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Manikin � Advantages

�  Variety available � Reusable � Clean �  Acceptable anatomy

� Disadvantages �  Expensive �  Low tissue realism �  Limited anatomy variation

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Manikin

� Description �  Anaesthetic training

model �  3rd division Bronchi �  Extendable neck

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The Pig Torso �  Advantages

�  Available �  Cheaper �  Real tissue �  Comparable anatomy

�  Disadvantages �  Infection risk �  Animal ethics �  Anatomy differences �  Single use �  Difficult to store

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The Pig Torso �  Different to humans

�  Long nose and jaws �  Serrated hard palate �  Laryngeal cartilage arrangement �  Physiological pharyngeal pouch

�  Previously prepared �  Shortened to allow scope and instruments �  Supine positioned �  FB inserted

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Sim Man and Sim Baby � Advantages

�  Smart manikins ○  Scenarios

� Human anatomy � Reusable � Clean

� Disadvantages �  Single anatomy � Not real tissue �  1st division only �  Very expensive

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VR Bronchoscopy Model �  Flexi bronch �  Examination �  Biopsy �  Auto metrics

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Cadavers

� Advantages � Highest realism (fresh frozen) �  Variable real anatomy

� Disadvantages �  Expensive �  Ethical issues �  Infection control �  Limited extension

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Sequence �  Bronch assembly �  Bronch insertion �  Identify glottis �  Rotate & Insert into trachea �  Proceed to bronchi �  Find FB �  Remove FB �  Re-insert FB

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FB Removal �  Aim:

�  Find �  Remove �  Re-insert

�  Negative: �  Advancement �  Trauma �  Drops

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Post Op �  Aim

�  Show the post op field ○  Raters score tissue trauma

�  Replace the FB

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Manikin

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Pig

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Task specific

�  ISCP �  S D NA

� Validated tool �  Assembly of instruments �  Visual inspection of supraglottis/glottis �  Visual inspection subglottis �  Visual inspection trachea/carina/bronchi �  Atraumatic removal of foreign body

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Task specific

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Item Satisfactory Dev Required

Not Assessed

T12 Demonstrates knowledge of the rigid endoscopy and protects structures while negotiating the scope

T13 Achieves an adequate passage through oro-pharynx and larynx through purposeful movements in order to intubate the scope successfully

T14 Makes effective use of suction and keeps tracheal and bronchial lumen in the centre

Unable to perform Able to perform majority

Performs easily with good flow

Item 1 2 3 4 5

3 Assembly of appropriate laryngoscopic and bronchoscopic instruments

5a Visual inspection of supraglottis/glottis

5b Visual inspection subglottis

5c Visual inspection trachea/carina/bronchi

6a Atraumatic removal of foreign body 18

Global 1-5

�  ISCP �  S D NA

� Validated tool �  Set up of endoscopes �  Knowledge of instruments �  Instrument handling �  Respect for tissue �  Time and motion �  Knowledge of procedure �  Flow of operation �  Overall surgical performance

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Global

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Number Item Satisfactory Dev Required Not assessed

G1 Follows an agreed, logical sequence or protocol for the procedure

G2 Consistently handles tissue well with minimal damage

G5 Uses instruments appropriately and safely

G6 Proceeds at appropriate pace with economy of movement

G9 Uses assistant(s) to the best advantage at all times

Set-up of Endoscopes Chose inappropriate endoscope &/or could not assemble all

Chose appropriate endoscope & able to

assemble with prompting

Set-up appropriately sized endoscope without assistance or prompting

1 2 3 4 5

Knowledge of Instruments Frequently asks for wrong instrument or used inappropriate instrument

Knew names of most instruments & used

appropriate instrument Obviously familiar with instruments & their names

1 2 3 4 5

Instrument Handling Repeatedly makes tentative or awkward movements Competent use of

instruments but occasionally stiff or awkward

Fluid moves with instruments & no awkwardness

1 2 3 4 5

Respect for Tissue Uses unnecessary force or caused damage by inappropriate use of instruments

Careful handling of tissue by occasional inadvertent

damage to tissue

Consistently handled tissues appropriately w/ minimal damage

1 2 3 4 5

Time and Motion Many unnecessary moves but some unnecessary moves Efficient time/motion & maximum efficiency Clear economy of movement

