Roger Kneebone - Academia.edu (original) (raw)
Papers by Roger Kneebone
Journal of surgical education
Leadership is particularly important in complex highly interprofessional health care contexts inv... more Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of "The Burns Suite" (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS. A total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen's κ co...
Chapter in 'Communication in Surgical Practice', S. White & J. Cartmill, (Eds.) Equinox Publishin... more Chapter in 'Communication in Surgical Practice', S. White & J. Cartmill, (Eds.) Equinox Publishing, 2016.
Quality and Safety in Health Care
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
A case of primary amyloidosis presenting as a goitre is reported. The clinical features of amyloi... more A case of primary amyloidosis presenting as a goitre is reported. The clinical features of amyloid goitre are described and the difficulties in making a pre-operative diagnosis are discussed. A plan of management for this rare thyroid condition is suggested.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
ABSTRACT
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
Twelve cases of dermatofibrosarcoma protuberans in Black patients admitted to Baragwanath Hospita... more Twelve cases of dermatofibrosarcoma protuberans in Black patients admitted to Baragwanath Hospital, Johannesburg, between 1979 and 1983 are reviewed. The cause of this slow-growing, low-grade malignant fibrous histiocytoma is unknown, but there is some evidence that trauma may be a predisposing factor. The clinical and histological features of dermatofibrosarcoma protuberans are described, and treatment by wide tridimensional excision with local reconstruction is recommended.
Studies in health technology and informatics
The use of simulation in the training and assessment of procedural skills is widely acknowledged ... more The use of simulation in the training and assessment of procedural skills is widely acknowledged as a powerful and necessary alternative to the traditional apprenticeship model. However advanced, simulation on its own cannot provide the necessary conditions for holistic practice. The Integrated Procedural Performance Instrument presented in this paper combines simulated patients (SPs) with inanimate models, items of medical equipment or computer generated virtual models to recreate a panel of realistic scenarios, each addressing a combination of technical and non-technical clinical challenges. The result is a safe yet authentic clinical context which can be used for training and assessment. This novel use of simulation provides a patient-centred, learner-focused approach that builds up a composite picture of technical skills, communication skills and professional behaviours across a range of challenging clinical situations.
Journal of Advanced Nursing, 2015
To observe the extent and the detail with which playing music can impact on communication in the ... more To observe the extent and the detail with which playing music can impact on communication in the operating theatre. According to the cited sources, music is played in 53-72% of surgical operations performed. Noise levels in the operating theatre already exceed World Health Organisation recommendations. There is currently a divide in opinions on the playing of music in operating theatres, with few studies conducted and no policies or guidance provided. An ethnographic observational study of teamwork in operating theatres through video recordings. Quantitative and qualitative data analysis approaches were used. This study was conducted between 2012-2013 in the UK. Video recordings of 20 operations over six months in two operating theatres were captured. The recordings were divided into music and non-music playing cases. Each case was logged using a request/response sequence identified through interactional analysis. Statistical analysis, using a χ(2) , explored the difference between the proportion of request repetitions and whether music was playing or not. Further interactional analysis was conducted for each request repetition. Request/response observations (N = 5203) were documented. A chi-square test revealed that repeated requests were five times more likely to occur in cases that played music than those that did not. A repeated request can add 4-68 seconds each to operation time and increased tensions due to frustration at ineffective communication. Music played in the operating theatre can interfere with team communication, yet is seldom recognized as a potential safety hazard. Decisions around whether music is played and around the choice of music and its volume, are determined largely by surgeons. Frank discussions between clinicians, managers, patients and governing bodies should be encouraged for recommendations and guidance to be developed.
British Journal of Surgery
Exploring the historical roots of our profession can help us understand how current procedures an... more Exploring the historical roots of our profession can help us understand how current procedures and practices have come about. Such exploration can unearth ideas from the past that were side-lined or overlooked due to changing needs and priorities, but which might fit the needs of today. And as we have recently discovered, there is nothing new under the sun.
Simulation In Healthcare: The Journal of the Society for Simulation in Healthcare, 2007
Simulation In Healthcare: The Journal of the Society for Simulation in Healthcare, 2007
Simulation In Healthcare: The Journal of the Society for Simulation in Healthcare, 2007
Simulation In Healthcare: The Journal of the Society for Simulation in Healthcare, 2007
Journal of burn care & research : official publication of the American Burn Association, Jan 28, 2015
Educational theory highlights the importance of contextualized simulation for effective learning.... more Educational theory highlights the importance of contextualized simulation for effective learning. The authors recently published the concept of "The Burns Suite" (TBS) as a novel tool to advance the delivery of burns education for residents/clinicians. Effectively, TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. Recently, simulation-based team training (SBTT) has been advocated as a means to improve interprofessional practice. The authors aimed to explore the role of TBS in SBTT. A realistic pediatric burn resuscitation scenario was designed on "advanced trauma and life support" and…
Academic Medicine, 2015
The authors aimed to map and explicate what surgeons perceive they learn in the operating room. T... more The authors aimed to map and explicate what surgeons perceive they learn in the operating room. The researchers used a grounded theory method in which data were iteratively collected through semistructured one-to-one interviews in 2010 and 2011 at four participating hospital sites. A four-person data analysis team from differing academic backgrounds qualitatively analyzed the content of the transcripts employing an immersion/crystallization approach. Participants were 22 UK surgeons, some of whom were in training at the time of the study and some of whom were attending surgeons. Major themes of learning in the operating room were perceived to be factual knowledge, motor skills, sensory semiosis, adaptive strategies, team working and management, and attitudes and behaviors. The analysis team classified 277 data points (short paragraphs or groups of sentences conveying meaning) under these major themes and subthemes. A key component of learning in the operating room that emerged from these data was sensory semiosis, defined as learning to make sense of visual and haptic cues. Although the authors found that learning in the operating room occurred across a wide range of domains, sensory semiosis was found to be an important theme that has not previously been fully acknowledged or discussed in the surgical literature. The discussion draws on the wider literature from the social sciences and cognitive psychology literature to examine how professionals learn to make meaning from "signs" making parallels with other medical specialties.
