MOOCs and other Ghosts
in CV surgery
Paul Sergeant
KU.Leuven, Belgium
The educational curriculum of technical skills
for anastomotic techniques in ischemic heart diseases
Science of learning
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Use of wiki-concepts
Affordable and ubiquitous available processes
Distributed and blended learning processes
Individualized adult-centered processes
Individualized learning communities
Institutional or regional supervision
Confidentiality of training processes with respect for scholar
Curricular design
Deconstruction in teachable components
Use of simulation preceding real-life surgery
Commitment to the simulator
Repeated guidance in simulation
Formative assessments, preferably using OSATS
Gamification
Discussion Boards
My virtual CV surgery
is a series of four learning continua
Learning continuum of
“my virtual anastomosis”
Process:
Step 1: Participate in a local simulation lab
Step 2: get your own simulator and material
Step 3: get an access code to the MOOC
Step 4: follow a strict curriculum “in the cloud”
Step 5: at regular steps an individualized formative assessment
The wiki-concept in the creation
of low-fidelity simulators
Facts:
manufactured in a protected workshop in Czech republic
N=3400 in use worldwide
cost 40 euro/simulator
host/graft tubing at 0.1 euro/anastomosis
My virtual anastomosis simulation labs
Scholar sign-in in our MOOC
Curricular design for
simulation lab and MOOC: step 1
Curricular design for
simulation lab and
MOOC:
step 2
step 3
step 4
OSATS-based formative assesments for
simulation labs and MOOC:
Objective Structured Assessments of a Technical Skill
JTCVS2008;136:1486
Criterion
Arteriotomy
Poor
1
2
Avg
3
4
Excel
5
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3
4
5
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2
3
4
5
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5
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2
3
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5
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5
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5
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(porcine model: able to identify target, proper use of blade, single groove,
centered)
Graft Orientation
(proper orientation for toe-heel, appropriate start and end-points)
Bite appropriate
(entry and exit points, number of punctures, even and consistent distance from
edge)
Spacing appropriate
(even spacing, consistent distance from previous bite, too close vs too far)
Use of needle holder
(finger placement, instrument rotation, facility, needle placement, pronation
and supination, proper finger and hand motion, lack of wrist motion)
Use of forceps
(facility, hand motion, assist needle placement, appropriate traction on tissue)
Needle angles
(proper angle relative to tissue and needle holder, consider depth of field,
anticipating subsequent angles)
Needle transfer
(needle placement and preparation from stitch to stitch, use of instrument and
hand to mount needle)
Suture management/tension
(too loose vs tight, use of tension to assist exposure, avoid entanglement)
Knot tying
(adequate tension, facility, finger and hand follow for deep knots)
Totals
Grand total
Regular (8) mandatory interfaces (HIPAA-compliant)
between scholar and trainer (blog, text, video and picts)
Regular (8) mandatory interfaces (HIPAA-compliant)
between scholar and trainer (blog, tekst, video and picts)
Creation of an individualized
HIPAA-compliant learning community
Progress made in
three hours simulation
C. Schreiber Salzburg Oct 9 2013
from zero skills to this in one day
Conclusions
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More than 500 surgeons in the MOOC from > 50 countries worldwide, adding around
> 20 every week.
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A series of four integrated, blended and distributed learning continua have/are been
created.
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My virtual anastomosis
My virtual mitral valve
My virtual aortic valve and root
My virtual VSD
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The science of learning is meticulously implemented at every single step.
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The leverage of a global multinational MD company (Ethicon J&J)
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The leverage of an ad-hoc HIPAA-compliant health collaboration platform (Meplis
Inteligência em Saude)
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The young surgeons will be ready to transfer their skills to patient care through an
active structured process and not through saturation and saturation and saturation.