 2017, Learning in a simulated environment, A Practical Guide for Medical Teachers, Editors: Dent, Harden, Hunt, Hodges, Publisher: Elsevier, Pages: 92-100, ISBN: 9780702068911
This highly regarded book recognises the importance of educational skills in the delivery of quality teaching in medicine. The contents offer valuable insights into all important aspects of medical education today.
Korzeniowski P, Brown DC, Sodergren M, et al., 2016, Validation of NOViSE – a novel Natural Orifice Virtual Surgery Simulator, Surgical Innovation, Vol: 24, Pages: 55-65, ISSN: 1553-3514
The goal of this study was to establish face, content and construct validity of NOViSE – the first force-feedback enabled virtual reality (VR) simulator for Natural Orifice Transluminal Endoscopic Surgery (NOTES). Fourteen surgeons and surgical trainees performed three simulated hybrid trans-gastric cholecystectomies using a flexible endoscope on NOViSE. Four of them were classified as “NOTES experts” who had independently performed ten or more animal or human NOTES procedures. Seven participants were classified as ‘Novices’ and three as ‘Gastroenterologists’ with no or minimal NOTES experience. A standardized five-point Likert-scale questionnaire was administered to assess the face and content validity. NOViSE showed good overall face and content validity. In 14 out of 15 statements pertaining to face validity (graphical appearance, endoscope and tissue behaviour, overall realism), ≥50% of responses were “agree” or “strongly agree”. In terms of content validity, 85.7% of participants agreed or strongly agreed that NOViSE is a useful training tool for NOTES and 71.4% that they would recommend it to others. Construct validity was established by comparing a number of performance metrics such as task completion times, path lengths, applied forces, etc. NOViSE demonstrated early signs of construct validity. Experts were faster and used a shorter endoscopic path length than novices in all but one task. The results indicate that NOViSE authentically recreates a trans-gastric hybrid cholecystectomy and sets promising foundations for the further development of a VR training curriculum for NOTES without compromising patient safety or requiring expensive animal facilities.
Huddy JR, Weldon SM, Ralhan S, et al., 2016, Sequential simulation (SqS) of clinical pathways: a tool for public and patient engagement in point-of-care diagnostics., BMJ Open, Vol: 6, Pages: e011043-e011043, ISSN: 2044-6055
OBJECTIVES: Public and patient engagement (PPE) is fundamental to healthcare research. To facilitate effective engagement in novel point-of-care tests (POCTs), the test and downstream consequences of the result need to be considered. Sequential simulation (SqS) is a tool to represent patient journeys and the effects of intervention at each and subsequent stages. This case study presents a process evaluation of SqS as a tool for PPE in the development of a volatile organic compound-based breath test POCT for the diagnosis of oesophagogastric (OG) cancer. SETTING: Three 3-hour workshops in central London. PARTICIPANTS: 38 members of public attended a workshop, 26 (68%) had no prior experience of the OG cancer diagnostic pathway. INTERVENTIONS: Clinical pathway SqS was developed from a storyboard of a patient, played by an actor, noticing symptoms of oesophageal cancer and following a typical diagnostic pathway. The proposed breath testing strategy was then introduced and incorporated into a second SqS to demonstrate pathway impact. Facilitated group discussions followed each SqS. PRIMARY AND SECONDARY OUTCOME MEASURES: Evaluation was conducted through pre-event and postevent questionnaires, field notes and analysis of audiovisual recordings. RESULTS: 38 participants attended a workshop. All participants agreed they were able to contribute to discussions and like the idea of an OG cancer breath test. Five themes emerged related to the proposed new breath test including awareness of OG cancer, barriers to testing and diagnosis, design of new test device, new clinical pathway and placement of test device. 3 themes emerged related to the use of SqS: participatory engagement, simulation and empathetic engagement, and why participants attended. CONCLUSIONS: SqS facilitated a shared immersive experience for participants and researchers that led to the coconstruction of knowledge that will guide future research activities and be of value to stakeholders concerned with the inv
Loisillier A, Granados A, Barrow A, et al., 2016, Thimble end effector for palpation skills training, 10th International Conference on Haptics - Perception, Devices, Control, and Applications (EuroHaptics), Publisher: SPRINGER INT PUBLISHING AG, Pages: 86-96, ISSN: 0302-9743
Interaction with force feedback haptic devices is often non-intuitive, obtrusive and unrealistic, particularly for the simulation of palpation skills training where a thimble is commonly found as an end-effector. A user will typically use two hands to steady the device and push one or more thimbles onto their fingers. New designs of thimbles, responsible for fastening the end effector of a haptic device onto the finger of the user have been explored, but do not solve the issue of introducing elements that are not present in the task being simulated. We introduce a number of design techniques, with early evaluation results for improving the way users engage, maintain connection and then disengage with thimble-connected haptic interfaces. The designs of the thimbles presented in this paper include rings and different opening shapes, which aim at creating a vacuum effect, as well as a mechanical grip around the finger of the user in order to hold it. Thimble effectiveness, as a function of low impedance on insertion and high impedance on removal, was assessed through a study which highlighted that the relationship between thimble opening size and finger circumference is a critical factor. We present results about the impact of the size of the rings on the insertion and extraction force, followed by a reflection on an improved experimental protocol.
