Neda Taghinejadi

As the end of my project is drawing closer, I feel this is a good point to reflect upon what skills I have learnt and developed. Most obviously, the surgical skills I have learnt first spring to mind! Using the simulators is something I would recommend to any student interested in surgery - they have equipped me with highly valuable skills which I hope will facilitate me in pursuing a career in Gynaecology.

However, during the course of the project, I have learnt much much more than surgical skills alone. In particular, I have greatly improved my organisational and time-management skils. Looking back at my reflections in this blog, this was evidently a major worry of mine - and still is! My degree schedule has become even busier this term - not only do I have an additional module, but I also have countless essays, presentations and a 10,000 dissertation to work towads! Not to mention my commitments to societies (and sometimes even a social life...) This year really has been a juggling act. But, it has greatly improved my ability to manage my time and make the most of it. This is certainly one of the most valuable skills I have developed during my project.

Finally, one more lesson - the rewards of commitment. I am so glad I made the decision to ake on this project, and have realised that great things can happen when you make the most of every opportunity. Now, I sincerely hope that the outcmes of this project wil be as useful to others as it has been to e, and will increase opportunities for other students in the near future.

So far I have been able to observe two operations being performed in theatre at the Royal Free hospital: laparoscopic sterilisation, and laparoscopic salpingectomy Observing the procedures I am learning on the simulator is a vital part of my self-directed learning model, and is the final stage I must complete before recording myself performing any procedure.

It was not easy to arrange to observe either procedure - my tutor had to drop by theatre on a daily basis to enable me to eventually observe the salpingectomy. However, it was definitely worth it - I think this is an absolutely vital stage in this learning model. It is a fantastic opportunity to be able to ask questions whilst observing a doctor performing the procedure, and to compare the techniques used with your own.

Everything was going so well. I felt confident that I had achieved a high standard in performing the laparoscopic sterilization, and that I was gradually achieving a similar standard in the salpingectomy. Until I was reminded of the fact that with technology, as with everything else, things can go wrong!

In this case, the left trocar of the Lap Mentor lost its "haptic interface" - what provides you with tactile feedback as you perform. Despite (as my tutor put it) several attempts to "resuscitate" the machine, it was out of order for 3 weeks.

One more lesson that I learnt from this: that I'm probably enjoying my project a bit too much! I'd got into such a routine that during such a long break, I really started to miss practising on the machine...Perhaps Henry David Thoreau wasn't too far off when he wrote "Men have become the tools of their tools"! 

My thoughts before starting the project:

After I first decided to embark upon my e-learning project, my initial feelings were that of pure excitement. Being very interested in obstetrics and gynaecology, I felt extremely lucky to be getting such hands-on experience in this field. However, as the first day of my project approached, I began to feel quite apprehensive about what I was undertaking. As a third year medical student at UCL, my training has been purely theoretical and this was to be one of my first practical medical experiences. I had no experience or knowledge of simulator technology or surgery, both of which I had given little thought to before. I also felt very conscious of my busy schedule as a medical student. Thus, before I had even begun to practice on the simulator, my thoughts were occupied by two main questions:

1. Was it wise to commit to such an ambitious project alongside my degree? and…
2. Would I be capable of acquiring surgical skills, and performing four surgical procedures?

Getting Started on the Simulator:

What I found was that both of my questions were answered within my first few sessions on the simulator.

My tutor made it clear that he expected my degree (and not the project!) to be my main priority, and that my sessions and meetings would not clash with my teaching. This instantly made me feel more relaxed about being able to manage both commitments. Also, I was shown a video of a simulated surgical procedure that another medical student had performed. It was very reassuring to know that another medical student, with no surgical training, had been able to acquire surgical skills and perform to a high standard.

With each further session on the simulator, my concerns were dissipated and my excitement about the project grew. I found that my learning curve at the beginning of the project was extremely steep, and very soon I felt quite comfortable with the simulator. I also found practicing on the simulator very enjoyable – the laparoscopic basic skills in particular are highly comparable to a video game, with very obvious objectives. This made completing the tasks really satisfying, and the better I got the more rewarding it became.

Acquiring Surgical Skills:

After completing the basic laparoscopic skills module, I progressed to the next stage of the project: performing a cholecystectomy! As a medical student, I found it really exciting to see how my skills could be used in an anatomical setting. However, at the same time, it became more difficult for me to assess how well I was performing. Unlike in the previous module, where performance was often measured using very clear indicators (e.g. percentage of ducts clipped) making 100% very achievable, the cholecystectomy was measured mainly using far more subtle indicators, such as efficiency and safety. As a perfectionist, I found it frustrating that I couldn’t necessarily achieve 100% on all of the indicators – in fact, I’m still working towards this goal on several exercises!

What affects performance?

As I continued the project, I discovered that several factors could affect my overall performance.

Most importantly, I found that my attitude when starting the session could affect how well I carried out the procedure. For example, if I was in a rush, I would prioritise the speed of the procedure over quality - obviously, this was not helpful in improving my skills! Thus, I learnt that it was important for me to plan my time carefully, and not try and “squeeze in” a session between other commitments!

Furthermore, (as cheesy as it sounds) I found it very useful to treat the simulation as if it was a real patient. I found that this attitude would make me more careful, improve my performance and enable me to learn a lot more from each session. This would be one of the first things I would recommend to any other student or doctor using the simulation machines.

Another factor which frequently affected my performance was problems with the simulator itself. On a few occasions, the simulator would not recognise the instruments after I inserted them, or the instruments would twitch on the screen. As this problem was out of my control, I would find this very frustrating and I found that it would affect my performance for the rest of the session!

Managing my time:

As I have mentioned before, splitting my time between my degree, this project, and extra-curricular activities was a major concern of mine. I had even been advised against taking on the project by my peers in the year above me. However, I am very glad that I stuck to my gut feeling and did not let this worry dissuade me. I have found that the most important thing is just being able to manage my time – something which I think I have achieved so far.

Looking back, I also think it was a very good decision to start the project before the start of term  – this enabled me to come in very frequently, and become very comfortable with my skills on the simulator before my degree had even started.

My overall thoughts so far:

Whilst many of my initial concerns have been dissipated, this is not to say that I am completely confident about the project! In particular, what I am now most worried about is presenting my project, as I lack confidence in my presenting and speaking skills. However, I am extremely happy with my progress on this project, and have enjoyed it much more than I expected. It has strengthened even more my desire to go into obstetrics and gynaecology, and has introduced me to an interest that I had never really considered before: surgery! Now, I have once more found my thoughts occupied by two main questions:

1. Why is surgical simulation technology so underappreciated? and…
2. Why can’t all students and doctors have some kind of access to this technology!?