A targeted training course leads to measured improvement in endoscopic assisted breast surgery
Creators: name: Yunjian Zhang
name: Lin, Ying
name: Kuang, Ming
Publisher: name: F1000 Research Limited
Year: 2023

description: Even the endoscopic is commonly used in many surgical fields, less seem in breast surgery education program, only a few published papers introduced these techniques. Some senior experts focus on how to modify the endoscopic/laparoscopic/robotic assisted surgical techniques, seldom seniors play attention to how to teach the junior surgeon. With the increasing cases of young breast cancer patient in China, the techniques of endoscopic assisted NSM with implant-based or flap-based breast reconstruction achieving the better cosmetic effects compare to the traditional open surgery, causing the trend in breast surgical field these years.<br> <br> The initiative will involve the following key components:<br> Designing a Postgraduate Curriculum for Endoscopic assisted Nipple-Sparing Mastectomy by the model 4C/ID in medical education (AMEE Guide No.93). The curriculum contains four key components: learning task; procedural information; supportive information; part-task practice.<br> According to the AMEE Guide, we have to follow 10 concrete procedures in order to build up a powerful whole task-based learning environment:<br> 1. Design learning tasks;<br> 2. Arrange learning assessments;<br> 3. Sort learning tasks;<br> 4. Design related knowledge and theoretical system courses;<br> 5. Clarify cognitive strategies;<br> 6. Identifying learner psychological patterns;<br> 7. Set a programmed surgical process;<br> 8. Clear cognitive rules (IF-SO);<br> 9. How to make decisions through understanding and applying relevant theoretical knowledge;<br> 10. Design specific training.<br> <br> After that we have to assess whether the curriculum fits for the purpose and we need some effective assessment strategies: To assess students' learning outcomes, we will implement a variety of assessment strategies. These may include formative assessments, such as online quizzes or case-based assignments, to gauge students' understanding and progress throughout the intervention. Summative assessments, such as written examinations or structured oral examinations, will be conducted at the end of the intervention period to evaluate students' humanistic care and communications, surgical skills, anatomic knowledges, teamwork spirit, critical thinking abilities, and overall knowledge acquisition.<br> By implementing this comprehensive initiative, we aim to create an immersive and learner-centered educational environment. We will collect the data (operation improvement evaluation, such as miniCEX; learning report and reflection, such as questionare for surgeon and PROs) from the trainees analysing data after 1 month, 3 months, even longer than 6 months; inviting elite trainees act as a teacher and play flipped class. The interactive nature of the intervention encourages active participation and peer learning, promoting effective communication and teamwork skills essential for healthcare professionals.<br> <br> Through this initiative, we anticipate that surgical residencies' six general competencies including: Patient care; Medical Knowledge; Professionalism; Systems-based Practice; Practice-based Learning; Interpersonal and Communication Skills.<br> In conclusion, our initiative to designing a postgraduate curriculum for endoscopic assisted nipple-sparing mastectomy by the model 4C/ID in medical education improving the trainees’ competency of postgraduate and junior breast surgeon.<br> <br> Implementing the project of designing a Postgraduate Curriculum for Endoscopic assisted Nipple-Sparing Mastectomy by the model 4C/ID in medical education requires careful planning and execution. Here is a detailed explanation of how we plan to implement the project:<br> <br> 1. Curriculum mapping and planning:<br> - The curriculum map makes the curriculum more transparent to all the stakeholders: the teacher, the student, the curriculum developers, the manager, the profession and the public.<br> - The curriculum map demonstrates the links between the different elements of the curriculum, e.g. between learning outcomes and learning opportunities and between the parts within one element, e.g. between different learning outcomes.<br> - Planning and implementing a curriculum requires careful attention to detail. Ten questions provide a useful checklists: What is the training programme’s mission? What are the expected learning outcomes? What content should be included? How should the content be organised? What educational strategies should be adopted? What teaching methods should be used? How should assessment be carried out? How should details of the curriculum be communicated? What educational environment should be fostered? How should the process be managed?<br> <br> 2. Whole-task learning objects:<br> - Innovation in medical education is a cyclical process of change and stepwise improvement.<br> - Whole-task learning in medical education requires strong collaboration between developers and endusers. End-users of medical innovation are both students and teachers as well.<br> - The 4C/ID model is an instructional design model that guides the design of whole-task based learning environments.<br> - By following 10 concrete steps, medical courses and curricula can be transformed into powerful whole task-based learning environments.<br> <br> 3. focus on four components:<br> - learning task: make the junior surgeon learn how to perform nipple sparing mastectomy by endoscopic technique, achieve the competency oriented: including patient care; medical knowledge; professionalism; systems-based practice; practice-based learning; interpersonal and communication skills.<br> - procedural information: learning the procedure of nipple sparing mastectomy using endoscopic techniques step by step.<br> - supportive information: learning the fundamental endoscopic skills and breast surgery related theory demonstrating standardized procedures by experienced breast surgeon.<br> - part-task practice: including simulation learning and assessment, such as Mini-CEX and patient report outcomes (PROs) were used as assessment tools to assess the trainees' competency.<br> <br> 4. Curriculum evaluation:<br> - Demonstrate that the curriculum is fit for purpose as determined by the achievement od the minimum standards expected by an accrediting body such as the World Federation for Medical Education, which has set out minimum standards for educational programmes at undergraduate, postgraduate,and continuing education level.<br> - Establish that the programme as set out on paper corresponds with the curriculum in action and what the student learns. <br> - Identify the strengths and weaknesses of the curriculum.<br> - Kirkpatrick’s four levels of evaluation.<br> Level I (opinion/reaction): Evaluation at this level examines how participants in the education programme react to it. Are they satisfied? Do they like or dislike it? Does it meet their needs?<br> Level II (Competence/learning): This level moves beyond the learner’s satisfaction. The extent to which there is a difference in the learner’s knowledge, skills or attitudes is assessed. Student’s performance in written or clinical assessments is studied and taken as evidence of the effectiveness of the education programme.<br> Level III (Performance/behaviour transfer): Changes in the learner’s behaviour are studied at this level. As a result of the education programme do students communicate more effectively in their day-to-day contacts with patients? Do students apply their knowledge of surgical skill to perform better procedure during the endoscopic assist nipple sparing mastectomy?<br> Level IV (Outcome/results): Did the patients satisfied for the cosmetic effects? Did the patients had better quality of life after such operation. Did the breast cancer patients have similar prognosis between the endoscopic assist nipple sparing mastectomy and the traditional open surgery?