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Different Methods for Training Technicians

Different Methods for Training Technicians. Jennifer Martinick , MBBS. Disclosure. Dr. Martinick developed this Training Placer Board and receives a royalty from sales. 2 Greatest Problems in Placement is Incorrect Technique. Forceps inserted TOO DEEPLY. Consequences;

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Different Methods for Training Technicians

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  1. Different Methods for Training Technicians Jennifer Martinick, MBBS

  2. Disclosure Dr. Martinick developed this Training Placer Board and receives a royalty from sales.

  3. 2 Greatest Problems in Placement is Incorrect Technique • Forceps inserted TOO DEEPLY. Consequences; • Squashes & kills follicle • Follicle comes out again with forceps due to ‘imprint’ • Dislodges clotted blood; starts bleeding again • Over handling & death of follicle • INCORRECT/Rough grasp of follicle. Consequences; • ‘Dragged’/Jammed follicle is bent/twisted & doesn’t grow • The CLEAR LASERED HOLES & HARD texture of the TPB addresses these issues; it stops the forceps entering deeply & allows the teacher to see if the graft is bent in the recipient hole

  4. Bottleneck in HT is graft placing Commonly encountered problems: • Incorrect grasp of follicle with forceps • Not parting hair away that occludes the hole • Roughly jamming follicles into holes • Putting forceps too deeply into hole • Causing follicle compression & injury with more likelihood of it coming out again • Creating false passages, bleeding & popping

  5. Roughly Jammed MISTAKES!!!! Poor Forceps Application Upside Down Grafts bent in HT

  6. AIM: Develop a training medium to overcome placement problems Trainer Placer Board • Demonstrates how to implant effectively so as to eliminate inappropriate movements • Standardizes, simplifies and systematizes the training procedure • Increases the percentage of trainable applicants • Decreases time to competency and clinic expenses • Enhances dexterity, eye/ hand co-ordination, teaches a gentle 2- touch placement technique • Learn to differentiate between sagittal and coronal placement using either bent or straight forceps

  7. Training Setup

  8. The Board has 30 slits, 10 each of 2mm, 1.5mm, & 1mm Its hard texture discourages forceps’ deep penetration and encourages gentle feeding of the graft into the slits Its clear nature allows the trainer to check on placement & observe poorly placed grafts. Grafts preserved in 10% formalin are used. Staff like it because it’s impersonal, can talk & get feedback. There’s no bleeding & they don’t feel like they’re hurting the patient.

  9. Lesson One: Learn the required movement to implant a small graft into a large slit in 2-3 movements. This implantation is then repeated into the medium size slits and then the smallest slits. Lesson Two: Place 10 large grafts, 10 medium grafts and 10 small grafts systematically, gently and accurately into the appropriate slits within the shortest time frame. The technician is re-tested & times documented after every 10 hours of O.R. time. (See Video Coronal and Sagittal Placements)

  10. Good Technique Grab tip-to-tip Place 1mm into ‘scalp’ Gently grab ½ way & rock the rest in

  11. Results • After 40 hours, 3 groups emerge; Good prospect, possible, no prospect. • Our results to date show that 40-50% of applicants can be trained • There is an enhanced appreciation for quality & speed • Inappropriate movements & techniques are decreased • And there is increased gentleness in graft handling

  12. Lesson 3 Advanced Trainer Placer Board The Advanced Board has 66 sites. It focuses on constantly changing direction, relationship and orientation. The technician must change wrist angles, use differing forceps grasps, & body posture. This mimics a virtual procedure when 3 or 4 technicians may be planting. One hour training on this board is followed by a quantum leap in comprehension. An average placer takes less than 15 minutes to fill the sites; an outstanding one, less than 12 minutes (See Video)

  13. A Planned Training System of Placing • Minimizes time wasted on unsuitable trainees • In 40 hours selects those with average/above performance levels • Helps build a ‘bank’ of back-up trainees • Focuses on movements to enhance efficiency & effectiveness • Minimizes unproductive time of technician & surgeon • Reduces on-the-job frustration • Develops effective feedback routine • Enhances staff morale & confidence • Decreases staff frustration & burnout • Improves productivity & predictability of outcomes • Decreases turnaround time if staff leave • Creates a shorter procedure time • Uses less blades & other consumables • Decreases clinic expenses • Surgeon gains control of his clinic

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