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Biomedical subjects

R L Kneebone

Publications and source records attributed to R L Kneebone.

11 recordsLinked to original sources
PubMed2006

Innovative training for new surgical roles--the place of evaluation.

BACKGROUND: This paper describes the central role of 'external' evaluation, provided by an independent researcher, in developing an innovative curriculum for new professional roles with surgery. Workforce changes affecting the National Health Service provided an opportunity to develop 2 new roles and design training programmes to support them. The perioperative specialist practitioner (PSP) role was designed from scratch, while surgical care practitioner (SCP) training built on existing practice. Training programmes combined formal modules at Imperial College London (approximately 48 days over 10 months) with supervised clinical practice in each participant's base hospital. Programmes balanced factual knowledge, clinical and communication skills, professional issues and personal development and used a range of innovative techniques. EVALUATION METHODS: A qualitative approach based on a utilisation-focused model monitored the development and implementation of 4 pilot PSP and SCP training programmes. A total of 124 individual and 48 group interviews were conducted at intervals over 3 years, sampling course participants, the project team clinical supervisors and administrators. An independent researcher collected, analysed and presented data at key stages, feeding back findings to the project team as the programmes evolved. DISCUSSION: Effective training programmes for new roles can be developed, but the process is time-consuming and requires sensitivity. An independent evaluator offers great benefits, modulating the collaborative partnership between participants and project team. Positive responses (relating to content and teaching methods) from our study enabled us to refine a learner-centred programme. Negative responses often demanded immediate action to address important concerns, and evaluation provided early warning. External evaluation provides a vital perspective in the development of curricula supporting new roles.

Curriculum↗
PubMed2005

Blurring the boundaries: scenario-based simulation in a clinical setting.

CONTEXT: The ability to perform clinical procedures safely is a key skill for health care professionals. Performing such procedures on conscious patients is challenging and requires a combination of technical and communication skills. We have developed quasi-clinical scenarios, where inanimate models attached to simulated patients provide a convincing learning environment. Procedures are rated by expert observers and by the 'patient' and recorded for subsequent review. This study explores the potential of locating such scenarios within a real clinical setting, allowing participants to experience the challenges of the workplace while ensuring patient safety. An innovative portable digital recording device (the 'Virtual Chaperone') is evaluated for use in clinical settings. METHODS: A qualitative design (observation and interview studies) investigated volunteer medical students undertaking 2 procedure scenarios (insertion of urinary catheter and wound closure with sutures) within the accident unit of a large London hospital. All procedures were observed in real time and recorded digitally (using the Virtual Chaperone). A protocol was used for structured feedback. Observational and interview data was analysed using standard qualitative techniques. RESULTS: Seven sessions with 22 undergraduate medical students took place over 9 months within 1 centre. Data confirmed the feasibility of using a moveable, self-contained training scenario within an authentic clinical setting. Overall, the response from participants was positive. CONCLUSION: Scenario-based teaching within an authentic clinical environment is feasible and perceived by participants to be educationally useful. This approach blurs traditional boundaries between skills laboratory teaching and clinical practice and may offer considerable advantages in training for clinical procedures.

Clinical Competence↗
PubMed2004

Simulation and clinical practice: strengthening the relationship.

INTRODUCTION: This discussion paper argues for a creative synthesis between simulation and clinical practice, where an iterative process of continual interaction ensures that skills are learned and reinforced within the context of everyday professional life. BACKGROUND: Evidence is mounting that long-established approaches to surgical training are no longer acceptable in the current ethical and professional climate. This paper considers alternatives to the traditional approach of 'learning by doing' in a clinical context, focusing on recent developments in the technology of simulation and virtual reality. Clinical expertise is a complex phenomenon and no single theory can account for its acquisition. After a brief contextualising overview, Vygotsky's 'zone of proximal development' is proposed as a conceptual framework for task-based surgical learning that takes place within skills laboratories. The discussion is located within a wider context of educational theory, drawing on current thinking about situated learning and apprenticeship. The notion of 'legitimate peripheral participation' in a complex professional environment places technical skill alongside a range of other competencies that are necessary to safe practice. CONCLUSIONS: Simulation offers a safe environment within which learners can repeatedly practise a range of clinical skills without endangering patients. Comprehensive simulated environments allow a move away from isolated tasks to more complex clinical situations, recreating many of the challenges of real life. Such simulations, however, can operate in isolation from their clinical context, ignoring the learning needs of individuals within a real health care environment. To realise its full potential as a learning aid, simulation must be used alongside clinical practice and linked closely with it.

