Publications
276 results found
Cope A, Bezemer J, Mavroveli S, et al., 2016, What attitudes and values are incorporated into self as part of professional identity construction when becoming a surgeon?, Academic Medicine, Vol: 92, Pages: 544-549, ISSN: 1938-808X
Purpose: To make explicit the attitudes and values of a community of surgeons, with the aim of understanding professional identity construction within a specific group of residents.Method: Using a grounded theory method, the authors collected data from 16 postgraduate surgeons through interviews. They complemented these initial interview data with ethnographic observations and additional descriptive interviews to explore the attitudes and values learned by surgeons during residency training (2010-2013). The participants were attending surgeons and residents in a general surgical training program in a university teaching hospital in the United Kingdom.Results: Participating surgeons described learning personal values or attitudes that they regarded as core to "becoming a surgeon" and key to professional identity construction. They described learning to be a perfectionist, to be accountable, and to self-manage and be resilient. They discussed learning to be self-critical, sometimes with the unintended consequence of seeming neurotic. They described learning effective teamwork as well as learning to take initiative and be innovative, which enabled them to demonstrate leadership and drive actions and agendas forward within the health care organization where they worked.Conclusions: To the authors' knowledge, this is the first study to systematically explore the learning of professional identity amongst postgraduate surgeons. The study contributes to the literature on professional identity construction within medical education. The authors conclude that the demise of the apprenticeship model and the rise of duty hours limitations may affect not only the acquisition of technical skills but, more important, the construction of surgeon professional identity.
Kneebone RL, Frampton S, 2016, John Wickham's new surgery: 'minimally invasive therapy", innovation, and approaches to medical practice in twentieth-century Britain, Social History of Medicine, ISSN: 1477-4666
The term ‘minimally invasive’ was coined in 1986 to describe a range of procedures that involvedmaking very small incisions or no incision at all for diseases traditionally treated by open surgery.We examine this major shift in British medical practice as a means of probing the nature of surgical innovationin the twentieth century. We first consider how concerns regarding surgical invasiveness hadlong been present in surgery, before examining how changing notions of post-operative care formed afoundation for change. We then go on to focus on a professional network involved in the promotionof minimally invasive therapy led by the urologist John Wickham. The minimally invasive movement,we contend, brought into focus tensions between surgical innovation and the evidence-based modelof medical practice. Premised upon professional collaborations beyond surgery and a re-positioning ofthe patient role, we show how the movement elucidated changing notions of surgical authority.
Bezemer J, Murtagh G, Cope A, et al., 2016, Surgical decision making in a teaching hospital: a linguistic analysis, ANZ JOURNAL OF SURGERY, Vol: 86, Pages: 751-755, ISSN: 1445-1433
Kneebone RL, 2016, Simulation reframed, Advances in Simulation, Vol: 1, ISSN: 2059-0628
BackgroundSimulation is firmly established as a mainstay of clinical education, and extensive research has demonstrated its value. Current practice uses inanimate simulators (with a range of complexity, sophistication and cost) to address the patient ‘as body’ and trained actors or lay people (Simulated Patients) to address the patient ‘as person’. These approaches are often separate.Healthcare simulation to date has been largely for the training and assessment of clinical ‘insiders’, simulating current practices. A close coupling with the clinical world restricts access to the facilities and practices of simulation, often excluding patients, families and publics. Yet such perspectives are an essential component of clinical practice.Main bodyThis paper argues that simulation offers opportunities to move outside a clinical ‘insider’ frame and create connections with other individuals and groups. Simulation becomes a bridge between experts whose worlds do not usually intersect, inviting an exchange of insights around embodied practices—the ‘doing’ of medicine—without jeopardising the safety of actual patients.Healthcare practice and education take place within a clinical frame that often conceals parallels with other domains of expert practice. Valuable insights emerge by viewing clinical practice not only as the application of medical science but also as performance and craftsmanship.Such connections require a redefinition of simulation. Its essence is not expensive elaborate facilities. Developments such as hybrid, distributed and sequential simulation offer examples of how simulation can combine ‘patient as body’ with ‘patient as person’ at relatively low cost, democratising simulation and exerting traction beyond the clinical sphere.The essence of simulation is a purposeful design, based on an active process of selection from an originary world, abstraction of what is c
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
Kneebone R, 2016, Prosthetic possibilities, The Lancet, Vol: 388, Pages: 1045-1046, ISSN: 0140-6736
Kneebone RL, 2016, Performing surgery: commonalities with performers outside medicine, Frontiers in Psychology, Vol: 7, ISSN: 1664-1078
This paper argues for the inclusion of surgery within the canon of performance science. The world of medicine presents rich, complex but relatively under-researched sites of performance. Performative aspects of clinical practice are overshadowed by a focus on the processes and outcomes of medical care, such as diagnostic accuracy and the results of treatment. The primacy of this “clinical” viewpoint—framed by clinical professionals as the application of medical knowledge—hides resonances with performance in other domains. Yet the language of performance is embedded in the culture of surgery—surgeons “perform” operations, work in an operating “theater” and use “instruments.” This paper asks what might come into view if we take this performative language at face value and interrogate surgery from the perspective of performance science.
