ABSTRACT
Objectives Surgical instrumentation teaching is included as an essential part of surgical training in the core surgical training syllabus. Access to formal teaching is variable, and opportunities for informal teaching have been further reduced by the COVID-19 pandemic. We aimed to design a course to fulfil these local trainees' needs. A move away from face-to-face teaching has occurred successfully during the pandemic, but little literature exists on how face-to-face courses can be best designed during this time. We aimed to describe the practicalities of running a face-to-face course with COVID restrictions. Methods Junior doctors and nurses rotated around five stations led by theatre nurses and senior doctors, each with common instruments from different surgical subspecialties. Social distancing was observed, and level 2 personal protective equipment (PPE) was worn throughout the course. Matched pre- and post-course tests allowed evaluation of learning. Results The course had 20 attendees, and the test scores improved following the course by an average of 9% (p = 0.009). All attendees (100%) found the course improved their knowledge and confidence. Feedback was overwhelmingly positive, and the significant improvement in the multiple-choice question (MCQ) scores demonstrates that this was an effective method of delivering teaching despite the COVID-19 restrictions on social distancing. Conclusion This course shows that instrumentation training is valuable to trainees and provides a good example to other educators, showing the workings of how a practical course may be run face-to-face during the pandemic.
ABSTRACT
INTRODUCTION: Prone positioning is deployed as a critical treatment for improving oxygenation in patients with Acute Respiratory Distress Syndrome. This regimen is currently highly prevalent in the COVID-19 pandemic. The pandemic has brought about increased concern about how best to safely avoid brachial plexus injuries when caring for unconscious proned patients. METHODS: A review of the published literature on brachial plexus injuries secondary to proning ventilated patients was performed. This was combined with a review of available international critical care guidelines in order to produce a succinct set of guidelines to aid critical care departments in reducing brachial plexus injuries during these challenging times. DISCUSSION: There is no one manner in which prone positioning an unconscious patient can be made universally safe. This paper provides 6 key steps to reducing the incidence of brachial plexus injuries while proning and suggests a safe and sensible management and referral pathway for the conscious patient in which a brachial plexus injury is identified. CONCLUSION: There is in truth no completely safe position for every patient and certainly there will be anomalies in anatomy that will predispose certain individuals to nerve injury. Thus the injury rate cannot be reduced to zero but an understanding of the principles of protection will inform those undertaking positioning.