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Lahanas V, Loukas C, Georgiou K, Lababidi H, Al-Jaroudi D. Virtual reality-based assessment of basic laparoscopic skills using the Leap Motion controller. Surg Endosc 2017; 31:5012-5023. [PMID: 28466361 DOI: 10.1007/s00464-017-5503-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The majority of the current surgical simulators employ specialized sensory equipment for instrument tracking. The Leap Motion controller is a new device able to track linear objects with sub-millimeter accuracy. The aim of this study was to investigate the potential of a virtual reality (VR) simulator for assessment of basic laparoscopic skills, based on the low-cost Leap Motion controller. METHODS A simple interface was constructed to simulate the insertion point of the instruments into the abdominal cavity. The controller provided information about the position and orientation of the instruments. Custom tools were constructed to simulate the laparoscopic setup. Three basic VR tasks were developed: camera navigation (CN), instrument navigation (IN), and bimanual operation (BO). The experiments were carried out in two simulation centers: MPLSC (Athens, Greece) and CRESENT (Riyadh, Kingdom of Saudi Arabia). Two groups of surgeons (28 experts and 21 novices) participated in the study by performing the VR tasks. Skills assessment metrics included time, pathlength, and two task-specific errors. The face validity of the training scenarios was also investigated via a questionnaire completed by the participants. RESULTS Expert surgeons significantly outperformed novices in all assessment metrics for IN and BO (p < 0.05). For CN, a significant difference was found in one error metric (p < 0.05). The greatest difference between the performances of the two groups occurred for BO. Qualitative analysis of the instrument trajectory revealed that experts performed more delicate movements compared to novices. Subjects' ratings on the feedback questionnaire highlighted the training value of the system. CONCLUSIONS This study provides evidence regarding the potential use of the Leap Motion controller for assessment of basic laparoscopic skills. The proposed system allowed the evaluation of dexterity of the hand movements. Future work will involve comparison studies with validated simulators and development of advanced training scenarios on current Leap Motion controller.
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Affiliation(s)
- Vasileios Lahanas
- Medical Physics Lab-Simulation Center, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75 Str., 11527, Athens, Greece
| | - Constantinos Loukas
- Medical Physics Lab-Simulation Center, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75 Str., 11527, Athens, Greece.
| | - Konstantinos Georgiou
- Medical Physics Lab-Simulation Center, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75 Str., 11527, Athens, Greece
| | - Hani Lababidi
- Center for Research, Education & Simulation Enhanced Training, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dania Al-Jaroudi
- Center for Research, Education & Simulation Enhanced Training, King Fahad Medical City, Riyadh, Saudi Arabia
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452
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Celentano V, Browning M, Hitchins C, Giglio MC, Coleman MG. Training value of laparoscopic colorectal videos on the World Wide Web: a pilot study on the educational quality of laparoscopic right hemicolectomy videos. Surg Endosc 2017; 31:4496-504. [PMID: 28378076 DOI: 10.1007/s00464-017-5504-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/08/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Instructive laparoscopy videos with appropriate exposition could be ideal for initial training in laparoscopic surgery, but unfortunately there are no guidelines for annotating these videos or agreed methods to measure the educational content and the safety of the procedure presented. Aim of this study is to systematically search the World Wide Web to determine the availability of laparoscopic colorectal surgery videos and to objectively establish their potential training value. METHODS A search for laparoscopic right hemicolectomy videos was performed on the three most used English language web search engines Google.com, Bing.com, and Yahoo.com; moreover, a survey among 25 local trainees was performed to identify additional websites for inclusion. All laparoscopic right hemicolectomy videos with an English language title were included. Videos of open surgery, single incision laparoscopic surgery, robotic, and hand-assisted surgery were excluded. The safety of the demonstrated procedure was assessed with a validated competency assessment tool specifically designed for laparoscopic colorectal surgery and data on the educational content of the video were extracted. RESULTS Thirty-one websites were identified and 182 surgical videos were included. One hundred and seventy-three videos (95%) detailed the year of publication; this demonstrated a significant increase in the number of videos published per year from 2009. Characteristics of the patient were rarely presented, only 10 videos (5.4%) reported operating time and only 6 videos (3.2%) reported 30-day morbidity; 34 videos (18.6%) underwent a peer-review process prior to publication. Formal case presentation, the presence of audio narration, the use of diagrams, and snapshots and a step-by-step approach are all characteristics of peer-reviewed videos but no significant difference was found in the safety of the procedure. CONCLUSIONS Laparoscopic videos can be a useful adjunct to operative training. There is a large and increasing amount of material available for free on the internet, but this is currently unregulated.
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453
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Faucheron JL, Sage PY, Trilling B. Proctologic surgery done by residents: Who is the surgeon in real life? J Visc Surg 2017; 153:483-484. [PMID: 28340898 DOI: 10.1016/j.jviscsurg.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J-L Faucheron
- Colorectal Unit, Department of Surgery, Michallon University Hospital, 38000 Grenoble, France; University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000 Grenoble, France.
| | - P-Y Sage
- Colorectal Unit, Department of Surgery, Michallon University Hospital, 38000 Grenoble, France
| | - B Trilling
- Colorectal Unit, Department of Surgery, Michallon University Hospital, 38000 Grenoble, France; University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000 Grenoble, France
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454
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Yiasemidou M, Glassman D, Mushtaq F, Athanasiou C, Williams MM, Jayne D, Miskovic D. Mental practice with interactive 3D visual aids enhances surgical performance. Surg Endosc 2017; 31:4111-4117. [PMID: 28283764 PMCID: PMC5636856 DOI: 10.1007/s00464-017-5459-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/03/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evidence suggests that Mental Practice (MP) could be used to finesse surgical skills. However, MP is cognitively demanding and may be dependent on the ability of individuals to produce mental images. In this study, we hypothesised that the provision of interactive 3D visual aids during MP could facilitate surgical skill performance. METHODS 20 surgical trainees were case-matched to one of three different preparation methods prior to performing a simulated Laparoscopic Cholecystectomy (LC). Two intervention groups underwent a 25-minute MP session; one with interactive 3D visual aids depicting the relevant surgical anatomy (3D-MP group, n = 5) and one without (MP-Only, n = 5). A control group (n = 10) watched a didactic video of a real LC. Scores relating to technical performance and safety were recorded by a surgical simulator. RESULTS The Control group took longer to complete the procedure relative to the 3D&MP condition (p = .002). The number of movements was also statistically different across groups (p = .001), with the 3D&MP group making fewer movements relative to controls (p = .001). Likewise, the control group moved further in comparison to the 3D&MP condition and the MP-Only condition (p = .004). No reliable differences were observed for safety metrics. CONCLUSION These data provide evidence for the potential value of MP in improving performance. Furthermore, they suggest that 3D interactive visual aids during MP could potentially enhance performance, beyond the benefits of MP alone. These findings pave the way for future RCTs on surgical preparation and performance.
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Affiliation(s)
- Marina Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK.
| | - Daniel Glassman
- School of Surgery, Health Education Yorkshire and the Humber, University of Leeds, Willow Terrace Road, Leeds, LS2 9JT, UK
| | - Faisal Mushtaq
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Christos Athanasiou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK
| | - Mark-Mon Williams
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, LS2 9JT, UK
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK
| | - Danilo Miskovic
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK
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455
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Abstract
The comparison of the developments obtained by training for aviation with the ones obtained by training for surgery highlights the efforts that are still required to define shared and validated training curricula for surgeons. This work focuses on robotic assisted surgery and the related training systems to analyze the current approaches to surgery training based on virtual environments. Limits of current simulation technology are highlighted and the systems currently on the market are compared in terms of their mechanical design and characteristics of the virtual environments offered. In particular the analysis focuses on the level of realism, both graphical and physical, and on the set of training tasks proposed. Some multimedia material is proposed to support the analysis and to highlight the differences between the simulations and the approach to training. From this analysis it is clear that, although there are several training systems on the market, some of them with a lot of scientific literature proving their validity, there is no consensus about the tasks to include in a training curriculum or the level of realism required to virtual environments to be useful.
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Affiliation(s)
| | - Diego Dall'Alba
- Department of Computer Science, University of Verona, Verona, Italy
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456
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Quah C, Mehta R, Shivji FS, Hassan S, Chandrasenan J, Moran CG, Forward DP. The effect of surgical experience on the amount of radiation exposure from fluoroscopy during dynamic hip screw fixation. Ann R Coll Surg Engl 2017; 99:198-202. [PMID: 27551896 PMCID: PMC5450269 DOI: 10.1308/rcsann.2016.0282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2016] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Dynamic hip screw (DHS) fixation for proximal femur fractures is one of the most common procedures in trauma that requires the use of fluoroscopy. Emphasis is often placed on producing the 'perfect picture', which may lead to excessive use of fluoroscopy, without added patient benefit. This study, the largest of its kind, aimed to determine the effect of surgical experience on the amount of radiation exposure from fluoroscopy during DHS fixation. METHODS All hospital admissions for extracapsular proximal femur fractures to our institution between 2007 and 2012 were analysed. Patient demographics, fracture configuration, grade of surgeon and the total radiation dose after fixation were recorded. Analysis of variance was performed to assess differences in radiation levels between different grades of surgeon. RESULTS A total of 1,203 patients with a mean age of 81.3 years (range: 21-105 years) were included in the study. The majority of the fractures were three-part (33.3%), followed by two-part (32.2%), four-part (25.7%) and basicervical (8.9%). Registrars (ST3-ST8) used a significantly higher radiation dose than consultants for all fracture types (p=0.009). When analysed separately by trainee group, the most junior registrars (ST3-ST4) and the most senior registrars (ST7-ST8) were found to use significantly higher radiation levels than consultants (p=0.037 and p<0.001 respectively). CONCLUSIONS The level of surgical experience does influence the amount of radiation exposure from fluoroscopy during DHS fixation. Surgical trainees should not ignore the potential harmful effects of radiation and should be equipped with the knowledge of how to keep the radiation exposure as low as possible.
