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EDUCATION
Year : 2002  |  Volume : 18  |  Issue : 2  |  Page : 213-218
 

"The stepladder approach" for education in laparoscopic surgery and an action plan for laparoscopic surgery education in Indian urology


Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

Correspondence Address:
Santosh Kumar
Department of Urology, JIPMER, Pondicherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

Attention is being paid to the education in laparoscopic urological surgery which has become an important treat­ment method. This article briefly describes the challenges of different types of surgeries and the basic concepts of educational process. "The Stepladder Approach" for laparoscopic surgery education is suggested and its two components "The Stepladder of Educational Objectives" and "The Stepladder of Educational Experiences" are described along with the examples of evaluation meth­ods. Finally, an action plan for laparoscopic surgery edu­cation in Indian urology is suggested.


Keywords: Stepladder Approach; Education; Laparoscopic Surgery


How to cite this article:
Kumar S. "The stepladder approach" for education in laparoscopic surgery and an action plan for laparoscopic surgery education in Indian urology. Indian J Urol 2002;18:213-8

How to cite this URL:
Kumar S. "The stepladder approach" for education in laparoscopic surgery and an action plan for laparoscopic surgery education in Indian urology. Indian J Urol [serial online] 2002 [cited 2019 Oct 15];18:213-8. Available from: http://www.indianjurol.com/text.asp?2002/18/2/213/37651



   Introduction Top


Laparoscopic surgery has come to stay in urology and attention is being paid to imparting education in laparo­scopic urological surgery. [1],[2],[3],[4] This article briefly describes the challenges of different types of surgeries and the basic concepts of educational process. "The Stepladder Approach" for education in laparoscopic surgery is sug­gested and its two components "The Stepladder of Edu­cational Objectives" and "The Stepladder of Educational Experiences" are described along with the examples of evaluation methods. Finally, an action plan for laparoscopic surgery education in Indian urology is sug­gested.


   I. The Challenges of Different Types of Surgeries Top


Different types of surgeries require different tactile, manipulative and visual skills of the surgeon [Table - 1]. These skill requirements become more and more com­plex from open surgery through transurethral surgery, ureterorenoscopic surgery, percutaneous renal surgery, laparoscopic surgery and robotic surgery making the performance of these surgeries more and more complicated from the view point of technology as well as surgeon's skills.


   II. The Basic Concepts of Educational Process Top


Education is a process the chief goal of which is to bring about desirable changes in the behaviour of the learner. [5] The term "behaviour" in general English means deportment, manners or way of conducting oneself [6] but in educational science it has a wider meaning and it includes ways of think­ing, feeling and doing. Furthermore, the behaviour of the learner is defined in the form of educational objectives.

Educational process consists of the three components of educational objectives, educational experiences and evalu­ation methods [Figure - 1]. These three components, which are interconnected and interrelated by feedback, are defined and described later with examples from the field of urological laparoscopic surgery.

Educational objectives are statements which describe what the learners should be able to do at the end of a learning period that they could not do beforehand. [5] Educational ob­jectives define what the learner should be able to do. Hence they are also called learning objectives.

Teaching objective

The teacher should be able to teach the learners how to perform basic laparoscopic surgeries in urology.

Learning objective

At the end of MCh (Urology) course, the learners should be able to perform basic laparoscopic surgeries in urology.

Educational objectives should always be written as learn­ing objectives and not as teaching objectives because learn­ing objectives exactly tell the learners what they are expected to learn.


   III. 'The Stepladder Approach' Top

"The Stepladder Approach" for education in laparoscopic surgery is suggested. "The Stepladder Approach" is designed to facilitate the learning of laparoscopic surgery in system­atic, step-wise and orderly fashion. "The Stepladder Ap­proach" is based on well-known principles of education in which a complex learning task is divided into smaller tasks which are then arranged in a simple to complex order to facilitate learning. [7] "The Stepladder Approach" consists of "The Stepladder of Educational Objectives" and "The Step­ladder of Educational Experiences".


