ICOSET Parallel Sessions

Parallel Session 1

Helping and Working with Struggling Trainees

Presenters

Gill Hardman, Haroon Rehman, Eric Holmboe, Nadeem Khwaja, Humphrey Scott, Lisa Hadfield-Laws

Overview

Despite the drive to rename this vulnerable group “Trainees with additional needs”, there are circumstances where a trainee is in difficulty with no clear route to progression and sometimes with an apparent disconnect between insight and ability.  Supervisors are anxious about being accused of bullying.  Failing trainees without insight can be quick to accuse their supervisors of bullying, possibly because this then diverts attention from any of their shortcomings.  Participants in this session will use common scenarios to consider best ways of recognising and helping trainees in difficult situations and who struggle with insight into their own difficulties.

Participants will learn how to formulate principles to protect and support trainees and trainers during remediation, plan ways of initiating some of these difficult conversations and access different pathways to guidance and support.

The session will centre around 3 case studies of trainees:

1. Lacking in insight

a) Technical skills

2. With confidence issues

a) Imposter phenomenon

b) Fixed v growth mindset

3. Involving diversity themes

a) Neurodiversity

b) Differential attainment

Suggested reading

• Remediation of the Struggling Learner. Jeannette Guerrasio. AHME Press
• Hauer KE, Ciccone A, Henzel TR, Katsufrakis P, Miller SH, Norcross WA, Papadakis MA, Irby DM. Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature. Acad Med. 2009 Dec;84(12):1822-32.

Parallel Session 2

Online Learning in Surgical Training and Practice

Presenters

Mary Klingensmith, Douglas Smink, Amit Joshi, Max Riley, Fiona Kerray

Overview

Attendees at this workshop will engage in an active conversation around current and ideal online learning platforms for surgical care of patients, preparation for didactics and examinations, and lifelong learning. Through a combination of brief didactics, small group conversations and interactive discussion, they will depart with a compendium of best sources for online surgical learning.

The workshop aims to cover how to conduct a brief review of types of online learning platforms, how to have practicing surgeons and trainees share online resources they use for surgical training and how to arrive at some consensus about what constitutes high-quality online resources.

The session will review the types of online resources available and other resources that should be considered. It will also discuss what makes an online resource valuable/valid, whether surgeons and trainees perceive value differently, whether geography matters and how important peer review is in online resources.

Suggested reading

• Barmettler G, Adnan S, Malcolm TSN, Terhune K, Joshi ART. Power of the collective: A review of multimodal internet-based surgical education resources in the 21st century. J Surg Oncol. 2021 Aug;124(2):174-180. doi: 10.1002/jso.26482. PMID: 34245581.
• Caldwell KE, Pei KY, Dickinson KJ. Learner engagement when utilizing the virtual platform for education.
• https://www.facs.org/education/division-of-education/publications/rise/articles/virtual-learner-engagement
• Pradarelli JC, Yule S, Smink DS. The eNOTSS Platform for Surgeons' Nontechnical Skills Performance Improvement. JAMA Surg. 2020; 155(5):438-439.

Parallel Session 3

Wicked Problems in Surgical Education

Presenters

Jason Frank, Adrian Anthony

Overview

Contemporary surgical training worldwide faces a number of recurring challenges.  This session will provide a forum for surgical training leaders and trainees to debate 3 themes: (1) bullying and harassment, (2) the role of training time in achieving competence, and (3) coaching and feedback.  Participants will have the opportunity to debate the themes in small groups, then be part of a larger discussion about potential solutions.

Delegates will be introduced to three ‘wicked problems’ posed by the following questions;

1. Why can’t we eradicate bullying and harassment from surgical training?
2. If all surgeons learn at different rates, can we ever standardize training time?
3. Why are there recurring concerns about poor or absent feedback or coaching from supervisors in surgical training?

The session aims to cover how to analyse factors that contribute to recurring challenges in surgical education and how to describe potential solutions to address these recurring challenges.