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Affiliation(s)
- C Quah
- Nottingham University Hospitals NHS Trust , UK
| | - R Mehta
- University of Nottingham , UK
| | - F S Shivji
- Nottingham University Hospitals NHS Trust , UK
| | - S Hassan
- Nottingham University Hospitals NHS Trust , UK
| | | | - C G Moran
- Nottingham University Hospitals NHS Trust , UK
| | - D P Forward
- Nottingham University Hospitals NHS Trust , UK
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457
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Lindlohr C, Lefering R, Saad S, Heiss MM, Pape-Köhler C. Training or non-surgical factors-what determines a good surgical performance? A randomised controlled trial. Langenbecks Arch Surg 2017; 402:645-653. [PMID: 28238058 DOI: 10.1007/s00423-017-1567-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 02/09/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acquiring laparoscopic skills is a necessity for every young surgeon. Whether it is a talent or a non-surgical skill that determines the surgical performance of an endoscopic operation has been discussed for years. In other disciplines aptitude testing has become the norm. Airlines, for example, have implemented assessments to test the natural aptitude of future pilots to predict their performance later on. In the medical field, especially surgery, there are no similar comparable tests implemented or even available. This study investigates the influence of potential factors that may predict the successful performance of a complex laparoscopic operation, such as the surgeon's age, gender or learning method. METHODS This study focussed 70 surgical trainees. It was designed as a secondary analysis of data derived from a 2 × 2 factorial randomised controlled trial of practical training and/or multimedia training (four groups) in an experimental exercise. Both before and then after the training sessions, the participating trainees performed a laparoscopic cholecystectomy in a pelvitrainer. Surgical performance was then evaluated using a modified objective structured assessment of technical skills (OSATS). Participants were classified as 'Skilled' (high score in the pre-test), 'Good Learner' (increase from pre- to post-test) or 'Others' based on the OSATS results. Based on the results of the recorded performance, the training methods as well as non-surgical skills were eventually evaluated in a univariate and in a multivariate analysis. RESULTS In the pre-training performance 11 candidates were categorised as 'Skilled' (15.7%), 35 participants as 'Good Learners' (50.0%) and 24 participants were classified as 'Others'. The univariate analysis showed that the age, a residency in visceral surgery, and participation in a multimedia training were significantly associated with this grouping. Multivariate analyses revealed that residency in visceral surgery was the most predictive factor for the 'Skilled' participants (p = 0.059), and multimedia training was most predictive for the 'Good Learner' (p = 0.006). Participants in the group of 'Others' who were neither 'Skilled' nor improved in the training phase were younger (p = 0.011) and did not receive multimedia (p < 0.001) or practical (p = 0.025) training. CONCLUSION The type of learning method has been shown to be the most effective factor to improve laparoscopic skills, with multimedia training proving to be more effective than practical training.
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Affiliation(s)
- Cornelia Lindlohr
- Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany.
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - S Saad
- Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany
| | - M M Heiss
- Department for Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - C Pape-Köhler
- Department for General and Abdominal Surgery, Protestant Hospital, Cologne-Weyertal, Germany
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458
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Sanromán-Álvarez P, Simal-Julián JA, García-Piñero A, Miranda-Lloret P. Multitask Box Trainer for Endoscopic Endonasal Skull Base Surgery: ENDOtrainer. World Neurosurg 2017; 101:304-307. [PMID: 28232211 DOI: 10.1016/j.wneu.2017.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Pablo Sanromán-Álvarez
- Department of Neurological Surgery, HUiP La Fe, Valencia, Spain; Department of Neurological Surgery, Hospital Álvaro Cunqueiro, Vigo, Spain.
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459
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Abstract
BACKGROUND Surgical residents need to train laparoscopic skills for minimally invasive procedures at an early stage. The aim of this study was the investigation and assessment of appendectomy carried out at a university medical center over the previous decade regarding the frequency of operations by residents in training and the type of surgical technique used (laparoscopic vs. open). METHODS A retrospective analysis of appendectomies carried out from 2005 to 2014 at the clinic for general, visceral and transplant surgery was performed. Operators were stratified into two groups (group 1: residents and group 2: fellows/attending surgeons). Surgery was classified as laparoscopic or open appendectomy. RESULTS Out of 1,587 appendectomies analyzed 946 were performed laparoscopically (59.6 %). The percentage of laparoscopic appendectomies increased significantly over the decade analyzed (p < 0.001) and reached 94.4 % in 2014. From 2005 until 2007 the rate of appendectomies by residents was 17.9 % (77 out of 430). Laparoscopic appendectomy was performed in 5.8 % and was only performed by fellows or attending surgeons. From 2008 to 2014 the rate of surgeries by residents significantly increased (p < 0.001) and accounted for 57.6 % (range 19.4-66.9 %). CONCLUSION Regardless of the surgical technique used, appendectomy is still a primary training operation for surgical residents. An early and focused training of minimally invasive visceral surgery in the new regulations for continuing medical education starts with laparoscopic appendectomy.
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Affiliation(s)
- T Huber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - M Paschold
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - F Bartsch
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - H Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - W Kneist
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
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460
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Bassil A, Rubod C, Borghesi Y, Kerbage Y, Schreiber ES, Azaïs H, Garabedian C. Operative and diagnostic hysteroscopy: A novel learning model combining new animal models and virtual reality simulation. Eur J Obstet Gynecol Reprod Biol 2017; 211:42-47. [PMID: 28178577 DOI: 10.1016/j.ejogrb.2017.01.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/17/2017] [Accepted: 01/30/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT Hysteroscopy is one of the most common gynaecological procedure. Training for diagnostic and operative hysteroscopy can be achieved through numerous previously described models like animal models or virtual reality simulation. We present our novel combined model associating virtual reality and bovine uteruses and bladders. STUDY DESIGN End year residents in obstetrics and gynaecology attended a full day workshop. The workshop was divided in theoretical courses from senior surgeons and hands-on training in operative hysteroscopy and virtual reality Essure® procedures using the EssureSim™ and Pelvicsim™ simulators with multiple scenarios. Theoretical and operative knowledge was evaluated before and after the workshop and General Points Averages (GPAs) were calculated and compared using a Student's T test. RESULTS GPAs were significantly higher after the workshop was completed. The biggest difference was observed in operative knowledge (0,28 GPA before workshop versus 0,55 after workshop, p<0,05). All of the 25 residents having completed the workshop applauded the realism an efficiency of this type of training. The force feedback allowed by the cattle uteruses gives the residents the possibility to manage thickness of resection as in real time surgery. Furthermore, the two-horned bovine uteruses allowed to reproduce septa resection in conditions close to human surgery CONCLUSION: Teaching operative and diagnostic hysteroscopy is essential. Managing this training through a full day workshop using a combined animal model and virtual reality simulation is an efficient model not described before.
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Affiliation(s)
- Alfred Bassil
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France.
| | - Chrystèle Rubod
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France; University of Lille North of France, F-59000 Lille, France
| | - Yves Borghesi
- CH Valenciennes, Department of Gynaecology and Obstetrics, F-59300 Lille, France
| | - Yohan Kerbage
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France
| | | | - Henri Azaïs
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France; University of Lille North of France, F-59000 Lille, France
| | - Charles Garabedian
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France; University of Lille North of France, F-59000 Lille, France
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461
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Orlando MS, Thomaier L, Abernethy MG, Chen CCG. Retention of laparoscopic and robotic skills among medical students: a randomized controlled trial. Surg Endosc 2017; 31:3306-3312. [PMID: 28078455 DOI: 10.1007/s00464-016-5363-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/13/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although simulation training beneficially contributes to traditional surgical training, there are less objective data on simulation skills retention. OBJECTIVE To investigate the retention of laparoscopic and robotic skills after simulation training. METHODS We present the second stage of a randomized single-blinded controlled trial in which 40 simulation-naïve medical students were randomly assigned to practice peg transfer tasks on either laparoscopic (N = 20, Fundamentals of Laparoscopic Surgery, Venture Technologies Inc., Waltham, MA) or robotic (N = 20, dV-Trainer, Mimic, Seattle, WA) platforms. In the first stage, two expert surgeons evaluated participants on both tasks before (Stage 1: Baseline) and immediately after training (Stage 1: Post-training) using a modified validated global rating scale of laparoscopic and robotic operative performance. In Stage 2, participants were evaluated on both tasks 11-20 weeks after training. RESULTS Of the 40 students who participated in Stage 1, 23 (11 laparoscopic and 12 robotic) underwent repeat evaluation. During Stage 2, there were no significant differences between groups in objective or subjective measures for the laparoscopic task. Laparoscopic-trained participants' performances on the laparoscopic task were improved during Stage 2 compared to baseline measured by time to task completion, but not by the modified global rating scale. During the robotic task, the robotic-trained group demonstrated superior economy of motion (p = .017), Tissue Handling (p = .020), and fewer errors (p = .018) compared to the laparoscopic-trained group. Robotic skills acquisition from baseline with no significant deterioration as measured by modified global rating scale scores was observed among robotic-trained participants during Stage 2. CONCLUSION Robotic skills acquired through simulation appear to be better maintained than laparoscopic simulation skills. CLINICAL TRIAL This study is registered on ClinicalTrials.gov (NCT02370407).
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Affiliation(s)
- Megan S Orlando
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 301 Mason Lord Drive Suite 3200, Baltimore, MD, 21224, USA
| | - Lauren Thomaier
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 301 Mason Lord Drive Suite 3200, Baltimore, MD, 21224, USA
| | - Melinda G Abernethy
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 301 Mason Lord Drive Suite 3200, Baltimore, MD, 21224, USA
| | - Chi Chiung Grace Chen
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 301 Mason Lord Drive Suite 3200, Baltimore, MD, 21224, USA.