   IV. 'The Stepladder of Educational Objectives' Top

"The Stepladder of Educational Objectives" in laparo­scopic urological surgery is given in [Figure - 2]. Under Objective 1, learners should be able to create pneumoperi­toneum, insert laparoscopic ports, remove these ports and close port sites. Under Objective 2, learners should be able to identify normal urinary and male genital structures, their anatomical relations and their abnormalities and diseases during laparoscopy. Under Objective 3, learners should be able to perform various operative manipulations such as tissue fixation, tissue dissection, tissue apposition and closure, tissue retrieval, hemostasis and vascular control. Under Objective 4, learners should be able to perform basic laparoscopic surgeries such as orchiopexy, unroofing of simple renal cyst and simple nephrectomy for small nonfunctioning kidney. Under Objective 5, learners should be able to perform advanced laparoscopic surgeries such as simple nephrectomy for benign diseases.
"The Stepladder Approach" requires that learners start at the first step (Objective 1) and they move to the next higher step only when they have demonstrated desired competence in the performance of the first step on an ap­propriate evaluation.


   V. 'The Stepladder of Educational Experiences' Top

"The Stepladder of Educational Experiences" in laparoscopic urological surgery is given in [Figure - 3]. "The Stepladder Approach" requires that for each "Educational Objective of the Stepladder" learners start at the first step and they move to the next higher step only when they have demonstrated desired competence in the perform­ance of the first step on an appropriate evaluation. Thus for each "Educational Objective of the Stepladder" the entire "Stepladder of the Educational Experiences' is to be used appropriately. However, for some "Educational Objectives of the Stepladder" some "Educational Experi­ences of the Stepladder" may not be necessary.


   VI. Evaluation Methods Top


Evaluation methods for various "Educational Objectives of the Stepladder" usually consist of checklists enumerat­ing various sequential steps of the procedure. Each step is assessed for its satisfactory performance. As an example, [Table - 2] gives a checklist for the evaluation of the proce­dure of creating pneumoperitoneum. [8] In another exam­ple, [Table - 3] gives a checklist for the evaluation of the procedure of transperitoneal laparoscopic unroofing of simple renal cyst. [8]


   VII. An Action Plan for Laparoscopic Surgery Education in Indian Urology Top


An action plan for education in laparoscopic urological surgery in Indian urology is given in [Table - 4]. All MCh (or DNB) training centres should have facilities for laparo­scopic surgery. Regional laparoscopic surgery centres should perform advanced laparoscopic surgery and should also have facilities of advanced endotrainers, virtual real­ity and animal laboratory.

 
   References Top

1.Cadeddu JA, Wolfe JS, Nakada S, et al. Complications of laparo­scopic procedures after concentrated training in urological laparo­scopy. Journal of Urology 2001; 166: 2109-2111.  Back to cited text no. 1    
2.Traxer O, Gettman MT, Napper CA, et al. The impact of intense laparoscopic skills training on the operative performance of urol­ogy residents. Journal of Urology 2001; 166: 1658-1661.  Back to cited text no. 2    
3.Rosser JC Jr, Murayama M. Gabriel NH. Minimally invasive surgi­cal training solutions for the twenty-first century. Surgical Clinics of North America 2000; 80: 1607-1624.  Back to cited text no. 3    
4.Bhandari M, Rao HSG. Training and credentials in urology. In Hema AK, ed, Laparoscopic Urologic Surgery. New Delhi : BI Churchill Livingstone Pvt Ltd. 2000; 303-307.  Back to cited text no. 4    
5.Guilbert JJ. Educational Handbook for Health Professional. Geneva :World Health Organisation, 1981.  Back to cited text no. 5    
6.The Concise Oxford Dictionary of Current English. Sixth Edition. Delhi : Oxford University Press, 1980.  Back to cited text no. 6    
7.Anderson LW, Block JH. Mastery learning model of teaching and learning. In : International Encyclopaedia of Education. London Pergamon Press, 1985.  Back to cited text no. 7    
8.Winfield HN. Laparoscopic surgery. In : Tanagho EA, McAninch JW, eds, Smith's General Urology. Fifteenth Edition. New York Lange Medical Books/McGraw-Hill, 2000; 146-182.  Back to cited text no. 8    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]

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    Abstract
    Introduction
    I. The Challenge...
    II. The Basic Co...
    III. 'The Stepla...
    IV. 'The Steplad...
    V. 'The Stepladd...
    VI. Evaluation M...
    VII. An Action P...
    References
    Article Figures
    Article Tables

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