Collaborative Learning and Communities in Orthopedic Surgery

The process of learning a new surgical procedure has been described as ”See one, do one, and teach one.” 

However, in reality the acquisition of specific motor skill’s is more about cognitive, integrative and autonomous stages for the learner. I have taught pediatric orthopedic surgery for many years, probably in the same way as it has been done for centuries. In this situation I see myself as a coach helping the orthopedic resident (student), during their three months rotation at my department, through the different stages in a process that is the opposite of collaborative learning. However, maybe the use of online technologies can create a community for learning and enable collaboration.

The earlier stages of traditional surgical training take place outside the operating room. First we intellectualize the task by discussing indications for surgery, relevant anatomical structures and potential errors, which helps to create a theoretical framework.

In this stage, the student gathers information from the teacher, textbooks and online resources but the student is not sharing this knowledge with the community. I believe that the use of computer supported collaborative learning systems built around different surgical procedures could enhance learning and  teaching. I am not aware of any hospital that have developed this type of novel system and this blog post are just my speculations regarding a possible design and advantages.

This type of new learning tool, an e-learning platform, has the potential to provide greater access of standardized information regarding a specific surgical procedure using instructional design and learning object principles.

The content should mainly be created by subgroups of residents responsible for the 10-15 different surgical procedures they need to learn how to perform independently or under supervision. The content should include information to help the students to understand the mechanics of the surgical procedure. Other types of content could be flashcards and a quiz mode created by the students  to let them self-assess their knowledge. This would also let the student and the teacher track the theoretical learning results. With a personal profile, the student could create, add and later review their content and decide what they want to share with the community. The public information would also be reviewed and developed based on feed back from the students and teachers.

My imaginary platform allows collaboration for orthopedic residents at my hospital both within their group of students but also between different generations of residents (approximately 12 residents per year) and teachers sharing and comment on information but also provide the possibility to ask and answer questions. The community could also include other pediatric orthopedic departments and other subspecialties included in the orthopedic residents curriculum.

I am not proposing that future Orthopedic Surgeons should do there surgical training online and the key to acquiring surgical knowledge is experience. Since without some form of shared experience, it is hard for teacher and student to share one another’s thought processes. Therefore the student will in the next step move from being online to the real world in the surgery theater and observe while I carry out the surgical procedure and deconstruct it to distinct steps.

One function of the e-learning platform could allow the student to later review these steps by watching video clips and perform the procedure in a computer game/simulation before moving to the next stage.

The next time we perform the surgery I am observing and comment the student, who now is in the integrative stage, doing the surgery. With out this critical stage, it is hard for me to transfer my knowledge and for the student to reflect and truly learn the surgery.

It would be of great value to video record the event and let the student observe and review his own performance before moving to the last stage. The video recordings could also be edited to a library with short video clips illustrating the most common mistakes novice surgeons keep doing and hopefully prevent future residents repeating the same mistakes. In surgery there is a tradition of only learning from your own mistakes and not from others. I am aware of the practical and ethical issues regarding patient privacy but this is a proposal in a blog.

Another important aspect of surgical training is to gradually give the student confidence to perform the surgery alone. Therefor the final step and exam is that I try to be quite and not interrupt while the student who now have reached the autonomous stage, execute the surgery independently.

In reality, I am not always the teacher I would like to be (the one described in this blog), mostly due to the everyday workload at the hospital. But I am convinced that both residents and the teachers in their life long surgical training could benefit from collaborative learning.

However, I would like to finish this blog post with a citation from another blog post by a Surgeon and fellow student at this ONL-course.

”Today, Google and Johnsson & Johnsson are getting together constructing a surgical robot that not only have superior skills compared to human hands, it can actually think and take independent decisions. In a near future there will be no place for human surgeons.”

References:

Miller G. The Assessment of Clinical Skills/Competence/Performance. Acad Med. 1999;65(9):63-7.

Taveira-Gomes et al. A novel collaborative e-learning platform for medical students – ALERT STUDENT. BMC Medical Education 2014, 14:143

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Digital me

Last week my laptop died!

Even though I have probably spent more time with my laptop than with my kids I have no emotional relation to the computer and have been looking forward to changing model. However, I panicked when the technician told me that they had to send my computer away for weeks to access my documents.

Of course I have a backup of the hard drive (even if it is at least three months old). The problem was that I had traveled half around the world from my backup and the day after my laptop died I was responsible for an important course. Everything I needed, including my lectures, was on my inaccessible hard drive.

I should have taken a back up of relevant documents on a USB memory stick but I did not. Alternatively I could have used Dropbox, but for me it is only a tool to send large files to colleagues. Luckily, I usually use my email to send important files to myself even though it is a very primitive back up solution.

This ONL-course and my PBL-group have made me realized how old fashion I work regarding digital tools for teaching and how inefficient I use new digital ways to communicate in research project. One example is how my co-authors and I send drafts to each other with changes made in red (and nobody is 100% sure they have been working on the last version of the document) instead of using Google drive or similar solutions from Microsoft.

However, hopefully my new ”digital me” starts as soon as my brand new laptop advertised as the ”The future of notebooks” is delivered. This computer that is supposed to represent a paradigm shift do not have a normal USB port and I am looking forward to moving from physical hard drives that can break to embrace cloud computing. I do not care about security issues or if Google or Apple in theory have access to the cloud. I just want access to my data weather or not I am using my smart phone, laptop or computer at work. But more important I want a solution were back ups are done automatically and my family photos of analog me are stored in a safe place.

New Digital Tools

I am currently both a student, lecturer and a course coordinator.

The incentive for me to participate in ONL 152 is to learn about new digital tools. After the first two weeks of the course I have already had new encounters with Prezi and Padlet creating presentations, and other groups have presented impressive examples using digital tools like Piktochart, Powtoon, Google drive, Sway, and Slidesshare for their presentations. It was also a new experience for me to use the different Google platforms to find course information and to communicate with fellow students and teachers.  I think Google provides a excellent platforms for communication and collaboration especially considering it is for free.

While being a student, I have also tried to find time during these two weeks to finish my lectures for teaching assignments. Unfortunately I have never mastered the chalkboard as a teacher but after only a week as an ONL student I have realized that there are other digital options to engage students and create a more interactive type of lectures and hopefully the standard (boring) Power Point presentation is about to be replaced. It surprised me how easy it was to use and publish presentations made with Prezi and Padlet. Even though I am not convinced that these platforms are suitable for every type of presentation I am looking forward to explore them more and hopefully also find other digital teaching tools.

In addition to teaching next week I am also a course coordinator and I am going to use Prezi for my introduction the first day of the course. To be the course coordinator includes a never ending list of administrative course related stuff. I hope the ONL 152 course will introduce me to digital tools that make this part of being an educator more efficient. I think one of the major advantages of digital learning is the possibility to with the right kind of digital tools (and the knowledge how to use them) scale an on-line course from a group of 20 students to 200 or     200 000 students with out necessarily increasing the work load for the course coordinator.

To conclude my first blog post:

I am very positive to ONL and my new digital tools, and I am looking forward to the next topic.