Educational journeys to colorectal surgical expertise: The place and impact of simulation training

Goddard, Stuart 2023. Educational journeys to colorectal surgical expertise: The place and impact of simulation training. DHS Thesis, Cardiff University. Item availability restricted.

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Abstract

Introduction: This thesis explores how surgical trainees engage in simulation-based training (SBT) as part of a structured programme and how they relate their training to the practice of laparoscopic colorectal surgery in the operating theatre (OT). Both these environments have their own sociocultural fingerprint, that is, social, cultural and cognitive patterns of activity, with a language and discourse unique to them. Conventional insights on how SBT benefits surgical practice outcomes are indicated by improved individual performance in specific technical tasks. In contrast, this thesis explores the strength of the social discourse in which such learning is situated, which mediates SBT to the OT. The research questions are: • Through what social mechanisms are the complex clinical skills of surgery learnt through the Welsh Laparoscopic Colorectal Training Scheme (WLCTS), and translated into the operating theatre context? • How do laparoscopic colorectal trainees perceive the value of and make their training meaningful? • How could the learning theories discussed, inform a framework which can both acknowledge the social experience of simulation in facilitating the negotiation of learning and enable the professional development of the trainees? Deep learning is a social exercise in the creation of ‘semiotic’ signals through negotiating multiple channels of social and material activity. Distributed cognition (DCog) and Cultural-Historical Activity Theory (CHAT) are employed as organising theoretical principles. Methodology: Eight participants were observed across two hemicolectomy courses in the Welsh Laparoscopic Colorectal Training Scheme, where task completion required working in pairs. Over 11 hours of video data were analysed for trainee interactions across the simulated operating table. Scores were assigned to trainees’ prior experience and changes in task complexity and partial regression analysis was used to explore relationships. Nine guided conversation-style interviews were conducted with colorectal trainees immediately after the courses, followed again six to eight months later with seven participants, where they described how they made sense of their co-participation in simulation within their operating practice. Abductive thematic analysis was used on a total of 10½ hours of transcript data, to identify key themes including semiotic signals, negotiated activity and mental rehearsal as a phase between simulation training and operating. Findings: Task complexity was related to task completion time. The shared prior experience of trainees related to improved task completion times rather than individual experience. Prior experience was linked to the way interactive social cues were utilised. Task complexity was linked to the way material artefacts were exchanged between trainees. Meaningful knowledge was acquired and exchanged through the learning design of graduated task activity, model and interaction fidelity, instrument sharing and verbal and non-verbal transactions. Such ‘negotiated knotworking’, as an extension of CHAT, is illustrated by the interactions of these social and material activities. SBT proved valuable in improving the capacity of trainees to reflect and mentally construct the operative context, which becomes important in rehearsing clinical activity. Conclusions: The interaction of social and material exchanges during shared activity is where trainees make sense of their technical skills. Because such shared activity is present in both simulation and operation, simulation needs to provide not just task fidelity, but also an opportunity for social and material interaction in a way that is professionally recognisable in the OT. By utilising co-constructed activity and making use of multiple material and social interactions, the WLCTS enabled the development of surgical language and ‘semiotic’ association of mutual colorectal artifacts. Through mental rehearsal, trainees prepared, planned and made informed decisions. Sharing of prior experience signals the importance of co-dependence in role and activity negotiation. Because of these, socially organised learning theory which contains the operation activities within SBT and OT are suitable candidates for a learning framework.

Item Type:	Thesis (DHS)
Date Type:	Completion
Status:	Unpublished
Schools:	Social Sciences (Includes Criminology and Education)
Subjects:	H Social Sciences > H Social Sciences (General)
Date of First Compliant Deposit:	12 April 2023
Last Modified:	12 Apr 2023 11:29
URI:	https://orca.cardiff.ac.uk/id/eprint/158540

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