James, Hannah K. (2020) Cadaveric simulation for postgraduate specialist training of trauma & orthopaedic surgeons. PhD thesis, University of Warwick.

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Abstract

Surgical training is threatened by reduced working hours and a health service that is struggling to meet patient demand. There is a need to maximise training efficiency to ensure the calibre of the consultant surgical workforce is maintained. One solution is using simulation as an adjunct to the traditional master-apprentice training model. Junior surgeons-in-training can be rapidly upskilled in the simulation laboratory, moving the early part of the learning curve away from patients. Cadaveric simulation uses deceased human bodies to teach operations. A systematic review showed that there is an abundance of low quality evidence that cadaveric simulation induces short-term behavioural change when assessed by objective measures. There is a lack of evidence of skill retention longitudinally, of transfer to live theatre and of patient benefit. A national survey of simulation provision in Trauma & Orthopaedic training programmes showed widespread but inconsistent provision of cadaveric simulation, with a complex funding landscape and reliance on industry sponsorship. A systematic review of technical skills assessment tools used in Trauma & Orthopaedics showed the utility evidence for these is weak, and there is inadequate evidence to support the continued use of the procedure based assessment as the gold-standard in high stakes assessment of competency. A consensus exercise developed a core outcome set of clinically relevant radiographic measurements to assess technical operative skills. A multicentre randomised controlled trial comparing the performance of cadaveric vs standard-trained junior surgeons-in-training showed that there were some significant improvements in implant position, acute complication rate and blood transfusion requirement across three common trauma operations. There could be substantial cost savings for the health service if all junior surgeons-in-training received cadaveric simulation. A qualitative study showed that it provides an optimal deliberate practice environment to learn a wide range of technical and non-technical skills in a complete training package.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RD Surgery
Library of Congress Subject Headings (LCSH):	Surgeons -- Training of -- Great Britain, Education -- Simulation methods, Traumatology, Orthopedic surgery
Official Date:	March 2020
Dates:	Date Event March 2020 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Griffin, Damian R. ; Pattison, Giles (Researcher in trauma and orthopaedics) ; Fisher, Joanne D.
Sponsors:	Arthritis Research UK ; Health Education West Midlands ; University of Warwick ; CVC Capital Partners ; Royal College of Surgeons of England
Format of File:	pdf
Extent:	433 leaves : illustrations (some colour)
Language:	eng

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