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Training the Trainer in advanced Laparoscopic surgery-LAPCO TT Nader Francis & Mark Coleman

Training the Trainer in advanced Laparoscopic surgery-LAPCO TT Nader Francis & Mark Coleman. Contents. Scope for Training the Trainer (TT) Development and structure of LAPCO –TT Assessment and evaluation of TT Summary & take home message. Challenges with training in advanced laparoscopy.

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Training the Trainer in advanced Laparoscopic surgery-LAPCO TT Nader Francis & Mark Coleman

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  1. Training the Trainer in advanced Laparoscopic surgery-LAPCO TT Nader Francis & Mark Coleman

  2. Contents • Scope for Training the Trainer (TT) • Development and structure of LAPCO –TT • Assessment and evaluation of TT • Summary & take home message

  3. Challenges with training inadvanced laparoscopy • Technical • Limitations of laparoscopy • Challenging pathology • Long learning curve • Non-technical • Situation awareness • Decision making • Task management • Leadership • Communication and teamwork • Organisational context • Time constrains • Financial constrains • Meeting targets

  4. Learning curve in laparoscopic colorectal surgery Conversion Complications 152 143 103 Blood loss Op time 96 87 LN harvest Hospital stay 103 Miskovic et al 2010. Learning curve and in laparoscopic colorectal surgery: systematic review

  5. NTP in Laparoscopic Colorectal surgery - England Welcome to LAPCO National Training Programme for Laparoscopic Colorectal SurgeryThe National Training Programme for Laparoscopic Colorectal Surgery has been developed by the Department of Health to train NHS consultant colorectal surgeons in England. The aim is to give all suitable patients with colorectal cancer access to a fully trained laparoscopic colorectal surgeon according to the 2006

  6. Scope of Lapco TT • Need to structure the framework of training • Efficacy and efficiency of training • Shorten the learning curve • Ensure patient safety • A national course to provide training tools to all national trainers • Evaluate the impact of TT course

  7. Lapco TT • ▪ JAG Endoscopy Training the Trainer model • (Roland Valori and John Anderson) • ▪ Designed a Lapco TT course curriculum • Piloting TT in laparoscopic colorectal surgery Roland Valori John Anderson

  8. Pilot Lapco TT 2010

  9. Lapco TT - Course Faculty • Course Facilitators: Mark Coleman & Nader Francis • Funded by Cancer Action Team (DoH) • Course Faculty:● Greg Wynn ● John Griffith● Tom Cecil ● Charles Maxwell Armstrong● Amjad Parvaiz ● Rob Longman● Ian Jenkins ● Andrew Miller● Matthew Clarke ● Austin Acheson • Course Organiser & NTP Programme Manager Laura Langsford

  10. DAY 1 – Core competencies • Conscious competence • Framework of training • (Set- Dialogue & Closure) • Taking over in theatre • Performance enhancing instruction • Performance enhancing feedback • Assessment of training • Optimising the training environment • Dealing with difficult trainee

  11. Day1 – Dry skills training

  12. Day 2 – Live theatre ● Review of learning objectives and re-visit The training framework ● Coaching local trainee for 20 minutes ● Debrief ○ Trainer debriefs local trainee ○ Facilitator debriefs trainer ● Course review and evaluation

  13. Unconscious Incompetence Conscious Incompetence Unconscious Competence Conscious Competence Conscious competence

  14. Framework of technical skills training technical From TCT Endoscopy Guide-with permission

  15. Progress with TT LAPCO • Pilot course Plymouth-March 2010 • First course Portsmouth June 2010 • 3 courses a year (2 facilitator/ 4 faculty and 6 delgates) • To Date: Run 7 courses at Bradford, St Marks, Basingstoke, Colchester, Portsmouth, Nottingham • 47 national trainers/ experts in laparoscopic colorectal surgery have attended the course with very positive feedback

  16. Lapco TT - Educational Assessment • 10 minute recorded simulated training session before & after course • Mini STTAR for training and behaviour – 2 assessors • Trainers interviewed on attitudes pre and post course qualitative evaluation • Assessment using Observer XT behavioural analysis software by two assessors Hugh Mackenzie

  17. Structured Training Trainer Assessment Report (STTAR)

  18. STARR form Assessment - Overall

  19. STARR form Assessment - Stages

  20. Software analysis of events

  21. Conclusions Changes In behaviour can be demonstrated immediately after the TT course Trainers use a more structured approach to training, increasing the time and detail within the ‘Set’ Further studies are required to ascertain whether these changes are maintained whilst training in their own clinical environment

  22. Summary • Advanced laparoscopic surgery is technically challenging and requires comprehensive training to achieve competence • A structured framework of teaching is required • This can be achieved at a national level and potentially could be adapted to other specialities in advanced laparoscopic surgery

  23. Acknowledgements Course Development Roland Valori John Anderson Fiona Carter Co-facilitator Mark Coleman Course organiser Laura Langsford Educational Assessment George Hanna Hugh Mackenzie Tamzin Cuming Susannah Wyles

  24. Thank you

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