Surgeons and Wii

“Kahol and Smith conducted studies in which trainee surgeons played a Nintendo Wii video game called Marble Mania, which requires players to develop dexterity in their hand movements to succeed at the game.
The trainees then wore “cybergloves” that allowed Kahol and Smith to evaluate their performance in simulated surgery. The researchers discovered that the trainees who played Marble Mania performed the surgical exercises significantly better than those who did not play.”

Second Life and the power of virtual health

The question of using virtual simulations to teach medicine came up at the Cabin Fever conference. Here is an excerpt from ScienceRoll, one of the most comprehensive writers about virtual medicine.
“I’ve always wanted to post these links, so here is the time. I, among others, see a great potential in educating medicine in Second Life, the virtual world. But of course, just under some certain circumstances. I’ll tell you more about it when I make my new slideshow public this weekend.”

Deliberate Practice

At the Cabin Fever conference in Alberta, I promised to write about teaching students to deliberately practice the art and skill of medicine. Why, because doctors who depend on experience without reflection:
 frequently construct a serviceable conceptual framework based on algorithms, then practice to achieve a level of performance sufficient to most needs -C. Desforges (2005)
 sub-optimal processes may achieve successful outcomes and when they do succeed, they may be reinforced -R. Rhodes (2005)
 rate evidence as good or bad based on how well it supports assumptions
 stick to beliefs even in the face of overwhelming contradictory evidence -Guest et al (2001)
Whereas physicians who used deliberate practice techniques had:
 a greater body of knowledge about their domain of expertise than other individuals
 highly adapted representations that aid in planning, prediction and evaluation (10,000-100,000 patterns)
 accurate memory for new information and patterns in their domain
 continuing high levels of performance after the age when less accomplished performers begin to decline. – K. A. Ericsson et all (1993)
Guest et al concluded that teaching deliberate practice means providing learners with opportunities to:

1. Address problems in medicine at the upper level of their ability

• Take an educational history
• Plan appropriate challenging patients at least once a week
• Suggest an independent learning project of interest to the student

2. Develop a livelong habit of self monitoring (seek out blind spots)

• Assist students to identify their strengths
• Provides students with opportunities to identify and correct mistakes in a safe environment
• Significant Event Audit
• One Minute Preceptor

3. Repeat tasks to improve

• Guide through multiple cases
• Skills and knowledge increase with repetition to the point where you are unconsciously competent (automatic)
• Key is timely feedback to prevent mistakes that might result in becoming unconsciously incompetent
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Open Disclosure

I’m blogging from CabinFever, the University of Alberta’s conference for medical faculty. The first session I attended dealt with the issue of open disclosure to patients of harm resulting from medical errors. I thought I would share the Health Quality Council of Alberta’s suggestions about what should be included in the initial disclosure conversation.
1. An appropriate apology
2. Known and agreed upon facts
3. Patient’s questions/concerns
4. Consequences of harm and any side effects to look for
5. Discussion of ongoing care
6. What happens next
7. Arrangements for future meetings
8. Contact details in case of further questions.
Given these guidelines, how might you assist students, residents to develop skills in this area?