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 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

Learning curve in laparoscopic colorectal surgery

Miskovic et al 2010. Learning curve and in laparoscopic colorectal surgery: systematic review

ComplicationsConversion

Op time Blood loss

Hospital stayLN harvest

103152 143

8796

103

Welcome to LAPCONational Training Programme for Laparoscopic Colorectal Surgery

The 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

• 206 surgeons Engaged with NTP- 1/3 Colorectal Consultants in England.

• 139 consultants undergoing training

• 67  NTP Trainers

NTP in Laparoscopic Colorectal surgery - England

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

▪ JAG Endoscopy Training the Trainer model

(Roland Valori and John Anderson)

▪ Designed a Lapco TT course curriculum

•Piloting TT in laparoscopic colorectal surgery

Lapco TT

Roland Valori

John Anderson

Pilot Lapco TT 2010

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

• 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

DAY 1 – Core competencies

Day1 – Dry skills training

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

Conscious competence

Unconscious Incompetence

Conscious

Incompetence

Unconscious

Competence

Conscious

Competence

technictechnicalal

From TCT Endoscopy Guide-with permission

Framework of technical skills training

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

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

Structured Training Trainer Assessment Report (STTAR)

STARR form Assessment - Overall

STARR form Assessment - Stages

Pre – Course Scenario

Post – Course Scenario

SET length 1 minute 14 seconds 1 minute 59 seconds

Identifying trainee knowledge

8 times 14 times

Identifying concerns 1 time 5 times

Laying Ground rules 0 times 6 times

CLOSURE No Trainers One Trainer

Software analysis of events

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

Conclusions

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

Acknowledgements

Course Development Roland Valori John AndersonFiona Carter

Co-facilitator Mark ColemanCourse organiser Laura Langsford Educational Assessment

George Hanna Hugh MackenzieTamzin Cuming

Susannah Wyles

Thank you