Dr. Jörg Ansorg • Professional Board of German Surgeons • Luisenstraße 58-59 • 10117 Berlin • Germany

Tel: +49 30/28004-150 • Fax: +49 30/28004-159 • ansorg@bdc.de

E-Learning, Blended Learning,

Mobile Learning and Beyond

How are classical and new approaches in CME working for surgeons today?

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

16.800

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Professional Board of German Surgeons

• Largest surgical association in Europe

• Strong in surgical training, CME and CPD

• Long-term experience in eCME

• Connected to Europe by the

European Board of Surgeons (EBS)

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Evidence and Needs Assessment of Surgeons in CME

• Low evidence

• Difficulties in measuring behaviour change

• Need for structured studies on practice improvement

Surgical needs

• Learning for the daily practice is most important

• Best didactical approach: theoretical plus hands-on activities

• New procedures are percepted by practical courses and visitation

• Effectiveness of learning due to shortage of time and staff in hospitals

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

eCME Course

Theory & Interaction

Classical CME Workshop

Theory Hands-on

Todays Practice in CME and eCME

Electronic Learning (eCME)

• Courses • Reviews • Taped lectures • Video lessons

Classical CME activities

• Congresses and Seminars • Workshops • Group learning • (self-) assessment

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

CME and eCME in Surgery

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

CME and eCME in Surgery

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

CME by the BDC|Acadamy

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Procedures and video courses

• Lectures and presentations

• text book like courses

• CME certified content

• more than 900 courses online

• www.ecme-center.org

eCME by the BDC|Academy

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Acceptance of eCME in Surgery in Germany and Europe

Source: EBS & EACCME 2013 Source: PBGS 2013

0%

200%

400%

600%

800%

1000%

1200%

German CME and eCME Courses in Surgery (PBGS events only)

CME Events eCME Events

0%

200%

400%

600%

800%

1000%

1200%

European Accreditation of CME in Surgery (EACCME Acreditation by EBS)

CME Events eCME Events

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Declining interest on (pure) eCME

• Reduced learning discipline on computers

• Reduced quality of self driven learning by professionals

• Time consumption similar to classical CME events

• CME fees and travelling expenses w/o relevance

• Missed practical experiences / manual exercises

• Missed social interaction

(e.g. discussion, exchange of experiences...)

• Missed extraordinary seminar setting

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

What‘s next on eCME

• Blended Learning

• Mobile Learning

• Collaborative Learning

• Mental Training

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Blended Learning Course

Theory & Interaction Refresh Theory Hands-on

1) Blended Learning – the Best of both Worlds

Electronic Learning

• Theoretical Preparation • Assessment • Post-course rehearsal

Hands-on Workshops

• Refresh theory only • OR Workshops • Much more time for practice

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

2) Mobile Learning

• Taking advantage of smartphones and tablets

• Rapid online at the point of interest

• Mobile learning and reference in your pocket

BDC|Mobile App: • Member magazine “Passion Surgery” • E-Learning account from [eCME-Center] • News from the surgeons world

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

3) Collaborative Learning

• PBGS social network

• Pre- and post course guides

• Learning communities

• Career network

• Special interest communities

• Legal and contract consulting

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Web 2.0

3) Collaborative Learning – From Cloud Dust to...

Wiki

Keep in touch

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Learning Community

...Red Line Learning

Mental Training

E-Learning

Post-course Guide

Pre-course Guide

Hands-on

Stay tuned

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

4) Mental Training for Surgeons

Electronic Learning +

• Preperation • Pre-study guide • Cognitive simulation

Hands-on Workshops

• Refresh theory • OR Workshops • Much more time for practice

Blended Learning Course

Theory & Interaction Mental Training Refresh Theory Hands-on

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

The New “e” in eCME: Efficient CME

Blended Learning

• Pre- and post course e-learning activities and communication

• More time for practice and hands-on activities on-site

Collaborative Learning

• Web 2.0 features for participation, collaboration and reference

• community experience leads to learning plans/curricula (red line learning)

Mental Training

• Efficient mind and motor programming via cognitive simulation

• Supported by e-learning, mobile learning and textbooks

Efficient Learning

• Learning based on a CME curriculum

• Supported by eCME, mCME, bCME, hands-on courses and mental training

Dr. Jörg Ansorg • Professional Board of German Surgeons • Luisenstraße 58-59 • 10117 Berlin • Germany

Tel: +49 30/28004-150 • Fax: +49 30/28004-159 • ansorg@bdc.de

Mental Training and Practice in Surgery

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

What do they have in common?

• Intense concentration

• complex fine and gross motor ability

• routinely performed in dynamic environments under

• Considerable pressure Sevdalis et al. 2013

Hans-Dieter Hermann Chief Sports Psychologist German National Soccer Team

Felix Neureuther German Ski Alpin Professional

You Andi Common Surgeon at work

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Mental training is the systematically repeated imagination

of a movement without actual performing it.

(e.g. cognitive simulation or symbolic rehearsal)

Feltz & Landers (1983)

Mental Training in Sports, Aviation and Surgery

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

The Key Feature of Mental Training - Nodal Points

• necessary (mandatory) structural motor components

• must be performed in a specific sequence

• reduction in the degrees of freedom.

Going through the track in mind (symbolic rehearsal)

See and feel an action in one‘s imagination

Means for reducing stress and enhancing performance

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

MT in Surgery – Nodal Points for Lap. Cholecystectomy

1. Bringing in the trocars

2. Exploring of the liver

3. Searching for the gallbladder

4. Fixing of the basis of the gallbladder

5. Fixing of the infundibulum

6. Incising of the peritoneal lining in the infundibulum

7. Exposing of the cystic duct and the cystic artery

8. Clipping of the cystic duct and the cystic artery

9. Cutting of the cystic duct and the cystic artery

10. Subserous shelling out of the gallbladder

11. Inspecting the liver bed

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

MT in Surgery – Guidelines for Application

1. Concentration exercise to focus on yourself and the upcoming surgery

2. Learn the nodal points by e-learning or textbooks

3. Imagine the surgery from your inner perspective

4. Do it in a systematically repeated way

=> Mental training in surgery

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

VR Simulation Training vs. Mental Training (Grange et al. 2012)

• MT is a powerful enhancement tool in laparoscopic skills acquisition

• Virtual Reality Simulation is not

• Box Training associated with MT is a better method than VRS with MT

vs.

BT BT+MT BT+VRS VRS+MT

#6 European CME Forum, London 11/2013 ansorg@bdc.de

eCME, bCME, mCME and Beyond in Surgery

Curriculum Mental Training in Surgery 2013

E-Learning

• Understanding the theoretical background

MT 1 Course

• Understanding and exercise of mental training in surgery

• Easy procedure without performing any hands-on tasks

MT 2 Course

• Mental and practical training based on standard procedures

• Usage of e-learning or textbooks, box training and simulation

MT 3 Course

• Individual mental training of special needs and procedures

MT 4 Course

• Mental training for interdisciplinary OR-teams

Train-the-trainer course

• Training for mental trainers

• Certification to the MT trainer board