Suggested reading

Bullying and harassment

• Leisy HB, Ahmad M  “Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review” BMC Med Ed 2016; 16:127. DOI 10.1186/s12909-016-0639-8

Time in achieving competence

• Skjold-Ødegaard B,  Søreide K “Competency-based Surgical Training and Entrusted
• Professional Activities – Perfect Match or a Procrustean Bed?” Ann Surg 2021;273:e173–e175 DOI: 10.1097/SLA.0000000000004521

Feedback

• Liberman AS, Liberman M, Steinhert Y, McLeod P, Meterissian S “Surgery residents and attending surgeons have different perceptions of feedback” Medical Teacher 2005;27(5):470-472 DOI: 10.1080/0142590500129183

Parallel Session 4

Coaching and Mentoring in Surgery

Presenters

Emma Stapleton, Andrew Diver, Veronique Spiteri, Nathan Stephens, Christopher Caddy, Pala Rajesh

Overview

Mentorship is increasingly recognised as an essential component of surgical education and training. The Royal College of Surgeons of England advocates mentoring at all stages of surgeons’ careers and acknowledges mentoring as a separate entity to training, remedial or supervisory relationships.1

The General Medical Council recommends that all staff who are new to a role or organisation must have access to mentoring as good medical practice.2

Research suggests that mentoring relationships can enhance confidence in doctors, reduce stress, and positively influence career progression as well as professional and personal development and well-being.3–6

In this exciting, dynamic, and experiential session, participants will be introduced to the concept of mentoring via active participation and discussion of themes. They will also explore new perspectives including reverse mentoring, which will bring value to their roles as trainees, trainers, mentees, mentors.

Participants will be given the opportunity to:

• Enhance their understanding of coaching and mentoring in surgery through active exploration of their existing beliefs, perceptions, and experiences
• Experiment with active listening techniques
• Explore new perspectives including reverse mentoring, mentorship training, and the benefits of mentoring for mentors as well as mentees
• Be introduced to a framework for mentoring conversations
• Identify ways to embed coaching and mentoring techniques into their everyday practice
• Share perspectives and feedback via the Vevox app

This session will be relaxed, interactive and experiential, with the following structure:

1. Introduction to coaching and mentoring

• What is the difference between coaching and mentoring?
• What are the experiences and perspectives within the group?
• Active listening exercise
• Use of a framework for mentoring conversations

2. Making the most of being a mentee

• Video: my experience as a mentee
• What do mentees want from a mentoring relationship?
• Mentoring programmes – why do we need them and what forms do they take?

3. Being a mentor

• Video: my experience as a mentor
• Mentor training – why do we need trained mentors and informed mentees?
• Reverse mentoring and the wider benefits of mentoring

At the end of the session there will be active group discussion to share perspectives, to discuss what has been learned, and to share feedback via the Vevox app, so that this is visible to all participants. Methods will include micro-lectures, short videos, active participation, use of the Vevox app to collate perspectives and feedback, and active group discussions.

• RCS Professional and Clinical Standards. Mentoring: A Guide to Good Practice.; 2015
• Wilkie V. Leadership and Management for All Doctors. Vol 62.; 2012. doi:10.3399/bjgp12X636290
• Sinclair P, Fitzgerald JEF, Hornby ST, Shalhoub J. Mentorship in surgical training: Current status and a needs assessment for future mentoring programs in surgery. World J Surg. 2015;39(2):303-313. doi:10.1007/s00268-014-2774
• Steven A, Oxley J, Fleming WG. Mentoring for NHS doctors: Perceived benefits across the personal-professional interface. J R Soc Med. 2008;101(11):552-557. doi:10.1258/jrsm.2008.080153
• Stamm M, Buddeberg-Fischer B. The impact of mentoring during postgraduate training on doctors’ career success. Med Educ. 2011;45(5):488-496. doi:10.1111/j.1365-2923.2010.03857.
• Singletary SE. Mentoring surgeons for the 21st century. In: Annals of Surgical Oncology. Vol 12. ; 2005:848-860. doi:10.1245/ASO.2005.04.035
• Connor and Pokora ‘Coaching and mentoring in the workplace
• Atul Gawande ‘Personal Best’ The New Yorker, Sep 26 2011 www.newyorker.com/magazine/2011/10/03/personal-best
• General Medical Council (2013). Good Medical Practice www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice

Parallel Session 5

Human factors and psychological safety

Presenters

Steven Yule, Shireen McKenzie, Teodor Grantcharov, Emma Howie

Overview

Non-technical skills (situation awareness, decision making, leadership, communication and teamwork) are essential for safe surgical care, and a subset of Human Factors, the science of enhancing work systems. This interactive session will draw together the current state of the art in non-technical skills education for operating room (OR) team members and demonstrate why every clinician who is passionate about maintaining high performance needs to be engaged in this topic. The example to be used is the acclaimed NOTSS course run by the RCSEd established by Professor Steven Yule. You are invited to consider other VUCA working environments.

