Medical Teacher
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Simulation is an adjunct to clinical training, not a replacement Morkos Iskander To cite this article: Morkos Iskander (2015) Simulation is an adjunct to clinical training, not a replacement, Medical Teacher, 37:6, 602-602 To link to this article: http://dx.doi.org/10.3109/0142159X.2015.1016490
Published online: 25 Feb 2015.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [University of Lethbridge]
Date: 05 November 2015, At: 20:18
Letters to the Editor
must seek to maximize his learning through other avenues. The implications conferred by the implementation of the EWTD have not made it easy for trainees; however, adaptability is a hallmark of a good doctor. Nigel Yong Boon Ng & Mark Twoon, The Suttie Centre, University of Aberdeen, Aberdeen, AB25 2ZD, UK. Tel: þ447 851516285; E-mail: [email protected]
simulation is not valid. They are a useful adjunct to training, but cannot replace clinical experience. This issue has arisen by a change in the structure of training due to the EWTD. In order to reach a satisfactory resolution it is necessary, in my view, to address the structure of the program as a whole, rather than make subtle adjustments of unproven efficacy. Morkos Iskander, Kent Lodge, Broadgreen Hospital, Thomas drive, L14 3LB, UK. E-mail: [email protected]
Declaration of interest: The authors report no declarations of interest. Declaration of interest: The author reports no conflicts of interest.
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References Iskander M. 2014. The needs of surgical training in the era of the European Working Time Directive. Med Teach 36(6):544–545. Palter VN, Grantcharov TP. 2014. Individualized deliberate practice on a virtual reality simulator improves technical performance of surgical novices in the operating room: A randomized controlled trial. Ann Surg 259(3):443–448.
Simulation is an adjunct to clinical training, not a replacement
References Calhoon JH, Baisden C, Holler B, Hicks GL, Bove EL, Wright CD, Merrill WH, Fullerton DA. 2014. Thoracic surgical resident education: A costly endeavor. Ann Thorac Surg 98:2012–2015. Steigerwald SN, Park J, Hardy KM, Gillman LM, Vergis AS. 2015. Does laparoscopic simulation predict intraoperative performance? A comparison between the Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics. Am J Surg 209:34–39.
Robust DREEM factor analysis
Dear Sir
Dear Sir
It is with great interest that I read the letter Ng et al. (2014) titled ‘Adapt surgical training to the European Working Time Directive’, suggesting that there are various means to tackle the impending crisis in surgical training due to the impact of the European Working Time Directive (EWTD). The authors have correctly highlighted that simulation has been demonstrated to be of great value to surgical trainees. This has been suggested in literature, and is recommended by Ng et al. (2014) as a potential route to solving this issue. Surgical trainees have in the past constructed a variety of low-tech DIY simulators for laparoscopic surgery, for example, as well as practicing various techniques in wet and dry lab settings for quite some years. While there is a trend in simulation training to use more technologically advanced and more complex simulation, this has not been shown to provide any increased benefit over the simpler models (Steigerwald et al. 2014). Furthermore, the burden of cost in establishing a valid simulation program, as well as maintaining it is often underestimated, and limits its practical application, especially when placed in the context of strict budgetary controls (Calhoon et al. 2014). Finally, as a surgeon, my first priority is to the patient and to patient safety. I require my training to adequately prepare me for undertaking the operations as a consultant, in order to ensure competence and maintain standards. It is worth noting that there is an increasing trend for trainees to pursue posttraining fellowships to achieve that requirement. As the use of simulation training has increased, so has our understanding of them. I believe that the assumption that the reduced clinical training can be countered by increased
At its conference in May 2014, the Korean Medical Education Society reported Dundee Ready Education Environment Measure (DREEM) data from 9096 students in 40/41 of that country’s medical schools in a study led by Dr Joohyun Park. This provides an exciting opportunity for a robust factor analysis of both data from one national medical education culture and comparison with pooled data from other recent factor analyses. While factor analysis of DREEM has been reported more than a dozen times in the last decade, seven studies had fewer respondents than the minimum sample size of 300 recommended by Wetzel (2012). Five studies analysed data from 323 to 586 respondents. The respondents in these studies included German (n ¼ 205), Greek (n ¼ 323) and New Zealand (n ¼ 176) dental students; Irish (n ¼ 239), Swedish (n ¼ 395), Pakistani (n ¼ 419–586), and Greek (n ¼ 487) medical students; Australian (n ¼ 245) osteopathy students; and American (n ¼ 214) veterinary students. Two studies (one from Germany and one from Spain) had sample sizes of 1119 and 1391, respectively. Yusoff (2012) analysed four administrations of DREEM to the same cohort of 186 Malaysian medical students. Wetzel (2012) also noted that ‘‘Large sample sizes generally produce more stable factor structures and better approximate population parameters’’ (p. 1066), and there are indications of a trend confirming more stable factor structure for DREEM with larger sample sizes. A pooled analysis could investigate this trend as well as explore variables including Professional differences e.g. between dental and medical students Gender differences
602
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Simulation is an adjunct to clinical training, not a replacement Morkos Iskander To cite this article: Morkos Iskander (2015) Simulation is an adjunct to clinical training, not a replacement, Medical Teacher, 37:6, 602-602 To link to this article: http://dx.doi.org/10.3109/0142159X.2015.1016490
Published online: 25 Feb 2015.
