“See one, do one, teach one”: inadequacies of current methods to train surgeons in hernia repair

IntroductionWorldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery.MethodsAn expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group’s first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as “strong” (recommendations) or “weak” (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term “should” refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores.Results and summaryThe risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with “watchful waiting” since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment s...

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“…This underscores the need for effective training methods to ensure that patients will benefit. 36 , 37 …”

Section: Training and The Learning Curvementioning

confidence: 99%

“…Twenty-five years after the introduction of laparoscopic IH repair, surgeons and surgical trainees have, however, voiced concerns about being incompletely prepared. 36 , 37 Prior underestimation of the learning curve may have contributed to this unease.…”

Section: Training and The Learning Curvementioning

confidence: 99%

International guidelines for groin hernia management

Simons¹,

Śmietański²,

Bonjer³

et al. 2018

Hernia

1,356

674

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“…Halsted was not only interested in developing a system to train surgeons, but also in creating teachers and role models. (p.2) Although there have been criticisms of the SODOTO method in the health sciences community in regards to non-uniform application, lack of feedback and patient safety (Lenchus, 2010; http://dx.doi.org/11.11645/13.2.2652 Rodriguez-Paz et al, 2009;Zahiri, Park, Pugh, Vassiliou, & Voeller, 2015), it is still relevant in this bibliographic instruction application. Kotsis and Chung (2013) go on to describe that 'In support of the 'see one, do one, teach one' method, one is more likely to learn and remember the steps of a surgical procedure if one learns it 'hands on' and explains it to someone else' (p. 3).…”

Section: Introductionmentioning

confidence: 99%

Personalised video instruction

Kean

Robinson²

2019

JIL

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The liaison librarian to a college with a substantial and growing online learning population began using asynchronous, personalised video instruction as an online replacement for the traditional face-to-face, one-on-one bibliographic instruction reference appointment. This project was informed by the framework of metaliteracy and the “See One, Do One, Teach One” instruction methodology utilised by the health sciences. While formal outcomes assessment has yet to be conducted, unsolicited comments from students are overwhelmingly positive, and preliminary data analysis of usage and engagement reveals several promising trends. 65% of all watched videos were watched for the entire duration of the video, and the liaison librarian found video creation to be less time-consuming than scheduling appointments. The liaison librarian to a university with a substantial and growing online learning population began using asynchronous, personalised video instruction as an online replacement for the traditional face-to-face, one-on-one bibliographic instruction reference appointment. This project was informed by the framework of metaliteracy and the ‘See One, Do One, Teach One’ instruction methodology utilised by the health sciences. While formal outcomes assessment has yet to be conducted, unsolicited comments from students are overwhelmingly positive, and preliminary data analysis of usage and engagement reveals several promising trends. Of all watched videos 65% were watched for the entire duration, and the liaison librarian found video creation to be less time-consuming than scheduling appointments. Providing personalised video instruction tailored to the individual student’s information literacy need is a novel approach that may benefit online learners and librarians alike.

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“…Video-demonstrations were mentioned as one of the most important learning methods in our study. Zahiri and colleagues found video-demonstrations to be important for 87% of surgical trainees [6]. An advantage of online videos is that they can be accessed on demand by surgical residents-any time and any place-known as the just-in-time principle [20].…”

Section: Discussionmentioning

confidence: 99%

“…The training of surgical residents is evolving from the traditional "see one, do one, teach one" model towards preparation before stepping into the operating room (OR) [6]. One of the reasons being the duty hour restriction which has led to less exposure time in the OR [7] and decreasing educational outcomes [8].…”

Section: Introductionmentioning

confidence: 99%

Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents

Nazari

Dankbaar

Sanders

et al. 2020

Hernia

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Purpose During surgical residency, many learning methods are available to learn an inguinal hernia repair (IHR). This study aimed to investigate which learning methods are most commonly used and which are perceived as most important by surgical residents for open and endoscopic IHR. Methods European general surgery residents were invited to participate in a 9-item web-based survey that inquired which of the learning methods were used (checking one or more of 13 options) and what their perceived importance was on a 5-point Likert scale (1 = completely not important to 5 = very important). Results In total, 323 residents participated. The five most commonly used learning methods for open and endoscopic IHR were apprenticeship style learning in the operation room (OR) (98% and 96%, respectively), textbooks (67% and 49%, respectively), lectures (50% and 44%, respectively), video-demonstrations (53% and 66%, respectively) and journal articles (54% and 54%, respectively). The three most important learning methods for the open and endoscopic IHR were participation in the OR [5.00 (5.00–5.00) and 5.00 (5.00–5.00), respectively], video-demonstrations [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively], and hands-on hernia courses [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively]. Conclusion This study demonstrated a discrepancy between learning methods that are currently used by surgical residents to learn the open and endoscopic IHR and preferred learning methods. There is a need for more emphasis on practising before entering the OR. This would support surgical residents’ training by first observing, then practising and finally performing the surgery in the OR.

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“See one, do one, teach one”: inadequacies of current methods to train surgeons in hernia repair

Abstract: There was a consensus among HTF members and surgical trainees that a comprehensive, dynamic, and flexible educational program employing various media to address contemporary key deficits in the care of hernia patients would be welcomed by surgeons.

Cited by 23 publications

References 26 publications

International guidelines for groin hernia management

International guidelines for groin hernia management

Personalised video instruction

Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents

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