What is a pantogen?

A pantogen is a customisable script, aiming to provide all the expert information required to perform an operation.

Where does the word come from?

The word pantogen comes from the Greek panto- meaning all, and the familiar gen meaning information. The word is completely new in this context and with this derivation.

Is there a problem in surgical training and surgical quality control?

All traditional surgical training methods lack time and space to give little more than the principles and some detail of surgical operations. Even one-to-one teaching can be inadequate.
The trainee often has to rely on trial and error, common sense and intuition to fill in the gaps. Expertise may be gained only slowly, with unacceptable risks to patients. The problem is worsened with shorter hours of duty and reduced training programs.
Few, if any, operating departments have detailed surgical scripts to control the quality of the operations performed.

How can a pantogen help in training and quality control?

The pantogen stores, on a computer, the very large amount of the information that an expert uses when performing an operation. This information is in a form that is accessible to the trainee and the operating department alike.

THE STRUCTURE OF A PANTOGEN

SECTIONS, STEPS AND PANTINOS

SECTIONS

These are similar to the familiar divisions seen in traditional text.

STEPS

Each section is divided into an unlimited number of STEPS. These are very small, and much more numerous than are seen in textbooks. Each step is often just a simple command.

PANTINOS

A pantino is an item of information. Each step is supported by an unlimited number of pantinos. Such pieces of information are usually very simple, obvious when pointed out, and easy to remember, but might take years to acquire by trial and error.
Pantinos have not been comprehensively documented previously. Some steps such as "Check you have the correct patient" need little information support. Other steps will require a large number of pantinos, of several different types.
Pantinos come in 24 or more useful surgical categories, which break down into three main groups - basic pantinos, problem- avoiding pantinos and problem-solving pantinos.

The categories fit into the easily remembered acronym WIMBLEDON DITCHES SUPERMAN.

Any step may be supported by pantinos from any category.

USE OF PANTOGENS

Content

The content of the information is unlimited in size and scope. It is perhaps 20 times that available from standard operating surgical books. It is personalised to a surgeon's exact preferences.

Applications

We keep printouts in ring binders in the theatre for the theatre staff, particularly those in training. Each double page consists of a text page on the right and a blank page on the left for written comments, notes and sketches. The information is amended/ updated/ changed as techniques develop and to record solutions to new surgical variants and problems. The text is expanded to cover questions and particular difficulties experienced by trainees.
We have texts covering over 60 general surgical operations ranging from haemorrhoidectomy to 3-stage oesophagectomy.
Colleagues in other hospitals can easily modify the information to suit their own regimes, equipment, materials and training requirements. They then have their own documentation in their theatres.
Each trainee can collect pantogens. They can modify, add to and expand the texts as they pick up hints and tips from surgeons during their rotations.
Further, the principle has been extended into three interactive multimedia programs on CD-ROM. They cover basic skills for the surgeon's assistant, open repair of inguinal hernia and laparoscopic cholecystectomy. They give multisensory impact to the trainee. They contain aptitude testing, modular structured teaching, exercises, tests and appraisals, plus simulations and decision training practice.

The latter two disks qualify the user for 4 hours of Category 1 CME credits with the American Medical Association.

Customising and writing pantogens

Edit any of the text on this printout by hand to suit your preferences. Have the alterations entered onto disk. You can then print out your own customised pantogen. It is as easy as that.
Writing new pantogens is harder work. However, most experienced surgeons can visualise the steps of their operations. It is relatively easy to dictate the first draft of the text into a hand held dictaphone. Dictating a few lines a day while sitting in a traffic jam is an efficient use of time.
Put everything down that comes to mind. There are no limitations to the size of the pantogen. The first draft can be rapidly typed onto disk using a word processor. Editing takes longer. Check the steps and the pantinos against what you actually do during your next case. Check them again when you are assisting your registrar. You will become aware how much information you use subconsciously as an expert, when you see a trainee operating. Add all this to the text. Do not leave anything to doubt. Put in the numbering last.
Expect to make three or four drafts before the text is good enough. Make printouts. You will be revising the text continually to accommodate your changes of surgical technique as time goes by.

WARNING

A pantogen is a useful tool for training and for quality control.

BUT

It has major limitations.
It does not cover all the details of the procedures.
It is not a comprehensive training system.
It may complement, but it does not replace standard accepted surgical practices, or accepted forms of surgical teaching and training.
It does not set out to establish or impose any specific standard of surgical practice.
It does not set out to impose any particular way of performing an operation.
It describes some procedures which carry an inherent high risk of serious or lethal complications.
It describes some procedures and operations which are changing very rapidly, but the information in a pantogen is only as good as its last update.

The information in a pantogen is only a part of the requirements for successful surgery.
Pantogens assumes certain levels of surgical skill. These skills may have been acquired with the help of more basic pantogens. eg The steps of an oesophagectomy are far more difficult than the steps in an inguinal hernia repair.
It is possible for a surgeon to follow pantogen steps to the letter, and still get into serious trouble for a large number of reasons, some of which are listed above.
The clinical judgment of the surgeon at all times overrides the information given in pantogens.

We accept that there are entirely acceptable alternatives to the procedures, techniques, equipment, and materials mentioned in pantogens.
We do not claim that any of the procedures, techniques, equipment, and materials in pantogens are in any way superior to others.
While the author and publishers have made strenuous efforts to make pantogens as safe and as reliable as they possibly can, they accept no liability for:
Problems occurring from the use of pantogens in their original or in any modified form, either now or in the future.
Any difficulties encountered in performing any of the techniques, or using any of the equipment or materials, surgical and non-surgical, described in the text.
Changes, discrepancies, errors that may appear in the information as the result of data inputting, programming, system faults, data handling, transmission, and printing or any other computerised process.
Pantogens should not be used on patients without the information being vetted by an expert surgeon.