Submit your article to this journal
Article views: 161
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [University of Lethbridge]
Date: 05 November 2015, At: 20:18
Letters to the Editor
must seek to maximize his learning through other avenues. The implications conferred by the implementation of the EWTD have not made it easy for trainees; however, adaptability is a hallmark of a good doctor. Nigel Yong Boon Ng & Mark Twoon, The Suttie Centre, University of Aberdeen, Aberdeen, AB25 2ZD, UK. Tel: þ447 851516285; E-mail: [email protected]
simulation is not valid. They are a useful adjunct to training, but cannot replace clinical experience. This issue has arisen by a change in the structure of training due to the EWTD. In order to reach a satisfactory resolution it is necessary, in my view, to address the structure of the program as a whole, rather than make subtle adjustments of unproven efficacy. Morkos Iskander, Kent Lodge, Broadgreen Hospital, Thomas drive, L14 3LB, UK. E-mail: [email protected]
Declaration of interest: The authors report no declarations of interest. Declaration of interest: The author reports no conflicts of interest.
Downloaded by [University of Lethbridge] at 20:18 05 November 2015
References Iskander M. 2014. The needs of surgical training in the era of the European Working Time Directive. Med Teach 36(6):544–545. Palter VN, Grantcharov TP. 2014. Individualized deliberate practice on a virtual reality simulator improves technical performance of surgical novices in the operating room: A randomized controlled trial. Ann Surg 259(3):443–448.
Simulation is an adjunct to clinical training, not a replacement
References Calhoon JH, Baisden C, Holler B, Hicks GL, Bove EL, Wright CD, Merrill WH, Fullerton DA. 2014. Thoracic surgical resident education: A costly endeavor. Ann Thorac Surg 98:2012–2015. Steigerwald SN, Park J, Hardy KM, Gillman LM, Vergis AS. 2015. Does laparoscopic simulation predict intraoperative performance? A comparison between the Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics. Am J Surg 209:34–39.
Robust DREEM factor analysis
Dear Sir
Dear Sir
It is with great interest that I read the letter Ng et al. (2014) titled ‘Adapt surgical training to the European Working Time Directive’, suggesting that there are various means to tackle the impending crisis in surgical training due to the impact of the European Working Time Directive (EWTD). The authors have correctly highlighted that simulation has been demonstrated to be of great value to surgical trainees. This has been suggested in literature, and is recommended by Ng et al. (2014) as a potential route to solving this issue. Surgical trainees have in the past constructed a variety of low-tech DIY simulators for laparoscopic surgery, for example, as well as practicing various techniques in wet and dry lab settings for quite some years. While there is a trend in simulation training to use more technologically advanced and more complex simulation, this has not been shown to provide any increased benefit over the simpler models (Steigerwald et al. 2014). Furthermore, the burden of cost in establishing a valid simulation program, as well as maintaining it is often underestimated, and limits its practical application, especially when placed in the context of strict budgetary controls (Calhoon et al. 2014). Finally, as a surgeon, my first priority is to the patient and to patient safety. I require my training to adequately prepare me for undertaking the operations as a consultant, in order to ensure competence and maintain standards. It is worth noting that there is an increasing trend for trainees to pursue posttraining fellowships to achieve that requirement. As the use of simulation training has increased, so has our understanding of them. I believe that the assumption that the reduced clinical training can be countered by increased
At its conference in May 2014, the Korean Medical Education Society reported Dundee Ready Education Environment Measure (DREEM) data from 9096 students in 40/41 of that country’s medical schools in a study led by Dr Joohyun Park. This provides an exciting opportunity for a robust factor analysis of both data from one national medical education culture and comparison with pooled data from other recent factor analyses. While factor analysis of DREEM has been reported more than a dozen times in the last decade, seven studies had fewer respondents than the minimum sample size of 300 recommended by Wetzel (2012). Five studies analysed data from 323 to 586 respondents. The respondents in these studies included German (n ¼ 205), Greek (n ¼ 323) and New Zealand (n ¼ 176) dental students; Irish (n ¼ 239), Swedish (n ¼ 395), Pakistani (n ¼ 419–586), and Greek (n ¼ 487) medical students; Australian (n ¼ 245) osteopathy students; and American (n ¼ 214) veterinary students. Two studies (one from Germany and one from Spain) had sample sizes of 1119 and 1391, respectively. Yusoff (2012) analysed four administrations of DREEM to the same cohort of 186 Malaysian medical students. Wetzel (2012) also noted that ‘‘Large sample sizes generally produce more stable factor structures and better approximate population parameters’’ (p. 1066), and there are indications of a trend confirming more stable factor structure for DREEM with larger sample sizes. A pooled analysis could investigate this trend as well as explore variables including Professional differences e.g. between dental and medical students Gender differences
602
