This document discusses how surgical skills are best taught through apprenticeship and formal training programs. It outlines several key points: - Historically, surgical skills were taught through apprenticeship models where students learned directly from masters in the operating room. Formal training programs emerged with advances in anesthesia and antisepsis. - Formal skills training involves progressing from cognition to integration to automation of skills according to Miller's Pyramid of Learning. This involves understanding principles, precision of movements, speed and efficiency. - Surgical skills workshops provide a controlled environment for repetition and practice, away from the stress of real operations, allowing for better acquisition and mastery of individual skills through the hand-eye-brain

1. "I hear and I forget.
I see and I remember.
I do and I understand."
----- Confucius
551-479 BC

2. Consider a recently aired
programme on Cooking

3. Master Chefs can do the same job
in different fashion.
Same ingredients can be used in
different manners

4. Some may refer
them as Quality
assurance and
Standardization
Today’s question is
How can I ensure
to produce exactly
the same result
with different
individual ?

5. How to teach new
tricks ?
• Setting up certain
Guidelines
• Implementing
Standard operating
Protocols
• Teach them through
Workshops

6. The example is
so simple
Same steps of dance
if done in synchronized
fashion
lead to a worth while
performance

8. Where did it all start !
The Master was
“obliged himself to teach and instruct”
and
had the obligation not to
“transfer his Prentice to another Master”
*Creswell CH. The Royal College of Surgeons of Edinburgh: historical notes
from 1505 to1905. Edinburgh; Oliver & Boyd: 1926

9. Apprenticeship to Formal training
 Till the end of 19th Century Cranium, Thorax and the
Abdomen were still sanctuaries to be explored by the
Master’s and no one else
 It was the introduction of Anesthesia and Antispesis that
led to widespread practice of these areas.
 This led surgical residents away from the apprentice
model to the some new called the “training programs”
 The important differences now were

10. How the New system changed the way we
teach ?
See and do Formal skills training

11. Sir William Halsted
University of Yale 1874
His Key lecture in 1904
was acknowledged in
1928 by the American
Medical Association to
endorse the need for
training in surgery

12. The Pioneer of the
modern day residency
/ apprenticeship
programs.
Believed it is important
for students to learn
from a master

13. “Assisting Surgery does not confer
the competency to perform certain
procedure”
First UK based
Surgical residency
program
established in 1972

14. MILLER’S PYRAMID OF
LEARNING A SKILL

15. 3 STAGES OF LEARNING
A SURGICAL SKILL
 COGNITION
To have the basic knowledge and
observation of a procedure or skill
 INTEGRATION
Comprehension of basic Principles /
economy and accuracy of movements
 AUTOMATION
Speed efficiency and Precision

16. Stages of Acquisition of Motor skills
 Initial stages include
1. Learning the perceptual awareness
2. Understanding the spatial arrangements
3. Comprehending the basic mechanical principles.

17. Stages of Acquisition of Motor skills
 Later stages include
1. Speed
2. Efficiency
3. Precision

18. How Surgical Skills workshop can
help?
 The skill acquisition is not Environment dependent ---
meaning a surgical skill need not to be learnt in an
operation theatre room.
 Acquisition of a Motor skill is better in a controlled
environment where the learner and the supervisor and
not under stress of a real case scenario
 Repetition of the any ensures Mastery only in that skill (
Hand-Eye-Brain loop