Journal of Surgical Education, 2015
Journal of Endourology
INTRODUCTION AND OBJECTIVES: Simulators within ureteroscopy have extensive validation evidence an... more INTRODUCTION AND OBJECTIVES: Simulators within ureteroscopy have extensive validation evidence and can now be integrated within a formalised curriculum. Additionally, non-technical skills are a common cause for error in the operating room and can also be developed via simulation. This study therefore aimed to: 1. To develop a ureteroscopy curriculum, integrating both technical and non-technical skills teaching. 2. Validate the developed curriculum terms of feasibility, acceptability, content validity and educational impact. METHODS: Curriculum development and content validation was conducted via Delphi methodology until a saturation of information was achieved. Novice medical students were then recruited (n=32) for a randomised control trial for validation. The intervention cohort completed the simulation-based curriculum; this group and the control cohort subsequently underwent assessment within a full immersion environment. Outcome measures included time to completion, OSATS score...
Journal of surgical education
Leadership is particularly important in complex highly interprofessional health care contexts inv... more Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of "The Burns Suite" (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS. A total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen's κ co...
Chapter in 'Communication in Surgical Practice', S. White & J. Cartmill, (Eds.) Equinox Publishin... more Chapter in 'Communication in Surgical Practice', S. White & J. Cartmill, (Eds.) Equinox Publishing, 2016.
Quality and Safety in Health Care
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
A case of primary amyloidosis presenting as a goitre is reported. The clinical features of amyloi... more A case of primary amyloidosis presenting as a goitre is reported. The clinical features of amyloid goitre are described and the difficulties in making a pre-operative diagnosis are discussed. A plan of management for this rare thyroid condition is suggested.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
ABSTRACT
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
Twelve cases of dermatofibrosarcoma protuberans in Black patients admitted to Baragwanath Hospita... more Twelve cases of dermatofibrosarcoma protuberans in Black patients admitted to Baragwanath Hospital, Johannesburg, between 1979 and 1983 are reviewed. The cause of this slow-growing, low-grade malignant fibrous histiocytoma is unknown, but there is some evidence that trauma may be a predisposing factor. The clinical and histological features of dermatofibrosarcoma protuberans are described, and treatment by wide tridimensional excision with local reconstruction is recommended.
Studies in health technology and informatics
The use of simulation in the training and assessment of procedural skills is widely acknowledged ... more The use of simulation in the training and assessment of procedural skills is widely acknowledged as a powerful and necessary alternative to the traditional apprenticeship model. However advanced, simulation on its own cannot provide the necessary conditions for holistic practice. The Integrated Procedural Performance Instrument presented in this paper combines simulated patients (SPs) with inanimate models, items of medical equipment or computer generated virtual models to recreate a panel of realistic scenarios, each addressing a combination of technical and non-technical clinical challenges. The result is a safe yet authentic clinical context which can be used for training and assessment. This novel use of simulation provides a patient-centred, learner-focused approach that builds up a composite picture of technical skills, communication skills and professional behaviours across a range of challenging clinical situations.
Journal of Advanced Nursing, 2015
To observe the extent and the detail with which playing music can impact on communication in the ... more To observe the extent and the detail with which playing music can impact on communication in the operating theatre. According to the cited sources, music is played in 53-72% of surgical operations performed. Noise levels in the operating theatre already exceed World Health Organisation recommendations. There is currently a divide in opinions on the playing of music in operating theatres, with few studies conducted and no policies or guidance provided. An ethnographic observational study of teamwork in operating theatres through video recordings. Quantitative and qualitative data analysis approaches were used. This study was conducted between 2012-2013 in the UK. Video recordings of 20 operations over six months in two operating theatres were captured. The recordings were divided into music and non-music playing cases. Each case was logged using a request/response sequence identified through interactional analysis. Statistical analysis, using a χ(2) , explored the difference between the proportion of request repetitions and whether music was playing or not. Further interactional analysis was conducted for each request repetition. Request/response observations (N = 5203) were documented. A chi-square test revealed that repeated requests were five times more likely to occur in cases that played music than those that did not. A repeated request can add 4-68 seconds each to operation time and increased tensions due to frustration at ineffective communication. Music played in the operating theatre can interfere with team communication, yet is seldom recognized as a potential safety hazard. Decisions around whether music is played and around the choice of music and its volume, are determined largely by surgeons. Frank discussions between clinicians, managers, patients and governing bodies should be encouraged for recommendations and guidance to be developed.
