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Title: The metacognitive enhancement of surgical technical skills training
Author: Cocker, Daniel Madoc
ISNI:       0000 0004 7963 7003
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2017
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Background and Aim Surgical education has become an area of increasing importance, debate and research over the last couple of decades as training opportunities have diminished despite increasing expectations. Simulation offers a safe, structured, and reproducible environment for learning complex motor skills. Educationalists are exploring ways of enhancing trainee simulation experience, and this thesis addresses this goal. This work aims to determine whether surgical trainees use metacognitive learning strategies to learn complex motor skills, whether such strategies can be used to augment this learning, and to investigate the feasibility and effect of application of these learning strategies. Methods Two literature searches were undertaken to assess current literature regarding surgical simulation training and metacognition. Interviews were carried out with ten senior surgical trainers to better understand surgical trainees' use of metacognitive learning strategies to learn, and which might be applicable to simulation surgical training. Two experimental studies were subsequently performed using surgical trainees, one a feasibility study and the other a blinded cohort study, assessing trainees' performance during repeated simulated operations. Results Senior surgical trainers demonstrated little knowledge of the construct of metacognition, but suggested metacognitive learning strategies are used to learn motor skills. Furthermore, expert demonstration/instruction, mental imagery, detailed constructive reflection and feedback, deconstruction of an operation, and monitoring progress are the metacognitive learning strategies most applicable to enhancing surgical trainees' development of surgical motor skills. The feasibility study demonstrated incorporation of these strategies into a simulation exercise, and the subsequent experimental study demonstrated a non-significant improvement in trainees' performance if the simulation exercise was metacognitively enhanced. Conclusions Surgical trainees use metacognitive learning strategies to learn complex motor skills. Enhancement of simulation exercises with metacognitive learning strategies produces a demonstrable, but without statistically significant improvement in performance. Future work should investigate further application of metacognitive learning strategies in the simulation suite and in the operating theatre.
Supervisor: Hanna, George ; Mavroveli, Stella ; Leff, Daniel Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral