SURGERY


Figure 4: ‘Fusion of O.ten Cate’ concept map and the learning curve unveiling Vigotski zone of professional development.


under supervision – with increased need for supervision and subsequent cost of training (Fig.4). Trainees on the path to proficiency, may underestimate the risk of deskilling, since they have not reached the level of deliberate effort to practice higher and the level of automatisms, which are expert attributes.11 The amount of time proficient trainees will be able to dedicate to supervise and train their junior fellows and to deal with difficulty is unclear. It seems reasonable to foresee they will be allocated the care of patients, requiring straightforward operations. The priority will be delivering safe care under the pressure of a predictable surge of activity fueled by postponed elective activities.


Conclusion


Under tragic circumstances, the COVID-19 crisis accelerates changes at an unprecedented speed. Virtual congresses have already replaced surgical conventions at short notice. However, hands-on practice seems to be on a gloomy ride. From novices to the proficient, the impact of the pandemic may have long- term consequences on surgical education. We foresee synergies between MT and DW that we propose pre-operatively for rehearsal and intra-operatively for synchronisation. Anytime, anywhere, on the mental stage of the operating theatre, the surgeon could be an actor seeing and hearing their self performing the show without a public audience. Hence, in the ‘new normality’, no surgeon nor trainee should suffer mentally or technically from non- practicing, in the present or future crisis. CSJ


References 1 Pang KH, Carrion DM, Gomez Rivas J, et al. The impact of COVID-19 on European health care and urology trainees. Eur Urol. In press. https://doi. org/10.1016/j.eururo.2020.04.042.


2 Feltz, D. L., Landers, D. M. (1983) The effects of mental practice on motor skill learning and performance: A meta-analysis. Journal of Sport Psychology, 5, 25–57.


3 Johnston N, McDonald N, Fuller R. Cognitive Task Analysis in air traffic controller and aviation crew training Part 3 Chapter 10 in Aviation Psychology in practice 1994 Ashgate Publlshing 2017 Routledge ISBN 13: 978-1-84014-133-7


4 McDonald J, Orlick T, Letts M. Mental Readiness in Surgeons and Its Links to Performance Excellence in Surgery. Journal of Pediatric Orthopaedics. 1995;15(5):691-7.


5 Immenroth M, Burger T, Brenner J, Nagelschmidt M, Eberspacher H, Troidl H. Mental training in surgical education: a randomized controlled trial. Ann Surg. 2007;245(3):385-91


6 Eldred-Evans D, Grange P, Cheang A, Yamamoto H, Ayis S, Mulla M, et al. Using the mind as a simulator: a randomized controlled trial of mental training. J. Surg. Educ. 2013;70(4):544-51


7 Kaulfuss1*, P. Marks1, F.K.H. Chun2, L.A. Kluth2, C.P. Meyer Mentales Training zur Verbesserung manueller und kognitiver Fähigkeiten – ein nachhaltiges und effizientes Tool in der urologischen Facharztausbildung? J. Urologe A Volume 58, Issue 1 Supplement, September 2019


8 Lönroth, Hans, Miller, Karl Laparoscopic Gastric Bypass A surgical primer that applies a unique concept of mental training © 2012 Springer ISBN 978-3-642-23001-1


9 Feige, K., Gollnick, I., Schmitz, P. et al. The 60 l WWW.CLINICALSERVICESJOURNAL.COM NOVEMBER 2020


application of surgical procedure manager (SPM): first experience with FESS. Eur Arch Otorhinolaryngol 274, 3407–3416 (2017).


10 Olle ten Cate 1, Linda Snell, Carol Carraccio Medical competence: the interplay between individual ability and the health care environment Med Teach 2010;32(8):669-75


11 Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med. 2015;90(11):1471‐1486.


Authors


Philippe Grange MD1 Christian P Meyer MD2 Johannes Lauscher MD3 Jason Shields MBA1 Marc Immenroth PhD1 Karl Miller MD1


Authors affiliations 1 Johnson & Johnson Institute Hamburg-D and Cincinnati-OH


2 Department Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany


3 Department of General, Digestive and Vascular Surgery, Charité Campus Benjamin Franklin, Berlin-D


Corresponding author Philippe Grange pgrange@its.jnj.com


©P. Grange - Kings learning institute 2010


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