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462
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Kaplan DJ, Patel JN, Liporace FA, Yoon RS. Intraoperative radiation safety in orthopaedics: a review of the ALARA (As low as reasonably achievable) principle. Patient Saf Surg 2016; 10:27. [PMID: 27999617 PMCID: PMC5154084 DOI: 10.1186/s13037-016-0115-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022] Open
Abstract
The use of fluoroscopy has become commonplace in many orthopaedic surgery procedures. The benefits of fluoroscopy are not without risk of radiation to patient, surgeon, and operating room staff. There is a paucity of knowledge by the average orthopaedic resident in terms proper usage and safety. Personal protective equipment, proper positioning, effective communication with the radiology technician are just of few of the ways outlined in this article to decrease the amount of radiation exposure in the operating room. This knowledge ensures that the amount of radiation exposure is as low as reasonably achievable. Currently, in the United States, guidelines for teaching radiation safety in orthopaedic surgery residency training is non-existent. In Europe, studies have also exhibited a lack of standardized teaching on the basics of radiation safety in the operating room. This review article will outline the basics of fluoroscopy and educate the reader on how to safe fluoroscopic image utilization.
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Affiliation(s)
- Daniel J Kaplan
- Department of Orthopaedic Surgery, RWJBarnabas Health - Jersey City Medical Center, 355 Grand St, Jersey City, NJ 07302 USA
| | - Jay N Patel
- Department of Orthopaedic Surgery, RWJBarnabas Health - Jersey City Medical Center, 355 Grand St, Jersey City, NJ 07302 USA
| | - Frank A Liporace
- Department of Orthopaedic Surgery, RWJBarnabas Health - Jersey City Medical Center, 355 Grand St, Jersey City, NJ 07302 USA
| | - Richard S Yoon
- Division of Orthopaedic Traumatology & Complex Adult Reconstruction, Department of Orthopaedic Surgery, Orlando Regional Medical Center, 1222 S Orange Ave, 5th Floor, Orlando, FL 32806 USA
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464
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Abstract
BACKGROUND It is important for a surgeon to perform surgical tasks under appropriate guidance from visual and kinesthetic feedback. However, our knowledge on kinesthetic (muscle) memory and its role in learning motor skills remains elementary. OBJECTIVES To discover the effect of exclusive kinesthetic training on kinesthetic memory in both performance and learning. METHODS In Phase 1, a total of twenty participants duplicated five 2 dimensional movements of increasing complexity via passive kinesthetic guidance, without visual or auditory stimuli. Five participants were asked to repeat the task in the Phase 2 over a period of three weeks, for a total of nine sessions. RESULTS Subjects accurately recalled movement direction using kinesthetic memory, but recalling movement length was less precise. Over the nine training sessions, error occurrence dropped after the sixth session. CONCLUSIONS Muscle memory constructs the foundation for kinesthetic training. Knowledge gained helps surgeons learn skills from kinesthetic information in the condition where visual feedback is limited.
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Affiliation(s)
- David Pinzon
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Roberto Vega
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Yerly Paola Sanchez
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
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465
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Arnaud AP, Frémond B, Violas P. [Application of the working time European directive on surgical residents in France: Threat or benefit for the training?]. Prog Urol 2016; 26:591. [PMID: 27717735 DOI: 10.1016/j.purol.2016.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A P Arnaud
- Service de chirurgie pédiatrique générale et urologique, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France.
| | - B Frémond
- Service de chirurgie pédiatrique générale et urologique, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France
| | - P Violas
- Service de chirurgie pédiatrique générale et urologique, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France
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466
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Borgmann H, Rodríguez Socarrás M, Salem J, Tsaur I, Gomez Rivas J, Barret E, Tortolero L. Feasibility and safety of augmented reality-assisted urological surgery using smartglass. World J Urol 2017; 35:967-72. [PMID: 27761715 DOI: 10.1007/s00345-016-1956-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/13/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess the feasibility, safety and usefulness of augmented reality-assisted urological surgery using smartglass (SG). METHODS Seven urological surgeons (3 board urologists and 4 urology residents) performed augmented reality-assisted urological surgery using SG for 10 different types of operations and a total of 31 urological operations. Feasibility was assessed using technical metadata (number of photographs taken/number of videos recorded/video time recorded) and structured interviews with the urologists on their use of SG. Safety was evaluated by recording complications and grading according to the Clavien-Dindo classification. Usefulness of SG for urological surgery was queried in structured interviews and in a survey. RESULTS The implementation of SG use during urological surgery was feasible with no intrinsic (technical defect) or extrinsic (inability to control the SG function) obstacles being observed. SG use was safe as no grade 3-5 complications occurred for the series of 31 urological surgeries of different complexities. Technical applications of SG included taking photographs/recording videos for teaching and documentation, hands-free teleconsultation, reviewing patients' medical records and images and searching the internet for health information. Overall usefulness of SG for urological surgery was rated as very high by 43 % and high by 29 % of surgeons. CONCLUSIONS Augmented reality-assisted urological surgery using SG is both feasible and safe and also provides several useful functions for urological surgeons. Further developments and investigations are required in the near future to harvest the great potential of this exciting technology for urological surgery.
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467
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McElnay PJ, McGoldrick C, Beamish AJ, Hoo C, Gokani VJ, Harries RL. Credentialing in surgical specialities: Recommendations by the Association of Surgeons in Training. Int J Surg 2016; 36 Suppl 1:S10-S13. [PMID: 27664557 DOI: 10.1016/j.ijsu.2016.09.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/18/2016] [Accepted: 09/19/2016] [Indexed: 11/25/2022]
Abstract
The General Medical Council (GMC) has conducted a consultation process on its proposals for "credentialing" in postgraduate medical practice in the UK. It has been suggested that these may be used to provide formal accreditation of a doctor's competency in a certain area of practice. There are 5 main issues being consulted upon: (a) the time point in a doctor's career at which credentialing should be undertaken, (b) the scope of practice that should be included in credentials and whether this should include any competency already accredited by a Certificate of Completion of Training, (c) the funding source for the credentialing process, (d) the bodies that are entitled to award a credential, and (e) who exactly should be eligible for a credential. The Association of Surgeons in Training has commented on each issue and made recommendations to the GMC. One area of practice that has already begun a regulation process is Cosmetic Surgery, in response to the lack of defined standards and a clear training pathway. Both the GMC and Royal College of Surgeons of England have now published standards in this area and will come into effect in 2016. The impact of these on surgical training is discussed.
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Affiliation(s)
- Philip J McElnay
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Ciara McGoldrick
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Andrew J Beamish
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Christopher Hoo
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Vimal J Gokani
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Rhiannon L Harries
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK.
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- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
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468
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Mohan HM, Gokani VJ, Williams AP, Harries RL. Consultant outcomes publication and surgical training: Consensus recommendations by the association of surgeons in training. Int J Surg 2016; 36 Suppl 1:S20-S23. [PMID: 27659508 DOI: 10.1016/j.ijsu.2016.09.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/10/2016] [Accepted: 09/18/2016] [Indexed: 01/18/2023]
Abstract
Consultant Outcomes Publication (COP) has the longest history in cardiothoracic surgery, where it was introduced in 2005. Subsequently COP has been broadened to include all surgical specialties in NHS England in 2013-14. The Association of Surgeons in Training (ASiT) fully supports efforts to improve patient care and trust in the profession and is keen to overcome potential unintended adverse effects of COP. Identification of these adverse effects is the first step in this process: Firstly, there is a risk that COP may lead to reluctance by consultants to provide trainees with the necessary appropriate primary operator experience to become skilled consultant surgeons for the future. Secondly, COP may lead to inappropriately cautious case selection. This adjusted case mix affects both patients who are denied operations, and also limits the complexity of the case mix to which surgical trainees are exposed. Thirdly, COP undermines efforts to train surgical trainees in non-technical skills and human factors, simply obliterating the critical role of the multidisciplinary team and organisational processes in determining outcomes. This tunnel vision masks opportunities to improve patient care and outcomes at a unit level. It also misinforms the public as to the root causes of adverse events by failing to identify care process deficiencies. Finally, for safe surgical care, graduate retention and morale is important - COP may lead to high calibre trainees opting out of surgical careers, or opting to work abroad. The negative effects of COP on surgical training and trainees must be addressed as high quality surgical training and retention of high calibre graduates is essential for excellent patient care.
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Affiliation(s)
- Helen M Mohan
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Vimal J Gokani
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Adam P Williams
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Rhiannon L Harries
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK.
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- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
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469
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Yoo SJ, Thabit O, Kim EK, Ide H, Yim D, Dragulescu A, Seed M, Grosse-Wortmann L, van Arsdell G. 3D printing in medicine of congenital heart diseases. 3D Print Med 2016; 2:3. [PMID: 30050975 PMCID: PMC6036784 DOI: 10.1186/s41205-016-0004-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
Congenital heart diseases causing significant hemodynamic and functional consequences require surgical repair. Understanding of the precise surgical anatomy is often challenging and can be inadequate or wrong. Modern high resolution imaging techniques and 3D printing technology allow 3D printing of the replicas of the patient’s heart for precise understanding of the complex anatomy, hands-on simulation of surgical and interventional procedures, and morphology teaching of the medical professionals and patients. CT or MR images obtained with ECG-gating and breath-holding or respiration navigation are best suited for 3D printing. 3D echocardiograms are not ideal but can be used for printing limited areas of interest such as cardiac valves and ventricular septum. Although the print materials still require optimization for representation of cardiovascular tissues and valves, the surgeons find the models suitable for practicing closure of the septal defects, application of the baffles within the ventricles, reconstructing the aortic arch, and arterial switch procedure. Hands-on surgical training (HOST) on models may soon become a mandatory component of congenital heart disease surgery program. 3D printing will expand its utilization with further improvement of the use of echocardiographic data and image fusion algorithm across multiple imaging modalities and development of new printing materials. Bioprinting of implants such as stents, patches and artificial valves and tissue engineering of a part of or whole heart using the patient’s own cells will open the door to a new era of personalized medicine.
