Teaching Surgical Model Development in Research by Using Situated Learning and Instructional Scaffolding

Abstract

Resources detailing the scope, details, and duration for teaching and learning surgical model development in research are poorly described. Situated learning and instructional scaffolding are useful skill-building tools. Herein, we discuss educational theory in the context of a training paradigm for surgical researchers, using our experience with a nonunion femoral fracture model as an example. Stages of learning include cognitive, associative, and autonomous stages. In surgical training, the cognitive stage involves the acquisition of basic knowledge, including anatomy, surgical approach, instrumentation, and suturing, which can be taught by using books, videos, skeletons, and cadavers. To these basic skills, the associative stage adds advanced techniques-including anesthesia, asepsis, hemostasis, and the full surgical procedure-through mentored nonsurvival surgical experiences. After a mentor has assured competence, trainees perform supervised and then independent survival surgeries to complete the autonomous stage. Through these stages, instructional scaffolding is applied in the context of a situated learning environment in which trainees learn in a layered approach through their own experiences. Thus, the proposed training paradigm is structured to teach trainees how to think and act as surgeons so they can adapt and grow, rather than only to ensure technical competency in a specific model. Development and mastery of complex surgical models may require as long as 6 mo to achieve optimal outcomes, depending on the preexisting skill of the research surgeons, technical difficulty, and the stage of model evolution.

Figure 1.

Visual guide for training novice surgeons in surgical model development. Artist's rendering of the suggested steps to train novice surgeons. These steps encompass the 3 major stages of learning: cognitive, associative, and autonomous. The cognitive stage should begin with a conversation between the novice surgeon and a surgical mentor, such as a consulting veterinarian. This consultation is followed by gaining IACUC approval for the desired surgical protocol. Next, the appropriate surgical tools should be ordered. The novice surgeon then should begin learning about the surgical model, acquiring relevant background information, and understanding the application of specific methods. The novice surgeon can then use appropriate simulations or anatomic specimens, such as skeletons, to understand spatial relationships between any implants, surgical tools, and the tissues that will be operated on. The novice surgeon begins the associative stage of learning by practicing on cadavers to train hand dexterity and instrument use. Next, the novice surgeon can assist the surgical mentor in performing the desired surgical model to understand the intricacies of the model and to observe mentor expertise in aseptic technique and instrument handling. During this stage, the veterinarian is instructing the novice surgeon. Afterward, the novice surgeon can practice the surgical model with assistance from the mentoring surgeon in a nonsurvival surgery setting. After gaining competence and experience, the autonomous stage begins, in which the novice surgeon can demonstrate mastery of the surgical model to the observing surgical mentor. Finally, the novice surgeon has completed the stages of training and can begin to independently perform surgeries, develop proficiency, and generate study data.

Figure 2.

Plan for training new surgeons in surgical model development. Description of training plan involves preparation and the training components incorporated within cognitive, associative, and autonomous stages, as well as the estimated duration for each component. Note that durations are dependent on the complexity of surgery, experience of trainee, and length of study.

Figure 3.

Dermestid beetle–cleaned skeletons for training surgical techniques. (A) Dermestid beetle–cleaned skeleton allows visualization of the size and scale of the surgical area and skeletal anatomy. (B) Equipment for LockingMouseNail (RISystem, Davos, Switzerland) surgery alongside an isolated left femur gives trainee an idea of the size ratio between surgical implants and femur. From left to right: locking pins, locking nail guide arm, mouse femur, locking nail, and microdrill with 1.6-mm burr. Scale bar, 1 cm.