Sadideen H, Goutos I, Kneebone R, 2016, Burns education: The emerging role of simulation for training healthcare professionals, Burns, Vol: 43, Pages: 34-40, ISSN: 0305-4179
Burns education appears to be under-represented in UK undergraduate curricula. However current postgraduate courses in burns education provide formal training in resuscitation and management. Simulation has proven to be a powerful modality to advance surgical training in both technical and non-technical skills. We present a literature review that summarises the format of current burns education, and provides detailed insight into historic, current and novel advances in burns simulation for both technical and non-technical skills, that can be used to augment surgical training. Addressing the economic and practical limitations of current immersive surgical simulation is important, and this review proposes future directions for integration of innovative simulation strategies into training curricula.
Sadideen H, Wilson D, Moiemen N, et al., 2016, Using "The Burns Suite" as a Novel High Fidelity Simulation Tool for Interprofessional and Teamwork Training., Journal of Burn Care & Research, Vol: 37, Pages: 235-242, ISSN: 1559-047X
Educational theory highlights the importance of contextualized simulation for effective learning. The authors recently published the concept of "The Burns Suite" (TBS) as a novel tool to advance the delivery of burns education for residents/clinicians. Effectively, TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. Recently, simulation-based team training (SBTT) has been advocated as a means to improve interprofessional practice. The authors aimed to explore the role of TBS in SBTT. A realistic pediatric burn resuscitation scenario was designed based on "advanced trauma and life support" and "emergency management of severe burns" principles, refined utilizing expert opinion through cognitive task analysis. The focus of this analysis was on nontechnical and interpersonal skills of clinicians and nurses within the scenario, mirroring what happens in real life. Five-point Likert-type questionnaires were developed for face and content validity. Cronbach's alpha was calculated for scale reliability. Semistructured interviews captured responses for qualitative thematic analysis allowing for data triangulation. Twenty-two participants completed TBS resuscitation scenario. Mean face and content validity ratings were high (4.4 and 4.7 respectively; range 4-5). The internal consistency of questions was high. Qualitative data analysis revealed two new themes. Participants reported that the experience felt particularly authentic because the simulation had high psychological and social fidelity, and there was a demand for such a facility to be made available to improve nontechnical skills and interprofessional relations. TBS provides a realistic, novel tool for SBTT, addressing both nontechnical and interprofessional team skills. Recreating clinical challenge is crucial to optimize SBTT. With a better understanding of the theories underpinning simulation and interprofessional education, future simulation scenarios
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.
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].
Kneebone RL, 2016, Performing surgery, Performance and the Medical Body, Publisher: Bloomsbury Publishing, Pages: 67-81, ISBN: 9781472570802
This edited collection focuses on performance practice and analysis that engages with medical and biomedical sciences.
