151
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Doğan Değer M, Alperen Yıldız H, Denizhan Demirkıran E, Madendere S. Current status of urological training and differences between institutions. Actas Urol Esp 2022; 46:285-292. [PMID: 35177364 DOI: 10.1016/j.acuroe.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/17/2021] [Revised: 04/26/2021] [Accepted: 05/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Appropriate training of urology residents is important to secure not only high-quality patient care, but also the bright future of our specialty. We aimed to investigate residency training from the perspective of qualification and standardization and to evaluate surgical education, publication output, working conditions, future plans, and overall satisfaction, in a comprehensive way. METHODS We conducted a survey of urology chief residents/recent graduates in Turkey to identify differences between institutions and deficiencies in urology resident training. A total of 155 chief residents/recently graduated specialists were contacted by phone and a survey was completed. RESULTS The survey response rate was 96.1%. Respondents had high proficiency in endourology (97.3%), similar to Canada and European countries. However, they reported a lack of proficiency in laparoscopy (28.9%) and functional urology (26.2%). Also, no one had completed a robotic procedure as first surgeon. A total of 75.2% respondents had no first author publication, and 10.1% had no first author abstract presentation. There was no significant difference between institution types with or without certification. There was a satisfaction rate of 87.2% among participants. CONCLUSIONS It was observed that qualified and standardized training could has not been achieved and the positive effects of certification have not been seen yet. There is a lack of modernization in all aspects of education, and there is no standardized curriculum addressing academic research. Therefore, there is a risk that future urologists will have insufficient skills. We hope this study serves as a guide for modernization and standardization in urology training.
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Affiliation(s)
- M Doğan Değer
- Departamento de Urología, Hospital Edirne Sultan 1(er) Murat, Edirne, Turkey.
| | | | | | - S Madendere
- Departamento de Urología, Hospital Gümüşhane, Gümüşhane, Turkey
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152
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Hamid M, Naumann DN, Digne-Malcolm H, Kanwal A, Puventhiranathan P, Phelan L, Dilworth M. Surgical training during the COVID-19 pandemic at a designated 'cold' site: are we meeting the challenge? Ann R Coll Surg Engl 2022; 104:421-426. [PMID: 34784248 PMCID: PMC9157855 DOI: 10.1308/rcsann.2021.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION There has been a marked reduction in surgical operative training opportunities during the COVID-19 pandemic. This may be improved by the establishment of 'cold' sites for NHS elective surgery. We investigated the training opportunities at a newly designated elective surgery cold site in the West Midlands, UK. METHODS An observational retrospective study was undertaken to include all gastrointestinal and urological elective surgery at a single 'cold' site during the first peak of the COVID-19 pandemic. Patient demographics, details of surgery and data relating to surgical training such as primary surgeon and portfolio index procedure were collected. Factors affecting the likelihood of trainees being the primary surgeon were analysed using logistic regression models. RESULTS There were 880 patients, with a median (interquartile range) age of 62 (48-74). Some 658 (74.8%) procedures were defined as 'index procedures' for specialty training year 4 (ST4) level: 409/509 (80.4%) for urology, 155/235 (66%) for colorectal and 94/136 (69.1%) for upper gastrointestinal (GI). Only 253/880 (28.8%) procedures were performed by a trainee as the primary surgeon: 201/509 (39.4%) for urology, 21/235 (8.9%) for colorectal and 31/136 (22.8%) for upper GI. The likelihood of a trainee being the primary surgeon was reduced for major surgery (p<0.001) and for GI surgery when compared with urology (p<0.001). CONCLUSIONS Surgical training was facilitated at an elective surgery 'cold' site during the COVID-19 pandemic, but at lower levels than anticipated. Type of surgery influenced trainee participation. Surgical training should be incorporated into 'cold' site elective surgical services if trainees are to be prepared for the future.
