270 results found
Kneebone R, Houstoun W, Houghton N, 2021, Medicine, magic, and online performance, LANCET, Vol: 398, Pages: 1868-1869, ISSN: 0140-6736
Schlegel C, Smith C, Abe K, et al., 2021, Onomatopoeia - listening to the sounds behind the words comment, GMS Journal for Medical Education, Vol: 38, Pages: 1-6, ISSN: 2366-5017
Miller R, Hotton M, Williamon A, et al., 2021, Surgical performance anxiety and wellbeing among surgeons, Annals of Surgery, Vol: 275, Pages: 632-639, ISSN: 0003-4932
Objective: This national cross-sectional study aims to establish the prevalence and potential impact of performance anxiety among surgeons and investigate its association with psychological traits and wellbeing.Summary and background data: Despite a growing awareness that human factors, non-technical skills and wellbeing in healthcare affect patient outcomes, an area that has remained unexplored is surgical performance anxiety (SPA).Methods: A prospectively registered, cross-sectional study using mixed methods was conducted across the United Kingdom (U.K.). Data captured included demographics, surgical specialty, trait anxiety, trait perfectionism, SPA and surgical perfectionism scores. Wellbeing was assessed using The Short Warwick-Edinburgh Mental Wellbeing Scale, while qualitative data were collected regarding surgeons’ experiences of SPA.Results: A total of 631 responses were collected. Mean age was 41·2 years and mean surgical experience 15·3 years. 62% were male and 52% of consultant grade. 100% felt that SPA affected surgeons, with 87% having experienced it themselves. 65% reported SPA negatively impacted surgical performance and 96% felt SPA negatively impacted surgeons’ wellbeing. Male surgeons reported significantly better wellbeing than female surgeons. Surgeons with SPA reported significantly worse wellbeing compared with surgeons who did not experience SPA. Surgeons in general experienced significantly lower mental wellbeing compared with population norms. Thematic analysis highlighted a reticence to share SPA openly and need for cultural change.Conclusions: SPA is a very common and significant challenge among surgeons across all specialties at all levels of experience in the U.K. It is perceived by surgeons to affect surgical performance adversely and is associated with worse psychological wellbeing. A more open culture of sharing and acknowledgement has been identified to be beneficial.
Houghton N, Houstoun W, Yates S, et al., 2021, Cross-disciplinary perspectives on the transition to remote education, BMJ Simulation & Technology Enhanced Learning, Vol: 7, Pages: 586-589, ISSN: 2056-6697
The COVID-19 pandemic has prompted the cancellation of clinical attachments and face-to-face teaching at medical schools across the world. Experiential learning—through simulation or direct patient contact—is essential for the development of clinical skills and procedural knowledge. Adapting this type of teaching for remote delivery is a major challenge for undergraduate medical education. It is also an opportunity for innovation in technology enhanced learning and prompts educators to embrace new ways of thinking. In this article, the authors explored how educators from different disciplines (medicine, music and performing arts) are using technology to enhance practical skills-based learning remotely.The authors, five experienced educators from different fields (surgery, medicine, music and magic), jointly documented the transition to technology enhanced remote teaching through a series of five structured conversations. Drawing from literature on distance learning in medicine and professional experience in education, the authors identified seven practice-enhancing recommendations for optimising teaching of procedural knowledge and skills. These are: (1) make a virtue out of necessity; (2) actively manage your environment; (3) make expectations clear; (4) embrace purposeful communication; (5) use digital resources; (6) be prepared for things to go wrong and (7) personalise the approach. The authors argue that widening the discourse in technology enhanced learning to include cross-disciplinary perspectives adds richness and depth to discussions. This article demonstrates a cross-disciplinary approach to addressing challenges in technology-enhanced medical education.This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data m
Kneebone R, 2021, Portrait or snapshot?, LANCET, Vol: 398, Pages: 292-292, ISSN: 0140-6736
Fawcett M, Coughlan C, McGeorge E, et al., 2021, Qualitative evaluation of asthma services for young people: a sequential simulation study, BMJ Simulation && Technology Enhanced Learning, Vol: 7, Pages: 134-139, ISSN: 2056-6697
Background Asthma is the most common chronic disease of childhood and an important preventable cause of mortality in children and young people (CYP). Few studies have brought together CYP and health professionals to understand the patient perspective of routine asthma care. We sought to explore how young people engage with routine asthma care in North West London through sequential simulation.Method We designed a sequential simulation focusing on routine asthma management in young people aged 12–18. A 20 min simulation was developed with four young people to depict typical interactions with school nurses and primary care services. This was performed to a mixed audience of young people, general practitioners (GPs), paediatricians, school nurses and commissioners. Young people were invited to attend by their GPs and through social media channels. Attendees participated in audio-recorded, facilitated discussions exploring the themes arising from the simulation. Recordings were transcribed and subjected to thematic analysis.Results 37 people attended the sequential simulation. Themes arising from postsimulation discussions included recognition of chaotic family lifestyles as a key barrier to accessing care; the importance of strong communication between multidisciplinary team professionals and recognition of the role school nurses can play in delivering routine asthma care.Conclusion Sequential simulation allows healthcare providers to understand routine asthma care for CYP from the patient perspective. We propose improved integration of school nurses into routine asthma care and regular multidisciplinary team meetings to reduce fragmentation, promote interprofessional education and address the widespread professional complacency towards this lethal condition.