Weldon S, Kneebone R, Bello F, 2016, Collaborative healthcare remodelling through Sequential Simulation (SqS): a patient and front-line staff perspective, BMJ Simulation & Technology Enhanced Learning, Vol: 2, Pages: 78-86, ISSN: 2056-6697
Background The Department of health funded an initiative to pioneer new approaches that would create a more integrated form of care.Local problem In order to receive funding, local Clinical Commissioning Groups were required to engage a range of stakeholders in a practical approach that generated the development of an integrated model of care.Intervention Two sequential simulation (SqS) workshops comprising 65 and 93 participants, respectively, were designed using real patient scenarios from the locality, covering areas of general practice, community health and adult social care. Workshops were attended by a diverse group of stakeholders. The first workshop addressed current care pathways and the second modelled ideal care pathways generated from the data obtained at the first workshop.Methods Discussions were captured through video recording, field-notes and pre and post questionnaires. Data was collated, transcribed and analysed through a combination of descriptive statistics and thematic analysis.Results The questionnaires revealed that attendees strongly agreed that they had had an opportunity to contribute to all discussions and raise questions, concerns and ideas (100%). Pre and post knowledge of current and new models of care was vastly improved. The opportunity to share information and to network was valued, with the SqS approach seen as breaking professional barriers (100%).Conclusions Simulation can be used as a tool to engage stakeholders in designing integrated models of care. The systematic data collection from the diverse ideas generated also allows for a much-needed ‘ear’ to those providing the solutions, as well as a legitimate and balanced perspective.
Weldon S, Ralhan S, Paice L, et al., 2016, Sequential simulation of a patient journey, Clinical Teacher, Vol: 14, Pages: 90-94, ISSN: 1743-4971
Objectives: To develop an intervention for educating pharmacists(community and hospital) about integrated care and their role in implementingit.Methods: We developed a sequential simulation derived from a patient’sjourney, the key scenario featuring a community pharmacist. The scenarioswere designed with input from pharmacists and patients, and emphasized theeffect operating in silos can have on the patient.Evaluation: Evaluation was by questionnaire, field notes and analysis ofvideo material. 21/37 (56.7%) participants responded to the questionnaire.19/21 expressed that they felt the event was a good or excellent educationalexperience, and had improved their confidence in their capability to improvepatient care. 19/21 said their knowledge and understanding of integrated carehad been enhanced. The sequential simulation was appreciated as a way ofvisualizing integrated care, with 19/21 describing it as good or excellent.Further themes were identified through video-analysis and field note analysis.Conclusion: Sequential Simulation is a novel and practical approach topresent current care pathways, aiming to generate a mutual focus, createparticipant empathy and bring the conventionalities of integrated care to life.We consider this approach helpful in preparing frontline staff to participate in integrated care.
Korzeniowski P, Barrow A, Sodergren M, et al., 2016, NOViSE: a virtual natural orifice transluminal endoscopic surgery simulator, International Journal of Computer Assisted Radiology and Surgery, Vol: 11, Pages: 2303-2315, ISSN: 1861-6410
Purpose: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians. Methods: We developed NOViSE - the first force-feedback enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom built and the behaviour of the virtual flexible endoscope is based on an established theoretical framework – the Cosserat Theory of Elastic Rods. Results: We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES Conclusions: VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype and the initial results indicate that it provides promising foundations for further development.