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Affiliation(s)
- M Hamid
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | | | - A Kanwal
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | - L Phelan
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - M Dilworth
- University Hospitals Birmingham NHS Foundation Trust, UK
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153
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Javier GG, Paloma SM, Andrea SC, Octavio CPP, Miguel Ángel DM. Impact of COVID-19 pandemic in surgical training of Junior Residents in general surgery. Heliyon 2022; 8:e09740. [PMID: 35747322 DOI: 10.1016/j.heliyon.2022.e09740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/06/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background The pandemic caused by SARS-CoV2 has had a huge impact on our health system. Due to both cancellation of elective surgery and restructuring in departments at most medical centers, surgical residents face a potential training deficit in their specialty.This study aims to objectively analyze and quantify the impact of the pandemic on the surgical activity of residents, in the setting of emergency and elective surgery, to assess whether this period has really supposed a training deficit. Material and methods A descriptive analysis is proposed, comparing the number of procedures performed by residents of our department during the year prior to the pandemic and during the pandemic, clustering them into different subgroups. Results The results give an optimistic outlook. In the first place, in elective surgery, despite the lower procedures performed in absolute numbers, the proportional participation of residents in the scheduled surgeries increased in all the subgroups analyzed, finding statistically significant differences and finally approaching the total number of procedures in both periods, without relevant differences in the comparison. As for emergency surgery, residents also increased their proportional participation in most subgroups, in this case reaching more total procedures, even in absolute numbers. Conclusion Therefore, the results seem to indicate that the teaching effort made by staff surgeons of the department has managed to palliate, in most of the subgroups analyzed, the decrease in surgical activity that the pandemic has produced, so, at least in the area of surgical practice, the impact of the pandemic has probably been reduced comparing to previous expectations.
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154
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Nagayo Y, Saito T, Oyama H. Augmented reality self-training system for suturing in open surgery: A randomized controlled trial. Int J Surg 2022; 102:106650. [PMID: 35525415 DOI: 10.1016/j.ijsu.2022.106650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/16/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Existing self-training materials are insufficient to learn open surgical procedures, and a new self-training system that provides three-dimensional procedural information is needed. The effectiveness and usability of a self-training system providing three-dimensional information by augmented reality (AR) were compared to those of an existing self-training system, instructional video, in self-learning of suturing in open surgery. MATERIALS AND METHODS This was a prospective, evaluator-blinded, randomized, controlled study. Medical students who were suturing novices were randomized into 2 groups: practice with the AR training system (AR group) or an instructional video (video group). Participants were instructed in subcuticular interrupted suture and each training system and watched the instructional video once. They then completed a pretest performing the suture on a skin pad. Participants in each group practiced the procedure 10 times using each training system, followed by a posttest. The pretest and posttest were video-recorded and graded by blinded evaluators using a validated scoring form composed of global rating (GR) and task-specific (TS) subscales. Students completed a post-study questionnaire assessing system usability, each system's usefulness, and their confidence and interest in surgery. RESULTS Nineteen participants in each group completed the trial. No significant difference was found between the AR and video groups on the improvement of the scores from pretest to posttest (GR: p = 0.54, TS: p = 0.91). The posttest scores of both GR and TS improved significantly from pretest in both groups (GR: both p < 0.001, TS: both p < 0.001). There was no significant difference between the groups in the system usability scale scores (p = 0.38). The motion provided in the AR system was more helpful for manipulating surgical instruments than the video (p = 0.02). CONCLUSION The AR system was considered as understandable and easy to use as the instructional video in learning suture technique in open surgery for novices.
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Affiliation(s)
- Yuri Nagayo
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Toki Saito
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
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155
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Ohtake S, Makiyama K, Yamashita D, Tatenuma T, Yao M. Objective assessment of laparoscopic targeting skills using a Short-Time Power of Difference (STPOD) method. Int J Comput Assist Radiol Surg 2022; 17:1029-1037. [PMID: 35426565 PMCID: PMC9124661 DOI: 10.1007/s11548-022-02622-2] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To ensure that the use of surgical training tools results in improvement of surgical skills, it is necessary to be able to measure and assess surgeons' skills. We established the Short-Time Power of Difference (STPOD) method as an evaluation tool for evaluating targeting technique. The STPOD method evaluates the distance from the actual movement of the forceps to the shortest linear path between two points in a short time period. We examined the effectiveness of the STPOD method as a new forceps kinematic analysis. METHODS Six residents were categorized as novices and six urologists as experts. All participants performed box trainer training and LapPASS® Simulator training. During the procedure, objective scores (time, distance, and STPOD) were recorded. STPOD (Power) evaluated motion smoothness and STPOD (Stop) evaluated the stop time of the forceps. RESULTS STPOD (Stop) on the right side of the experts was significantly lower than that of the novices in the box trainer. Furthermore, there were significant differences in the distances of left side and STPOD (Power) between the experts and the novices in the simulator. In the correlation of parameters between the box trainer and the simulator, time showed the strongest correlation, STPOD (Power) and distance showed a mild correlation. CONCLUSION We showed the construct validity of STPOD (Power) and STPOD (Stop) using both the box trainer and the simulator. This method is a good evaluation tool for assessing a physician's skill; however, there are much more complex motions that are performed in actual surgery. Future studies are needed to focus on evaluation in an environment closer to actual surgery and comparing with other existing methods.
