=== I. Introduction and Overview ===

Objective:

In this session, you will become familiar with the specific psychomotor skill of drilling bone and the rubric you will use to assess your skills.

1
Review the learning objectives for this Module.

By the end of this Module, you will be able to:

  • Use a rubric to self-assess and improve your bone drilling skills.
  • Drill on the bone simulator, without slipping.
  • Control the drill bit straight and steady.
  • Drill through the first cortex and engage the opposite cortex in a controlled manner without plunging.
  • Drill the far cortex, without plunging into the soft tissue.
2
Review the learning target and rubric for the skills you will learn in this Module on drilling bone.

You will use this rubric to assess your own skills and to measure your progress over time as you learn to drill bone on the simulator.

Assessment Rubric for Learning Target 5: I can accurately drill bone.

SKILLS: EMERGING

(I am just getting started on this skill)

APPROACHING

(I am still developing this skill)

MEETS

(I am competent and confident in this skill)

1. Drill hole without drill tip "walking" or slipping around the circumference I slip often, even on animal bone.

No. of slips__/10

I slip occasionally.

No. of slips __/10

I do not slip on bone or on the PVC simulator.

No. of slips __/10

2. Control the drill bit straight and steady I am not confident that I can control the drill straight and steady. I am somewhat confident that I can control the drill straight and steady, but not yet consistently. I am confident that I can control the drill bit straight and steady with consistency.
3. Drill through one cortex without plunging into intramedullary canal

Note: Plunge is defined as passing through near cortex and hitting far cortex in one maneuver

I am able to drill near the cortex but plunge into canal/cancellous bone.

No. of plunges __/10

I am able to drill near cortex without plunging into canal/cancellous bone most of the time.

No. of plunges __/10

I am able to consistently drill the far cortex without plunging.

No. of plunges __/10

4. Drill the far cortex without plunging into surrounding soft tissues I am able to drill the far cortex, but plunge.

No. of plunges __/10 __mm. measurement of drill tip distance on far cortex OR No. of buzzes__/10 OR No. of >1cm plunges__/10

I am able to drill the far cortex without plunging most times.  

No. of plunges __/10 __mm. measurement of drill tip distance on far cortex OR No. of buzzes__/10 OR No. of 5-10mm plunges__/10

I am able to consistently drill the far cortex without plunging.

No. of plunges __/10 __mm. measurement of drill tip distance on far cortex OR No. of buzzes__/10 OR No. of <5mm plunges__/10

3
Watch this video.
Annotations:
  • 0:00 How to drill properly
4
Make a plan with your learning partner and mentor.

Think through these questions:

  • What is your timeline to work through this Module?
  • If you have one, how will you work with your learning partner? How will you give each other feedback?
  • When will y ou meet with your mentor for feedback and discussion?
  • If you are on your own, can you take videos of you drilling the simulator and then review to assess your hand position and drill control?
5
Set up your bone simulator and gather the other materials you will need.

Materials needed:

  • Bone simulator (Basic, Simple or Advanced)
  • Electric or manual/hand drill
  • Drill bits
  • Computer or mobile phone to watch instructional videos
  • Mobile phone to take videos and something steady to place it on/hold it

II. Drilling Bone Skills Practice and Self-Assessment[edit | edit source]

Objective:

In this session, you will get hands on practice as you learn how to:

  • Drill holes in the bone simulator, without the drill tip slipping.
  • Control the drill bit straight and steady while drilling the bone simulator.
  • Drill through the first cortex and engage the opposite cortex, without plunging into the intramedullary canal.
  • Drill the far cortex, without plunging into the surrounding soft tissues.
1
Watch (and re-watch, as needed) the videos in step 3 above
2
Start practicing on your simulator.

Aim to drill at least 10 holes, at least a few millimeters apart.

3
Self-assess your bone drilling skills using the rubric for this Module.

Refer to the rubric in Step 2 at the beginning of this Module (you may want to print out one or more copies). Use the rubric to assess the following and note if you are EMERGING, APPROACHING, or MEETING each of the sub-skills.  This will help you know which knowledge and sub-skills require more practice. Please take notes on your self-assessment below.

  • Row 1: How many times did you slip?
  • Row 2: How well are you controlling the drill straight and steady?
  • Row 3: How many times did you plunge into the intramedullary canal?
  • Row 4: How many times did you drill through the far cortex and plunge into the soft tissues (and what is the depth of the plunge)?

SELF-ASSESSMENT NOTES:

4
Use your phone to record one or more videos of yourself drilling.

Watch the video(s) to assess your skills and see where you can improve. You can also share the video(s) with your mentor and learning partner for feedback.

5
Continuously assess your skills, using the rubric, and keep practicing until you feel competent and confident.

Continue to practice drilling until you are competent and confident with each skill and fulfilling the MEET criteria on the rubric. You may wish to complete the rubric multiple times, to assess your progress over time and to see which skills need more practice. Re-watch the instructional videos as many times as you need.

III. Evaluating your Bone Drilling Technique[edit | edit source]

Objective:

In this session, you will evaluate the bone drilling techniques you have learned, including through self-assessment and review with your learning partner and mentor.  

1
Reflect on your learning.

Think about where you started and where you are now with your bone drilling technique and where you are in moving through the rubric from EMERGING, to APPROACHING, to being able to MEET the criteria for each sub-skill.

2
Watch this video.
Annotations:
  • 0:00 Important basics of drilling bone
  • 0:05 Skill 1 - Setting the drill
  • 0:46 Skill 2 - Starting drilling
  • 1:35 Skill 3 - Straight & steady
  • 2:11 Skill 4 - Bite of the bit
  • 2:42 Skill 5 - Drilling through the far cortex
  • 3:38 Skill 6 - Avoid plunging
  • 4:19 Evaluation
3
Reflect on these questions and discuss with your learning partner and mentor as you review your self-assessment rubrics and any videos you have taken.
  • Are you able to consistently engage the cortex of the bone and start drilling, without slipping?
  • Are you consistently able to avoid the drill walking on the bone by reorienting it and keeping it straight and steady?
  • Can you feel the drill tip exit the near cortex and advance to the far cortex?
  • Can you feel the far cortex, start drilling it, and then wait to feel the sense of bite at the drill tip before it passes through the far cortex, so you do not plunge?
  • Once you are through, evaluate how far the drill has gone through the bone.
  • How confident do you feel drilling with the bone simulator?
  • What would help you feel more confident in your drilling skills?
  • What do you need more practice on before you drill on a patient?
  • What is your plan to practice more and what support would be helpful?
4
Keep practicing!

Continue to practice until you feel competent and confident that you can accurately drill bone. Over time, you should progress from EMERGING, to APPROACHING, to eventually MEETING the criteria for each sub-skill in the drilling bone rubric. Once you have determined that you MEET all of the sub-skills, you can move on to the next Module.

Page data
Part of ETALO Bone Drilling Module
Type Medical skill
Keywords drilling, bone, surgery
SDG Sustainable Development Goals SDG03 Good health and well-being
Authors ETALO
Published 2021
License CC-BY-SA-4.0
Affiliations Global Surgical Training Challenge
Language English (en)
Impact Number of views to this page and its redirects. Updated once a month. Views by admins and bots are not counted. Multiple views during the same session are counted as one. 228
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