She didn鈥檛 know it at the time, but when Elif Bilgic answered a 91社区 classified ad in 2012 looking for participants to take part in a skills acquisition study led by Dr. Melina Vassiliou, this marked the beginning of her longstanding relationship with the Steinberg-Bernstein Centre for Minimally Invasive Surgery (MIS Lab) at the Montreal General Hospital. Elif was studying anatomy and cell biology at 91社区; she had a strong interest in medicine and was looking for opportunities to get involved in areas of research that extended beyond basic science. When the study ended, Elif contacted Drs. Melina Vassiliou and Liane Feldman, expressing a desire to do research at the MIS Lab. 鈥淭hey were very open and encouraged me to learn more about what they were doing,鈥� says Elif. 鈥淚 think I just kind of fell in love with the research I was doing and the people I was surrounded by. It meant a lot to me.鈥�
Elif continued to be involved in many educational research projects at the MIS Lab and the Henry K.M. de Kuyper Education Centre in the ensuing years. She finished her Bachelor鈥檚 degree and then completed a PhD in Experimental Surgery where her research focused on the assessment of laparoscopic suturing skills.
As she explains, 鈥淢edical students first learn open suturing. This method offers a pretty good range of motion, with your hands and wrist providing 360掳 maneuverability. But this is limited in laparoscopic surgery, which involves using long instruments and looking through a camera that shows on the monitors. You鈥檙e working with a 3D area but looking at a 2D monitor, so there are issues with depth perception. There is a lack of dexterity that requires more experience and exposure to master.鈥�
There are many different simulation tools and models that can be used to practice laparoscopic suturing鈥攊ncluding ex vivo animal tissues, augmented virtual reality with added haptics, cadavers and live anesthetized animals鈥攂ut inanimate models are often the most cost-effective. 鈥淵ou don鈥檛 always need a high-fidelity model to teach the skill,鈥� emphasized Elif. 鈥淪imulation training is an adjunct to their exposure, designed to help the learners, not to replace their clinical exposure. If, in simulation, they can be exposed to advanced laparoscopic surgery techniques, we can help them learn when to change the angle of a needle, how to penetrate a tissue properly, how to do suturing when the tissue is under tension. If they already know how to do this in the OR, they can focus on other aspects of the operation that are more difficult to teach through simulation.鈥�
Assessment drives learning
鈥淎 lot of our focus has been on suturing because that was identified as one of the main skills required in the OR that could benefit from simulation training. As part of the 91社区 team, we developed advanced suturing tasks to better reflect the complexities of the current operations. Our goal is to use these platforms for assessment and training purposes. The tasks are one component, an instrument to teach and learn, but if you don鈥檛 know how to assess or what to look for within the performance, it鈥檚 hard to actually improve,鈥� stresses Elif. 鈥淎ssessment is a big part in all simulation work. The more proof we have that something works, the more likely it is that people are going to understand the value of it. That鈥檚 where research comes in, and it takes years to build this.鈥�
Evolving needs require updated training methods
Elif is currently completing a postdoctoral fellowship at 91社区鈥檚 Steinberg Centre for Simulation and Interactive Learning under the supervision of MIS pioneer Dr. Gerald Fried, Edward W. Archibald Professor and Chairman of the Department of Surgery at 91社区, and Surgeon-in-Chief of the 91社区 Health Centre. Dr. Fried established minimally invasive surgery as a clinical and academic program at 91社区 in 1990. Over the years, he and his colleagues have made significant advances towards the training of surgeons and the process of introducing innovation into clinical practice.
As Dr. Fried explains, 鈥淔or over a century, surgery was taught by the apprenticeship model whereby surgeons learned by practicing on patients. The introduction of minimally invasive surgery not only transformed clinical care but allowed us to redesign our educational paradigm. The use of simulation-based training and verification that the learner has actually achieved the learning goals through reliable and valid measures of performance have improved the efficiency of learning and enhanced patient safety. Elif has identified an unmet learning need, advanced laparoscopic suturing, and developed a simulation curriculum and performance measures to address this need. Her work will be extremely valuable by ensuring that all surgeons will be capable of suturing using laparoscopic tools and can apply these skills in challenging situations.鈥�
Research takes time
For anyone who is interested in pursuing a career in research, Elif wants them to know that research takes time: 鈥淵ou need time to learn, to figure out your objectives and the area you want to focus on, to figure out your methodology, to talk to the right people, to conduct the study. Residents, faculty and students all have big time constraints; it鈥檚 not easy to get them to participate. You need to build a connection with them, to encourage participation. It takes a lot of time and work before you can publish. Some people feel down because it takes a long time, but that鈥檚 normal. Eventually it will happen. You just have to be patient. That鈥檚 what I learned. I think also you need to like what you鈥檙e doing, the area you鈥檙e working in. You鈥檒l work more passionately and do a much better job if you like what you do.鈥�
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