Traditional Apprenticeship Model Research Articles

Redefining the Professional Identity of the Surgeon by Reflecting on Critical Incidents in London, United Kingdom

INTRODUCTION: Critical incidents are increasingly prevalent documented events in National Health Service (NHS) hospitals in the United Kingdom. Claims are made against the NHS in cases of medical negligence, with Obstetrics and Gynaecology accounting for 15% of the total claims, the second highest among all specialties.  OBJECTIVE: To understand the impact of critical incidents on the developing surgical identity of Obstetric and Gynaecological trainees in London, United Kingdom. METHODS: A Qualitative study using semi-structured styled interviews. The interviews were audio-recorded and subsequently transcribed. The data was then analysed. Six trainees, of specialist trainee level three to seven were interviewed separately. This consisted of five female and one male doctors. This is within the current gender ratio difference in London. RESULTS: Undergoing a critical incident was felt to be a traumatic experience for all trainees involved. The incident itself and its management by the department, hospital or deanery had a significant impact on the psycho-social well-being of the doctor involved. Critical incidents can negatively affect the professional development of the surgeon. Surgical identity is an area that appears to be in the hidden curriculum, however many trainees struggled to define what their surgical identity was and how it may have been affected. CONCLUSION: Critical incidents cause significant psycho-social distress for the developing surgeon. Surgical identity should be implicitly understood within medical education. This study highlights the urgent need for those writing medical curricula; both undergraduate and postgraduate to make the implicit explicit. Surgical identity discourse must be a priority for the new curriculum. Professionalism and an ability to endure the psychological stress caused by undergoing critical incidents is likely to be enhanced, by creating a strong sense of belonging within the surgical profession. The loss of the traditional apprenticeship model and its mentors must be considered within the new design. 

Assessment of Surgical Training Modality Efficacy in Medical Students – A Comparison of Surgical Simulation, Video Demonstration, and Live Instruction

Objectives Surgical simulation is a growing form of education in medical training, but it remains unclear how simulation compares to traditional lecture or apprenticeship models of teaching when translating procedural knowledge to surgical performance. This study aimed to assess the effectiveness of translating procedural knowledge to surgical skill when trained by the surgical simulation app “Touch Surgery (TS),” recorded video lecture, or in-person teaching of the trigger finger release (TFR) surgery. The study also aimed to identify the learners’ preferred teaching modality. Methods Twenty-seven first- and second-year medical students were recruited to participate. They were randomly assigned to one of three cohorts (n=9) as designated by a different TFR surgery learning modality: surgical simulation through TS (cohort “SS”), video demonstration (cohort “VIDEO”), or live teaching by a board-certified orthopaedic hand surgeon (cohort “LIVE”). Each participant completed their modality three times. They then completed an assessment of the procedural steps before performing the TFR surgery on a cadaver. Outcome measures included procedural test scores and cadaveric performance, evaluated using a surgery-specific detailed checklist, a global rating scale (GRS) of soft surgical skills, and a pass/fail assessment. Participants graded their modality’s usefulness using a 5-point Likert scale. Results There was no statistically significant difference in TFR procedural assessment scores (P=0.123) or cadaveric surgical performance between groups when evaluated by the surgery-specific step checklist (P=0.549), GRS (P=0.567), and pass/fail assessment (P=0.874). Students in the LIVE cohort rated their modality as their first-choice training tool (P=0.009); however, those in the SS cohort rated their modality as easiest to use, follow, and understand (P=0.010). Conclusion All educational modalities should be considered in surgical training. This study demonstrates that students can perform cognitively and technically similar learning from virtual or live formats; however, they preferred live teaching. Level of Evidence III

Does exposure to research experiences have different learning outcomes than prior exposure to lab techniques in non-research settings?

