Learning surgery from afar

Posted by a.hay on 19 December 2013 - 10:00am

By Paula Smith, Academic eFacilitator at the University Of Edinburgh’s School of Clinical Surgery.

This article is part of our series: a day in the software life, in which we will be asking researchers from all disciplines to discuss the tools that make their research possible.

Trainee surgeons can sometimes be held back by limited access to time and tuition. Distance learning meets this strong need as it aids more conventional methods and improves both the training of surgeons and their professional development. One standout example is the award-winning online Masters programme in Surgical Sciences. This was created by the University of Edinburgh and is a response to trainee surgeons having less and less access to clinical cases in both elective and emergency settings. The programme was launched in 2007 and is a flexible, part-time route for would-be surgeons to help reinforce theory and engage in intellectual debate.

Currently, some 250 students from over 40 countries have enrolled in the three year programme. It has not only proved useful for teaching surgical practice in developed countries, but has had a major impact on the quality of training in the developing world too. Furthermore, our students have much higher pass rates for the Membership of the Royal College of Surgeons (MRCS), which they need to progress with their careers, than trainees who have enrolled on other courses.

Students on the programme encounter virtual patient scenarios in the bespoke virtual learning environment (VLE) using Labyrinth software, which was developed inhouse by Edinburgh’s Learning Technology Section. As its name suggests, Labyrinth lets students follow a pathway of medical events as they relate to a virtual patient. It creates narrative medical cases that invite users to make their own decisions, and so guide their own learning. This helps develop the critical analysis skills a surgeon will need to make informed choices.

Each clinical case scenario has clear goals that tie in with the curriculums for anatomy, radiology, physiology, and pathology. They also have a focus on the assessment and care of the surgical patient. The case scenarios are set up so as to require students to make a decision based on the diagnosis and the facts presented to them on each new online page.

The outcomes of their choices are then presented on the pages that follow. Students have the chance at this point to revise their diagnosis and management of the patient. This helps students be pragmatic about what they would do in a real life clinical setting. Students are also able to assess their progress through a sophisticated multiple choice question system that is included within each case scenario. This gives answers and feedback and helps students to gauge and modify their progress. Although Labyrinth encourages self-directed learning, our students are also supported by an expert team of e-tutors. Using forums, the tutors are able to expand upon the themes developed in the case scenarios and also help the students to learn from one another.

Since our students are both part-time and all busy surgical trainees with clinical commitments, we know only too well that there will be peaks and troughs in their available time throughout the course. Nonetheless, peer-assessment of these discussion boards can be a reliable way to make sure that students cover all the course material. That said, the students we surveyed would not support it as a replacement for expert tutor assessment.

What is the next step? The success of our programme has led to calls for a similar scheme, this time aimed at advanced surgical trainees. We and our partner institution, The Royal College of Surgeons of Edinburgh, have also built on the success of the course by developing four further part time, online postgraduate degrees. These cover Surgical Sciences, Urology, Vascular and Endovascular, Trauma and Orthopaedics, and General Surgery.

Finally, the programme ties in well with my own research interests in the areas of VLEs, peer assessment, and learning analytics. As we now have a large cohort of students enrolled on the programme, we also now have a great deal of useful feedback data. This has applications not only for other online courses, but on-campus training too.

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