Kneebone R, 2016, Modelling the body, The Lancet, Vol: 387, Pages: 114-115, ISSN: 0140-6736
Sadideen H, Weldon S-M, Saadeddin M, et al., 2015, A Video Analysis of Intra- and Interprofessional Leadership Behaviors Within "The Burns Suite": Identifying Key Leadership Models, Journal of Surgical Education, Vol: 73, Pages: 31-39, ISSN: 1931-7204
ObjectiveLeadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of “The Burns Suite” (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS.MethodsA total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen’s κ coefficient was used to measure inter-rater agreement and calculated as κ = 0.7 (substantial agreement). Each video was watched 4 times, focusing on 1 of the 4 team members per viewing (senior surgeon, senior nurse, trainee surgeon, and trainee nurse). The frequency and types of leadership behavior of each of the 4 team members were recorded. Statistical significance to assess any differences was assessed using analysis of variance, whereby a p < 0.05 was taken to be significant. Leadership behaviors were triangulated with verbal cues and actions from the videos.ResultsAll 3 scenarios were successfully completed. The mean scenario length was 22 minutes. A total of 362 leadership behaviors were recorded from the 12 participants. The most evident leadership behaviors of all team members were adhering to guidelines (which effectively equates to following Advanced Trauma and Life Support/Emergency Management of Severe Burns resuscitation guidelines and hence &l
Bezemer J, Korkiakangas T, Weldon S, et al., 2015, Unsettled teamwork: Communication and learning in the operating theatres of an urban hospital, Journal of Advanced Nursing, Vol: 72, Pages: 361-372, ISSN: 0309-2402
AimTo explore the unsettling effects of increased mobility of nurses, surgeons and other healthcare professionals on communication and learning in the operating theatre.BackgroundIncreasingly, healthcare professionals step in and out of newly formed transient teams and work with colleagues they have not met before, unsettling previously relatively stable team work based on shared, local knowledge accumulated over significant periods of close collaboration.DesignAn ethnographic case study was conducted of the operating theatre department of a major teaching hospital in London.MethodVideo recordings were made of 20 operations, involving different teams. The recordings were systematically reviewed and coded. Instances where difficulties arose in the communication between scrub nurse and surgeons were identified and subjected to detailed, interactional analysis.FindingsInstrument requests frequently prompted clarification from the scrub nurse (e.g. ‘Sorry, what did you want?’). Such requests were either followed by a relatively elaborate clarification, designed to maximize learning opportunities, or a by a relatively minimal clarification, designed to achieve the immediate task at hand.ConclusionsSignificant variation exists in the degree of support given to scrub nurses requesting clarification. Some surgeons experience such requests as disruptions, while others treat them as opportunities to build shared knowledge.
Cope AC, Bezemer J, Kneebone R, et al., 2015, 'You see?' Teaching and learning how to interpret visual cues during surgery, MEDICAL EDUCATION, Vol: 49, Pages: 1103-1116, ISSN: 0308-0110
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Korkiakangas T, Weldon S, Bezemer J, et al., 2015, “Coming Up!”: Why verbal acknowledgement matters in the operating theatre, Publisher: Equinox
Kneebone RL, Pelletier C, 2015, Learning safely from error? Reconsidering the ethics of simulation-based medical education through ethnography, Ethnography and Education, Vol: 11, Pages: 267-282, ISSN: 1745-7831
‘Human factors’ is an influential rationale in the UK national health service to understand mistakes, risk and safety. Although there have been studies examining its implications in workplaces, there has been little investigation of how it is taught, as a form of professional morality. This article draws on an observational study of human factors teaching in four hospital simulation centres in London, UK. Its main argument is that the teaching of human factors is realised through an identification and positive evaluation of ‘non-technical skills’ and the espousal of ‘non-judgemental’ pedagogy, both of which mean that mistakes cannot be made. Professional solidarity is then maintained on the absence of mistakes. We raise questions about the ethics of this teaching. The study is situated within a history of ethnographic accounts of medical mistakes, to explore the relationship between claims to professional knowledge and claims about failure.
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
Kneebone RL, 2015, When I say … reciprocal illumination, Medical Education, Vol: 49, Pages: 861-862, ISSN: 1365-2923
This paper proposes the idea of education as engagement rather than transmission, by which I mean an open-minded exchange of perspectives resulting in ‘reciprocal illumination’ for everyone who takes part. Terminology is important here. Mention the term ‘public engagement’ and people think of experts pontificating about their pet subject – at science fairs, perhaps, or outreach activities. The assumption is that experts know lots and transmit their knowledge without being changed much, and that members of the public don't know much at all and stand to gain far more. However, perhaps a different framing might open new opportunities.
Kneebone RL, Pelletier C, 2015, Fantasies of medical reality: An observational study of simulationbased medical education, Psychoanalysis, Culture and Society, Vol: 21, Pages: 184-203, ISSN: 1543-3390
Medicine is increasingly taught in immersive simulated environments, to supplement the apprenticeship model of work-based learning. Clinical research on this educational practice focuses on its realism, defined as a property of simulation technology. We treat realism as a function of subjective but collectively organised perception and imbued with fantasy, which we define by drawing on Lacanian studies of virtual reality and workplace organisation. Data from an observational study of four simulation centres in London teaching hospitals is drawn on to present an account of what was taught and learned about medicine, including medical failure, when medical practice was simulated.
Cope AC, Mavroveli S, Bezemer J, et al., 2015, Making Meaning From Sensory Cues: A Qualitative Investigation of Postgraduate Learning in the Operating Room, ACADEMIC MEDICINE, Vol: 90, Pages: 1125-1131, ISSN: 1040-2446
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
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