A large body of literature has established the benefits of undergraduate research experiences via the traditional apprenticeship model. More recently, several studies have shown that many of these benefits can be recapitulated in course-based undergraduate research experiences (CUREs) that are more scalable and easier for students to participate in, compared to the apprenticeship-based research experiences. Many Biology curricula also incorporate more traditional laboratory courses, where students learn to use common laboratory techniques through guided exercises with known outcomes. Indeed, many programs across the nation provide such programs or courses for students early in their careers, with a view toward increasing student interest and engagement in Biology. While there is general consensus that all lab experiences have some benefits for students, very few studies have examined whether either research experiences or learning biological techniques in more traditional lab courses directly impacts student performance in lecture courses. Here, we show that prior familiarity with laboratory techniques does not improve student performance in a lecture course, even if these techniques are directly related to content being taught in the course. However, having prior research experience improves performance in the course, irrespective of whether the research experience included the use of course-related laboratory techniques.

Innovative models for teaching reproduction in small animals: The experience at DIMEVET of Bologna University

For a long time, the main way to acquire the skills necessary for good veterinary practice has been the traditional apprenticeship model (observe, assist, and perform under supervision). However, in the last years, more creative and innovative teaching models have been adopted by academic institutions and, parallelly, the opportunities to gain hands-on experience for clinical and surgical procedures are becoming more limited. For that reason, the introduction of the models can provide a potential solution to the ethical and legal implications related to the use of live animals for educational purposes and the biosafety risks deriving from the manipulation of human/animal cadavers. The activity on this topic at DIMEVET and, in particular, the experience about teaching reproduction includes in-house production and use of models for learning skills both for degree (fifth and third years of course) and post-graduate courses. Our models are designed on the basis of two fundamental aspect: the student level and the teacher target. The aim of this study was to evaluate, for the first time in literature, how much the use of simulators impacts on practical teaching in degrees and post graduate courses at DIMEVET, considering different learners with different levels of knowledge and skills. Namely, effectiveness, adequacy and quality of simulators have been checked assessing students' learning experience and teacher's opinion by specific satisfaction questionnaires and considering the attendance at the training sessions and the results of a final examination (PHY group) and an in vivo test (POST group). The rate of satisfaction was high among the three groups considered and the participants that had used the models had a higher success, both in the final examination and in vivo test.Data collected have been useful in order to show an improvement in teaching at DIMEVET in the field of reproduction, despite the relatively short years of experience using simulation. With this study we demonstrate that the adequacy of the models is not correlated to how simulators is built, whether with basic materials or not faithfully in terms of anatomical appearance, but it is important that it is realistic in terms of psychomotor procedure. In conclusion, the use of models permits the student to gain the hand-eye coordination and dexterity necessary to perform certain skills and the models proposed are meeting the desired educational goals.

Metric-Based Simulation Training to Proficiency for Endovascular Thrombectomy in Ischemic Stroke.

Ischemic stroke is one of the leading causes of death and long-term disability in the West. Mechanical revascularization techniques are considered the standard of care for large vessel occlusive stroke. Traditional apprenticeship models involve doctors training their skills on patients. Simulation platforms have long been recognized as an alternative to this. There has however been very little robust assessment of the training outcomes achieved on some of these platforms. At best, these simulations increase understanding of the procedural process and may help improve some technical skills; at worst they may instill bad habits and poor technique. The prerequisite of any simulation process must be to teach what to do, with which devices, in the correct sequence as well as what not to do. It should provide valid metric-based feedback to the trainee that is objective, transparent, and fair for formative and summative performance feedback. It should deliver a training program that measures the performance progress of trainees against expert benchmarks—benchmarks that represent an evidence-based peer-reviewed standard. In this paper, we present a perspective for PBP training for thrombectomy based on our experience with the process of procedure characterization, metric validation, and early experience of using this approach for proficiency training. Patient outcomes are not only determined by optimal performance in the Angio Suite but also by an efficient patient procedure pathway. There will be value in utilizing the PBP training standard not only for the procedure itself but also for the constituent elements of the stroke pathway to further improve treatment outcomes for ischemic stroke patients.