Clinical Competence↗
PubMed2003

Learning the skills of flexible sigmoidoscopy - the wider perspective.

BACKGROUND: Nurse-led gastrointestinal endoscopy is a priority clinical area in the UK. Endoscopic procedures are challenging to learn, requiring a combination of technical competence (manipulating a flexible endoscope and interpreting the findings) and interpersonal skills (engaging effectively with a conscious patient who is frequently apprehensive). This paper explores the potential of an innovative, scenario-based approach which links a simulated patient with a computer-driven virtual reality (VR) training device for flexible sigmoidoscopy. Within this safe yet realistic quasi-clinical environment, learners carry out the procedure while interacting with the 'patient'. Communication skills are assessed by simulated patients, while quantitative performance data relating to the procedure is generated automatically by the VR simulator. METHODS: This pilot study took place within a nurse practitioner endoscopy course. A mixed methodology combined qualitative and quantitative data (observation and interview studies, communication rating scales and a range of computer-generated output measures from the VR simulator) in a multifaceted evaluation. RESULTS: Seven nurses took part in the study. Participants found the scenarios to be a convincing and powerful learning experience. All experienced high levels of anxiety. Simulated patients identified strengths in participants' communication skills, together with areas for development. Simulator-based practice led to an improvement in objective performance measures. DISCUSSION: Scenario-based training provides a powerful learning experience, allowing participants to build their technical expertise and apply it within a holistic clinical context without the risk of causing harm. We used this pilot study as a springboard for discussions over wider implications of procedure-based skills training, locating it within the literature on expertise and situated learning.

Clinical Competence↗
PubMed2001

Skills training using multimedia and models.

All doctors need basic surgical skills. Learning and retaining such skills requires repeated practice. This article describes structured training provided by a multimedia computer program combined with practice on simulated tissue models.

Clinical Competence↗
PubMed1985

Cancer of the oesophagus in Soweto.

Oesophageal cancer is remarkably common in Transkei, a rural part of South Africa, but has not been thought to affect urban blacks nearly as often. The incidence of oesophageal cancer in Soweto, South Africa's largest urban black community, is assessed. The age-standardized incidence is 125/100 000 in men and 37/100 000 in women. Oesophageal cancer is now a disease as much of urban as of rural blacks, a fact which may be epidemiologically significant. The prognosis for oesophageal cancer in blacks is widely believed to be almost hopeless, regardless of treatment. The results of treatment in 265 patients over 3 years are presented - in 21% the disease was confined to the oesophagus and these patients were treated by oesophagectomy (30% 3-year survival rate); 23% had local spread and were treated by extra-oesophageal bypass (11% 1-year and 2% 2-year survival rate); and 51% had advanced disease (1% 1-year survival rate, no survivors at 2 years). Five per cent of the patients died before any treatment could be given.

Adult↗
PubMed1984

Dermatofibrosarcoma protuberans in black patients.

Twelve cases of dermatofibrosarcoma protuberans in Black patients admitted to Baragwanath Hospital, Johannesburg, between 1979 and 1983 are reviewed. The cause of this slow-growing, low-grade malignant fibrous histiocytoma is unknown, but there is some evidence that trauma may be a predisposing factor. The clinical and histological features of dermatofibrosarcoma protuberans are described, and treatment by wide tridimensional excision with local reconstruction is recommended.

Adolescent↗
PubMed1984

Amyloid goitre. A case report.

A case of primary amyloidosis presenting as a goitre is reported. The clinical features of amyloid goitre are described and the difficulties in making a pre-operative diagnosis are discussed. A plan of management for this rare thyroid condition is suggested.

Amyloidosis↗
PubMedDate not supplied

Music making.

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Anecdotes as Topic↗