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Affiliation(s)
- Shi-Joon Yoo
- Department of Diagnostic Imaging, University of Toronto, 555 University Avenue, Toronto, ON Canada.,Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Omar Thabit
- Department of Diagnostic Imaging, University of Toronto, 555 University Avenue, Toronto, ON Canada.,Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Eul Kyung Kim
- 3D HOPE (Human organ Printing and Engineering) Medical, 1008-65 Harbour Sqaure, Toronto, ON M5J2L4 Canada
| | - Haruki Ide
- Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Deane Yim
- Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Anreea Dragulescu
- Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Mike Seed
- Department of Diagnostic Imaging, University of Toronto, 555 University Avenue, Toronto, ON Canada.,Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Lars Grosse-Wortmann
- Department of Diagnostic Imaging, University of Toronto, 555 University Avenue, Toronto, ON Canada.,Division of Cardiology - Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON Canada
| | - Glen van Arsdell
- Division of Cardiovascular Surgery - Department of Surgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G1X8 Canada
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470
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Egan RJ, Abdelrahman T, Tate S, Ansell J, Harries R, Davies L, Clark G, Lewis WG. Modular emergency general surgery training: A pilot study of a novel programme. Ann R Coll Surg Engl 2016; 98:475-8. [PMID: 27269241 PMCID: PMC5210010 DOI: 10.1308/rcsann.2016.0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Pan-speciality consensus guidance advocates mandatory emergency general surgery (EGS) training modules for specialist registrars (StRs). This pilot study evaluated the impact of EGS modules aimed at StRs over 1 year. Methods Eleven StRs were allocated a focused 4-week EGS module, in addition to the standard 1:12 on-call duty rota, in a tertiary surgical centre. Primary outcome measures included the number of indicative emergency operations and validated Procedure Based Assessments (PBAs) performed, both during the EGS module and over the training year. Results StRs performed a median of 11 (range 5-15) laparotomies during the EGS module versus 31 (range 9-49) over the whole training year. StRs attended 43.7% of available laparotomies during the module (range 24.1-63.7%). EGS modules provided more than one-third of the total emergency laparotomy experience, and a quarter of the emergency colectomy, appendicectomy and Hartmann's procedure experience. There were no differences in EGS module-related outcomes between junior and senior StRs. Significantly more PBAs related to laparotomy and segmental colectomy were completed during EGS modules than the on-call duty rota, at 32% versus 14% (p<0.001) and 48% versus 22% (p=0.019), respectively. Performance levels were maintained following module completion. Conclusions These findings provide an important baseline when considering future modular EGS training.
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Affiliation(s)
- R J Egan
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | | | - S Tate
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | - J Ansell
- Wales Deanery, Neuadd Meirionnydd , Cardiff , UK
| | | | - L Davies
- University Hospital of Wales , Cardiff , UK
| | - Gwb Clark
- University Hospital of Wales , Cardiff , UK
| | - W G Lewis
- University Hospital of Wales , Cardiff , UK
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471
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Jimbo T, Ieiri S, Obata S, Uemura M, Souzaki R, Matsuoka N, Katayama T, Masumoto K, Hashizume M, Taguchi T. Preoperative simulation regarding the appropriate port location for laparoscopic hepaticojejunostomy: a randomized study using a disease-specific training simulator. Pediatr Surg Int 2016; 32:901-7. [PMID: 27514861 DOI: 10.1007/s00383-016-3937-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE We verified the appropriate port location for laparoscopic hepaticojejunostomy using a comprehensive laparoscopic training simulator. METHODS We developed a hepaticojejunostomy model, consist of common hepatic duct and intestine and participants required to place two sutures precisely using two different port locations (A: standard port location, B: modified port location). The order of tasks was randomly determined using the permuted block method (Group I: Task A → Task B, Group II: Task B → Task A). The time for task completion and total number of errors were recorded. In addition, we evaluated the spatial paths and velocity of both forceps. Statistical analyses were performed using a statistical software program. RESULTS The time for the task, the total error score, and the spatial paths and velocity of both forceps were not significantly different between groups I and II. Furthermore, the port location and order of tasks (group I or group II) did not significantly affect the results. In contrast, there were significant differences in the performance between experts and novices, who were classified as such based on the total number of experienced endoscopic surgeries. CONCLUSION Preoperative port simulation in advanced surgery using our artificial simulator is feasible and may facilitate minimally invasive surgery for children.
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472
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Burdett C, Dunning J, Goodwin A, Theakston M, Kendall S. Left-handed cardiac surgery: tips from set up to closure for trainees and their trainers. J Cardiothorac Surg 2016; 11:139. [PMID: 27580858 PMCID: PMC5007814 DOI: 10.1186/s13019-016-0523-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
There are certain obstacles which left-handed surgeons can face when training but these are not necessary and often perpetuated by a lack of knowledge. Most have been encountered and overcome at some point but unless recorded and disseminated they will have to be resolved repeatedly by each trainee and their trainers. This article highlights difficulties that the left-hander may encounter in cardiac surgery and gives practical operative advice for both trainees and their trainers to help overcome them.
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Affiliation(s)
- Clare Burdett
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Andrew Goodwin
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Maureen Theakston
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Simon Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
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473
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Harries RL, Williams AP, McElnay PJ, Gokani VJ. Association of surgeons in training 40th anniversary conference: Liverpool #ASiT2016. Int J Surg 2016; 36 Suppl 1:S1-S4. [PMID: 27565241 DOI: 10.1016/j.ijsu.2016.08.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/20/2016] [Indexed: 11/17/2022]
Abstract
The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patient alike. ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges and specialty associations, and represents trainees in all ten surgical specialities. We were delighted to be celebrating our 40th Anniversary Conference in the fantastic city of Liverpool with over 700 delegates in attendance and in the company of many ASiT Past Presidents. The conference programme focused on how to overcome threats to training in light of the recent turbulent events associated with the junior doctor contract dispute with inspiring talks from Professor Sir Bruce Keogh, NHS Medical Director and Rt Hon Heidi Alexander MP, Shadow Health Secretary. The other central topic to the conference was 'celebrating excellence in surgical training' and we were thankful to many other high profile speakers who attended to help in this celebration. In addition, over £4000 was distributed between more than 30 prizes and was awarded by the incoming President, Mr Adam Williams, to delegates who presented the highest scoring academic work from over 1200 submitted abstracts.
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Affiliation(s)
- Rhiannon L Harries
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK.
| | - Adam P Williams
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Philip J McElnay
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Vimal J Gokani
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
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474
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Stefanidis D, Anton NE, McRary G, Howley LD, Pimentel M, Davis C, Yurco AM, Sevdalis N, Brown C. Implementation results of a novel comprehensive mental skills curriculum during simulator training. Am J Surg 2016; 213:353-361. [PMID: 27666640 DOI: 10.1016/j.amjsurg.2016.06.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 04/15/2016] [Accepted: 06/12/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mental skills training refers to the implementation of cognitive performance-enhancing strategies to promote optimal performance. We aimed to develop a surgery-specific mental skills curriculum (MSC) and obtain initial evidence of efficacy. METHODS The developed MSC consisted of 8 proven performance-enhancing modules. Its efficacy was assessed during laparoscopic simulator-based practice by novices using validated instruments of mental skills, workload, and stress, in addition to a skill transfer test to a porcine model. A paired t test was used to analyze the data. RESULTS Nine surgical novices completed the curriculum. Compared with baseline assessment, participants improved significantly their laparoscopic performance and mental skills after completion of the MSC. All participants completed the task in the porcine model without an appreciable change in their perceived stress. During the skill transfer test, 8 participants were observed using mental skills taught in the MSC. CONCLUSIONS A surgery-specific simulator-based MSC was developed, and its efficacy in improving mental skills and surgical performance was supported during a surgical skill transfer test.
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Affiliation(s)
- Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 125, Indianapolis, IN 46202, USA; Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, USA.
| | - Nicholas E Anton
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - Graham McRary
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - Lisa D Howley
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, USA; Medical Education, Carolinas HealthCare System, Charlotte, NC, USA
| | - Manuel Pimentel
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - Cameron Davis
- Medical Education, Carolinas HealthCare System, Charlotte, NC, USA
| | - Ashley M Yurco
- Medical Education, Carolinas HealthCare System, Charlotte, NC, USA
| | - Nick Sevdalis
- Centre for Implementation Science, Department of Health Service and Population Research, King's College, London, UK
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475
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Harries RL, Williams AP, Ferguson HJM, Mohan HM, Beamish AJ, Gokani VJ. The future of surgical training in the context of the 'Shape of Training' Review: Consensus recommendations by the Association of Surgeons in Training. Int J Surg 2016; 36 Suppl 1:S5-S9. [PMID: 27562689 DOI: 10.1016/j.ijsu.2016.08.238] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/20/2016] [Indexed: 11/16/2022]
Abstract
ASiT has long maintained that in order to provide the best quality care to patients in the UK and Republic of Ireland, it is critical that surgeons are trained to the highest standards. In addition, it is imperative that surgery remains an attractive career choice, with opportunities for career progression and job satisfaction to attract and retain the best candidates. In 2013, the Shape of Training review report set out recommendations for the structure and delivery of postgraduate training in light of an ever increasingly poly-morbid and ageing population. This consensus statement outlines ASIT's position regarding recommendations for improving surgical training and aims to help guide discussions with regard to future proposed changes to surgical training.
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Affiliation(s)
- Rhiannon L Harries
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK.
| | - Adam P Williams
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Henry J M Ferguson
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Helen M Mohan
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Andrew J Beamish
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Vimal J Gokani
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
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- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
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476
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Burdett C, Theakston M, Dunning J, Goodwin A, Kendall SWH. Left-handed surgical instruments - a guide for cardiac surgeons. J Cardiothorac Surg 2016; 11:135. [PMID: 27542837 PMCID: PMC4992330 DOI: 10.1186/s13019-016-0497-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/14/2016] [Indexed: 11/25/2022] Open
Abstract
For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed surgeon. Although they exist, they are not available in many surgical centres. As a result, most operating theatre staff (including many left-handers) have little knowledge of their value or even application. With specific reference to cardiac surgery, this article addresses the ways in which they differ, why they are needed and what is required - with tips on use.
