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PCACS. Penn Center for Advanced Clinical Simulation. Integrated Surgical Skills Curriculum. Surgical Knowledge Manual Skills. PCACS: Penn Center for Advanced Clinical Simulation. PCACS. Residents Surgical Skills Curriculum. Medical Students Surgical Skills Curriculum. …
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PCACS Penn Center for Advanced Clinical Simulation Integrated Surgical Skills Curriculum Surgical Knowledge Manual Skills
PCACS: Penn Center for Advanced Clinical Simulation PCACS Residents Surgical Skills Curriculum Medical Students Surgical Skills Curriculum … Surgical Skills Curriculum
Integrated Surgical Skills Curriculum Objectives - Surgical Knowledge - Manual Skills Core Competence - Medical Knowledge - Patient Care - Interpersonal and Communication Skills - Professionalism - Practice based learning - Systems-Based Practice
Integrated Surgical Skills Curriculum Team Members: 3 to 4 Residents: One PGY 3 /Lab Res One PGY 2 Two PGY 1
Week 1 Schedule Concepts Skills Drill Interaction with The Clinical Expert Each Day Self Directed Learning Team Based Skills
Day 1 General Surgery Concepts Session 1: Introduction to Surgical Tools and Instruments Session 2: Aseptic and Sterile Techniques Session 3: Suture Material and Handling Skills Drill Session 4: Knot Tying Techniques Interaction With the Clinical Expert Session 5: Video Interaction with Surgeon eg. Excissional Biopsy Self Directed Learning Session 6: Self Directed Practice Session Session 7: Group Dynamic Training Clinical Scenarios eg. SCARED Session. Stanford Course on Active Resuscitation Evaluation Decision Making Team Based Skills
Day 2 Trauma Concepts Session 1: Brief Review ATLS Concepts Session 2: Airway Management, Line Placement, .. Session 3: Thoracotomy, Tube thoracostomy, .. Skills Drill Session 4: Chest Tube Placement (Trauma Man) Trachs & Cricothyroid, (Trauma Man) Central Line Placement (SimLab/TraumaMan) Interaction With the Clinical Expert Session 5: Video Interaction with Trauma Surgeon Video Review of Trauma Response Sessions Self Directed Learning Session 6: Self Directed Practice Session Session 7: Group Dynamic Training Clinical Scenarios (eg. Trauma Scenario Review c Trauma Surgeon) Group Dynamic Training
Day 3 SCC Concepts Session 1: Understanding Ventilators Session 2: Understanding Hemodynamic Monitoring Skills Drill Session 3: Central Line Placement , Intubation Skills Interaction With the Clinical Expert Session 4: Case Scenario review with Surgical Critical Care Expert Session 5: Self Directed Practice Session/SimMan Self Directed Learning Group Dynamic Training Session 6: Review of Different Clinical Scenarios c SimMan (Section I)
Day 3 SCC Laerdal SimMan Features: Extensive Practical Features Allows Individual and Group Practice of multiple clinical scenarios Airway features: Cardiac functions: CPR: Blood Pressure: Circulatory skills and IV drug administration: Sounds: Genitalia for urinary catheterization: Event log: Easy to use scenario and trend tools: Air supply available by two alternatives: Air compressor/regulator unit Easy to use: Portable: Easy storage and transportation.