Mulki O, Plumptre I, Granados A, et al., 2016, Bimanual vaginal examination: Using innovation through cognitive task analysis to standardise practise and enhance teaching, Publisher: Wiley, Pages: 205-205, ISSN: 1470-0328
Kneebone R, Weldon S-M, Bello F, 2016, Engaging patients and clinicians through simulation: rebalancing the dynamics of care, Advances in Simulation, Vol: 1, ISSN: 2059-0628
This paper proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues. This use of simulation is a radical departure from traditional transmission models of education and training. Instead, we frame simulation as co-development, through which professionals, patients and publics share their equally (though differently) expert perspectives. The paper argues that a process of participatory design can bring about new insights and that simulation offers understandings that cannot easily be expressed in words. Drawing on more than a decade of our group’s research on simulation and engagement, the paper summarises findings from studies relating to clinician-patient collaboration and proposes a novel approach to address the current need. The paper outlines a mechanism whereby pathways of care are jointly created, shaped, tested and refined by professionals, patients, carers and others who are affected and concerned by clinical care.
Ralhan S, Weldon S, Kneebone R, et al., 2016, Sequential Simulation Workshops: An Innovative Approach to Working Together (engaging front-line staff, patients and publics) to Develop New Integrated Models of Care, Trainees in the Association for the Study of Medical Education
Powell P, Sorefan Z, Hamilton S, et al., 2016, Exploring the potential of sequential simulation., The Clinical Teacher, Vol: 13, Pages: 112-118, ISSN: 1743-498X
CONTEXT: Several recent papers have highlighted the need for better integrated care to improve health care for children and families. Our team spent a year exploring the potential of 'Sequential Simulation' (SqS) as a teaching tool to address this need with young people and multidisciplinary teams. SqS allows the simulation of a series of key events or 'crunch points' that come together to represent the patient journey, and highlights the impact of individuals on this journey. The pilot SqS was based on an adolescent with asthma - a common condition that requires excellent multidisciplinary care with the patient at the centre. INNOVATION: The SqS was designed using transportable sets and audio-visual equipment to create realism. Actors were employed to play the roles of the young person and mother and health professionals played themselves. The SqS was run at different events with varied audiences, including young people, health professionals and teachers. It was used to explore the difficulties that can arise during a patient journey, the importance of communication throughout, and to highlight the significance of each individual in the patient experience. RESULTS: The SqS was met with enthusiasm and felt to be an innovative and effective way of promoting better teamwork and communication. It was well received at a school asthma education event for pupils and community teams, demonstrating its varied potential. The year was the first step in the introduction of this exciting new concept that has the potential to help promote better integrated care for paediatric patients and their families. Our team spent a year exploring the potential of 'Sequential Simulation' as a teaching tool [to provide better integrated care].
Brunckhorst O, Shahid S, Aydin A, et al., 2015, Simulation-based ureteroscopy skills training curriculum with integration of technical and non-technical skills: a randomised controlled trial, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 29, Pages: 2728-2735, ISSN: 0930-2794
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- Citations: 40
Kneebone RL, Weldon SM, Ralham S, et al., 2015, Sequential Simulation (SqS): an innovative approach to educating GP receptionists about integrated care via a patient journey – a mixed methods approach, BMC Family Practice, Vol: 16, ISSN: 1471-2296
BackgroundAn evaluation of an effective and engaging intervention for educating general practice (GP) receptionists about integrated care and the importance of their role within the whole system was conducted.MethodsWorkshops took place in North West London, one of England’s 14 ‘Integrated Care Pioneers.’ Three training days featuring Sequential Simulations (SqS) were held. Forty GP receptionists attended on each day, as well as 5–6 patients and 8–9 healthcare professionals. The SqS developed was from a collection of patient stories, the key scene of which featured a GP receptionist. The scenes were designed to show the consequences for the patient of professionals working in silos. This provided the focus for facilitated table discussions. The discussants suggested ways in which an unfortunate series of events could have been dealt with differently. These suggestions were then incorporated in a re-designed SqS. Evaluation was conducted through questionnaires, field notes and analysis of video material. Descriptive statistics and thematic analysis were applied.ResultsNinety three participants responded to the questionnaire out of 131 attendees. All (93/93) respondents reported that the event was a powerful learning experience and that they had gained confidence in improving patient care. 98 % (91/93) reported that their knowledge of integrated care had improved. The simulation was rated highly as a learning experience [60 % (57/93) - excellent, 39 % (37/93) good]. Further evidence of educational benefit was expressed through comments such as: ‘The simulations really got me thinking about the patient as a human with many problems and situations.’ConclusionSqS is an innovative and practical way of presenting current care pathways and health care scenarios in order to create a shared focus, engage the emotions of the participants and bring the principles of integrated care to life. Facilitated table discussions are an opportuni
