258 results found
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
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, 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.
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
Kneebone R, 2019, The vanishing art of doing, BMJ, Vol: 364, ISSN: 0959-8138
Kneebone R, Schlegel C, Spivey A, 2018, Science in hand: how art and craft can boost reproducibility, Nature, Vol: 564, Pages: 188-189, ISSN: 0028-0836
Sadideen H, Plonczak A, Saadeddin M, et al., 2018, How educational theory can inform the training and practice of plastic surgeons, Plastic and Reconstructive Surgery Global Open, Vol: 6, Pages: 1-8, ISSN: 2169-7574
It is important to optimize our current learning and teaching models, particularly in a climate of decreased clinical exposure. With technical advancements and clinical care now more accountable, traditional methods of skill acquisition need to be revisited. The past decade has seen changes in plastic surgery curricula. There has also been a shift toward competency-based training programs reflecting the growing emphasis on outcomes-based surgical education. This review explores the role of educational theory in promoting effective learning in practical skills teaching. Key models of educational theory are presented and their application to plastic surgery training to an expert level are highlighted. These models include (1) learning within communities of practice (Lave and Wenger’s theory); (2) the role of the zone of proximal development and importance of the availability of expert assistance (Vygotsky’s theory); (3) skill acquisition and retention (Dreyfus’ and Dreyfus’, and Fitts’ and Posner’s theories); (4) development of expertise after repeated practice and regular reinforcement (Ericsson’s theory); and (5) the assessment of competence (Miller’s triangle). Future plastic surgeons need to possess a thorough understanding of the technical and nontechnical skills required to manage patients effectively. Surgical educators are therefore compelled to develop practical training programs that can teach each of these skills in a safe, learner-centric manner. It is hoped that new approaches to surgical skills training are designed in light of our understanding of educational theory to optimize the training of the next generation of plastic surgeons.
Weil A, Weldon SM, Kronfli M, et al., 2018, A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: a mixed methods study, Nurse Education Today, Vol: 71, Pages: 26-33, ISSN: 0260-6917
BACKGROUND: A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs. OBJECTIVES: The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life. SETTING/PARTICIPANTS: Based on the results of a formal Training Needs Analysis, four SqS Simulation™ specialty-based courses were designed for general medical and surgical multidisciplinary teams in an acute UK hospital. METHODS: Over three months, seven SqS Simulation™ sessions were attended by fifty-seven multidisciplinary healthcare professionals. A quasi-experimental mixed-methods study was conducted using open and closed-ended questionnaires, pre and post-intervention. Changes in course attendees' confidence levels were analysed and qualitative data from free-text answers informed potential reasons for any differences identified. RESULTS: Confidence improved for all professional cohorts (p < 0.001). The differences were found to be highly significant for 'doctors' (p < 0.001), significant for 'therapists' (p = 0.02) and not significant for the 'nurses' cohort (p = 0.238). This was explored further using a qualitative explanatory framework. Categories included: Communicating with Families; Teamwork; Goal Planning; Do Not Attempt Cardiopulmonary Resuscitation; Course Usefulness; Prior Training; and Clinical Experience. CONCLUSION: This study has shown an overall improvement in confidence across disciplines after attending a SqS Simulation™ course. The differences in quantitative results between disciplines were explored through the qualitative data
Tribe H, Harris S, Kneebone RL, 2018, Life on a knife edge: Using simulation to engage young people in issues surrounding knife crime, Advances in Simulation, Vol: 3, ISSN: 2059-0628
