Revision 7T · Full Tutorial Edition · Updated 1 September 2026
PWR-158 · SUPERVISED full tutorial
Practise safe instrument navigation only inside an accredited dry-lab simulation
This lesson teaches a complete simulation method for basic procedural dexterity: verify the simulator and role, map instruments and no-touch zones, establish a stable view, move deliberately, manage force, stop on error, inspect damage and debrief. It never authorises touching a patient, animal, biological tissue or live clinical equipment.
What you will produceIn an accredited, faculty-supervised dry-lab task, the learner transfers six foam objects between marked zones within the validated error and damage limits and executes the emergency stop correctly.
Method8 numbered Power-specific steps
Practice authorityFull method with qualified supervision where stated
Full step-by-step individual tutorial · TLU-PWR-158
In an accredited, faculty-supervised dry-lab task, the learner transfers six foam objects between marked zones within the validated error and damage limits and executes the emergency stop correctly.
Pre-brief checklist, no-touch zone map, force/damage markers and event log.
Before you start
Prepare an accredited programme-selected dry-lab box trainer with inert foam objects and programme-approved instruments
Before the first surgical and procedural dexterity attempt, write the exact result you will score: Validated error, force, damage and quality across simulator and supervised target task.
Faculty verifies enrolment, role, equipment, decontamination, simulator integrity, emergency stop, access and scope of the dry-lab task.
The learner states aloud that the exercise supplies no patient, animal, live-tissue or clinical authority.
3 · The method
Follow these steps in order
Verify simulator and stop control
With faculty, confirm the dry-lab mode, inert contents, instrument identity, camera orientation and the exact command or action that stops the task.
Why: Procedural practice is safe only when the operational boundary and stop are unambiguous.
Check: The learner identifies every inert component and demonstrates the stop before movement.
Map active tips and no-touch zones
On the monitor, point to each instrument tip, target zone and prohibited boundary. Practise moving each tip in free space without contact.
Why: Indirect view can hide where the active end is relative to tissue-equivalent boundaries.
Check: Both tips remain visible and out of no-touch zones during free-space rehearsal.
Establish a stable view
Centre the field, adjust approved ergonomics and pause until the target, both tips and receiving zone are visible at once.
Why: Movement without a complete view creates unmeasured collision risk.
Check: The full work area remains visible without leaning, strain or camera drift.
Approach before grasping
Move one tip toward the centre of the foam object at low speed, stop beside it, then close the grasper only to the marked force cue.
Why: Separating approach from closure prevents blind grabbing and excess force.
Check: The tip stops at the object before closure and leaves no crush mark.
Transfer through the safe corridor
Lift only to the marked height, travel along the programme path and keep the second instrument parked unless assigned a support role.
Why: A declared corridor limits collisions and unnecessary two-tool motion.
Check: The object and both tips remain inside their allowed zones.
Place before releasing
Lower into the centre of the receiving mark, stop movement, then open the grasper. Do not throw, flick or release while moving.
Why: Controlled placement reveals endpoint accuracy and prevents bounce or loss.
Check: The object stays within the receiving boundary after release.
Stop and declare any error
At a drop, collision, lost view, force marker or equipment change, freeze, say the error and await faculty reset. Do not self-rescue unless the rubric instructs it.
Why: Transparent error response protects the simulation record and prevents escalation.
Check: Every error is declared immediately and handled by the approved reset rule.
Inspect and debrief transfer
Count completed transfers, drops, collisions, force/damage marks and time; compare with the validated rubric and review one video segment with faculty.
Why: Simulator speed alone does not establish technique or clinical transfer.
Check: The record contains error, force, damage, support and faculty decision—not only completion time.
4 · Worked example
See the whole method used once
Scenario
In an accredited skills lab, a faculty member supervises six foam-ring transfers between coloured pegs in a box trainer.
Walkthrough
The learner verifies inert rings, instruments, camera orientation and demonstrates the verbal “stop” command.
They map both tips and the red no-touch border, then centre the full field.
On ring one, they stop beside the centre before grasping and travel through the marked corridor.
Ring three drops; they freeze, declare “drop,” and wait for the faculty reset rather than chasing it.
They complete five accepted transfers with one drop, no collision and no damage; video review shows one high lift, so faculty holds progression and assigns a matched dry-lab repeat.