EP-524 Implementing Simulation Based Learning (SBL) to Reduce the Gap in Surgical Training, A Theoretical Evaluation Approach

BackgroundThe current surgical training is severely affected by COVID-19 pandemic with redeployment and reduced number of elective procedure across NHS hospitals, this has affected both core and higher surgical trainees, rendering the traditional apprenticeship model obsolete. It became evident that the future of Surgical training and innovation will require a combination of simulation and operative exposure to overcome the obstacle of reduced exposure in surgical education and operative training.DiscussionIn our theoretical analysis, we will discuss the efficacy, safety and impact of relying on SBL to fill the gaps in surgical training.Clinical exposure alone will not be sufficient to train procedure based speciality trainees to their highest proficiency. SBL is one design that is supported by learning theories such as Transformational Learning and Experiential Learning Theory.In a high fidelity simulation, such as laparoscopic simulation courses, all concepts of facilitated learning are fulfilled which strongly supports our hypothesis.On balance, given the complexity of skills learnt, it remains difficult to measure the efficacy of transferring the learnt capabilities into practice and standardise this among learners. SBL also leaves non-technical skills un-assessed in depth.ConclusionThe disruption of training due to COVID-19 affected our procedure based learning, this leaves us with a dilemma to catch-up with these unmet training needs. SBL could be one of the adjuncts that fill in the gaps on the short and medium term. Implementing SBL in surgical training curriculum, should be evaluated for efficacy and cost effectiveness.

Endovascular embolization techniques in acute thoracic and abdominal bleedings can be technically reproduced and trained in a standardized simulation setting using SLA 3D printing: a 1-year single-center study

BackgroundEndovascular embolization techniques are nowadays well established in the management of acute arterial bleedings. However, the education and training of the next generation of interventionalists are still based on the traditional apprenticeship model, where the trainee learns and practices directly at the patient, which potentially affects the patient’s safety. The objective of this study was to design and develop a standardized endovascular simulation concept for the training of acute bleeding embolizations, based on real-life cases.ResultsAn adaptable and cost-effective endovascular simulator was developed using an in-house 3D print laboratory. All thoracic and abdominal acute bleeding embolizations over more than a year with appropriate pre-interventional computed tomography scans were included to manufacture 3D printed vascular models. A peristaltic pump was used to generate pulsatile flow curves. Forty embolization cases were engaged in this study, and 27 cases were fully reproduced in the simulation setting (69.23%). The simulation success was significantly lower in pulmonary embolizations (p = 0.031) and significantly higher in soft tissue (p = 0.032) and coil embolizations (p = 0.045). The overall simulation success was 7.8 out of 10 available points.ConclusionsUsing stereolithography 3D printing in a standardized simulation concept, endovascular embolization techniques for treating acute internal hemorrhages in the chest and abdomen can be simulated and trained based on the patient-specific anatomy in a majority of the cases and at a broad spectrum of different causes.

Perceptions on Non-traditional Models of Fieldwork Supervision

Occupational therapy fieldwork education has historically followed the traditional apprenticeship model, which pairs one student with one fieldwork educator for supervision and guidance through the transformational process from student to entry-level clinician. There is an absence of high-level evidence to support this model as best practice in fieldwork education. Despite data published to endorse alternative supervision models, fieldwork educators (FWEs) appear hesitant to embrace these approaches. The purpose of this investigation was to explore occupational therapy practitioners’ views on the value and challenges associated with the implementation of non-traditional models of supervision during Level II fieldwork education. The study specifically targeted practitioners’ opinions related to the 1:2, 2:1, and group models. A descriptive survey gathered data from 304 participants across the United States. Results indicated that 48% of occupational therapy practitioners have never utilized a non-traditional supervision model. Practitioners identified three primary barriers to usage of non-traditional supervision models in Level II fieldwork education: time commitment, lack of physical resources, and lack of education on the topic. Survey findings revealed that partnering institutions were the primary means by which FWEs received training related to fieldwork supervision. The conclusions from this study highlight the significant need to develop continuing education specific to non-traditional fieldwork supervision models. Practical recommendations are discussed to aid in promoting non-traditional supervision model usage. Collaboration between academic and fieldwork educators is imperative to expanding fieldwork opportunities necessary to ensure best practice in student preparation.