The aim of this session of to look at the acquisition of the non-technical skills that are required to be effective in the surgical environment.  We aim to equip you with the tools, technologies and expertise to improve your own non-technical skills, work effectively in operating room teams, and handle challenging situations in the operating room. The following themes will be explored:

• What are the NOTSS skills required in theatre?
• Can you be situationally aware if you are concentrating on a motor skill?
• What are the potential implications and harm of a poor theatre environment?
• How to create a psychologically safe environment?
• How can you improve your non-technical skills?
• What is the role of the trainer in setting standards in non-technical skills?

 The session aims to cover how to:

1. Articulate the importance of non-technical skills in the care of surgical patients.
2. Distinguish between non-technical and technical surgical team skill sets.
3. Identify several techniques that they can utilize to improve their own non-technical skills.

Mitigate patient safety risks by incorporating best practices in situation awareness, decision making, teamwork, communication and leadership.

Suggested reading

• Flin, R., Youngson, G. G., & Yule, S. (2015). Enhancing Surgical Performance: A Primer in Non-technical Skills. CRC Press.
• Wood, T. C., Raison, N., Haldar, S., Brunckhorst, O., McIlhenny, C., Dasgupta, P., & Ahmed, K. (2017). Training Tools for Nontechnical Skills for Surgeons—A Systematic Review. Journal of Surgical Education, 74(4), 548–578.

Parallel Session 6

Following Kern’s six-step approach to develop technical simulation-based training programmes

Presenters

Lars Konge and Leizl Joy Nayahangan

Overview

This workshop will enable clinical teachers to develop simulation-based training programmes for technical skills following Kern’s six-step approach to curriculum development.

Simulation-based education has grown rapidly in the last 10 years, with numerous studies providing evidence that it works and has beneficial educational effects. Many training programmes are developed, however the quality varies across the different fields.

Furthermore, one of the challenges of simulation-based education remains the effective integration into the overall curriculum. Most often, the development of curricula does not follow a systematic educational framework. Instead, training programmes are developed and implemented based on local inclinations and experiences (1, 2).

Kern et al. (3) have developed a six-step approach to curriculum development including:

• problem identification and general needs assessment
• targeted needs assessment
• goals and objectives
• educational strategies
• implementation
• valuation

Following this structured approach ensures optimal facilitation and interoperability of curriculum design.

Suggested reading

• Khamis NN, Satava RM, Alnassar SA, Kern DE. A stepwise model for simulation-based curriculum development for clinical skills, a modification of the six-step approach. Surgical endoscopy. 2016;30(1):279-87. 
• Nayahangan LJ, Stefanidis D, Kern DE, Konge L. How to identify and prioritize procedures suitable for simulation-based training: Experiences from general needs assessments using a modified Delphi method and a needs assessment formula. Medical teacher. 2018;40(7):676-83. 
• Kern D T, P, Howard D, Bass E. Curriculum development for medical education: A six-step approach. Baltimore: Johns Hopkins University Press; 1998. 
• Downing SM, Yudkowsky R. Assessment in health professions education. New York: Routledge; 2009. 
• Cook DA, Hatala R. Validation of educational assessments: a primer for simulation and beyond. Advances in Simulation. 2016;1(1):31. 
• Konge L, Clementsen P, Larsen KR, Arendrup H, Buchwald C, Ringsted C. Establishing pass/fail criteria for bronchoscopy performance. Respiration. 2012;83(2):140-6. 
• Cook DA, Hamstra SJ, Brydges R, Zendejas B, Szostek JH, Wang AT, et al. Comparative effectiveness of instructional design features in simulation-based education: systematic review and meta-analysis. Medical teacher. 2013;35(1):e867-98. 
• Cold KM, Konge L, Clementsen PF, Nayahangan LJ. Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion. Respiration. 2018:1-8. 
• Konge L, Bjerrum F, Nayahangan LJ, Schroeder TV. Developing and running a surgical simulation centre: experiences from Copenhagen, Denmark. J Surg Simul. 2015;2:47-52.
• Konge L, Ringsted C, Bjerrum F, Tolsgaard MG, Bitsch M, Sorensen JL, et al. The Simulation Centre at Rigshospitalet, Copenhagen, Denmark. Journal of surgical education. 2015;72(2):362-5.