ABSTRACT
Objectives: Recent reforms to postgraduate medical education, the 'Shape of Training (SoT)' and 'Excellence by Design: standard for postgraduate curricula' mandate a re-evaluation of the way in which surgical education is delivered, particularly in the teaching of surgical techniques. More so, as we continue to train with the restrictions imposed by the COVID pandemic, emphasis must be placed on maximising every training opportunity. Design: In this article, we demonstrate the utility of an instructional design method to enhance the teaching of neurosurgical procedures. Specifically, we utilise the instructional design method of teaching first described by Robert Gagne in the 1960s. Subjects: The framework we provide can be used to equip all neurosurgical trainees with the necessary capabilities to achieve the high-level outcomes expected from the new curriculum. Methods: We design a lesson plan using Gagne's nine events of instruction, in this case using burr hole evacuation of chronic subdural haematomas as an example. The ordered nature of Gagne's nine-step model allows a complete picture to be formed and structures teaching for a comparable learning experience. Conclusions: One particular strength of this teaching method is placing the learned skill in the wider context of patient care includes perioperative management. By empowering trainees to consider all aspects of the underlying reasoning for a procedure, well-rounded clinicians can be developed who are comfortable in the real-world application of procedural skills. The creative lesson plan optimises the learning process and ensures that the objectives are comprehensively fulfilled. The structured approach fortifies a good basis for understanding the operation and ensures that progression to independence is a safe approach.
ABSTRACT
Objectives: Simulation sessions were designed and introduced into the Cardiff University Clinical Neurosciences placement for 4th-year medical students. We present our approach to delivering these simulation sessions, student feedback and our recent experience in the context of the COVID19 pandemic. Design: Three emergency clinical neuroscience simulation scenarios were designed, aimed at final phase (Year 4-5) medical students. Subjects: Final phase (Year 4-5) medical students. Methods: The sessions are delivered weekly during the academic year by the Clinical Neurosciences teaching fellows at The University Hospital of Wales, (UHW) to groups of sixeight students. Student pairs work through each scenario in a high-fidelity simulation suite under the guidance of the tutor. Observing students remain engaged through participation as patient relatives or medical colleagues. Upon completion, learners are debriefed using the Pendleton Model for feedback/reflection, and anonymised feedback is then collected. Results: One year of collated feedback revealed that 90% (109/122) of respondents strongly stated that the sessions were enjoyable, achieved the desired learning outcomes, and advanced their clinical knowledge. One hundred percent of respondents (122/122) agreed that the sessions improved their confidence at managing medical emergencies. Due to the COVID19 pandemic, session modifications included: a larger simulation suite to facilitate social distancing;procurement of appropriate personal-protective-equipment, and a reduction in session size, (<6 students) offset by higher session frequency. Conclusions: Simulation sessions provide a safe, structured environment in which learners can gain confidence managing emergencies. Feedback confirms that our sessions achieve these goals for most students. The possibility of further restrictions on students' exposure to patients remains high due to rising medical student numbers and potential COVID19 resurgences. There may thus be a need to expand the volume and scope of these simulations to cover more scenarios and broader learning outcomes, to ensure future students gain necessary skills and confidence to manage neurological emergencies.