Result
The learner demonstrates controlled dry-lab navigation and transparent error response. The held progression correctly recognises that simulator performance is not clinical authority.
5 · Right and wrong
Compare correct or safer execution with the common wrong version
Right and wrong comparison
Moment
Right / safer
Wrong / riskier
Why it matters
Verify simulator and stop control
With faculty, confirm the dry-lab mode, inert contents, instrument identity, camera orientation and the exact command or action that stops the task.
Begin because the box looks inert without verifying mode or stop.
Procedural practice is safe only when the operational boundary and stop are unambiguous.
Map active tips and no-touch zones
On the monitor, point to each instrument tip, target zone and prohibited boundary. Practise moving each tip in free space without contact.
Move instruments before identifying tips and prohibited zones.
Indirect view can hide where the active end is relative to tissue-equivalent boundaries.
Establish a stable view
Centre the field, adjust approved ergonomics and pause until the target, both tips and receiving zone are visible at once.
Operate while a tip or receiving zone is outside the camera view.
Movement without a complete view creates unmeasured collision risk.
Approach before grasping
Move one tip toward the centre of the foam object at low speed, stop beside it, then close the grasper only to the marked force cue.
Close the grasper while still approaching at speed.
Separating approach from closure prevents blind grabbing and excess force.
Transfer through the safe corridor
Lift only to the marked height, travel along the programme path and keep the second instrument parked unless assigned a support role.
Lift high and sweep across the field without a declared corridor.
A declared corridor limits collisions and unnecessary two-tool motion.
6 · Common mistakes
Spot the error and apply the correction
Common mistakes and corrections
Mistake
Fix
Begin because the box looks inert without verifying mode or stop.
With faculty, confirm the dry-lab mode, inert contents, instrument identity, camera orientation and the exact command or action that stops the task.
Move instruments before identifying tips and prohibited zones.
On the monitor, point to each instrument tip, target zone and prohibited boundary. Practise moving each tip in free space without contact.
Operate while a tip or receiving zone is outside the camera view.
Centre the field, adjust approved ergonomics and pause until the target, both tips and receiving zone are visible at once.
Close the grasper while still approaching at speed.
Move one tip toward the centre of the foam object at low speed, stop beside it, then close the grasper only to the marked force cue.
Lift high and sweep across the field without a declared corridor.
Lift only to the marked height, travel along the programme path and keep the second instrument parked unless assigned a support role.
7 · Practice
Turn the steps into a usable skill
First session
Accredited faculty identify dry-lab box trainer, inert foam objects, programme-approved instruments, no-touch zones & emergency stop. Learner demonstrates stop with instruments parked before any timed or scored transfer begins.
Map both active tips on monitor & rehearse a free-space corridor that keeps them visible. Faculty reset camera or posture if a tip disappears, a shaft levers on port or learner leans to compensate for an unstable view.
Approach first foam object with active tip open, stop at target, close only to validated grip mark & lift into approved corridor. Crushing, dragging or blind closure is declared immediately rather than hidden in a completion-time score.
Transfer object between marked zones while receiving location remains visible. Stop above destination, lower fully & release before withdrawing; an object dropped outside safe zone triggers practised emergency stop & faculty reset.
Complete remaining transfers within faculty's error & damage limits. Record collisions, no-touch contacts, crush marks, drops, obscured tips & stop use separately from time, because speed cannot cancel a procedural error.
End with instrument parking, foam inspection & faculty debrief. Learner reconstructs one approach-to-placement trace & one error response; successful dry-lab transfer does not confer patient-care authority or permission to handle live tissue.
Repeat plan
Faculty control all later dry-lab blocks. A second block repeats same six-object geometry; a third may alter one zone position after emergency stop & visibility gates remain reliable. No live, animal, cadaveric or patient context follows from this tutorial & instrument or port difficulty changes only within accredited curriculum.
Progress when
In an accredited, faculty-supervised dry-lab task, learner transfers six foam objects between marked zones within validated error & damage limits & executes emergency stop correctly.
Full work area remains visible without leaning, strain or camera drift.
Object stays within receiving boundary after release.
Record contains error, force, damage, support & faculty decision—not only completion time.
Do not progress when
Do not start a scored transfer until both active tips & every no-touch boundary are continuously visible.
Stop & declare event after any collision, crush mark, dropped object, port levering, obscured tip or incorrect emergency-stop response.
Do not progress on basis of faster completion when validated error or damage limits are exceeded.