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Affiliation(s)
- Clare Burdett
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
| | - Maureen Theakston
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Andrew Goodwin
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Simon William Henry Kendall
- Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
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477
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Abstract
Simulation in surgical training is playing an increasingly important role as postgraduate medical education programs navigate an environment of increasing costs of education, increased attention on patient safety, and new duty hour restrictions. In obstetrics and gynecology, simulation has been used to teach many procedures; however, it lacks a standardized curriculum. Several different simulators exist for teaching various routes and aspects of hysterectomy. This article describes how a formal framework of increasing levels of competencies can be applied to simulation in teaching the procedure of hysterectomy.
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Affiliation(s)
- Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, University of Calgary, 29 Street NW, Calgary, Alberta T2N 2T9, Canada.
| | - Erin A Brennand
- Department of Obstetrics and Gynecology, University of Calgary, 29 Street NW, Calgary, Alberta T2N 2T9, Canada
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478
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Abstract
AIM OF THE STUDY During minimally invasive abdominal surgery, a laparoscope is used to film the procedure, which is transmitted to a flat screen monitor. The horizontality of the image depends on the orientation in space and the visual comfort of the surgeon. Observing the screen via a lateral angle of incidence frequently results in the camera assistant making errors in determining the horizontality of the image. Thus, what is "right" for the camera assistant is not necessarily 'right' for the surgeon. We aimed to explain the impact of these errors in laparoscope manipulation, by the description of the parallax effect. PATIENTS AND METHODS To describe this phenomenon of perceptions changing depending on the angle of view, from the basis of the parallax effect, we observed the change of position and for two observers, (the surgeon and the camera assistant) seated at two different locations, using an experimental set up (i.e., photography equipment, a screen and a pelvitrainer). RESULTS The position of the camera assistant positioned at an angle of incidence of 45° from the surgeon, the observation of the screen with a lateral incidence changes the perception of the image viewed on the screen. For correcting the conflict between the subjective visual perception of the camera assistant and the actual image horizon, the camera assistant instinctively rotates the image, which can lead to an "incorrect" image, deleterious for the surgeon. CONCLUSIONS This article introduces a previously unexplained concept in medical literature, called the parallax effect. The parallax effect results in the camera assistant making systematic errors in determining image horizontality on the screen.
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Affiliation(s)
- J Cahais
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - L Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - E Huet
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - J-J Tuech
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France.
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479
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Derbew M, Laytin AD, Dicker RA. The surgical workforce shortage and successes in retaining surgical trainees in Ethiopia: a professional survey. Hum Resour Health 2016; 14:29. [PMID: 27380899 PMCID: PMC4943482 DOI: 10.1186/s12960-016-0126-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Medical workforce shortages represent a major challenge in low- and middle-income countries, including those in Africa. Despite this, there is a dearth of information regarding the location and practice of African surgeons following completion of their training. In response to the call by the WHO Global Code of Practice on the International Recruitment of Health Personnel for a sound evidence base regarding patterns of practice and migration of the health workforce, this study describes the current place of residence, practice and setting of Ethiopian surgical residency graduates since commencement of their surgical training in Ethiopia or in Cuba. METHODS This study presents data from a survey of all Ethiopian surgical residency training graduates since the programme's inception in 1985. RESULTS A total of 348 Ethiopians had undergone surgical training in Ethiopia or Cuba since 1985; data for 327 (94.0 %) of these surgeons were collected and included in the study. The findings indicated that 75.8 % of graduates continued to practice in Ethiopia, with 80.9 % of these practicing in the public sector. Additionally, recent graduates were more likely to remain in Ethiopia and work within the public sector. The average total number of surgeons per million inhabitants in Ethiopia was approximately three and 48.0 % of Ethiopian surgeons practiced in Addis Ababa. CONCLUSIONS Ethiopian surgeons are increasingly likely to remain in Ethiopia and to practice in the public sector. Nevertheless, Ethiopia continues to suffer from a drastic surgical workforce shortage that must be addressed through increased training capacity and strategies to combat emigration and attrition.
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Affiliation(s)
- Miliard Derbew
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, PO Box 5729, Addis Ababa, Ethiopia.
| | - Adam D Laytin
- Center for Global Surgical Studies, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Rochelle A Dicker
- Center for Global Surgical Studies, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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480
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Öfner D. Leadership and training. Eur Surg 2016; 48:163-5. [PMID: 27340394 DOI: 10.1007/s10353-016-0421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/15/2016] [Indexed: 11/01/2022]
Abstract
Against the background of substantial changes in the field of healthcare in Austria, the specialization in surgery must be reconsidered starting from modified points of view. However, in this context, the new training regulations are not the only standard: the training officers must show leadership skills by paying attention to the modified framework conditions and by promoting a new corporate culture related to training with innovating concepts. The challenge of the threatening quality loss in surgery can only be addressed in this way.
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481
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Lam CK, Sundaraj K, Sulaiman MN, Qamarruddin FA. Virtual phacoemulsification surgical simulation using visual guidance and performance parameters as a feasible proficiency assessment tool. BMC Ophthalmol 2016; 16:88. [PMID: 27296449 PMCID: PMC4906728 DOI: 10.1186/s12886-016-0269-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computer based surgical training is believed to be capable of providing a controlled virtual environment for medical professionals to conduct standardized training or new experimental procedures on virtual human body parts, which are generated and visualised three-dimensionally on a digital display unit. The main objective of this study was to conduct virtual phacoemulsification cataract surgery to compare performance by users with different proficiency on a virtual reality platform equipped with a visual guidance system and a set of performance parameters. METHODS Ten experienced ophthalmologists and six medical residents were invited to perform the virtual surgery of the four main phacoemulsification cataract surgery procedures - 1) corneal incision (CI), 2) capsulorhexis (C), 3) phacoemulsification (P), and 4) intraocular lens implantation (IOL). Each participant was required to perform the complete phacoemulsification cataract surgery using the simulator for three consecutive trials (a standardized 30-min session). The performance of the participants during the three trials was supported using a visual guidance system and evaluated by referring to a set of parameters that was implemented in the performance evaluation system of the simulator. RESULTS Subjects with greater experience obtained significantly higher scores in all four main procedures - CI1 (ρ = 0.038), CI2 (ρ = 0.041), C1 (ρ = 0.032), P2 (ρ = 0.035) and IOL1 (ρ = 0.011). It was also found that experience improved the completion times in all modules - CI4 (ρ = 0.026), C4 (ρ = 0.018), P6 (ρ = 0.028) and IOL4 (ρ = 0.029). Positive correlation was observed between experience and anti-tremor - C2 (ρ = 0.026), P3 (ρ = 0.015), P4 (ρ = 0.042) and IOL2 (ρ = 0.048) and similarly with anti-rupture - CI3 (ρ = 0.013), C3 (ρ = 0.027), P5 (ρ = 0.021) and IOL3 (ρ = 0.041). No significant difference was observed between the groups with regards to P1 (ρ = 0.077). CONCLUSIONS Statistical analysis of the results obtained from repetitive trials between two groups of users reveal that augmented virtual reality (VR) simulators have the potential and capability to be used as a feasible proficiency assessment tool for the complete four main procedures of phacoemulsification cataract surgery (ρ < 0.05), indicating the construct validity of the modules simulated with augmented visual guidance and assessed through performance parameters.
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Affiliation(s)
- Chee Kiang Lam
- School of Mechatronic Engineering, Universiti Malaysia Perlis (UniMAP), Kampus Pauh Putra, 02600, Arau, Perlis, Malaysia.
| | - Kenneth Sundaraj
- Faculty of Electronics and Computer Engineering, Universiti Teknikal Malaysia Melaka (UTeM), Hang Tuah Jaya, 76100, Durian Tunggal, Melaka, Malaysia
| | - Mohd Nazri Sulaiman
- Department of Ophthalmology, Hospital Tuanku Fauziah (HTF), Jalan Kolam, 01000, Kangar, Perlis, Malaysia
| | - Fazilawati A Qamarruddin
- Department of Ophthalmology, Hospital Tengku Ampuan Rahimah (HTAR), Jalan Langat, 41200, Klang, Selangor, Malaysia
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482
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Gruwez JA. What is needed to become a good surgeon? Acta Chir Belg 2016; 116:146-148. [PMID: 27643570 DOI: 10.1080/00015458.2016.1215950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This lecture has been delivered as a part of the RBSS-BAST symposium 'What does it need to become a good surgeon'. The lecture relates to the evolution that has taken place over the last decades in relation to the training in surgery. It also gives some hints to younger colleagues how to make a successful career in surgery.
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483
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Dorozhkin D, Nemani A, Roberts K, Ahn W, Halic T, Dargar S, Wang J, Cao CGL, Sankaranarayanan G, De S. Face and content validation of a Virtual Translumenal Endoscopic Surgery Trainer (VTEST™). Surg Endosc 2016; 30:5529-5536. [PMID: 27129546 DOI: 10.1007/s00464-016-4917-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 04/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical paradigm, where peritoneal access is achieved through one of the natural orifices of the body. It is being reported as a safe and feasible surgical technique with significantly reduced external scarring. Virtual Translumenal Endoscopic Surgical Trainer (VTEST™) is the first virtual reality simulator for the NOTES. The VTEST™ simulator was developed to train surgeons in the hybrid transvaginal NOTES cholecystectomy procedure. The initial version of the VTEST™ simulator underwent face validation at the 2013 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) summit. Several areas of improvement were identified as a result, and the corresponding modifications were implemented in the simulator. This manuscript outlines the results of the subsequent evaluation study, performed in order to assess the face and content validity of the latest VTEST™ simulator. METHODS Twelve subjects participated in an institutional review board-approved study that took place at the 2014 NOSCAR summit. Six of the 12 subjects, who are experts with NOTES experience, were used for face and content validation. The subjects performed the hybrid transvaginal NOTES cholecystectomy procedure on VTEST™ that included identifying the Calot's triangle, clipping and cutting the cystic duct/artery, and detaching the gallbladder. The subjects then answered five-point Likert scale feedback questionnaires for face and content validity. RESULTS Overall, subjects rated 12/15 questions as 3.0 or greater (60 %), for face validity questions regarding the realism of the anatomical features, interface, and the tasks. Subjects also highly rated the usefulness of the simulator in learning the fundamental NOTES technical skills (3.50 ± 0.84). Content validity results indicate a high level of usefulness of the VTEST™ for training prior to operating room experience (4.17 ± 0.75).
