Look and learn

This section is so we can stand on the shoulders of giants and learn from others mistakes.

"Be afraid be very afraid"

Orthopaedic education

How do we learn

Psychomotor skills (Operating ) are difficult skills to teach.

Dubrowski et al, suggested an excellent example of how we teach trainees to drill through bone.

Often the trainee is told to drill through the both cortices " DONT plunge through", often reinforced with a cautionary tail of the neurovascular structures that lurk medially.

This danger/ fear factor does not help the trainee develop the skills needed to become competent drilling through bone.

Using Kinesiology Dubrowski et al showed that

Experienced surgeons

• Used lower drilling forces when penetrating the second cortex in comparison with that applied when drilling through the first cortex.

• Anticipated the penetration of the second cortex and reduced pressure further just prior to penetration

Novice surgeons

• Used higher forces when drilling through the second cortex in comparison with that used when penetrating the first cortex

Hence when teaching a trainee how to drill avoid simply saying "Don't plunge", suggest.

• Use more pressure on drilling the first cortex

• Reduce the pressure when drilling the second cortex

• Anticipate penetration of the second cortex based on the Feel of the soft tissues and sound of the drill.

In other words, rather than teaching the trainee to optimize the outcome measure (akin to teaching them the answer to a motor problem), we should teach them movement processes leading to this outcome (or how to solve the motor problem).
 

This approach of critical appraisal of all motor skills is important.

Reducing complex motor tasks to small easily digestible steps.

References

Adam Dubrowski and David Backstein; The Contributions of Kinesiology to Surgical Education; JBJS - Am., Dec 2004; 86: 2778 - 2781.
 

Last updated 11/09/2015