COVID-19: An alternative approach to postgraduate supervision in the digital age

Universities globally are facing enormous governmental pressure to increase postgraduate output, and in turn, contribute to the knowledge economy. This pressure is transferred to research supervisors, who have to navigate the complexities of research supervision to not only meet postgraduate output targets set by the university in particular, but postgraduate output targets set by government in general. Before the COVID-19 pandemic, research supervision mostly followed the traditional apprenticeship or group model approach to supervision, where engagement took the form of face-to-face interactions. With the COVID-19 pandemic came social distancing, which forced research supervision to move to online platforms. The core objective of this article was to peruse selected research supervision models or approaches to determine which model or approach would be most suited to an online supervision context, if any. This article advances a re-imagined view of research supervision in higher education. The author proposes an argument for an alternative approach to research supervision, most appropriate to the online supervision environment. The ontological stance, from the perspective of constructivism, underpinned the interrogation of selected research supervision models or approaches with the view to engender a different understanding of what the core components of a research supervision framework could be in the context of COVID-19, with due regard to the “pedagogy of supervision”. This article will be of value to emerging South African research supervisors and scholars in the higher education realm. Keywords: research supervisors, research supervision models, online supervision, COVID-19, pedagogy of supervision

997 A Systematic Review of Hernia Repair Simulation Models

Abstract Introduction There are barriers to education in both open and laparoscopic hernia repair technique, due to the laparoscopic learning curve, as well as reduced theatre time for junior surgical trainees. This is particularly evident during the current COVID-19 pandemic. Simulation models may provide further opportunities for training in hernia repair outside of the traditional surgical apprenticeship model. Method A systematic review was carried out following PRISMA guidelines to identify and evaluate simulation models in hernia repair. Of the 865 records screened, 26 were found to be relevant. These were assessed for face, content, and construct validity, as well as attempts to assess educational impact. Results Simulation models were identified comprising of animal tissues, synthetic materials, as well as VR technology. Models were designed for instruction in repair of inguinal, umbilical, incisional and diaphragmatic hernias. 4 of the 21 laparoscopic hernia repair models described demonstrated validity across several domains, and 3 of these 4 models were part of simulation-based courses demonstrating transferability of skills learnt in simulation to the operating room. Of the 5 open hernia repair simulation models, none were found to have demonstrated an educational impact in addition to assessing validity. Conclusions Few models individually were able to demonstrate validity and educational impact. Several novel assessment tools have been developed for assessment of progress when performing simulated and real laparoscopic inguinal hernia repair. More study is required, particularly for open hernia repair, including randomized controlled trials with large sample sizes to assess the transferability of skills.

The role of simulation in training breast surgeons: a systematic review.

As surgical education has evolved, most curricula have favoured a competency-based approach over traditional apprenticeship models. Surgical simulation can be a useful aide in the training of both oncological and reconstructive breast surgery trainees. This review investigates the extent to which simulation of breast surgery procedures has been validated as a training tool. A comprehensive literature search for studies evaluating the objective validity of breast surgery simulators was performed, using MEDLINE, EMBASE and the Cochrane Library databases. Studies assessing construct, concurrent or predictive validity were included, as well as those demonstrating skill acquisition. The initial literature search returned 1,625 hits, with only five articles meeting the inclusion criteria. Simulators were designed to train procedures such as breast augmentation, lesion biopsy and excision. Of these, breast biopsy was the most simulated procedure (three studies). Two studies evaluated animal models, two evaluated synthetic models and one study assessed both a synthetic and animal model. Construct validity was confirmed in two studies, concurrent validity in one study and a learning curve demonstrated in another study. No association between experience and performance was seen in the remaining study. The quality of the evidence presented in each article was low due to numerous limitations. Despite the abundance of breast surgery simulators created for trainees, few have been objectively validated and they only cover a narrow range of breast procedures. Although early results are promising, further studies are required before routine use of simulators is considered in breast surgery curricula.

Traditional Clinical Outcomes in Prelicensure Nursing Education: An Empty Systematic Review.

Effectiveness of traditional apprenticeship models used in undergraduate nursing education has been questioned in the literature for over 50 years. This systematic review aimed to examine best evidence available upon which to base decisions regarding use of traditional clinical experience with prelicensure nursing students. A systematic review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine electronic databases were searched. Full-text review was completed for 118 articles meeting inclusion criteria. No studies reported learning outcomes attributed to clinical education models, resulting in an empty review. Studies were commonly self-reports of perceptions and confidence, lacking quantitative outcomes. No sufficient evidence was found to support traditional clinical models. The scope of nursing practice and patient complexity requires higher order thinking skills, ability to prioritize, and leadership in interdisciplinary care environments. This review raises serious concerns about how nurse educators assess learning in traditional clinical environments. [J Nurs Educ. 2021;60(3):136-142.].

