MOOCs and other Ghostsin CV surgery

Paul SergeantKU.Leuven, Belgium

The educational curriculum of technical skills for anastomotic techniques in ischemic heart diseases

Science of learning

• Use of wiki-concepts• Affordable and ubiquitous available processes• Distributed and blended learning processes• Individualized adult-centered processes• Individualized learning communities• Institutional or regional supervision• Confidentiality of training processes with respect for scholar• Curricular design• Deconstruction in teachable components• Use of simulation preceding real-life surgery• Commitment to the simulator• Repeated guidance in simulation• Formative assessments, preferably using OSATS• Gamification• Discussion Boards

My virtual CV surgery is a series of four learning continua

Learning continuum of “my virtual anastomosis”

Process:Step 1: Participate in a local simulation labStep 2: get your own simulator and materialStep 3: get an access code to the MOOCStep 4: follow a strict curriculum “in the cloud”Step 5: at regular steps an individualized formative assessment

The wiki-concept in the creation of low-fidelity simulators

Facts: manufactured in a protected workshop in Czech republicN=3400 in use worldwidecost 40 euro/simulatorhost/graft tubing at 0.1 euro/anastomosis

My virtual anastomosis simulation labs

Scholar sign-in in our MOOC

Curricular design for simulation lab and MOOC: step 1

Curricular design for simulation lab and MOOC:

step 2

step 3

step 4

Criterion Poor Avg ExcelArteriotomy(porcine model: able to identify target, proper use of blade, single groove, centered)

1 2 3 4 5

Graft Orientation(proper orientation for toe-heel, appropriate start and end-points)

1 2 3 4 5

Bite appropriate(entry and exit points, number of punctures, even and consistent distance from edge)

1 2 3 4 5

Spacing appropriate(even spacing, consistent distance from previous bite, too close vs too far)

1 2 3 4 5

Use of needle holder(finger placement, instrument rotation, facility, needle placement, pronation and supination, proper finger and hand motion, lack of wrist motion)

1 2 3 4 5

Use of forceps(facility, hand motion, assist needle placement, appropriate traction on tissue)

1 2 3 4 5

Needle angles(proper angle relative to tissue and needle holder, consider depth of field, anticipating subsequent angles)

1 2 3 4 5

Needle transfer(needle placement and preparation from stitch to stitch, use of instrument and hand to mount needle)

1 2 3 4 5

Suture management/tension(too loose vs tight, use of tension to assist exposure, avoid entanglement)

1 2 3 4 5

Knot tying(adequate tension, facility, finger and hand follow for deep knots)

1 2 3 4 5

TotalsGrand total

OSATS-based formative assesments for simulation labs and MOOC:

Objective Structured Assessments of a Technical SkillJTCVS2008;136:1486

Regular (8) mandatory interfaces (HIPAA-compliant) between scholar and trainer (blog, text, video and picts)

Regular (8) mandatory interfaces (HIPAA-compliant) between scholar and trainer (blog, tekst, video and picts)

Creation of an individualized HIPAA-compliant learning community

C. Schreiber Salzburg Oct 9 2013from zero skills to this in one day

Progress made in three hours simulation

Conclusions

• More than 500 surgeons in the MOOC from > 50 countries worldwide, adding around > 20 every week.

• A series of four integrated, blended and distributed learning continua have/are been created.– My virtual anastomosis – My virtual mitral valve– My virtual aortic valve and root– My virtual VSD

• The science of learning is meticulously implemented at every single step.

• The leverage of a global multinational MD company (Ethicon J&J)

• The leverage of an ad-hoc HIPAA-compliant health collaboration platform (Meplis Inteligência em Saude)

• The young surgeons will be ready to transfer their skills to patient care through an active structured process and not through saturation and saturation and saturation.