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Affiliation(s)
- Denis Dorozhkin
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Arun Nemani
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Kurt Roberts
- Gastrointestinal Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Woojin Ahn
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Tansel Halic
- Computer Science Department, University of Central Arkansas, Conway, AR, USA
| | - Saurabh Dargar
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Jinling Wang
- Biomedical, Industrial and Human Factors Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Caroline G L Cao
- Biomedical, Industrial and Human Factors Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Ganesh Sankaranarayanan
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA.
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484
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Harries RL, Gokani VJ, Smitham P, Fitzgerald JEF. Less than full-time training in surgery: a cross-sectional study evaluating the accessibility and experiences of flexible training in the surgical trainee workforce. BMJ Open 2016; 6:e010136. [PMID: 27091819 PMCID: PMC4838701 DOI: 10.1136/bmjopen-2015-010136] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Generational changes in lifestyle expectations, working environments and the feminisation of the medical workforce have seen an increased demand in postgraduate less than full-time training (LTFT). Despite this, concerns remain regarding access to, and information about, flexible training for surgeons. This study aimed to assess the opinions and experiences of LTFT for surgical trainees. DESIGN Prospective, questionnaire-based cross-sectional study. SETTING/PARTICIPANTS An electronic, self-administered questionnaire was distributed in the UK and Republic of Ireland through mailing lists via the Association of Surgeons in Training and British Orthopedic Trainee Association. RESULTS Overall, 876 completed responses were received, representing all grades of trainee across all 10 surgical specialties. Median age was 33 years and 63.4% were female. Of those who had undertaken LTFT, 92.5% (148/160) were female. Most worked 60% of a full-time post (86/160, 53.8%). The reasons for either choosing or considering LTFT were childrearing (82.7%), caring for a dependent (12.6%) and sporting commitments (6.8%). Males were less likely to list childrearing than females (64.9% vs 87.6%; p<0.0001). Only 38% (60/160) found the application process easy and 53.8% (86/160) experienced undermining behaviour from workplace staff as a result of undertaking LTFT. Of all respondents, an additional 53.7% (385/716) would consider LTFT in future; 27.5% of which were male (106/385). Overall, only 9.9% of all respondents rated current LTFT information as adequate. Common sources of information were other trainees (47.3%), educational supervisors (20.6%) and local postgraduate school website (19.5%). CONCLUSIONS Over half of surgical trainees working LTFT have experienced undermining behaviour as a result of their LTFT. Despite a reported need for LTFT in both genders, this remains difficult to organise, access to useful information is poor and negative attitudes among staff remain. Recommendations are made to provide improved support and information for those wishing to pursue LTFT.
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Affiliation(s)
- Rhiannon L Harries
- Association of Surgeons in Training Council, Association of Surgeons in Training, London, UK
| | - Vimal J Gokani
- Association of Surgeons in Training Council, Association of Surgeons in Training, London, UK
| | - Peter Smitham
- The British Orthopaedic Trainees Association, British Orthopaedic Association Offices, London, UK
| | - J Edward F Fitzgerald
- Association of Surgeons in Training Council, Association of Surgeons in Training, London, UK
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485
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Miguelena JM, Domínguez Cunchillos F. Training in breast surgery in Spain. Cir Esp 2016; 94:323-30. [PMID: 27059252 DOI: 10.1016/j.ciresp.2016.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 01/12/2016] [Accepted: 01/16/2016] [Indexed: 11/20/2022]
Abstract
Breast surgery is a key part of training and competency in general surgery in Spain and is a "frontier area" that can be efficiently managed by general surgeons and gynecologists. The main objective of the training process consists of the surgical treatment of breast cancer, including conservative surgery, oncoplastic and reconstructive techniques. This article analyses the current status of breast surgery training in Spain and schematically proposes potential targets of the different training programs, to improve access and training for surgeons and residents in this area, taking into account the RD 639/2014 and European regulation. The priority is to specify the level of training that should be achieved, in relation to the group of professionals involved, considering their area of competency: surgery resident, educational programs, and surgeons with special dedication to this area.
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486
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Wanibuchi M, Noshiro S, Sugino T, Akiyama Y, Mikami T, Iihoshi S, Miyata K, Komatsu K, Mikuni N. Training for Skull Base Surgery with a Colored Temporal Bone Model Created by Three-Dimensional Printing Technology. World Neurosurg 2016; 91:66-72. [PMID: 27062915 DOI: 10.1016/j.wneu.2016.03.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A 3-dimensional temporal bone model for skull base surgical training was reconstructed via the use of a selective laser sintering technique, which is one of the 3-dimensional printing technologies. METHODS The temporal bone model was created in 2 pieces to remove powder material in the mastoid air cells and to place dye into the semicircular canal and the Fallopian canal. RESULTS The powder material was minimal, and the decisive structures were identified in color. CONCLUSIONS This artificial model will pave the way to a "new era" in surgical training and medical education.
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Affiliation(s)
- Masahiko Wanibuchi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shouhei Noshiro
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiya Sugino
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Iihoshi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kei Miyata
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
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487
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Gabriel E, Attwood K, Young J, Cappuccino H, Kumar S. Impact of American College of Surgeons Oncology Group Z11 on surgical training at an academic cancer center. J Surg Res 2016; 201:266-71. [PMID: 27020806 PMCID: PMC5315694 DOI: 10.1016/j.jss.2015.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/25/2015] [Accepted: 11/12/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The application of the American College of Surgeons Oncology Group Z0011 trial (Z11) has resulted in fewer completion axillary lymph node dissections (ALNDs) for select patients. We hypothesize that the application of Z11 may result in fewer ALND cases for surgeons in training. METHODS In the setting of an academic cancer center incorporating Z11 into routine practice, we compared the total number of ALND performed in a pre-Z11 period (January 2007-April 2011, 52 mo) and post-Z11 period (April 2011-February 2014, 34 mo). We also identified the number of patients in the post-Z11 era in whom ALND was omitted as a result of Z11. Clinical and pathologic characteristics among these groups were analyzed. RESULTS A total of 279 and 191 ALNDs were performed in the pre-Z11 and post-Z11 groups, respectively. Variables were similar among these groups with respect to demographics, tumor characteristics, and surgeries performed. There was no difference in the monthly rates of ALND between groups-5.37 cases/mo (pre-Z11) and 5.62 cases/mo (post-Z11), P = 0.52. We identified a total of 53 patients for whom ALND was omitted due to Z11 application in the post-Z11 period, representing a potential 21.7% decrease (53/191 + 53) in the number of ALNDs in this period. CONCLUSIONS Although the application of Z11 could potentially impact surgical training with a 21.7% decrease in ALND cases (53/191 + 53), the surgical case volume at an academic cancer center absorbs this decrease and maintains consistent levels of training for ALND.
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Affiliation(s)
- Emmanuel Gabriel
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Jessica Young
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Helen Cappuccino
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Shicha Kumar
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
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488
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Alaker M, Wynn GR, Arulampalam T. Virtual reality training in laparoscopic surgery: A systematic review & meta-analysis. Int J Surg 2016; 29:85-94. [PMID: 26992652 DOI: 10.1016/j.ijsu.2016.03.034] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/25/2016] [Accepted: 03/12/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Laparoscopic surgery requires a different and sometimes more complex skill set than does open surgery. Shortened working hours, less training times, and patient safety issues necessitates that these skills need to be acquired outside the operating room. Virtual reality simulation in laparoscopic surgery is a growing field, and many studies have been published to determine its effectiveness. AIMS This systematic review and meta-analysis aims to evaluate virtual reality simulation in laparoscopic abdominal surgery in comparison to other simulation models and to no training. METHODS A systematic literature search was carried out until January 2014 in full adherence to PRISMA guidelines. All randomised controlled studies comparing virtual reality training to other models of training or to no training were included. Only studies utilizing objective and validated assessment tools were included. RESULTS Thirty one randomised controlled trials that compare virtual reality training to other models of training or to no training were included. The results of the meta-analysis showed that virtual reality simulation is significantly more effective than video trainers, and at least as good as box trainers. CONCLUSION The use of Proficiency-based VR training, under supervision with prompt instructions and feedback, and the use of haptic feedback, has proven to be the most effective way of delivering the virtual reality training. The incorporation of virtual reality training into surgical training curricula is now necessary. A unified platform of training needs to be established. Further studies to assess the impact on patient outcomes and on hospital costs are necessary. (PROSPERO Registration number: CRD42014010030).