Day 4 GI Surgery Concepts Session 1: Instrument Tie, Hand Tie Two Hand Tie – Square Knot Two Hand Tie – Surgeon’s Square Knot Tow Hand Tie – Slip Knot One Hand Tie -- Slip Knot Skills Drill Session 2: Stapling Instrumentation Session 3: Suture and Skin stapling Interaction With the Clinical Expert Session 4: Video Interaction with the Expert Fascia/Abdominal Wound Closure Self Directed Learning Session 5: Self Directed Practice Session Group Dynamic Training Session 6: Review of Different Clinical Scenarios c SimMan (Section II)
Day 5 GI Surgery Session 1: Stapling Instrumentation Session 2: Anastomosis in GI Tract Concepts Session 3: Inanimate Lab – Basic Ligation -- Wedge Resection -- Functional end-to-end Anastomosis -- Bilroth II -- Low Anterior Resection Session 4: Synthetic Lab – Bowel Anastomosis Skills Drill Interaction With the Clinical Expert Session 5: Video Interaction with Clinical Surgeon Performing Bowel Anastomosis Session 6: Self Directed Practice Session Self Directed Learning Session 7: Expert procedure task analysis Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies Group Dynamic Training
Week 2 Schedule Concepts Skills Drill Interaction with The Clinical Expert Each Day Self Directed Learning Team Based Skills
Day 1 Plastic & Reconstructive Concepts Session 1: Scientific Basis of Wound Closure Techniques Session 2: Concepts of Flaps and Tension Free Reconstruction Session 3: Excision of benign skin lesions and closure of simple wounds Excision of a hand ganglion. Repair of divided hand extensor tendon Skills Drill Session 5: Video Interaction with Clinical Surgeon Performing Plastic Procedure/ Flap Interaction With the Clinical Expert Self Directed Learning Session 6: Self Directed Practice Session Session 7: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies Group Dynamic Training
Day 2 Vascular Surgery Concepts Session 1: Anatomy Review for Vascular Access Session 2: Concepts of Vascular Anastomosis Skills Drill Session 3: Practical Session Vascular Anastomosis (I) Session 4: Video Interaction with Clinical Surgeon Expert Performing Vascular Anastomosis Interaction With the Clinical Expert Self Directed Learning Session 5: Self Directed Practice Session Session 6: Expert procedure task analysis, Expert definition of most common errors for each step of procedure. Description of error prevention strategies and error rescue strategies Group Dynamic Training
Day 3 Basic Laparoscopy • Session 1: Key Skills in Laparoscopic Surgery • Port Placement • Camera and scope manipulation • Abdominal access and insufflation • Ergonomics • Session 2: Sharp and blunt dissection • Clip application electrosurgery • Looping • Tissue extraction • Port Site Closure Concepts Skills Drill Interaction With the Clinical Expert Session 3: Video Interaction with Clinical Surgeon Expert Performing Lap Chole Self Directed Learning Session 4: Self Directed Practice Session Group Dynamic Training Session 5: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 4 Vascular Surgery II Concepts Session 1: Anatomical Consideration for Vascular Incisions Session 2: Concepts of Endovascular Techniques Skills Drill Session 3: Practical Session Vascular Anastomosis (II) Session 5: Video Interaction with Clinical Surgeon Expert Performing Central Vascular Procedure/AAA Interaction With the Clinical Expert Self Directed Learning Session 6: Self Directed Practice Session Group Dynamic Training Session 7: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 5 Intermediate Laparoscopy Concepts Session 1: Techniques necessary to overcome the visual demands in laparoscopic surgery - Effective equipment and instrument positioning using ergonomic principles - Laparoscopic Energised Dissection Skills Drill Session 2: Laparoscopic suturing and knot tying Tumbled square knot using laparoscopic instruments to safely ligate a vessel Pick up an endoscopic needle and make a bite through tissue Form a surgeon’s knot using laparoscopic needle holders Demonstrate optimal bite placement and knot tying technique during laparoscopic tissue approximation Interaction With the Clinical Expert Session 3: Video Interaction with Clinical Surgeon Expert Performing Lap Band/ Gastric Bypass Self Directed Learning Session 4: Self Directed Practice Session Session 5: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies Group Dynamic Training
Week 3 Schedule Concepts Skills Drill Interaction with The Clinical Expert Each Day Self Directed Learning Team Based Skills