BackgroundKnife-related behaviour among young people is an increasing social concern with a total of 35 teenagers killed by knife attacks in England in 2017. Distributed simulation has been shown to be a valid method of portable simulation for medical professionals; however, its role in delivering a socially educational message to members of the public has not been previously studied. This paper explores how the novel use of simulation could be used to address a serious social issue amongst young people at risk of criminal knife behaviour.MethodsA qualitative approach was used to study a two-part workshop attended by two groups of young people vulnerable to knife crime. Based on the concepts of sequential simulation and distributed simulation previously developed at the Imperial College Centre for Engagement and Simulation Science, the first part of the workshop showed the patient journey of a young man stabbed in the abdomen, attended by policemen and paramedics, followed by the participants witnessing a simulated emergency abdominal operation on a silicone model and concluded with a dialogue between the surgeon, the victim (who required an intestinal stoma as a result of the knife injury) and his mother. The second part of the workshop involved further discussion with the participants regarding the role of knives from the personal and community perspective. Visual data was recorded during the workshops and qualitative data obtained from group and individual interviews were thematically analysed.ResultsA total of sixty teenagers aged 13–19 took part in the two workshops. The participant feedback suggested that the workshops provided a safe environment where young people could learn about and explore the consequences surrounding knife crime. Furthermore, participant recollection of key points was assessed between 4 and 6 weeks after the second workshop and the data suggested that the workshop could promote learning and a change in the participants’ knife
Granados A, Low-Beer N, Higham J, et al., 2018, Real-time visualisation and analysis of clinicians’ performance during alpation in physical examinations, IEEE Transactions on Biomedical Engineering, Vol: 65, Pages: 2042-2051, ISSN: 0018-9294
Objective: Motivated by the fact that palpation skills are challenging to learn and teach, particularly during Digital Rectal Examinations (DRE), and the lack of understanding of what constitutes adequate performance, we present a visualization and analysis system that uses small position and pressure sensors located on the examining finger, allowing the quantitative analysis of duration, steps, and pressure applied. Methods: The system is first described, followed by an experimental study of 20 experts from four clinical specialties performing ten DREs each on a benchtop model using the proposed system. Analysis of the constitutive steps was conducted to improve understanding of the examination. A Markov model representing executed tasks and analysis of pressure applied is also introduced. Results: The proposed system successfully allowed the visualization and analysis during the experimental study. General practitioners and nurses were found to execute more tasks compared to urologists and colorectal surgeons. Urologists executed the least number of tasks and were the most consistent group compared to others. Conclusion: The ability to “see through” allowed us to better characterize the performance of experts when conducting a DRE on a benchtop model, comparing the performance of relevant specialties, and studying executed tasks and the pressure applied. The Markov model presented summarizes task execution of experts and could be used to compare the performance of novices against that of experts. Significance: This approach allows for the analysis of performance based on continuous sensor data recording that can be easily extended to real subjects and other types of physical examinations.
Palfreyman H, Kneebone RL, 2018, Blind alleys and dead ends: researching innovation in late 20th century surgery, Medical Humanities, Vol: 44, Pages: 165-171, ISSN: 1473-4265
This article examines the fortunes of one particular surgical innovation in the treatment of gallstones in the late 20th century; the percutaneous cholecystolithotomy (PCCL). This was an experimental procedure which was trialled and developed in the early days of minimally invasive surgery and one which fairly rapidly fell out of favour. Using diverse research methods from textual analysis to oral history to re-enactment, the authors explore the rise and fall of the PCCL demonstrating that such apparent failures are as crucial a part of innovation histories as the triumphs and have much light to shed on the development of surgery more generally.
Kneebone R, 2018, In praise of boredom, Lancet, Vol: 392, Pages: 725-725, ISSN: 0140-6736
Kneebone RL, 2018, A fellowship of error, Lancet, Vol: 392, Pages: 111-111, ISSN: 0140-6736
Kneebone RL, 2018, Improvising medicine, The Lancet, Vol: 391, Pages: 2097-2097, ISSN: 0140-6736
For many clinicians, the word improvisation has a pejorative whiff—it smacks of being lazy, unprepared, or unprofessional. But improvisation is essential to clinical practice and we should prize, embrace, and practise it.
Kneebone R, 2018, Getting back in touch., Lancet, Vol: 391, Pages: 1348-1348, ISSN: 0140-6736
Weldon SM, Kronfli M, Bello F, et al., 2018, Using a Variety of Research Methods and Angles to Understand a New Approach That Explores Health-Care Services, Qualitative Health Research Conference, Publisher: SAGE PUBLICATIONS INC, Pages: 57-57, ISSN: 1609-4069
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