COGNITIVE SIMULATION  -  For surgeons across specialties


Shorten the learning curves

Everyone knows that surgical skills improve with practice. However a graph of performance versus experience creates a curve rather than a straight line. Thus 'practice makes perfect' is not as straightforward as it sounds. There is something else about the practice other than repetition that we need to be aware of.

Learning Curve


Surgical expertise involves multi-sensory interaction of experience. Better the multi-sensory information, quicker the skill progression. The real benefit of practice is in the information that surgeon perceive while operating. If you know how to process the sensory information effectively, you will shorten the learning curve.

The sensory information is processed and stored in the form of a mental model. Quality of this mental model determines the quality of performance. Good perceptual abilities allow surgeon to form a better model of the operative procedure, to predict the consequences of actions and therefore to plan and adjust the movement with greater accuracy. The operator is also able to interpret more efficiently the feedbacks and will have a richer network of information regarding the surgical skill.

The sensory information is collected in 4 stages.

1) Initial condition - The initial conditions consist of the sensory information received from various senses prior to the action by the operator. For e.g. in case of surgery, this may be proprioceptive information about the position of a hand and visual information of a patient on the operation table.

2) Response specifications - In the next step the operator orders the neuromuscular system to perform a specific movement. The action may be of stretching the skin with one hand and making an incision with the other.

3) Sensory consequences - This consists of the effect of the previous action noticed by sense organs i.e. eyes, proprioceptors etc. For example, you see the incision, bleeding from the incision and the tissue exposed after the incision.

4) Response outcome - This arises from information the surgeon has received after the action and consists of knowledge and results of his action. In the above example, the operator takes measures to control the bleeding or the next step of the operation.

Shortening the learning curveA novice surgeon making a skin incision for the first time may not have previously acquired information after the initial condition. This means that he does not know how much pressure he should apply to make a correct incision. Also he is unaware of what sensory feedback he should receive after he starts making a cut and what would be the response outcome when he has completed the incision. The result, more often than not, is the application of insufficient pressure on the scalpel and an incision of inadequate depth.

After the initial performance, information about each of the four categories is stored in the operator's mental model. This information can subsequently be used for improvement in the next performance. Each new performance provides information that helps refine subsequent movements. In the case of a novice surgeon making his subsequent incision, the sensory information on such factors as type of skin, thickness of subcutaneous fat, pressure applied to the scalpel, position of the hand and result obtained and used to plan the next incision. Presumably, more pressure will be applied at that time and the trainee will store the information within each of the four categories that will be used for the following incisions. Here for the sake of clarity only the pressure applied to the scalpel was considered. However, several other senses are involved in making an incision: such as the angle of the blade, the grip on the scalpel, the surgeon's posture, and so on. Cognitive simulation helps you to identify the important sensory modality, analyze it during the action and stores it for the better utilization during the action. Thus it brings about the changes in neuromuscular system with less number of repetitions.


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