Webb R, Kneebone R, 2021, Enough of experts?, NEW SCIENTIST, Vol: 245, Pages: 40-43, ISSN: 0262-4079
Kneebone R, Korkiakangas T, Weldon S, 2021, “Let me take care of you”: What can healthcare learn from a high-end restaurant to improve patient experience?, Journal of Communication in Healthcare, Vol: 14, Pages: 225-240, ISSN: 1753-8068
BackgroundThe patient experience is associated with patient satisfaction and health outcomes, presenting a key challenge in healthcare. The objective of the study was to explore the principles of care in and beyond healthcare, namely in a three Michelin-starred restaurant, and consider what, if any, principles of care from the diners’ experience could be transferrable to healthcare.MethodThe principles of care were first explored as part of observational fieldwork in a healthcare day surgery unit and the restaurant respectively, focusing on communication between the professionals and the patients or the diners. Care was subsequently explored in a series of public engagement events across the UK. The events used immersive simulation to recreate the healthcare and the dining experiences for the general public, and to stimulate discussion.ResultsA thematic analysis of the engagement discussions identified overarching themes in how care was experienced in and through communication; ‘informed, not bombarded’, ‘conversation, not interrogation’, ‘environment is communication’, and ‘being met as a person’. The themes suggested how the participants in simulation felt about the care they received in real time and provided recommendations for improved clinical practice.
Radzikowski J, Delmas L, Spivey A, et al., 2021, The Chemical Kitchen: Towards Remote Delivery of an Interdisciplinary Practical Course, Journal of Chemical Education, ISSN: 0021-9584
Kneebone R, Schlegel C, 2021, Thinking across disciplinary boundaries in a time of crisis, The Lancet, Vol: 397, Pages: 89-90, ISSN: 0140-6736
Granados A, Cox S, Low-Beer N, et al., 2020, Taking the pressure off the patient - understanding digital rectal examinations on a real subject, IEEE Transactions on Biomedical Engineering, Vol: 67, Pages: 2798-2805, ISSN: 0018-9294
Better understanding of palpation techniques during unsighted physical examinations has mostly been limited to qualitative and quantitative studies of performance of experts whilst conducting examinations on plastic benchtop models. However, little is known about their performance when conducting such examinations on real subjects. OBJECTIVE: The aim of this paper is to better understand palpation techniques of experts whilst conducting a Digital Rectal Examination on a real subject. METHODS: We recruited four consultants from relevant specialties and asked them to conduct two DREs on a Rectal Teaching Assistant whilst wearing small position and pressure sensors on their examining finger. We segmented the relevant anatomy from an MRI taken of the pelvic region, registered 3D models and analysed retrospectively performance in relation to executed tasks, supination/pronation, palpation convex hull and pressure applied. RESULTS: Primary care consultants examined the anatomy more holistically compared to secondary care experts, the maximum pressure applied across experiments is 3.3N, overall the pressure applied on the prostate is higher than that applied to rectal walls, and the urologist participant not only applied the highest pressure but also did so with the highest most prominent frequency (15.4 and 25.3 Hz). CONCLUSIONS: The results of our research allow for better understanding of experts' technical performance from relevant specialities when conducting a DRE, and suggest the range of pressure applied whilst palpating anatomy. SIGNIFICANCE: This research will be valuable in improving the design of haptics-based learning tools, as well as in encouraging reflection on palpation styles across different specialities to develop metrics of performance.
Kneebone R, 2020, Expert Understanding the Path to Mastery, Publisher: Penguin UK, ISBN: 9780241986141
In this groundbreaking book, Kneebone combines his own experiences as a doctor with insights from extraordinary people and cutting-edge research. He tells a story that resonates with us all - the story of how we can become expert.