Day 1 Thoracic Surgery Concepts Session 1: Anatomical Consideration for Thoracic Surgery Session 2: Thoracic Surgical Techniques Skills Drill Session 3: Animal Lab Lobectomy Session 4: Video Interaction with Clinical Surgeon Expert Performing Lobectomy/Thoracic Procedure Interaction With the Clinical Expert Self Directed Learning Session 5: Self Directed Practice Session Group Dynamic Training Session 6: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 2 Thoracic Surgery Concepts Session 1: Anatomical Consideration for Thoracic Surgery Session 2: Concepts of VATS Skills Drill Session 3: Animal Lab VATS Session 4: Animal Lab Nissen Session 5: Video Interaction with Clinical Surgeon Expert Performing VATS Procedure Interaction With the Clinical Expert Self Directed Learning Session 6: Self Directed Practice Session Group Dynamic Training Session 7: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 3 Colorectal Surgery Concepts Session 1: Anatomical Consideration Colorectal Surgery Session 2: Concepts of Bowel Anastomosis in Colorectal Skills Drill Session 3: Practical Session Bowel Anastomosis Session 4: Video Interaction with Clinical Surgeon Expert Performing Colon Surgery Interaction With the Clinical Expert Self Directed Learning Session 5: Self Directed Practice Session Group Dynamic Training Session 6: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 4 Colorectal Surgery Concepts Session 1: Anatomical Consideration for Colon Surgery Session 2: Concepts of Laparoscopic Colon Surgery Skills Drill Session 3: Animal Lab Laparosocopic Right Colectomy Session 5: Video Interaction with Clinical Surgeon Expert Performing Lap Colectomy Interaction With the Clinical Expert Self Directed Learning Session 6: Self Directed Practice Session Group Dynamic Training Session 7: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 5 Endocrine Surgery Concepts Session 1: Anatomical Consideration for Endocrine/Oncology Session 2: Concepts of Lap Adrenalectomy Skills Drill Session 3: Practical Session Advanced Laparoscopy Session 5: Video Interaction with Clinical Surgeon Expert Performing Thyroid/Adrenal Procedure Interaction With the Clinical Expert Self Directed Learning Session 6: Self Directed Practice Session Group Dynamic Training Session 7: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Week 4 Schedule Concepts Skills Drill Interaction with The Clinical Expert Each Day Self Directed Learning Team Based Skills
Day 1 Surgical Oncology Concepts Session 1: Anatomical Consideration for Endocrine/Oncology Session 2: Concepts of Thyroidectomy/Sarcoma/Melanoma Skills Drill Session 3: Practical Session Advanced Laparoscopy Session 4: Video Interaction with Clinical Surgeon Expert Performing Thyroid/Sarcoma/Melanoma Interaction With the Clinical Expert Session 5: Self Directed Practice Session, Allgoritmus for Sarcoma, Thyroid Mass, Melanoma Self Directed Learning Group Dynamic Training Session 6: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 2 Breast Surgery Concepts Session 1: Anatomical Consepts in Breast Surgery Session 2: Anatomical Concepts of Axillary LN Dissection Sentinel LN Biposy Skills Drill Session 3: Practical Session Lumpectomy, Sentinel LN Biopsy, Mastectomy Session 4: Video Interaction with Clinical Surgeon Expert Performing Lumbectomy, Sentinel LN Dissection, Interaction With the Clinical Expert Session 5: Self Directed Practice Session, Allgoritmus for Breast Mass Self Directed Learning Group Dynamic Training Session 6: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 3 Transplant Surgery Session 1: Anatomical Consepts in Liver Resections Session 2: Anatomical Concepts of Kidney, Liver Txpl Concepts Session 3: Practical Session Liver Resection in Wet Lab (Animal) Skills Drill Interaction With the Clinical Expert Session 4: Video Interaction with Clinical Surgeon Expert Performing Hepatic Lobecotmy, Txpl… Session 5: Self Directed Practice Session, Algorithms for Transplant Rejection Self Directed Learning Group Dynamic Training Session 6: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 4 Pediatric Surgery Session 1: Anatomical Aspects of common Pediatric Procedures Session 2: Surgical Techniques in Pediatric surgery Concepts Session 3: Review of common pediatric procedures with Inclusion of skills directed technical aspects Skills Drill Interaction With the Clinical Expert Session 4: Video Interaction with Clinical Surgeon Expert Performing Pediatric Surgery (Hernia, Pyloromyotomy, Volvulus, …) Session 5: Self Directed Practice Session, Algorithms for Pediatric Case Presentations Self Directed Learning Group Dynamic Training Session 6: Expert procedure task analysis, Expert definition of most common errors for each step of procedure Description of error prevention strategies and error rescue strategies
Day 5 Objective Skills Assessment • Formal content testing of subjects • Objective Structured Assessment of Technical Skills (OSATS) • Imperial College Surgical Assessment Device (ICSAD) • Multiple Objective Measures of Skills (MOMS) • Intraoperative Critical Event Management (ICEMAN)