Pediatric airway management education and training.

Education in medicine, informed by research findings, is moving away from the traditional apprenticeship model and increasingly embraces new, active learning methodologies. In this article, we will review these methodologies along with adult learning theories; we explore the available evidence on acquisition and maintenance of pediatric airway management skills, including technical and nontechnical skills. We recall the elements of a competency-based curriculum and how they can be applied in pediatric airway skill training and suggest mapping strategies based on research evidence. We propose future directions in education and educational research in the field.

Surgical resident training in Pakistan and benefits of simulation based training.

Apprentice-mentor is the traditional method for training surgical residents, but with the advent of time, advanced techniques have been developed to train residents. Simulation training is a time-effective method for training residents and is being used globally, but the majority of training hospitals in Pakistan have been practising apprenticeship model since it came into being. This review was planned to demonstrate the results of studies comparing the efficacy of trainees trained via the traditional apprenticeship model versus simulator-based training. Pubmed and Google Scholar were searched. Keywords used were 'simulation-based training', 'laparoscopic simulators' and 'surgical teaching methods'. Articles published between 1995 and 2017 were selected for review. The search was limited to articles published in English language. The review advocates implementation of simulation for training as well as assessment. This can be a magnificent step towards upgrading our healthcare system.

Something Always Works: A Self-Study of Strengths-based Coaching in Supervision

Mentoring remains a major component of teacher education programs. Moving away from the traditional apprenticeship model, teacher educators have begun to adopt more affirming coaching practices that nurture the strengths and inner qualities of pre-service teachers. In this self-study, the researcher—an emerging teacher educator hoping to enhance his practice—investigated ways to help pre-service teachers discover and develop their individual strengths and how strength-based coaching might impact his beliefs and assumptions. Data were drawn from interviews,focus groups, lesson plans, and researcher journal reflections as well as participant-created written responses and illustrations. Themes were developed using content analysis. Findings involved the teacher educator realizing the need for a variety for strengths-based exploration tools, the practicality of including strengths discussion in observation conferences and lesson planning, and the gaining of a new, appreciative mindset. Implications suggest a pathway for other teacher educators to consider when implementing strengths-based coaching.

Cognitive Apprenticeship in Orthopaedic Surgery: Updating a Classic Educational Model

To define cognitive apprenticeship and describe how it can be applied to orthopedic education. Traditional apprenticeships have been used through history as a teaching model for wide variety of skills. These apprenticeships are characterized by practical, on-the-job training in which the apprentice observes and assists a master in the completion of a task, and thereby learns the skills needed to complete that task on his or her own. Cognitive apprenticeship is differentiated from the traditional apprenticeship model primarily by its educational goals. Cognitive apprenticeships are used to teach skills which require internal though processes which cannot be readily observed externally by the teacher or the student. Here, we review the history of the cognitive apprenticeship concept, its basic principles, its applications to a wide variety of educational circumstances, and its potential use a framework for developing orthopedic curricula.

The role of simulation-based education in cardiology

### Learning objectives Simulation-based education (SBE) is a ‘technique and not a technology’ which aims to ‘replace or amplify real-life experiences with guided experience that evoke or replicate substantial aspects...

A pilot study to assess the effect of a deliberate teaching tool in clinical anaesthesiology

This article was migrated. The article was not marked as recommended. The traditional unstructured apprenticeship model of teaching is still prevalent despite evidence that a more deliberate approach to teaching is likely to enhance learning. No deliberate teaching tool has been designed for or evaluated in clinical anaesthesiology. This pilot study aims to measure the effect of a deliberate teaching tool on the operating theatre educational environment in clinical anaesthesiology. We used a literature review to identify desirable teaching practices in clinical anaesthesiology, to design the Concise Regular Assessment and Feedback for Teaching and learning (CRAFT) framework. The CRAFT framework was piloted as an 'intention-to-treat' pre-post interventional study, over a four-week period in two sites. The operating theatre educational environment score improved from 73.8 ± 12.4 to 78.8 ± 15.0 (mean ± SD, p = 0.002), with statistically significant improvements observed in three of the four educational environment domains. Differences in the degree of improvement were observed between study sites (p = 0.271) and participant gender (p = 0.069). Female learners found the intervention more feasible (p = 0.073) and acceptable (p = 0.015) than their male peers. An adequately powered multi-centre study is planned to determine if these effects can be observed in different training regions and to investigate underlying factors in the educational experience of female and male learners.