Brewin J, Tang J, Dasgupta P, et al., 2015, Full immersion simulation: validation of a distributed simulation environment for technical and non-technical skills training in Urology, BJU INTERNATIONAL, Vol: 116, Pages: 156-162, ISSN: 1464-4096
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- Citations: 45
Huddy J, Weldon S-M, Ralhan S, et al., 2015, Sequential simulation of clinical pathways: a tool for public and patient involvement in diagnostic research, UK Diagnostic Forum
Paice L, Weldon S, Ralhan S, et al., 2015, Sequential simulation (SqS) of a patient journey: an intervention to engage GP receptionists in integrated care, 15th International Conference on Integrated Care, Publisher: Ubiquity Press, ISSN: 1568-4156
Brunckhorst O, Shahid S, Aydin A, et al., 2015, The Relationship Between Technical And Nontechnical Skills Within A Simulation-Based Ureteroscopy Training Environment, JOURNAL OF SURGICAL EDUCATION, Vol: 72, Pages: 1039-1044, ISSN: 1931-7204
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- Citations: 36
Coates L, Weldon S-M, Rodrigues A, et al., 2015, Simulation as a public engagement: Engaging children in medicine and science in some surprising places, International Pediatric Simulation Symposia and Workshops
Weldon S, Woodward P, Granados A, et al., 2015, Future of Technology: The latest in simulation technology, RCGP - City Health Safeguarding the Future
Paice E, Weldon S-M, Ralhan S, et al., 2015, Patient produced simulation for education and training, International Forum on Quality and Safety in Healthcare
Brunckhorst O, Shahid S, Aydin A, et al., 2015, Training and assessing technical and non-technical skills for uretersocopy within a simulation-based curriculum - a randomised control trial, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS(, Publisher: WILEY-BLACKWELL, Pages: 39-39, ISSN: 0007-1323
Brunckhorst O, Shahid S, Aydin A, et al., 2015, DEVELOPMENT AND VALIDATION OF AN INTEGRATED SKILLS CURRICULUM WITHIN URETEROSCOPY - A RANDOMISED CONTROLLED TRIAL, Annual Meeting of the American-Urological-Association (AUA), Publisher: ELSEVIER SCIENCE INC, Pages: E244-E245, ISSN: 0022-5347
Brunckhorst O, Shahid S, Aydin A, et al., 2015, IS THERE A CORRELATION BETWEEN TECHNICAL SKILLS AND NON-TECHNICAL SKILLS PERFORMANCE WITHIN URETEROSCOPY?, Annual Meeting of the American-Urological-Association (AUA), Publisher: ELSEVIER SCIENCE INC, Pages: E268-E269, ISSN: 0022-5347
Coates L, Woodward P, Granados A, et al., 2015, Educational Technology and Innovations to Training and Patient Care Using Simulation, HENWL Primary Care Educator Conference
Weldon S, Bello F, Kneebone R, 2015, Sequential Simulation (SqS) Concept & Applications., UK Simulation in Nursing Education Conference
Harris A, Bello F, Kneebone R, 2015, Simulation and training in minimal access surgery, Training in Minimal Access Surgery, Pages: 35-47, ISBN: 9781447164937
This chapter summarises the increasingly important role that simulation has to play in the training of surgeons in minimal access surgery. This chapter defines commonly encountered terms from the simulation literature, describes the relevance of simulation to modern surgical practice, examines the evidence for and against the different types of simulators currently used in surgical simulation training, and considers the practicalities of adopting such an approach. The chapter concludes with an exploration of potential future directions in a rapidly evolving field.
Granados A, Bryan J, Abdalla T, et al., 2015, Haptics-based modelling of pigmented skin lesions, Pages: 159-165
Dermatology is under-represented in medical undergraduate education with newly graduated doctors not being able to identify common and important skin conditions. In order to become competent in diagnosing skin lesions, it is important to encounter multiple examples of a condition, as they vary between individuals. Three popular lesions have been identified due to their importance, including nodular melanoma, seborrhoeic keratosis and cherry haemangioma. In this paper we propose a haptics-enabled learning tool for pigmented skin lesions based on haptic texturing. Geometrical modelling, skin deformation and haptics modelling are described. Results of the implementation are presented along with an initial validation study comparing the haptics-based simulator with other methods, including temporary tattoos and silicon made models.
Rae AO, Khatib M, Sarker S, et al., 2015, The Effect of a Computer Based Open Surgery Simulation of an Inguinal Hernia Repair on the Results of Cognitive Task Analysis Performance of Surgical Trainees: An Educational Trial, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 40-40, ISSN: 0007-1323
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- Citations: 1
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