Kneebone R, 2020, Maps and guides., The Lancet, Vol: 396, Pages: 18-18, ISSN: 0140-6736
Kneebone R, 2020, Another hand on the scalpel, The Lancet, Vol: 395, Pages: 1184-1184, ISSN: 0140-6736
Kneebone R, Schlegel C, 2020, Taking a broader view: exploring the materiality of medicine through cross-disciplinary learning, BMJ Simulation & Technology Enhanced Learning, Vol: 6, Pages: 108-109, ISSN: 2056-6697
Kneebone R, 2020, In practice Making sense, The Lancet, Vol: 395, Pages: 677-677, ISSN: 0140-6736
Kneebone R, 2020, Challenging anatomy., The Lancet, Vol: 395, Pages: 405-406, ISSN: 0140-6736
Kelay TK, Ako E, Cook C, et al., 2019, Physician-patient interactions & communication with conscious patients during simulated cath-lab procedures: An exploratory study, BMJ Simulation & Technology Enhanced Learning, Vol: 5, ISSN: 2056-6697
Background This exploratory study investigates the feasibility for observing and evaluating intraoperative communication practices using simulation techniques. Complex procedures are increasingly performed on patients under local anaesthesia, where patients are fully conscious. Interventional cardiac procedures are one such example where patients have reported high levels of anxiety undergoing procedures. Although communication styles can serve to alleviate patient anxiety during interventions, leading to a better patient experience, there has been little observational research on communication, while patient perspectives in intraoperative contexts have been underexplored.Methods In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews.Results While independent ratings of physician–patient communications demonstrated few discernible differences according to physicians’ experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient’s anxiety scores were differentiable according to operators’ experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the pr
Kneebone R, 2019, Learning from the past, The Lancet, Vol: 394, Pages: 1221-1221, ISSN: 0140-6736
Shah A, Kneebone R, 2019, Learning on the Surgical Post-Take Ward Round: A Missed Informal Educational Opportunity, International Surgical Conference of the Association-of-Surgeons-in-Training (ASIT), Publisher: WILEY, Pages: 135-135, ISSN: 0007-1323
Weldon SM, Korkiakangas T, Calzada J, et al., 2019, A surgical team simulation to improve teamwork and communication across two continents: ViSIOT Proof-of-Concept Study, Journal of Surgical Education, Vol: 76, Pages: 1413-1424, ISSN: 1931-7204
BACKGROUND: Team communication in operating rooms is problematic worldwide, and can negatively impact patient safety. Although initiatives such as the World Health Organization's Surgical Safety Checklist have been introduced to improve communication, patient safety continues to be compromised globally, warranting the development of new interventions. Video-based social science methods have contributed to the study of communication in UK ORs through actual observations of surgical teams in practice. Drawing on this, the authors have developed a surgical team simulation-training model [Video-Supported Simulation of Interactions in the Operating Theatre (ViSIOT)]. A proof-of-concept study was conducted in the UK and USA to assess if the ViSIOT simulation-training has applicability and acceptability beyond the UK. METHODS: ViSIOT training was conducted at two simulation centers in the UK and USA over a 10-month period. All surgical team participants completed a questionnaire (that assessed design, education, satisfaction, and self-confidence in relation to the training). Descriptive and inferential statistics were performed for the quantitative data and thematic analysis was conducted for the qualitative data. RESULTS: There was strong agreement from all participants in terms of their perception of the course across all sub-sections measured. Nine themes from the qualitative data were identified. The two countries shared most themes, however, some emerged that were unique to each country. CONCLUSIONS: Practical developments in the course design, technology, and recruitment were identified. Evidence of the course applicability in the USA provides further affirmation of the universal need for team communication training within ORs. Further studies are required to assess its effectiveness in improving communication in OR practice.
Kneebone R, 2019, Taxidermy and the clinic, Lancet, Vol: 394, Pages: 208-2018, ISSN: 0140-6736
Kneebone R, 2019, In practice Personal space, The Lancet, Vol: 393, Pages: 2291-2291, ISSN: 0140-6736
Kneebone R, 2019, Dissecting the consultation, The Lancet, Vol: 393, Pages: 4-10, ISSN: 0140-6736
Pelletier C, Kneebone R, 2019, Exploration: Wigs, brown sauce and theatrical dames-clinical simulation as play, The Power of Play in Higher Education: Creativity in Tertiary Learning, Pages: 213-221, ISBN: 9783319957791
Weldon SM, Korkiakangas T, Kneebone R, 2019, How simulation techniques and approaches can be used to compare, contrast and improve care: an immersive simulation of a three-Michelin star restaurant and a day surgery unit, BMJ Simulation & Technology Enhanced Learning, Vol: 6, Pages: 65-66, ISSN: 2056-6697
Kneebone R, 2019, Looking and seeing, Lancet, Vol: 393, Pages: 1091-1091, ISSN: 0140-6736
Imran A, Holden B, Weldon SM, et al., 2019, 'How to help your unwell child': a sequential simulation project, BMJ Simulation and Technology Enhanced Learning, Vol: 6, Pages: 127-128, ISSN: 2056-6697
Kneebone RL, Oakes F, Bicknell C, 2019, Reframing surgical simulation: the textile body as metaphor, The Lancet, Vol: 393, Pages: 22-23, ISSN: 0140-6736
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