Implementing Competency-Based Medical Education in Internal Medicine Residency Training Program: the Process and Impact on Residents' Satisfaction.

BackgroundGraduate medical education is shifting from the traditional apprenticeship model to a competency-driven model. Here we describe the design and implementation of competency-based medical education (CBME) in an internal medicine residency program, and report satisfaction survey results.MethodsWe redesigned the residency curriculum as CBME to be resident-centred, systematic, focused on general internal medicine, to provide experience in various care setting, and work-based assessment. In the second year of this CBME transition, we surveyed residents' overall satisfaction using 5-point Likert scale. Feedback on their training program was also analysed.ResultsThe overall satisfaction score was 3.24 and thirteen residents (61.9%) answered that the preceptor's practical training in an educational atmosphere and improvement through training were the merits of the training program. However, residents complained about the working condition such as work overload.ConclusionWith the CBME implementation, most residents expressed satisfaction with the hospital's educational environment but they suffered from overwork. Further efforts to improve the educational program and environment are warranted.

Knee Arthroscopy: A Simulation Demonstrating the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool.

Virtual reality and cadaveric simulations are expensive and not readily accessible1. Innovative and accessible training adjuncts are required to help meet training needs. Cognitive task analysis (CTA) has been used extensively to train pilots and surgeons in other surgical specialties2-6. However, the use of CTA tools within orthopaedics is in its infancy. Arthroscopic procedures are minimally invasive and require a different skill set compared with open surgery. Residents often feel poorly prepared to perform this in the operating room because of the steep learning curve associated with acquiring basic arthroscopic skills. We designed the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool, which is, to our knowledge, the first CTA tool described in the orthopaedic literature, demonstrating significant objective benefits in training novices to perform diagnostic knee arthroscopy. The IKACTA tool, which is the combination of the written description of the phases below and the videos (with superimposed audio recordings) of each phase, utilizes simultaneous written and audiovisual modalities to teach diagnostic knee arthroscopy. The procedure was divided into 7 phases: (1) operating room and patient setup, (2) preparation and draping, (3) anterolateral portal placement, (4) examination of the patellofemoral joint and the lateral gutter, (5) examination of the medial compartment and anteromedial portal placement, (6) examination of the intercondylar notch and the lateral compartment, and (7) postoperative care and rehabilitation.For each phase, there are sections on the technical steps, cognitive decision-making behind each technical step, and potential errors and solutions. Video clips recorded by an expert surgeon in the operating room specific to each phase and audio voice recordings explaining each phase superimposed on the video clips were combined with the written information to design the IKACTA tool. Not applicable. This learning tool allows a trainee to learn each technical step, the cognitive decision-making underpinning each step, and potential errors and solutions relevant to each phase of the procedure. Furthermore, the learner can use written and audiovisual modalities simultaneously to learn this technique by reading the written component of the tool first and then watching the relevant video clips with the audio recordings for each phase of the procedure. Alternative training techniques currently include the traditional apprenticeship model, which is becoming increasingly insufficient in the current environment of reduced training hours7,8. Adjuncts to this model are essential to help meet training needs. The IKACTA tool has demonstrated significant objective benefits for novice trainees to learn diagnostic knee arthroscopy9. The idea behind this learning tool is for the trainee surgeon to use this tool independent of the trainer, prior to attending the operating room. The tool provides trainees with knowledge and cognitive understanding of the procedural steps before they perform this procedure on patients. They are aware of potential errors and methods to avoid or overcome these errors. We believe that this tool will reduce the initial difficult phase of the learning curve for junior residents and, therefore, will improve training efficiency in the operating room.