Achieving engagement with a Deliberate Practice programme using portable laparoscopy simulators - “Incentivised Laparoscopy Practice”

ABSTRACTBackgroundThe transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement, as reported in our 2014-15 study of an Incentivised Laparoscopy Practice (ILP) programme. Our subsequent multi-centre study examined barriers and facilitators, informing revisions of the programme for 2018-20. We now report engagement with the revised versions.MethodsIn ILP v2.1 and 2.2, two consecutive year-groups of new CSTs (n= 48 and 46) were loaned portable simulators. The 6-month programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review. ILP was set within a wider reform, “Improving Surgical Training”.ResultsILP v2.1 and 2.2 saw pass rates of 94% and 76% (45/48 and 35/46 trainees respectively), compared with only 26% (7/27) in v1, despite the v2.1 and v2.2 groups having less electronic gaming experience. In the ILP v2.2 group, 73% reported their engagement was adversely affected by COVID19 redeployments.ConclusionsSimply providing kit, no matter how good, is not enough. To achieve trainee engagement with take- home simulators, as in ILP v2, a whole programme is required, with motivated learning, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a “reform within a reform, within a context.” This may explain why trainee engagement fell away during early pandemic conditions.WHAT IS ALREADY KNOWN ON THIS SUBJECTAttaining automation of motor skills is essential to free up operating surgeons’ attention for higher cognitive functions.Laparoscopic operating skills can transfer from simulation to the operating room, and deliberate practice is the most important variable in the development of expertise.Simply providing take-home portable simulators to surgical trainees, even with online training programmes, is insufficient to facilitate consistent deliberate practice by more than a minority of trainees.WHAT THIS STUDY ADDSA package of evidence-based reforms transformed participation of Core Surgical trainees in a 6-month programme of practice using take-home portable simulators, resulting in near- 100% engagement.Such reforms are complex, including motivators for learning, individual and group practice, intermittent feedback, clear goals and assessments, and adoption into a wider curriculum reform called “Improving Surgical Training”.The improved engagement with this form of remote simulation-based training did not continue in the face of a national “lockdown” for the COVID19 pandemic, where there was widespread redeployment of trainees.

An Ultrasound Imaging Based Observer for Estimating NMES-Induced Muscle Fatigue: Theory and Simulation

Neuroprosthetic devices that use transcutaneous neuromuscular electrical stimulation (NMES) are potential interventions to restore skeletal muscle function in people with neurological disorders. As commonly noted, how to assess the NMES-induced muscle fatigue is a critical problem. This is because the capability of fatigue assessment is a necessary precursor for optimally modulating the NMES dosage to improve the control performance of a neuroprosthesis and ensure user’s safety. To effectively estimate the NMES-induced muscle fatigue, this paper proposes a novel state observer that combines a mathematical predictive fatigue model and intermittent feedback from ultrasound-derived strain images. The strain images quantify muscle contractility during NMES. Principal component regression (PCR) is used to derive a relationship between the strain images and instantaneous muscle force production. Lyapunov stability analysis was performed to obtain the convergence property of the designed observer. A globally uniformly ultimately bounded (GUUB) result was obtained. Simulations based on pre-recorded data from a human experiment were also conducted to demonstrate the performance of the designed observer.

A Financial Chaotic System Control Method Based on Intermittent Controller

Finance is the core of modern economy. The security and stability of the financial system is the key to stable economic and social development. During the operation of the financial system, financial chaos such as the severe turbulence of the financial market and the financial crisis occurred due to deterministic instability, which brought a great negative impact on economic growth and social stability. For the financial chaotic system, an intermittent feedback controller is designed in this paper. By adjusting the controller parameters, the financial system can be controlled from chaotic to periodic evolution. First, the dynamic equations and controllers of the financial system are analyzed and the range of values of the controller parameters is theoretically obtained. Then, the influence of parameters on the system is studied, and the feasibility of the proposed method is proved by numerical simulation. Finally, the practical significance of the controller on the macrocontrol of the financial crisis is discussed. It is theoretically proven that when the financial crisis comes, the financial system can be stabilized more quickly through appropriate control methods.