8 · Check the result
Measure what changed
Validated error, force, damage and quality across simulator and supervised target task
How: For Surgical and procedural dexterity, measure Validated error, force, damage and quality across simulator and supervised target task. Keep the surgical and procedural dexterity fixture stable. Target: In an accredited, faculty-supervised dry-lab task, the learner transfers six foam objects between marked zones within the validated error and damage limits and executes the emergency stop correctly. Log surgical and procedural dexterity errors, prompts, burden and stops.
Good result: Full work area remains visible without leaning, strain or camera drift. Object stays within receiving boundary after release. Record contains error, force, damage, support & faculty decision—not only completion time.
This does not prove: Dry-lab scores depend on the simulator, faculty rubric and validated error limits; transfer must be assessed inside the accredited programme rather than inferred here.
Self-check
Starting check — The learner identifies every inert component and demonstrates the stop before movement.
Can you show this before continuing? Both tips remain visible and out of no-touch zones during free-space rehearsal.
If you catch this mistake — Begin because the box looks inert without verifying mode or stop. — use this correction: With faculty, confirm the dry-lab mode, inert contents, instrument identity, camera orientation and the exact command or action that stops the task.
What this result does not prove: Dry-lab scores depend on the simulator, faculty rubric and validated error limits; transfer must be assessed inside the accredited programme rather than inferred here.
9 · Stop, adapt or get help
Keep the safety boundary practical
Stop and get help
Stop for equipment fault, live/biological material, sharp exposure, contamination concern, lost view, untracked instrument, pain, dizziness or faculty command.
Follow the lab incident process for any injury or contamination; no page instruction replaces it.
Do not start a scored transfer until both active tips & every no-touch boundary are continuously visible.
Stop & declare event after any collision, crush mark, dropped object, port levering, obscured tip or incorrect emergency-stop response.
Do not progress on basis of faster completion when validated error or damage limits are exceeded.
Accessibility and adaptations
Keep usual aids for Surgical and procedural dexterity; record each support inside the surgical and procedural dexterity setup.
Accessible opening check for Surgical and procedural dexterity: The learner identifies every inert component and demonstrates the stop before movement.
Faculty may adjust monitor, seating, controls, magnification, instrument handle or simulation timing only after confirming the validated task and safety envelope remain appropriate.
10 · Evidence and limits
Why these instructions are here
primary research
Randomised simulator research supports variable-practice effects in a bounded laparoscopic task, but faculty-controlled validation remains necessary.
A haptic simulator group performed worse than untrained controls on a porcine transfer model, and dyadic practice did not outperform individual practice on mean scores.
This dry-lab lesson teaches no incision, suturing, medication, sterile technique, patient management or independent procedure.
Dry-lab scores depend on the simulator, faculty rubric and validated error limits; transfer must be assessed inside the accredited programme rather than inferred here.
J J Kanitra; N Khogali-Jakary; S B Gambhir; A T Davis; M Hollis; C Moon; R Gupta; P S Haan; C Anderson; D Collier; D Henry; S Kavuturu · 2021 · Primary research
Progress is saved only in this browser on this device.
Step-by-step learner mode
Each activity includes its success check, a nearby accessible alternative and an “I’m stuck” correction path. Alternatives preserve the target where possible; when they change the task, Titan labels them as related rather than equivalent.
01
Verify simulator and stop control
With faculty, confirm the dry-lab mode, inert contents, instrument identity, camera orientation and the exact command or action that stops the task.
Why this step exists
Procedural practice is safe only when the operational boundary and stop are unambiguous.
Success check
The learner identifies every inert component and demonstrates the stop before movement.
I’m stuck on this step
Reset: Re-read this authored instruction — “With faculty, confirm the dry-lab mode, inert contents, instrument identity, camera orientation and the exact command or action that stops the task.” — and its success check, then attempt only this step.
Possible snag: Begin because the box looks inert without verifying mode or stop.
Correction: With faculty, confirm the dry-lab mode, inert contents, instrument identity, camera orientation and the exact command or action that stops the task.
Stop / get help: Stop for equipment fault, live/biological material, sharp exposure, contamination concern, lost view, untracked instrument, pain, dizziness or faculty command.
02
Map active tips and no-touch zones
On the monitor, point to each instrument tip, target zone and prohibited boundary. Practise moving each tip in free space without contact.
