training the trainer in advanced laparoscopic surgery-lapco tt nader francis & mark coleman
TRANSCRIPT
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Training the Trainer in advanced Laparoscopic surgery-LAPCO TT
Nader Francis & Mark Coleman
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Contents
• Scope for Training the Trainer (TT)
• Development and structure of LAPCO –TT
• Assessment and evaluation of TT
• Summary & take home message
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Challenges with training inadvanced laparoscopy
• Technical– Limitations of laparoscopy– Challenging pathology– Long learning curve
• Non-technical – Situation awareness– Decision making– Task management– Leadership – Communication and teamwork
• Organisational context– Time constrains– Financial constrains– Meeting targets
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Learning curve in laparoscopic colorectal surgery
Miskovic et al 2010. Learning curve and in laparoscopic colorectal surgery: systematic review
ComplicationsConversion
Op time Blood loss
Hospital stayLN harvest
103152 143
8796
103
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Welcome to LAPCONational Training Programme for Laparoscopic Colorectal Surgery
The National Training Programme for Laparoscopic Colorectal Surgery has been developed by the Department of Health to train NHS consultant colorectal surgeons in England. The aim is to give all suitable patients with colorectal cancer access to a fully trained laparoscopic colorectal surgeon according to the 2006
• 206 surgeons Engaged with NTP- 1/3 Colorectal Consultants in England.
• 139 consultants undergoing training
• 67 NTP Trainers
NTP in Laparoscopic Colorectal surgery - England
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Scope of Lapco TT
• Need to structure the framework of training• Efficacy and efficiency of training• Shorten the learning curve• Ensure patient safety
• A national course to provide training tools to all national trainers
• Evaluate the impact of TT course
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▪ JAG Endoscopy Training the Trainer model
(Roland Valori and John Anderson)
▪ Designed a Lapco TT course curriculum
•Piloting TT in laparoscopic colorectal surgery
Lapco TT
Roland Valori
John Anderson
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Pilot Lapco TT 2010
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Lapco TT - Course Faculty
•Course Facilitators: Mark Coleman & Nader Francis
•Funded by Cancer Action Team (DoH)
Course Faculty:● Greg Wynn ● John Griffith● Tom Cecil ● Charles Maxwell Armstrong● Amjad Parvaiz ● Rob Longman● Ian Jenkins ● Andrew Miller● Matthew Clarke ● Austin Acheson
Course Organiser & NTP Programme Manager Laura Langsford
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• Conscious competence
• Framework of training
(Set- Dialogue & Closure)
• Taking over in theatre
• Performance enhancing instruction
• Performance enhancing feedback
• Assessment of training
• Optimising the training environment
• Dealing with difficult trainee
DAY 1 – Core competencies
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Day1 – Dry skills training
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Day 2 – Live theatre
● Review of learning objectives and re-visit
The training framework
● Coaching local trainee for 20 minutes
● Debrief ○ Trainer debriefs local trainee ○ Facilitator debriefs trainer
● Course review and evaluation
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Conscious competence
Unconscious Incompetence
Conscious
Incompetence
Unconscious
Competence
Conscious
Competence
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technictechnicalal
From TCT Endoscopy Guide-with permission
Framework of technical skills training
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Progress with TT LAPCO
• Pilot course Plymouth-March 2010• First course Portsmouth June 2010
• 3 courses a year (2 facilitator/ 4 faculty and 6 delgates)
• To Date: Run 7 courses at Bradford, St Marks, Basingstoke, Colchester, Portsmouth, Nottingham
• 47 national trainers/ experts in laparoscopic colorectal surgery have attended the course with very positive feedback
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Lapco TT - Educational Assessment
• 10 minute recorded simulated training session before & after course
• Mini STTAR for training and behaviour – 2 assessors
• Trainers interviewed on attitudes pre and post course qualitative evaluation
• Assessment using Observer XT behavioural analysis software by two assessors
Hugh Mackenzie
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Structured Training Trainer Assessment Report (STTAR)
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STARR form Assessment - Overall
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STARR form Assessment - Stages
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Pre – Course Scenario
Post – Course Scenario
SET length 1 minute 14 seconds 1 minute 59 seconds
Identifying trainee knowledge
8 times 14 times
Identifying concerns 1 time 5 times
Laying Ground rules 0 times 6 times
CLOSURE No Trainers One Trainer
Software analysis of events
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Changes In behaviour can be demonstrated immediately after the TT course
Trainers use a more structured approach to training, increasing the time and detail within the ‘Set’
Further studies are required to ascertain whether these changes are maintained whilst training in their own clinical environment
Conclusions
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Summary
• Advanced laparoscopic surgery is technically challenging and requires comprehensive training to achieve competence
• A structured framework of teaching is required • This can be achieved at a national level and
potentially could be adapted to other specialities in advanced laparoscopic surgery
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Acknowledgements
Course Development Roland Valori John AndersonFiona Carter
Co-facilitator Mark ColemanCourse organiser Laura Langsford Educational Assessment
George Hanna Hugh MackenzieTamzin Cuming
Susannah Wyles
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Thank you