British Journal of Surgery
Exploring the historical roots of our profession can help us understand how current procedures an... more Exploring the historical roots of our profession can help us understand how current procedures and practices have come about. Such exploration can unearth ideas from the past that were side-lined or overlooked due to changing needs and priorities, but which might fit the needs of today. And as we have recently discovered, there is nothing new under the sun.
Simulation In Healthcare: The Journal of the Society for Simulation in Healthcare, 2007
Simulation In Healthcare: The Journal of the Society for Simulation in Healthcare, 2007
Simulation In Healthcare: The Journal of the Society for Simulation in Healthcare, 2007
Simulation In Healthcare: The Journal of the Society for Simulation in Healthcare, 2007
Journal of burn care & research : official publication of the American Burn Association, Jan 28, 2015
Educational theory highlights the importance of contextualized simulation for effective learning.... more Educational theory highlights the importance of contextualized simulation for effective learning. The authors recently published the concept of "The Burns Suite" (TBS) as a novel tool to advance the delivery of burns education for residents/clinicians. Effectively, TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. Recently, simulation-based team training (SBTT) has been advocated as a means to improve interprofessional practice. The authors aimed to explore the role of TBS in SBTT. A realistic pediatric burn resuscitation scenario was designed on "advanced trauma and life support" and…
Academic Medicine, 2015
The authors aimed to map and explicate what surgeons perceive they learn in the operating room. T... more The authors aimed to map and explicate what surgeons perceive they learn in the operating room. The researchers used a grounded theory method in which data were iteratively collected through semistructured one-to-one interviews in 2010 and 2011 at four participating hospital sites. A four-person data analysis team from differing academic backgrounds qualitatively analyzed the content of the transcripts employing an immersion/crystallization approach. Participants were 22 UK surgeons, some of whom were in training at the time of the study and some of whom were attending surgeons. Major themes of learning in the operating room were perceived to be factual knowledge, motor skills, sensory semiosis, adaptive strategies, team working and management, and attitudes and behaviors. The analysis team classified 277 data points (short paragraphs or groups of sentences conveying meaning) under these major themes and subthemes. A key component of learning in the operating room that emerged from these data was sensory semiosis, defined as learning to make sense of visual and haptic cues. Although the authors found that learning in the operating room occurred across a wide range of domains, sensory semiosis was found to be an important theme that has not previously been fully acknowledged or discussed in the surgical literature. The discussion draws on the wider literature from the social sciences and cognitive psychology literature to examine how professionals learn to make meaning from "signs" making parallels with other medical specialties.
Journal of Surgical Education, 2015
Journal of Endourology
INTRODUCTION AND OBJECTIVES: Simulators within ureteroscopy have extensive validation evidence an... more INTRODUCTION AND OBJECTIVES: Simulators within ureteroscopy have extensive validation evidence and can now be integrated within a formalised curriculum. Additionally, non-technical skills are a common cause for error in the operating room and can also be developed via simulation. This study therefore aimed to: 1. To develop a ureteroscopy curriculum, integrating both technical and non-technical skills teaching. 2. Validate the developed curriculum terms of feasibility, acceptability, content validity and educational impact. METHODS: Curriculum development and content validation was conducted via Delphi methodology until a saturation of information was achieved. Novice medical students were then recruited (n=32) for a randomised control trial for validation. The intervention cohort completed the simulation-based curriculum; this group and the control cohort subsequently underwent assessment within a full immersion environment. Outcome measures included time to completion, OSATS score...
Medical simulation has historically been studied in terms of the delivery of learning outcomes, o... more Medical simulation has historically been studied in terms of the delivery of learning outcomes, or the social construction of knowledge. Consequently, simulation-based medical education has been researched primarily in terms of the transfer of skills, or the reproduction of professional communities of practice. We make a case for studying simulation-based medical education as a cultural practice, situating it within a history of gaming and simulation, and which, by virtue of distinctive aesthetics, does not simply teach skills or reproduce professional practices but rather transforms how medicine can be made sense of. Three concepts from the field of game studies – play, narrative and simulation – are deployed to interpret an ethnographic study of hospital-based simulation centres and describe under-reported phenomena, including the cooperative work involved in maintaining a fictional world, the narrative conventions by which medical intervention are portrayed, and the political consequences of simulating the division of labour.
Medicine is increasingly taught in immersive simulated environments, to supplement the apprentice... more Medicine is increasingly taught in immersive simulated environments, to supplement the apprenticeship model of work-based learning. Clinical research on this educational practice focuses on its realism, defined as a property of simulation technology. We treat realism as a function of subjective but collectively organised perception and imbued with fantasy, which we define by drawing on Lacanian studies of virtual reality and workplace organisation. Data from an observational study of four simulation centres in London teaching hospitals is drawn on to present an account of what was taught and learned about medicine, including medical failure, when medical practice was simulated.