Why this step exists
Indirect view can hide where the active end is relative to tissue-equivalent boundaries.
Success check
Both tips remain visible and out of no-touch zones during free-space rehearsal.
I’m stuck on this step
Reset: Re-read this authored instruction — “On the monitor, point to each instrument tip, target zone and prohibited boundary. Practise moving each tip in free space without contact.” — and its success check, then attempt only this step.
Possible snag: Move instruments before identifying tips and prohibited zones.
Correction: On the monitor, point to each instrument tip, target zone and prohibited boundary. Practise moving each tip in free space without contact.
Stop / get help: Stop for equipment fault, live/biological material, sharp exposure, contamination concern, lost view, untracked instrument, pain, dizziness or faculty command.
03
Establish a stable view
Centre the field, adjust approved ergonomics and pause until the target, both tips and receiving zone are visible at once.
Why this step exists
Movement without a complete view creates unmeasured collision risk.
Success check
The full work area remains visible without leaning, strain or camera drift.
I’m stuck on this step
Reset: Re-read this authored instruction — “Centre the field, adjust approved ergonomics and pause until the target, both tips and receiving zone are visible at once.” — and its success check, then attempt only this step.
Possible snag: Operate while a tip or receiving zone is outside the camera view.
Correction: Centre the field, adjust approved ergonomics and pause until the target, both tips and receiving zone are visible at once.
Stop / get help: Stop for equipment fault, live/biological material, sharp exposure, contamination concern, lost view, untracked instrument, pain, dizziness or faculty command.
04
Approach before grasping
Move one tip toward the centre of the foam object at low speed, stop beside it, then close the grasper only to the marked force cue.
Why this step exists
Separating approach from closure prevents blind grabbing and excess force.
Success check
The tip stops at the object before closure and leaves no crush mark.
I’m stuck on this step
Reset: Re-read this authored instruction — “Move one tip toward the centre of the foam object at low speed, stop beside it, then close the grasper only to the marked force cue.” — and its success check, then attempt only this step.
Possible snag: Close the grasper while still approaching at speed.
Correction: Move one tip toward the centre of the foam object at low speed, stop beside it, then close the grasper only to the marked force cue.
Stop / get help: Stop for equipment fault, live/biological material, sharp exposure, contamination concern, lost view, untracked instrument, pain, dizziness or faculty command.
05
Transfer through the safe corridor
Lift only to the marked height, travel along the programme path and keep the second instrument parked unless assigned a support role.
Why this step exists
A declared corridor limits collisions and unnecessary two-tool motion.
Success check
The object and both tips remain inside their allowed zones.
I’m stuck on this step
Reset: Re-read this authored instruction — “Lift only to the marked height, travel along the programme path and keep the second instrument parked unless assigned a support role.” — and its success check, then attempt only this step.
Possible snag: Lift high and sweep across the field without a declared corridor.
Correction: Lift only to the marked height, travel along the programme path and keep the second instrument parked unless assigned a support role.
Stop / get help: Stop for equipment fault, live/biological material, sharp exposure, contamination concern, lost view, untracked instrument, pain, dizziness or faculty command.
06
Place before releasing
Lower into the centre of the receiving mark, stop movement, then open the grasper. Do not throw, flick or release while moving.
Why this step exists
Controlled placement reveals endpoint accuracy and prevents bounce or loss.
Success check
The object stays within the receiving boundary after release.
I’m stuck on this step
Reset: Re-read this authored instruction — “Lower into the centre of the receiving mark, stop movement, then open the grasper. Do not throw, flick or release while moving.” — and its success check, then attempt only this step.
Possible snag: The result from “Lower into the centre of the receiving mark, stop movement, then open the grasper. Do not throw, flick or release while moving.” does not yet meet this declared check: The object stays within the receiving boundary after release.
Correction: Return to the start of “Place before releasing”, reduce complexity or pace, and repeat only the part needed to satisfy: “The object stays within the receiving boundary after release.”
Stop / get help: Stop for equipment fault, live/biological material, sharp exposure, contamination concern, lost view, untracked instrument, pain, dizziness or faculty command.
07
Stop and declare any error
At a drop, collision, lost view, force marker or equipment change, freeze, say the error and await faculty reset. Do not self-rescue unless the rubric instructs it.
Why this step exists
Transparent error response protects the simulation record and prevents escalation.
