Can a new model for deliberate practice in microsurgery be designed using Motor Imagery & Mental Practice (MIMP) to produce expert performance among novices? Can the new training model improve skill acquisition to an expert level in a standardised microsurgical procedure for interns as compared to the current method of reading and observing the expert performing the surgery among interns in Singapore

1. Performance enhancing in surgical
training
Research Proposal for PhD (Education)
A MODEL FOR RAPID SURGICAL SKILL ACQUISITION IN
MICROSURGERY AMONG SURGICAL INTERNS
IN A GENERAL HOSPITAL IN SINGAPORE
Name : Vaikunthan Rajaratnam
LEARNING CENTRE : Cluster of Education & Social Sciences
Open University Malaysia (OUM)
SUPERVISOR : Dr Zahari Hamidon
ETHICS APPROVAL : DSRB NHG 2018/00077
GRANT : HOMER FY18/A02

2. Introduction
• competency @ 15,000 and 20,000 hours = 12.5
years ( @ 40 weeks/year and 5 day week at 8 hours a
day) (Purcell Jackson & Tarpley, 2009).
• reduced worked based training/patient exposure (Reznick
& MacRae, 2006).
• Becoming an expert (Dreyfus )with reduced training
hours???
• Usable,accessible and affordable model in skills training
“ten years’ duration of effortful activity which can only be sustained for a limited period daily to
allow for recovery from a daily or weekly routine”
Kavic, M. S. (2012). Teaching and Learning of Surgery. JSLS : Journal of the Society of Laparoendoscopic
Surgeons, 16(3), 341–344)
Kneebone, R., & Aggarwal, R. (2009). Surgical training using simulation. BMJ, 338, b1001.
Dreyfus, S. E. (2004). The Five-Stage Model of Adult Skill Acquisition. Bulletin of Science,
Technology & Society, 24(3), 177–181.

3. Source:Source: https http://approachesandmethods.blogspot.sg/2013/11/behaviorism.html
Bandura
Skinner
The Fits and Posner multi-stage theory
Deliberate
Practice
Erricson

4. Neural encoding-
•direct parietal connections
to spinal interneuron pools,
•modulation of spinal
circuits for goal-directed
actions
•of hand and arm,
supplementing traditional
direct frontal motor
pathways.
Rathelot, J.-A., Dum, R. P., & Strick, P. L. (2017). Posterior parietal cortex contains a command apparatus for
hand movements. Proceedings of the National Academy of Sciences, 114(16), 4255–4260.

5. New Model of Surgical TrainingNew Model of Surgical Training

6. Research Questions
• Can a new model for deliberate practice in microsurgery be designed
using Motor Imagery & Mental Practice (MIMP) to produce expert
performance among novices?
• Can the new training model improve skill acquisition to an expert
level in a standardised microsurgical procedure for interns as
compared to the current method of reading and observing the
expert performing the surgery among interns in Singapore?
MIMP = Motor Imagery Mental Practice

7. Significance of the Study

8. Methodology - Mixed Method
Can a new
training
model using
MIMP
improve skill
acquisition to
an expert
level

9. Development of MIMP instrument

10. Development MIMP
• cognitive walkthrough for the procedure
- verbal protocol
• steps of performing micro suturing
under the microscope using 8/0 nylon
sutures on the glove model (the suture
model)
• imagine themselves performing the
suturing
• report visual, cognitive, and kinaesthetic
cues
Ericsson, K. A. (2006). Protocol analysis and expert thought: Concurrent verbalizations of thinking during
experts’ performance on representative tasks. The Cambridge Handbook of Expertise and Expert
Performance, 223–242.

11. Evaluation of initial taxonomy
Yu, D., Minter, R. M., Armstrong, T. J., Frischknecht, A. C., Green, C., & Kasten, S. J. (2014). Identification
of technique variations among microvascular surgeons and cases using hierarchical task analysis.
Ergonomics, 57(2), 219–235.

12. Subtask
Join cut edge of glove
To connect the rubber glove together using
sutures
Start: needle driver is used
End: suture from the last stitch is cut
Inspect repair To ensure repair of rubber glove with
equidistant and secured knot and free ends
at right angles to incision
Start: suture from last stitch is cut
End: instrument is put down
Elements
Align To move edges of rubber glove in alignment
Start: tool moves towards glove edge to grasp and
move
End: rubber edge is released from tool after move
Drive needle To puncture rubber edge with needle
Start: needle moves towards rubber edge to pierce
End: needle fully passes the rubber edge walls or
is removed before passing the rubber edge
wall (failed attempt)
Withdraw suture To pull suture through rubber edge
Start: suture is pulled through the rubber edge
End: suture thread is no longer being pulled
Tie suture To fasten suture thread with knots
Start suture wrapped around needle driver
End knots are tightened
Cut suture To severe excess suture thread from knot
Start: scissors enter field of view to cut
Hierarchical Task Analysis
Goals ,tart and end criteria for
subtasks and elements

13. Phase 2: Script validation

14. Opportunistic sampling
surgical performance
Experiment Design

15. Outcome measure

16. Limitations of the study