Simulation Task Deconstruction Checklist
This checklist is designed to be used by developers of SELF modules for deconstructing the psychomotor element of surgical tasks (i.e the key elements of the physical skill that is performed with integrated knowledge and feedback).
Before you Begin:
- Define the Learner. Understand and define the needed context of the learner and deployment i.e. what is the minimum level of training and skill this learner has? This is needed to determine what do you need to address, and what do you NOT need to address in terms of the learner’s psychomotor skill such as: Are you teaching suturing, or is suturing a prerequisite skill?
- Define the endpoint. Considering where the learner is starting, define learning objectives and narrow down the scope of the expected simulator to only address those objectives. The simulator should be fit for purpose with as narrow a scope as possible.
- Keep your learner definition and the end goal in mind throughout the design process
Creating the Framework:
- Deconstruct the task into the sequential physical and decision-making steps within the procedure, and identify the tissue type that this step interacts with, and lay out in a table. These should be at the level of single interactions with tissues such as Surgical step: “identify cystic duct” Tissue: “cystic duct” and Manipulation type: “visual identification”. Surgical step: “Divide feeder artery” Tissue: “mid-sized artery” and Manipulation type: “seal then sharply divide”. Include variations for common complications. This is your starting list of tissues.
- Note whether each step is common to a large number of procedures (e.g. abdominal entry and closure) to which you would assign a “3”, unique to the procedure (e.g. “identify the appendiceal artery”) to which you would assign a “1”, or somewhere in-between (“2”). This aids in narrowing down what actually needs to be simulated with the physical simulator as common entry/closure techniques do not need to be covered in every module that uses them.
- Fidelity type. For all the unique/level 1 steps, and the level 2/3s in between those steps, list all the elements of the interaction with the simulated tissue which are essential for the learner to translate what they are learning over to clinical applications. Account for elements such as colour, anatomical shape/relationships, variability in those anatomical relationships, response to blunt or sharp dissection, “drillability”, elasticity, rigidity, tactile, auditory, olfactory, or consistency of texture.
- Only require a tissue fidelity type if is it arguably necessary to the aspect of the task being learned. Recognise that tactile fidelity requirements are not universal – they are dependent upon target learner experience, the procedure type, and the likelihood of incorrect technique causing complications. For example, a more experienced learner may be able to suspend disbelief when a tissue has low tactile fidelity and learn an essential element of a surgical step from visual fidelity alone, or alternately, when the performance of the step is so dependent on the characteristics of the material (such as sewing bowel to pancreas) anything but identical physical characteristics is likely to have the clinician practicing inappropriate techniques with potentially deadly consequences. Simplification serves to maximise cost effectiveness and fidelity with minimal complexity while addressing the learning objective
- Choose Materials. Use the deconstruction to choose appropriate materials for the various steps
| Surgical Step | Tissue | Manipulation type | Uniqueness | Desired type of feedback to the learner | Fidelity Type |
| Step 1 | |||||
| Step 2 | |||||
| Step 3 … |
Example of Task Deconstruction: IV Placement
| Step | Tissue type | Action and Fidelity type | Antiskills to avoid |
|---|---|---|---|
| Visually identify skin distention indicating a vein | Skin, vein, subcutaneous fat | Visual fidelity for identification of landmarks | Veins too easily seen through pale skin on a trainer, no training on different skin types |
| Palpate vein to verify, clean and prep skin with antiseptic | Skin, vein, subcutaneous fat | Tactile fidelity to palpation | Vein too easily felt, learner lost when encountering difficult to palpate veins |
| Placing light tension on the skin with your non-dominant hand, hold the needle bevel up and a 10-30 degree angle in your dominant hand and insert through the skin into the vein until you see the flash of blood return in the chamber | Skin, vein, subcutaneous fat, blood | Toughness to needle piercing (skin and vein), mobility of vein with respect to the skin, appropriately thin wall to have a large enough lumen, viscosity of blood, visual fidelity of blood | Vein or skin too hard to puncture, tissue behind vein too firm so “through and through” piercings don’t happen even with bad technique. Vein rigid with no mobility or rolling. Lumen too small or too large. All can lead to aggressive, rough or poorly angled needles |
| Decrease angle to parallel and advance 2-4mm | Vein | Toughness to needle piercing | Too soft, and the needle won’t advance without piercing the vein, too hard, and the advance can’t fail, leads to rough advancing |
| Slide the catheter over the needle and into the vein | Vein | Intubation of a lumen–resistance fidelity | Catheter must be able to stretch entry point and slide without inappropriate friction to prevent learner practicing overly rough insertions |
| Remove needle and attach IV set | Vein, skin and blood | Retention of the catheter–stickiness fidelity, blood viscosity and pressure | Catheter can’t slide out too easily, and blood should flow if needle removed, or learner will not practice rapid attachment of IV set. |