Success check
Every error is declared immediately and handled by the approved reset rule.
I’m stuck on this step
Reset: Re-read this authored instruction — “At a drop, collision, lost view, force marker or equipment change, freeze, say the error and await faculty reset. Do not self-rescue unless the rubric instructs it.” — and its success check, then attempt only this step.
Possible snag: The result from “At a drop, collision, lost view, force marker or equipment change, freeze, say the error and await faculty reset. Do not self-rescue unless the rubric instructs it.” does not yet meet this declared check: Every error is declared immediately and handled by the approved reset rule.
Correction: Return to the start of “Stop and declare any error”, reduce complexity or pace, and repeat only the part needed to satisfy: “Every error is declared immediately and handled by the approved reset rule.”
Stop / get help: Stop for equipment fault, live/biological material, sharp exposure, contamination concern, lost view, untracked instrument, pain, dizziness or faculty command.
08
Inspect and debrief transfer
Count completed transfers, drops, collisions, force/damage marks and time; compare with the validated rubric and review one video segment with faculty.
Why this step exists
Simulator speed alone does not establish technique or clinical transfer.
Success check
The record contains error, force, damage, support and faculty decision—not only completion time.
I’m stuck on this step
Reset: Re-read this authored instruction — “Count completed transfers, drops, collisions, force/damage marks and time; compare with the validated rubric and review one video segment with faculty.” — and its success check, then attempt only this step.
Possible snag: The result from “Count completed transfers, drops, collisions, force/damage marks and time; compare with the validated rubric and review one video segment with faculty.” does not yet meet this declared check: The record contains error, force, damage, support and faculty decision—not only completion time.
Correction: Return to the start of “Inspect and debrief transfer”, reduce complexity or pace, and repeat only the part needed to satisfy: “The record contains error, force, damage, support and faculty decision—not only completion time.”
Stop / get help: Stop for equipment fault, live/biological material, sharp exposure, contamination concern, lost view, untracked instrument, pain, dizziness or faculty command.
Correct versus incorrect execution
These accessible process diagrams are built from the tutorial’s own right/wrong teaching. They are not anatomical illustrations and do not add technique beyond the canonical tutorial.
Verify simulator and stop control — Procedural practice is safe only when the operational boundary and stop are unambiguous.
Correct / safer
With faculty, confirm the dry-lab mode, inert contents, instrument identity, camera orientation and the exact command or action that stops the task.
Wrong / riskier
Begin because the box looks inert without verifying mode or stop.
Map active tips and no-touch zones — Indirect view can hide where the active end is relative to tissue-equivalent boundaries.
Correct / safer
On the monitor, point to each instrument tip, target zone and prohibited boundary. Practise moving each tip in free space without contact.
Wrong / riskier
Move instruments before identifying tips and prohibited zones.
Establish a stable view — Movement without a complete view creates unmeasured collision risk.
Correct / safer
Centre the field, adjust approved ergonomics and pause until the target, both tips and receiving zone are visible at once.
Wrong / riskier
Operate while a tip or receiving zone is outside the camera view.
Approach before grasping — Separating approach from closure prevents blind grabbing and excess force.
Correct / safer
Move one tip toward the centre of the foam object at low speed, stop beside it, then close the grasper only to the marked force cue.
Wrong / riskier
Close the grasper while still approaching at speed.
Transfer through the safe corridor — A declared corridor limits collisions and unnecessary two-tool motion.
Correct / safer
Lift only to the marked height, travel along the programme path and keep the second instrument parked unless assigned a support role.
Wrong / riskier
Lift high and sweep across the field without a declared corridor.
Method-structure checklist
10 of 10 structural checks present
✓ Ordered, Power-specific instructions — present
✓ Every activity has a success check — present
✓ Materials or supplied records are declared — present
✓ Measurement or assessment rule is present — present
✓ Tutorial-specific troubleshooting is present — present
✓ Stopping or escalation boundary is present — present
✓ Every activity has an adjacent alternative — present
✓ Correct-versus-incorrect comparison is present — present
✓ Evidence context is bound to the Power record — present
✓ Planning metadata is present — present
The method-readiness band and presence checklist assess tutorial presentation and are separate from evidence quality for the underlying Power. They are automated editorial aids, not human approval.
Manual editorial sign-off: Pending. This tutorial must not display a human-approved state until an identified editor signs the exact content hash.