Practical training for health care professionals has a long lasting tradition [6] and is the key factor for excellence in medical treatment. During medical school, basic manual skills are taught to students, however, most of these need to be dramatically extended during their later occupation as a health care professional f.i. surgical procedures. And of these, most need to be trained regularly in order to maintain their skillfulness f.i. laparoscopic surgical approach. Other skills need to be adapted to new scientific findings or to the proper or new handling of instruments due to technological progress of the devices applied.

Postgraduate medical education for surgeons and for all manually working practitioners rely, in part, on surgical courses which can be conducted on models or on body donations of anatomical departments. However, the effectiveness of surgical training relies also on how similar that training is to daily medical practice as well as the environment in which the training occurred.

Fig. 1: Interaction between faculty and course participant during a course on kyphoplasty at Paracelsus Medical University Salzburg (Austria)

Looking into surgical courses for facial surgery or any aesthetic procedure of the human face, formalin embalmed specimens are of inferior usefulness when compared to a freshfrozen specimen. It was shown that embalming with formalin increases the rigidity of the tissues and leads to far-from-real haptics [2]. A surgical course planned for teaching several facial procedures might not have the same learning effect and the applicability to daily clinical scenarios might be reduced by using, or learning on, an unsuited specimen. Looking into spinal surgery, specimens preserved with Thiel-solution [3] will have a more beneficial learning effect when teaching procedures for corrections of scoliosis or procedures for the intervertebral disc, when compared to using formalin-embalmed specimens. This is due to the fact that Thiel-solution preserves the joints of a specimen in a flexible state and thus movement is still possible during manipulation. Therefore surgeons can still move the respective segments and the force applied to the surgical instruments is similar to that experienced later on in the operation rooms.

Another important factor for a successful and effective surgical course is the general setup of the course itself. The course environment starts with the accessibility of the respective center and reaches out to the leisure activities after the course. Regarding accessibility, the time spent traveling should be kept as short as possible for the participant unless other important factors are mandatory. Every course organizer should keep in mind that during the time a health care professional is away for postgraduate medical education his/her work continues and needs to be done upon return. This is sometimes very stressful and in many cases the reason why individuals do not participate in courses. Also of importance is the time in which the participants can talk to their peers and exchange experiences/problems/solution strategies „at eye level“. In general, this is done during leisure activities after the course or during dinners and this important time should not be underestimated by any course organizers. During the course an organizer should likewise assure that the transition times i.e. the time it takes to change rooms (between lecture room and catering area, or the wetlab) or the time the participants need to get dressed into specific clothing (f.i. scrubs) should also be kept as short as possible. In large groups this time can, in many cases, prolong the course schedule leading to inefficiency.

Fig. 2: Course image of a postgraduate educational course on knee
arthroscopy at Paracelsus Medical University Salzburg (Austria)

Another important factor that significantly influences the educational outcome of a course, is the ratio between faculty/supervisor/company representative and the participants. A good ratio for this in postgraduate surgical training courses is 1:3 and up to 1:6 (data based on the personal experience of the first author). In this group size, a participant can be well supervised and can train manually in the respective environment. Also the supervisor is able to advise and correct the participant properly when this ratio is present. Exceeding this ratio to 1:10 or to 1:20 might lead to a less beneficial educational course outcome for the participants.

An increasing amount of studies show that the overall educational environment is one of the major key factors for effective and long lasting education and influences the participants satisfaction and success [4-6]. The educational environment is referred to as the environment that encircles a course participant and his/her needs during and after a course. The more comfortable a participants feels the better is the educational outcome [5]. As it has been stated that stress levels can have an influence on cognition and memory [7]. This can be achieved either by the ideal location of a surgical course center (f.i. on a caribbean island) or by an outstanding 24-7 course and leisure program. However, this is not meant for course organizers to plan postgraduate medical education courses as a vacation, but to realize that the educational effect can be maximized when the environment is comfortable for the participant.

In conclusion, it can be stated that several factors need to be considered when the optimum benefit from a postgraduate educational course is intended. However, all of them need to be considered when aiming for the maximal beneficial educational effect experienced by the participant, which means that in the long term this will reflect in the healthcare provided by health care professionals.