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Affiliation(s)
- Medhat Alaker
- ICENI Centre, Colchester General Hospital, Department of Colorectal Surgery, Colchester CO 45JL, UK.
| | - Greg R Wynn
- ICENI Centre, Colchester General Hospital, Department of Colorectal Surgery, Colchester CO 45JL, UK
| | - Tan Arulampalam
- ICENI Centre, Colchester General Hospital, Department of Colorectal Surgery, Colchester CO 45JL, UK
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489
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Louridas M, Szasz P, de Montbrun S, Harris KA, Grantcharov TP. International assessment practices along the continuum of surgical training. Am J Surg 2016; 212:354-60. [PMID: 27018078 DOI: 10.1016/j.amjsurg.2015.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/25/2015] [Accepted: 12/02/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objectives of this study were to assemble an international perspective on (1) current, and (2) ideal technical performance assessment methods, and (3) barriers to their adoption during: selection, in-training, and certification. METHODS A questionnaire was distributed to international educational directorates. RESULTS Eight of 10 jurisdictions responded. Currently, aptitude tests or simulated tasks are used during selection, observational rating scales during training and nothing is used at certification. Ideally, innate ability should be determined during selection, in-training evaluation reports, and global rating scales used during training, whereas global and procedure-specific rating scales used at the time of certification. Barriers include lack of predictive evidence for use in selection, financial limitations during training, and a combination with respect to certification. CONCLUSIONS Identifying current and ideal evaluation methods will prove beneficial to ensure the best assessments of technical performance are chosen for each training time point.
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Affiliation(s)
- Marisa Louridas
- Department of Surgery, University of Toronto, 30 Bond Street, 16CC-056, Toronto, ON, M5B 1W8, Canada.
| | - Peter Szasz
- Department of Surgery, University of Toronto, 30 Bond Street, 16CC-056, Toronto, ON, M5B 1W8, Canada
| | - Sandra de Montbrun
- Department of Surgery, University of Toronto, 30 Bond Street, 16CC-056, Toronto, ON, M5B 1W8, Canada
| | - Kenneth A Harris
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Teodor P Grantcharov
- Department of Surgery, University of Toronto, 30 Bond Street, 16CC-056, Toronto, ON, M5B 1W8, Canada
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490
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Abstract
Introduction: There is paucity in the research on transfer validity of arthroscopic simulator training. The aim of this article is to determine whether skills derived from arthroscopic simulation are transferrable to the operating theatre and retained over time. Methods: A systematic review with rigorous criteria to identify the highest level of evidence available was carried out. The studies were critically appraised with narrative data synthesis. Results: Twenty-one studies on arthroscopic simulation were identified. Only two studies were randomised controlled trials. The first article demonstrated improved performance of basic knee arthroscopic tasks following a fixed period of training. The second article showed improved performance of arthroscopic tasks and no deterioration in the levels of skills following a period of six months. In addition, the two studies succeeded in demonstrating the importance of 3D motion analysis using computer simulators in the assessment of technical skills. Components of evaluation such as time to task completion, distance travelled by instruments and incidence of instruments collisions were associated with the highest validity and reliability of assessment. This systematic review highlighted the limitations of these two randomised studies. Discussion: Evidence from the two trials suggests that knee arthroscopy simulator training can result in improved performance. This review helped highlight the contribution of the two studies in terms of internal validity and consistency of using arthroscopic skills training. Further level I studies are however required to demonstrate the evidence for transfer and predictive validity of computer simulation as a training instrument.
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Affiliation(s)
- Tarek Boutefnouchet
- University Hospital Coventry and Warwickshire Clifford Bridge Road Walsgrave, Coventry CV2 2DX UK ; Warwick Medical School, The University of Warwick Coventry CV4 7AL UK
| | - Thomas Laios
- Department of Trauma and Orthopaedic Surgery, Heart of England NHS Foundation Trust, Heartlands Hospital Bordesley Green East Birmingham B9 5SS UK
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491
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Sugand K, Mawkin M, Gupte C. Training effect of using Touch Surgery for intramedullary femoral nailing. Injury 2016; 47:448-52. [PMID: 26596416 DOI: 10.1016/j.injury.2015.09.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/11/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Simulation in orthopaedic training is becoming increasingly popular and has been widely used in formal curricula. However, these resources are expensive and not easily accessible to every trainee. Other means of disseminating surgical education through virtual reality (VR) multimedia can act as useful adjunct to traditional methods of teaching. One validated VR platform is Touch Surgery, a cognitive task simulation and rehearsal app. OBJECTIVES The primary objective of this study was to identify the training effect of Touch Surgery intramedullary femoral nailing (IFN) modules using objective performance metrics over six consecutive attempts. Secondary objectives consisted of validated multiple choice questions (MCQ) testing before the first (pre) and after the sixth (post) attempts. METHODS 27 medical undergraduates were recruited to complete the decision-making process six consecutive times for four modules on the procedural steps of IFN. The modules consisted of (i) preparing the patient and equipment, (ii) femoral canal preparation, (iii) nail insertion and proximal locking, and (iv) distal locking and closure. Real-time objective performance metrics were obtained, stored electronically and analysed using the median and Bonett-Price 95% confidence intervals from the participants' attempts to assess training effect. Significance was calculated using the Mann-Whitney U test for independent data whilst the Wilcoxon signed ranked test was used for paired data. Significance was set as 2-tailed p-value <0.05. RESULTS Median performance scores per attempt for all four modules demonstrated a significant improvement ranging from 58 to 115%. Scoring variability and distribution was reduced and more predictable per attempt. Logarithmic learning curves elicited strong positive correlations between the number of attempts and scoring. Mean scores for pre and post-study MCQs tests significantly improved from 83 to 94% in all modules. CONCLUSION IFN modules on Touch Surgery app demonstrated a significant training effect with practice. Novices demonstrated cognitive competencies to ensure patient safety prior to operating. The app is an effective adjunct to traditional learning methods and has the potential for curricular implementation.
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Affiliation(s)
- Kapil Sugand
- MSk Lab, Imperial College London, Level 7 East, Charing Cross Hospital, Fulham, London W6 8RF, UK.
| | - Mala Mawkin
- MSk Lab, Imperial College London, Level 7 East, Charing Cross Hospital, Fulham, London W6 8RF, UK.
| | - Chinmay Gupte
- MSk Lab, Imperial College London, Level 7 East, Charing Cross Hospital, Fulham, London W6 8RF, UK.
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492
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Jaimovich SG, Bailez M, Asprea M, Jaimovich R. Neuro surgical training with simulators: a novel neuroendoscopy model. Childs Nerv Syst 2016; 32:345-9. [PMID: 26493056 DOI: 10.1007/s00381-015-2936-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/14/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study is to present a novel neuroendoscopy simulation model in live animals, with the objective of enhancing patient safety with realistic surgical training. METHODS A simulation model using live Wistar rats was designed after the approval of the Institutional Committee for the Care and Use of Laboratory Animals. Under anesthesia, a hydroperitoneum was created in order to simulate a cavity with mesenteric membranes and vessels, viscera, and a solid and bleeding tumor (the liver) floating in a liquid environment. For validation purposes, we evaluated trainees' basal and final skills for each neuroendoscopic procedure, and we also acknowledged trainees' and instructors' opinion on the model's realism. RESULTS This model is simple and low cost effective for complete and real-life training in neuroendoscopy, with the possibility of performing all the basic and advanced endoscopic procedures, such as endoscopic exploration, membrane fenestration, vessel coagulation, hematoma evacuation, and endoscopic tumor biopsy and resection using a ventricular neuroendoscopy set. Although the model does not represent human ventricular anatomy, a reliable simulation is possible in real living tissue in a liquid environment. Trainees' skills improvements were notorious. CONCLUSION Minimally invasive endoscopic techniques require specific training. Simulation training can improve and accelerate the learning curve. The presented training model allows simulating the different neuroendoscopic procedures. We believe that due to its practical possibilities, its simplicity, low cost, reproducibility, and reality, being live animal tissue, it can be considered a fundamental model within a complete training program on neuroendoscopy.
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Affiliation(s)
- Sebastián G Jaimovich
- Department of Pediatric Neurosurgery, Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan", 1881 Combate de los Pozos St, Buenos Aires, Argentina. .,Department of Pediatric Neurosurgery, FLENI Neurological Research Institute Dr. Raúl Carrea, Buenos Aires, Argentina.
| | - Marcela Bailez
- Head of Department of Surgery, Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Marcelo Asprea
- Bioterium and Experimental Surgery, Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Roberto Jaimovich
- Department of Pediatric Neurosurgery, FLENI Neurological Research Institute Dr. Raúl Carrea, Buenos Aires, Argentina.,Head of Department of Pediatric Neurosurgery, Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
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493
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Abstract
INTRODUCTION Pediatric surgical trainees worldwide face pressures from expansion of programs and training positions, subspecialization, regionalization, restrictions of working hours, and rigid training criteria. The era of apprenticeship training has long gone, and surgical education needs to be responsive and adapt to newer challenges. The aim of this study was to examine the teaching provision component of pediatric surgical training in the UK. METHOD A national teaching survey was sent to UK pediatric surgery trainees in 2010 and compared to results of a repeat survey in 2015. Analysis was carried out to compare type of teaching, trends in teaching delivery, quality, and attendance over time. RESULTS Regional variability was noted in teaching programs. Both provision of educational activities and ability to attend teaching improved between 2010 and 2015. Despite this, overall trainee satisfaction remained low, with 50% and 52% of respondents describing their teaching as "good" or "excellent" in 2010 and 2015, respectively (P=0.84). Seventy-five percent of centers provided simulation training, and 25% of respondents had regional teaching provided. Survey response rate was comparable between 2010 and 2015. CONCLUSION Variability in national educational provision was observed. We suggest regular national audit of educational activity and responsive adaption to external pressures on training if competent surgeons are to be the product of contemporary pediatric surgery training programs.
