SACM - Canada
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9651
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Item Restricted Supervision and autonomy in Periodontics Surgical Education: a Grounded Theory Study at an Academic Institution.(Saudi Digital Library, 2025) Alomar, Nuha; von Bergmann, HsingChiAbstract Background Clinical supervision is crucial in postgraduate surgical education, where balancing resident autonomy with patient safety is essential. While the development of autonomy is widely discussed in medical education, there is limited understanding of how supervision shapes this process in periodontic surgical education. Objective This dissertation aims to explore the processes of supervision and autonomy development in periodontics surgical education by generating substantive theories that explain how supervision is performed and how resident autonomy evolves over time. Methods A grounded theory method, following the approach of Strauss and Corbin, was used to develop substantive theories based on empirical data. Data collection included semi-structured interviews with eight instructors and seven residents across different program stages in an academic institution. Theoretical sampling guided participant selection, allowing refinement of emerging categories to be developed and refined through constant comparison. Memos and diagrams were used to track concept development, explore relationships between categories, and ensure coherence in the construction of theory. To ensure credibility, member checking was conducted in conjunction with data triangulation, incorporating multiple stakeholders’ perspectives. Saturation was reached when no new concepts emerged, confirming the robustness of the developed frameworks. Findings Two substantive theories emerged from this study. Adaptive Reasoning Mentorship explains the instructors' decision-making processes during supervision as responsive adjustments made in real-time. It illustrates how they adapt their approach based on their assessment of residents’ needs, patient considerations, and situational demands, reflecting on their experiences and expectations. Conditioned Relational Autonomy reconceptualizes autonomy as a relational, context-dependent construct that facilitates learning, rather than an individual achievement. This theory posits that autonomy develops through ongoing interactions between residents and instructors and is shaped by contextual influences. In this context, autonomy is negotiated through trust, prior experiences, residents’ demonstrated accountability, and instructors' interpretations of their educational and clinical responsibilities. Conclusion The findings expose the complexity of supervision in periodontics surgical education and emphasize that autonomy is not a fixed state but rather a negotiated and context-dependent progression. These insights contribute to the broader discourse on medical education and offer practical implications for improving supervisory approaches in surgical education.4 0Item Restricted Surgical Performance Analysis in a Simulated Virtual Reality Anterior Cervical Discectomy and Fusion Task(2021-08-06) Bakhaidar, Mohamad; Maestro, Rolando Del; Gregory BerryIntroduction: Multiple studies have demonstrated the effectiveness of virtual reality (VR) simulators in surgical skills training and assessment. Anterior cervical discectomy and fusion (ACDF) is among the most common spine procedures and requires trainees to master a broad spectrum of surgical techniques. The Sim-ortho VR simulator provides a validated anterior cervical discectomy and fusion (ACDF) simulated task. This validated tool can be used in the evaluation and assessment of surgical skill. Objective This thesis aims to analyze the three-dimensional data recorded by the Sim-Ortho VR simulator platform during the discectomy component of the ACDF task. We aim to use the generated data to develop novel metrics to assess the performance of participants with different levels of expertise. Hypothesis We hypothesize that the results of this analysis would establish a methodology to develop novel metrics that can identify performance variability between different groups of expertise and provide new insights into surgical expertise. Methods We recruited participants with different levels of expertise to perform a standardized ACDF simulation task. The three-dimensional structural data were generated from the simulator and recorded after each step. We collected and analyzed different data including volumes of each 5 structure at different stages of the procedure and rate of removal of the disc. Statistical significance was set as p < 0.05. Results Twenty-seven participants were included and divided into three groups based on their surgical expertise: medical student, resident, and post-resident groups. Medical students took longer to perform the discectomy compared to the other groups and left almost three times of disc residual as the resident and post-resident groups (p = 0.068). During the annulotomy component, the post-resident group removed 47.4% more disc than the resident and 102% more than the medical student group (p = 0.03). No statistically significant differences between groups were found during the second stage of the discectomy regarding disc residual and rate of removal. The post-resident group spent 19.1% of their surgical time actively working on areas adjacent to the dura, compared to 13.7% and 5.1% in the resident and medical student groups, respectively (p = 0.017). Conclusion Expert performance is associated with higher efficiency compared to resident and medical student groups. The amount removed and rate of removal represent other features of expertise during the annulotomy stage of the discectomy. These differences expose some of the features of experts’ performance that can be further studied and taught to junior trainees.21 0