MHealth for Teaching Neurotrauma Skills

1. What surgical psychomotor skills does your project aim to teach and to whom?

We aim to teach the surgical skill Burr Holes, for Head Trauma Management as part of the cranial opening surgery aiming to teach all surgeons and emergency personnel around the world.

2. What are the key features of your surgical training module?

The innovative training module for this project will be able to drive the users via an App in a step-by-step guided assessment process in order to master the procedure. The simulation technique will support users in developing mental (imagination, automatism, and strategy skills) and manual (automatism, dexterity, and speed) skills through Apps that can be easily distributed and managed even from home. The Apps, through its Augmented Reality functions, will guide the user in his/her learning experience and then, after the assessment, they will even be able to take it to practice, the operating room. 
Our App will be distilled to its simplest essence so that it can be applied in any scenario, from home, in a hospital, or a training facility (medical school). Over and over again.

3. How do you plan to do self-assessment as part of your surgical training module?

Checklists validated from international neurotrauma curricula will be used. For self-regulated learning to be effective, students need to be able to accurately assess their own performance on a learning task and use this assessment for the selection of a new learning task. The App will also be tailored to this need.
The mechanism for targeted feedback is included in the step by step process of the App which will enable the user to: ensure they are practicing the appropriate skills, modify their performance to improve competence, and determine when they have practiced to a sufficient level of mastery to perform the procedure.

It is an app functioning on mobiles even in less developed phones, no Wi-Fi needed. The procedure will be shown in augmented reality, over imposing the head of the patient in the (virtual) operating room, presenting a step by step procedure. The procedure as such allows also for the inclusion of follow up procedures.

The App will offer a 360-degree education around the procedure. It will include a preoperative list of tools, skin incisions, skull - and dural access, bleeding control, and closure steps.

After completing the training, practitioners will be able to:

• Recognize the surgical anatomy related to the procedure.
• Recognize the surgical instruments needed for the procedure.
• Recognize the surgical theater setting for the procedure.
• Recognize the basic surgical information to perform the procedure (preparation of the patient, disinfection, anesthesiology setting, skin preparation and incision, skin, muscles, and bone flap preservation during the procedure). 
• Recognize the technical difficulties and the possible mistakes related to the procedure.
• Recognize the importance to perform the procedure step by step in order to avoid mistakes.
• Recognize how to modify the approach and what kind of advantage can be obtained by this change.
• Recognize published research related to the procedure and assess advantages and different indications.
• Use appropriate decision-making skills.

The procedure as such allows also for the inclusion of follow-up procedures.

Traumatic Brain Injury (TBI) occurs when a sudden trauma causes damage to the brain, it is a major health problem and the leading cause of death and disability worldwide which has a large economic impact. It can affect anyone, anywhere, causing death and changing lives forever. TBI is a huge burden, especially in LMICS. There are around 49,940 neurosurgeons in the world and Traumatic Brain Injury (TBI) forms 60% of their workload.

Around 69 million people suffer from TBI every year. The vast majority are in LMICs, where 85% of the world’s population lives. The healthcare systems in LMICs have to deal with nearly three times as many cases as those in HICs. The limited data that exists suggests that LMIC patients have over twice the odds of dying following severe traumatic brain injury in addition to a greater degree of disability, making it increasingly important that adequate resources are devoted to neurosurgical care.

Teaching basic emergency surgical procedures to practitioners in these regions of the world is an important opportunity to fill the gaps in essential global surgical education.

This project addresses the above problem and focuses on emergency management of patients with TBI. The death of many patients - who are with clinical features of high intracranial pressure and in need of urgent management - will be avoided. During the Burr Hole procedure, one or more small holes are drilled in the skull to drain the hematoma. Contrary to what is believed, it is a very simple procedure that potentially all surgeons or primary physicians can perform. Hence, many lives can be saved if all surgeons receive this kind of education on how to perform that and are taught decision-making skills relative to neurotrauma.

An innovative feature of this project is that it is crossing the "specialty borders" as this procedure is usually only practiced by neurosurgeons. This project involves training other surgeons and emergency personnel with little or none past exposure to neurotrauma procedures. Potential users will include basic and advanced health providers taking care of acutely injured patients in different levels of resource settings (technicians, nurses, general physicians, residents, clinical - and surgical specialists).

This project has the potential to save many lives by preparing these health providers to do a basic transient surgical process before generating a referral process for definitive management.

Andres M. Rubiano (Clinician / Educator) Cali - Colombia - Meditech Foundation. MEDITECH, is a foundation for Medical / Technical Education & Research in Emergency and Disaster Healthcare. With its previous work in many constrained resources environments it has created a better understanding of what is already required.

Federico Nicolosi (Technical Expert / Clinician) Brescia - Italy - UpSurgeOn, Paolo Raimondo (Technical Expert) Brescia - Italy - UpSurgeOn, Giannantonio Spena (Technical Expert / Clinician) Brescia - Italy. UpSurgeOn is a start-up company that has developed the first hybrid simulation platform integrating digital and physical tools for neurological training through the use of Augmented Reality. 

Frederique Wiemeijer (Educator) Davos - Switzerland - Global Neuro Foundation. Global Neuro is a continuing medical education provider – accredited, in countries where applicable – a knowledge leader in Neurotrauma education and provider of Complex Cranial Access and Neurovascular education. 

We will create a plan on how to reach the different disciplines, settings and countries by connecting to the Champions in their field. In LMICS and countries prone to disasters, we will connect with MSF, Military, Mission hospitals through our network @ WHO.

Anyone intersted in support our project