1 2 3 4 5

Knowledge of Specific Procedure Deficient knowledge & needed instruction at most steps Knew all important steps of operation Demonstrated familiarity w/all aspects of operation

1 2 3 4 5

Flow of Operation Frequently stopped & unsure of next move Some forward planning with reasonable progression

Obviously planned course of operation with effortless flow

1 2 3 4 5

Overall Surgical Performance Poor Performs majority of surgery acceptably Outstanding

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Face and Content validity Face  and  content  validity  

State  the  level  of  agreement  with  the  following  statements:   strongly  disagree   disagree   undecided   agree   strongly  agree  

Face  

Appearance  of  anatomical  structures  is  realis:c     1   2   3   4   5  

Tissue  feel  is  realis:c   1   2   3   4   5  

Depth  percep:on  is  realis:c   1   2   3   4   5  

Image  projec:on  and  graphics  are  realis:c   1   2   3   4   5  

Content    

This  model  is  useful  for  teaching  anatomy   1   2   3   4   5  

This  model  is  useful  for  teaching  surgical  planning   1   2   3   4   5  

This  model  is  useful  for  improving  opera:ve  technique   1   2   3   4   5  

This  model  is  useful  for  improving  hand-­‐eye  coordina:on   1   2   3   4   5  

This  model  is  useful  as  an  over  all  training  tool   1   2   3   4   5  

Task    

This  model  is  useful  for  teaching  Bronchoscope  assembly   1   2   3   4   5  

This  model  is  useful  for  teaching  FB  removal   1   2   3   4   5  

This  model  is  useful  for  teaching  Pouch  stapling     1   2   3   4   5  

Global  

Skills  I  learned  are  transferable  to  the  opera:ng  theatre       1   2   3   4   5  

This  model  should  be  incorporated  into  training  curriculum   1   2   3   4   5  

I  would  recommend  this  model  to  trainees   1   2   3   4   5  Zaid Awad 21

Face validity �  Level of agreement (1-5): �  Delegates and faculty

�  Appearance of anatomical structures is realistic �  Tissue feel is realistic �  Depth perception is realistic �  Image projection and graphics are realistic

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Content validity �  Level of agreement (1-5): �  Delegates & Faculty

○  This  model  is  useful  for  teaching  anatomy ○  This  model  is  useful  for  teaching  surgical  planning ○  This  model  is  useful  for  improving  opera:ve  technique ○  This  model  is  useful  for  improving  hand-­‐eye  coordina:on ○  This  model  is  useful  as  an  over  all  training  tool

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Task �  Level of agreement (1-5): �  Delegates & Faculty

○  This  model  is  useful  for  teaching  Bronchoscope  assembly ○  This  model  is  useful  for  teaching  FB  removal ○  This  model  is  useful  for  teaching  Pouch  stapling  

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Global �  Level of agreement (1-5): �  Delegates & Faculty

○  Skills  learned  are  transferable  to  the  opera:ng  theatre        ○  This  model  should  be  incorporated  into  training  curriculum    ○  I  would  recommend  this  model  to  other  trainees    

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Remember

� This is not a test! �  If any, ○  You are testing the model ○  The faculty testing the tool

� Be honest and constructive � No 5/5 score for all! ○  On skills assessments and validity assessment

�  Feedback

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Remember

� We aim to learn surgical skills � We are not here to discuss clinical indication! � We only learn from OUR mistakes

�  If we validate a model and a tool � We get to do it more regularly and for free � We have a baseline to build on � We can compare other models and tools

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Before starting �  Familiarise yourself with setting

�  Connect scope to camera and light

�  Adjust focus, zoom and white balance

�  Examine your instruments

�  Position the Manikin/Pig

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Before starting �  Insert DVD

�  Type your name and procedure

�  Press record!

�  Check it is working

�  Double check it is working

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Final points �  Help each other �  Learn from each other �  Keep to time

�  Ensure all assessments are done �  Ensure you fill in the validation forms �  If it is not on the video: you haven’t done it!

�  The camera doesn’t lie

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