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494
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Ji C, Li R, Liang W, Chen Y, Zhang J. Plasticine Model: An Useful Surgical Training in Plastic Surgery. Aesthetic Plast Surg 2016; 40:174-81. [PMID: 26715575 DOI: 10.1007/s00266-015-0602-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To help surgical trainees reach a deep understanding of plastic operations, we developed and evaluated an economical and convenient model using plasticine for plastic surgical training. METHODS From Sep of 2012 to Dec of 2014, we invited 57 medical interns to participate in a program designed for the qualitative evaluation of this model. In this program, 57 interns were asked to simulate certain surgical operations under guidance of the experienced staff of our department using the plasticine model. The value of the plasticine model was evaluated through questionnaire surveys. Their acceptance of the plasticine model, as well as the benefits and the flaws, was evaluated by the questionnaire survey. RESULTS All the participants completed the training session as well as the questionnaire, all of whom felt that the plasticine model had increased their familiarity with the surgical procedure they were assigned. By remodeling plasticine, the trainees understood either the brief surgical procedures or some confusing operative details in plastic surgery. In the questionnaire surveys, the trainees showed considerable consensus with the training program. The flaws of this method were also listed. The flaws generally reflected that "it is difficult to model into a vivid image" and "it is not suitable for all the operation". CONCLUSIONS Overall, the plasticine model is accepted by the participants in this survey. This model is economical and versatile, and could be used as a complementary training tool for novices in simulated operation training of plastic surgery. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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495
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Singh S, Sharma V, Patel P, Anuragi G, Sharma RG. Telementoring: an Overview and Our Preliminary Experience in the Setting Up of a Cost-effective Telementoring Facility. Indian J Surg 2016; 78:70-3. [PMID: 27186048 DOI: 10.1007/s12262-015-1429-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022] Open
Abstract
Telementoring as a subset of telemedicine has evolved over the past few years, but it is yet to be utilized to its full potential. The technology holds promise in bridging divides of distance and enables far-flung areas to be mentored in operative advances. It thus has a special bearing in countries like India where health care is short staffed and many areas lack availability of quality care. We describe the setting up of a telementoring facility at our centre. As against a 'routine' facility with dedicated equipments which cost heavily, our facility was set up using mostly equipments commonly available in an operating room. The facility is presently functional and allows telementoring through an encrypted Web-based service. Our set-up design can be emulated in centres with financial constraint and can help raise the standard of surgical care.
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Affiliation(s)
- Suresh Singh
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
| | - Vivekanand Sharma
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
| | - Pinakin Patel
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
| | - Gajendra Anuragi
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
| | - Raj Govind Sharma
- Division of Surgical Oncology, Upgraded Department of Surgery, S.M.S. Medical College and Hospital, Jaipur, India
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496
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Stienen MN, Netuka D, Demetriades AK, Ringel F, Gautschi OP, Gempt J, Kuhlen D, Schaller K. Neurosurgical resident education in Europe--results of a multinational survey. Acta Neurochir (Wien) 2016; 158:3-15. [PMID: 26577637 DOI: 10.1007/s00701-015-2632-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Neurosurgical training aims at educating future generations of specialist neurosurgeons and at providing the highest-quality medical services to patients. Attaining and maintaining these highest standards constitutes a major responsibility of academic or other training medical centers. METHODS An electronic survey was sent to European neurosurgical residents between 06/2014 and 03/2015. Multiple logistic regression analysis was used to assess the effect size of the relationship between responder-specific variables (e.g., age, gender, postgraduate year (PGY), country) and the outcomes (e.g., satisfaction). RESULTS A total of 652 responses were collected, of which n = 532 were taken into consideration. Eighty-five percent were 26-35 years old, 76 % male, 62 % PGY 4 or higher, and 73.5 % working at a university clinic. Satisfaction rates with theoretical education such as clinical lectures (overall: 50.2 %), anatomical lectures (31.2 %), amongst others, differed largely between the EANS member countries. Likewise, satisfaction rates with practical aspects of training such as hands-on surgical experience (overall: 73.9 %), microsurgical training (52.5 %), simulator training (13.4 %), amongst others, were highly country-dependant. In general, 89.1 % of European residents carried out the first surgical procedure under supervision within the first year of training. Supervised lumbar-/cervical spine surgeries were performed by 78.2 and 17.9 % of European residents within 12 and 24 months of training, respectively, and 54.6 % of European residents operate a cranial case within the first 36 months of training. Logistic regression analysis identified countries where residents were much more or much less likely to operate as primary surgeons compared to the European average. The caseload of craniotomies per trainee (overall: 30.6 % ≥10 craniotomies/month) and spinal procedures (overall: 29.7 % ≥10 spinal surgeries/month) varied throughout the countries and was significantly associated with more advanced residency (craniotomy: OR 1.35, 95 % CI 1.18-1.53, p < 0.001; spinal surgery: OR 1.37, 95 % CI 1.20-1.57, p < 0.001). CONCLUSIONS Theoretical and practical aspects of neurosurgical training are highly variable throughout European countries, despite some efforts within the last two decades to harmonize this. Some countries are rated significantly above (and others significantly below) the current European average for several analyzed parameters. It is hoped that the results of this survey should provide the incentive as well as the opportunity for a critical analysis of the local conditions for all training centers, but especially those in countries scoring significantly below the European average.
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497
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Mavroudis C, Idriss R, Klaus KE. The MAVID heart holder: a demonstration device to anchor cadaver hearts for surgical simulation and practical education. Cardiol Young 2015; 25:1626-30. [PMID: 26675615 DOI: 10.1017/S1047951115002115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Performing open heart surgery involves learning challenging techniques and a need for realistic training models to achieve and maintain a high level of surgical skills. The MAVID heart holder is an organ holder primarily designed to hold the heart in its anatomic position for the purpose of surgical simulation and education, thereby closing the gap between surgical performance in the laboratory and in the operating room. The device is simple to use, can be adjusted to organ size, and has the necessary instrumentation to be used with any solid organ. The MAVID heart holder also provides a platform for presentation and assists in advancing the research sphere. The advantage over other existing models is that the MAVID heart holder uses real tissue and does not distort the organ at the attachment sites. Further, it offers superior stability as well as the ability to manipulate the organ during presentation and dissection. Training with the MAVID heart holder has the potential to shorten training time to acquire surgical skills and proficiency before performing these techniques in the operating room and in so doing enhance patient safety.
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498
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Martin RF. Alternative Considerations for Surgical Training and Funding. Surg Clin North Am 2015; 96:35-46. [PMID: 26612018 DOI: 10.1016/j.suc.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the late 1880s surgical residency programs have existed in forms that are similar to our current models. Many important variations have been introduced over time. On aggregate this system has worked remarkably well; though as economic, demographic, and cultural changes continue to evolve, one must wonder if we were to change our models how might we do that and what reasoning could we use. This article's focus is to take a stratospheric view of what could be done, particularly in the United States, rather than characterize what happens in other countries with other health economic systems.
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Affiliation(s)
- Ronald F Martin
- Marshfield Clinic and Saint Joseph's Hospital, 1000 North Oak Avenue, Marshfield, WI 54449, USA; Department of Surgery, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI 53726, USA; United States Army Reserve, Medical Corps, USA.
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499
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Herard P, Boillot F. Quality orthopaedic care in sudden-onset disasters: suggestions from Médecins Sans Frontières-France. Int Orthop 2016; 40:435-8. [PMID: 26614107 DOI: 10.1007/s00264-015-3054-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
Abstract
A huge change is needed in the conception and implementation of surgical care during sudden-onset disasters (SOD). The inadequate surgical response mounted by the majority of foreign medical teams (FMT) after Haiti's earthquake is a striking example of the need for a structured professional approach. Logistical capacity already exists to provide safe, timely, effective, efficient, equitable and ethical patient-centred care with minimum standards. However, knowledge, skills and training in the fields of general, orthopaedic and plastic surgery need further clarification. Surgical activity data and clinical examples from several Médecins Sans Frontières-France (MSF) projects are used here to describe the skill set and experience essential for surgeons working in SOD contexts.
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500
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Kloster BO, Lund L, Lindholt JS. Laparo- and thoracoscopic aortic aneurysm neck optimization and treatment of potential endoleaks type IA and II in a porcine model. Ann Med Surg (Lond) 2015; 5:5-10. [PMID: 26793311 PMCID: PMC4680631 DOI: 10.1016/j.amsu.2015.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/28/2015] [Accepted: 11/07/2015] [Indexed: 12/20/2022] Open
Abstract
Background Endovascular repair of aortic aneurysms has a higher incidence of late complications, and open conversion (OC) associated with high mortality may be required. As alternatives to OCs, we propose minimal invasive laparo-/thoracoscopic approaches, either to control endoleaks after endovascular repair, or to convert non-endovascular treatable cases due to a hostile neck anatomy by inserting a peri-aortic PTFE collar before endovascular repair. Such interventions may reduce complications and the necessity for OCs in the future. Methods In twelve pigs, were 10 had infra-/juxtrarenal AAAs, externally placed collars/aneuwraps around the proximal AAA neck and just below the left subclavian artery and division of the aortic side branches were carried out laparo-and thoracoscopically. Results For the laparoscopic and thoracoscopic procedures respectively, mean operative time was 143 ± 41 min and 86 ± 51 min and a mean of 2.6 and 2.25 aortic side branches were ligated/divided. For both procedures, the last half in the series were carried out significantly faster (p < 0.05) indicating a learning curve. Blood loss was minimal and no procedure related complications were seen. Conclusion Using these minimal invasive endoscopic approaches, it seems feasible to externally band aneurysm necks and ligate aortic side branches in a pig model. These procedures could potentially be considered as alternatives to OCs in controlling endoleaks and in improving the safety of endovascular interventions. As endoscopic aortic surgery is challenging a learning curve is expected. Practicing the described procedures using this model, can be used as a learning tool prior to similar interventions on humans. Laparo-/thoracoscopic approaches for treating endoleaks can be simulated in a pig model. Laparo-/thoracoscopic approaches to optimize a challenging aortic aneurysm neck can be simulated in a pig model. Endoscopic aortic surgery is challenging and a learning curve must be expected. A pig model with aortic aneurysm can be used as a realistic surgical learning tool before human application.
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Affiliation(s)
- Brian O Kloster
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Alle 4, 8800, Viborg, Denmark
| | - Lars Lund
- Department of Urology, OUH Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C., Denmark
| | - Jes S Lindholt
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Alle 4, 8800, Viborg, Denmark; Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Department of Cardiovascular and Thoracic Surgery, OUH Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C., Denmark
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