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© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 313–314 313 313 The view from here Early specialty courses and the spiral of learning Philip McElnay, Education Centre, Bristol Royal Infirmary, Bristol, UK T he ‘spiral of learning’ employed in medical education involves revisit- ing topics on a number of occasions. On each occasion, the complexity of the topic increases and a student’s understanding deepens. 1 This concept is employed between the Foundation Skills in Surgery (FSS) course, coordinated by the Association of Surgeons in Training, and the Intercollegiate Basic Surgical Skills (BSS) course, coordinated by the Royal College of Surgeons. The former I attended as a medical student, and the latter as a junior doctor. Both courses consist of small group sessions. Both discuss basic knowledge of sutures, drains and instruments. Both have practical sessions, allowing candidates to practise hand and instrument ties, simulated excision of cysts and suturing skills on animal models. Yet, despite their similarities the two courses are aimed at two different levels of experi- ence, and were two distinct points on my spiral of learning. Studies have demonstrated that introducing medical students to concepts and skills required in surgery at an early stage in their career have positive outcomes: they have a more constructive experience of their surgical placement, 2 and their ability to perform simple surgical proce- dures is improved. 3 This was certainly the case for me. I had no surgical knowledge prior to attending the FSS course, but it provided me with the basic knowledge and skills I needed to attend theatre as a medical student. Having physically practised hand tying on a skin model, I was able to understand the steps undertaken by the highly skilled senior surgeons operating in front of me. I didn’t spend half an hour learning how to scrub when I went to theatre, because I had practised it in a simulated environment. As such I was able to not only observe, but to participate in all stages of the operation. My spiral began with the FSS course. The faculty members were patient in helping me to develop a basic understanding of surgical reasoning. I could then use the experiences around me in hospital as learning opportuni- ties instead of being stumped by initial simple concepts. My spiral of surgical skill, experience and knowledge continued to deepen. The BSS course, which I attended 5 years later, had a similar format and thus acted as a further steep learning curve on my spiral of learning. After 4 years of experience between the courses and innumerable learning opportunities, I was able to quickly consolidate the basics The ’spiral of learning’ employed in medical education involves revisiting topics on a number of occasions

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Page 1: Early specialty courses and the spiral of learning

© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 313–314 313313

The view from here

Early specialty courses and the spiral of learning Philip McElnay , Education Centre , Bristol Royal Infi rmary , Bristol, UK

The ‘spiral of learning’ employed in medical education involves revisit-

ing topics on a number of occasions. On each occasion, the complexity of the topic increases and a student ’ s understanding deepens. 1 This concept is employed between the Foundation Skills in Surgery (FSS) course, coordinated by the Association of Surgeons in Training, and the Intercollegiate Basic Surgical Skills (BSS) course, coordinated by the Royal College of Surgeons. The former I attended as a medical student, and the latter as a junior doctor.

Both courses consist of small group sessions. Both discuss basic knowledge of sutures, drains and instruments. Both have practical sessions, allowing candidates to practise hand and instrument ties, simulated excision of cysts and suturing skills on animal models.

Yet, despite their similarities the two courses are aimed at two different levels of experi-ence, and were two distinct points on my spiral of learning. Studies have demonstrated that introducing medical students to concepts and skills required in surgery at an early stage in their career have positive outcomes: they have a more constructive experience of their surgical placement, 2 and their ability to perform simple surgical proce-dures is improved. 3 This was certainly the case for me. I had no surgical knowledge prior to attending the FSS course, but it provided me with the basic knowledge and skills I needed to attend theatre as a medical student. Having physically practised hand tying on a skin model, I was able to understand the steps undertaken by the highly skilled senior surgeons operating in front of me. I didn ’ t spend half an hour learning how

to scrub when I went to theatre, because I had practised it in a simulated environment. As such I was able to not only observe, but to participate in all stages of the operation.

My spiral began with the FSS course . The faculty members were patient in helping me to develop a basic understanding of surgical reasoning. I could then use the experiences around me in hospital as learning opportuni-ties instead of being stumped by initial simple concepts. My spiral of surgical skill, experience and knowledge continued to deepen .

The BSS course, which I attended 5 years later, had a similar format and thus acted as a further steep learning curve on my spiral of learning . After 4 years of experience between the courses and innumerable learning opportunities, I was able to quickly consolidate the basics

The ’spiral of learning’ employed in medical education involves revisiting topics on a number of occasions

tct_12111.indd 313tct_12111.indd 313 5/23/2014 3:09:31 PM5/23/2014 3:09:31 PM

Page 2: Early specialty courses and the spiral of learning

314 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 313–314

being taught and focus on more complex procedures.

My only criticism is that it is not widely publicised that the courses work synergistically. Like many junior doctors, I learn from experience and I am grateful that an educationally focused surgeon encouraged me to go on a course as early as second year at medical school. It has trans-formed the way I have learned and continue to learn. (This also goes to show that you should listen to your mentor – another great resource in surgical education!)

Early attendance at such courses can really kick-start a spiral of learning that will

continue throughout a doctor ’ s life.

REFERENCES

1 . Harden RM. What is a spiral curricu-lum? Med Teach 1999 ; 21 : 141 – 143 .

2 . Antiel RM , Thompson SM , Camp CL , Thompson GB , Farley DR. Attracting students to surgical careers: pre-clinical surgical experience . J Surg Educ 2012 ; 69 : 301 – 305 .

3 . Davis CR , O ’ Donoghue JM , McPhail J , Green AR. How to improve plastic surgery knowledge, skills and career interest in undergraduates in one day . J Plast Reconstr Aesthet Surg 2010 ; 63 : 1677 – 1681 .

Corresponding author ’ s contact details: Dr. Philip McElnay , Education Centre, Bristol Royal Infi rmary, Upper Maudlin Street, Bristol, BS2 8HW, UK. E-mail: [email protected]

Funding : None.

Confl ict of interest : None.

Ethical approval : Ethics approval has not been sought. No study has been carried out.

doi: 10.1111/tct.12111

Early attendance at such courses

can really kick-start a

spiral of learning that will continue throughout a doctor’s life

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