Basic surgical computer literacy

To introduce a VE-based surgical simulation requires a population of computer- aware individuals who are willing to adopt such a training system. Better to have co- operation than coercion. In order to ascertain where the population is on the computing ‘learning curve’ and to make the most of developing intuitive interfaces relatively familiar to most surgeons. An audit was conducted of surgical computer performance and training. The questions included:

 How much training had surgeons received?

 How much investment were they prepared to make e.g. purchasing their own equipment?

 What would be the best approach to getting better computer training, and hence literacy in the surgical population?

 What would be the most useful skills to teach surgeons?

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More will become apparent as the medical profession accepts the need to build this into their continuing professional development plans. The aim is for the VOEU user profile to support this. More information is available about revalidation for doctors on-line at

 Would they have any experience with which to compare a simulator?

 Will future training programmes using remote access to teaching material be deemed acceptable by trainees with as yet no such infrastructure being in place?

 What are the results of past and current VE evaluation efforts?

The survey was limited in time and focused for the sake of the pilot study for the role of the shoulder arthroscopy simulator and its interface, and so this limited the questionnaire to questions in Table 6.2:

Question Response Range

Have you used a Surgical Simulator before? Yes No

(if Yes, where? and which one?) Would Teleconferencing rather than travelling to

formal teaching be acceptable? And if yes, for what percentage of the sessions?

Yes No

10% 20% 30% 40% 50% 60% 70%

Table 6.2 Previous virtual working environment experience

6.11 Conclusions drawn from the 1st prototype simulation trials

There is much headway to be made with the training of ICT skills in the surgical population. Whilst the author is aware of senior clinicians who are still computer illiterate at the time of writing, the majority of trainees are now using the applications for supportive clinical work even if not everyday care delivery.

6.11.1 Significance of the 1st prototype simulation results

This state of affairs is quite striking, in a population that the UK government intends to have 100% on-line by 2010, with the planned introduction of revalidation likely to require significant audit data collection, especially when one considers that the population studied have all had a university education. The aim of the ICT Skills for Healthcare Professionals course is to bridge the gap between the ICT Haves and ICT Have Nots. This is proposed as an addition to the ‘on-line’ instructions to provide a ‘help’ service for VOEU and to structure a definitive course for those who wish to use it. This will be vital to the uptake and acceptance of the Virtual Orthopaedic European University (VOEU) within the orthopaedic community. On a positive note, the

willingness of the population to evaluate and embrace new technologies is encouraging. The majority wishing to use teleconferencing facilities for nearly half of formal teaching sessions (46% based upon the average preference for the group) highlights this.

6.11.2 Potential sources of bias

The most apparent biases are temporal and geographical.

 Temporal:The study was carried out in 1999 and represents the situation before the start of the VOEU project. It was necessary to collect the data again from trial candidates as they sign up to VOEU participating in the beta-testing phase as part ofthe 3rd prototype simulation. This is to get a temporal perspective in the uptake of digital technologies, and then to use this to target areas of limited expertise through future modifications to the educational courses.

 Geographical:This population were all from one region of one country. As part of a European trial, which will generate the main study of the thesis, the aim is to address this issue by developing the questionnaire as part of the registration process of VOEU, so that it will be possible to clarify which areas of Europe are more able to adopt VOEU, so that the policy for the Dissemination and Use Plan (DUP) can accommodate this.

6.11.3 Conclusions to be taken forward to the VOU3 simulation study

The following matters need to be addressed:

 Provision of a broad based ICT training resource for surgeons through the delivery of Multimedia Educational Orthopaedic Modules (MEOMs) for the ‘Basic Computing For Surgeons’ course.

 Provision of an ICT ‘help’ service for surgeons through the delivery of Multimedia Educational Orthopaedic Modules (MEOMs) for the Basic Computing for Surgeons course material being accessible through the search engines in VOEU.

 The need for updating this data resource on a regular (possibly biannual or annual) basis, which can be achieved through the DRJ component of the virtual observatory. This system will allow for ongoing results reporting, which is being developed as a part of VOEU.

 Integration of Flexible and Distance Learning (FDL) into surgical training using teleconferencing, which is beyond the remit of this thesis, but will be discussed in VOEU.

6.11.4 Questioning the validity of the 1st EVW prototype simulation results

 Are the results internally valid? The results have been checked and are arithmetically accurate. They represent the views and performance of around 90% of the population who are eligible members of the user group.

 Confounding (Distortion of apparent effect): This can be measured and controlled for. In light of the above figures, there is not enough data to stratify to eliminate all potential confounding variables, and so stratification by subgroups has to be regarded with thiscaveatin mind.

 External validity – Generalisability: Are the results valid for another populatione.g. your local population? With the United Kingdom, due to safeguards in the maintenance of training standards, the results are likely to be generalisable but may still indicate a national geographical bias.

 External validity – Importance: The nature of the work analysed implies that external validity is vital to the acceptance and uptake of such systems.

 External validity – Significance: This matter has already been addressed in Chapter 1 reflecting the history of surgical simulation and its motives, where the current social, political and medical motivation has been explored.

 External validity – Importance vs. Significance: The work is both timely and necessary. Continuing within the framework of a major European (5th framework) study adds external peer review, particularly concentrating upon the educational aspects of the work and credence to the evolving methodology for modelling and evaluation in surgery.

6.11.5 The 1st prototype simulation (EVW pilot study) evaluation methodology

The results were evaluated using the NASA-TLS (136) scale for the assessment of tasks, which allows users to rate tasks on a linear scale from 1 – 7 for complexity or difficulty. The mean values for the focus group are then expressed as a percentage. This method was extended to the main study, alongside the constructivist approach expanded above, in order to provide a comparison of the evaluation methodologies.

Redesigning the AIP, and other questions: Much of the original work of evaluating VEs was described in Barfield's book (137), and the general questions (many used by NASA) have been modified to assess the specific environment's needs. This forms the foundation of the reductionist methodology since it extends the Zeltzer (AIP) cube. As detailed in Chapter 4, the AIPES modification should more readily reflect the aspects of integration of the simulation that are not covered in AIP.