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Affiliation(s)
- Shinji Ohtake
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Daisuke Yamashita
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
- Department of Urology, Yokohama Sakae Kyosai Hospital, Yokohama, 247-8581 Japan
| | - Tomoyuki Tatenuma
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
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156
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Khatkar H, Ferro A, Kotecha S, Prokopenko M, Evans A, Kyriakides J, Botterill J, Sangha MS, See A, Kerstein R. Assessing the attitude of surgical trainees towards virtual reality simulation: A national cross-sectional questionnaire study. Scott Med J 2022; 67:87-92. [PMID: 35637548 DOI: 10.1177/00369330221103279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND We performed a cross sectional study to determine the attitudes of surgical trainees and medical students towards virtual reality (VR) simulation in surgical training. A survey was devised through an iterative process before distribution to surgical trainees, foundation year doctors and medical students through online platforms. METHODS The survey was disseminated within the United Kingdom through social media and email correspondence, in co-operation with national surgical organisations. 91 trainees responded from a variety of clinical specialities. RESULTS VR technology in surgical training was viewed positively, with 91.3% of trainees agreeing that VR should be both an adjunct in surgical training as well as a competency-based assessment tool. Barriers to access were present, with access notably more challenging for senior surgeons. CONCLUSION Virtual reality surgical simulation in surgical training is beginning to emerge as a genuine high-fidelity, low-risk solution to the lack of surgical case volume trainees are currently experiencing.
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Affiliation(s)
- Harman Khatkar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford, UK
| | - Ashley Ferro
- 8948Kings College Hospital NHS Trust, London, UK
| | | | | | - Ashish Evans
- 6397Oxford University Hospitals NHS Trust, Oxford, UK
| | | | | | | | - Abbas See
- 6084Northampton NHS Trust, Northampton, UK
| | - Ryan Kerstein
- 156485Queen Victoria Hospital NHS Trust, East Grinstead, UK
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157
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Hannan E, Ullah MF, Feeney G, Coffey JC, Peirce C. Surgical trainee perceptions of a 'surgeon of the week' system contrasted with a traditional on-call model: the impact on surgical education, patient safety and trainee quality of life. Ir J Med Sci 2022; 192:805-806. [PMID: 35622187 DOI: 10.1007/s11845-022-03036-4] [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] [Received: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Enda Hannan
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Co Limerick, Ireland.
| | - Mohammad Fahad Ullah
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Co Limerick, Ireland
| | - Gerard Feeney
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Co Limerick, Ireland
| | - John Calvin Coffey
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Co Limerick, Ireland.,School of Medicine, University of Limerick, Limerick, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, St Nessan's Road, Dooradoyle, Co Limerick, Ireland.,School of Medicine, University of Limerick, Limerick, Ireland
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158
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Hall AJ, Walmsley P. Technology-enhanced learning in orthopaedics: Virtual reality and multi-modality educational workshops may be effective in the training of surgeons and operating department staff. Surgeon 2022:S1479-666X(22)00077-4. [PMID: 35624020 DOI: 10.1016/j.surge.2022.04.009] [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] [Received: 10/25/2021] [Revised: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
AIM The aims were to assess the utility of: 1) virtual reality-mediated simulation, and 2) a multi-modality 'Bootcamp' in the delivery of total knee arthroplasty (TKA) teaching to orthopaedic surgical trainees. BACKGROUND Surgical training opportunities are diminished as a result of the COVID-19 pandemic which may result in delays to training completion and gaps in the permanent workforce. Modern and technology-enhanced learning methods have been identified as having the potential to support high-quality and sustainable education. METHODS This mixed-methods study assessed the educational benefit of two activities designed to teach TKA to junior (ST1-3) orthopaedic trainees. A multi-modality training Bootcamp was delivered that included: virtual reality (VR) and saw-bone simulation; tutorials, and case-based symposia. The VR component was delivered to different participants (surgical trainees, scrub nurses, and consultants) on a further two separate occasions. Qualitative and quantitative data were collected pertaining to utility and performance. RESULTS Trainees reported that the Bootcamp improved comprehension of arthroplasty principles including component alignment, knee balancing, and intraoperative strategies. Case-based discussions helped develop diagnostic and decision-making skills. The VR activity improved understanding of the surgical process map, increased ability to anticipate steps, and consider the procedure strategically. All staff groups found the VR activity beneficial and would recommend it as a useful addition to a surgical department. CONCLUSION VR-mediated simulation could augment the education of surgical trainees and scrub team staff by improving comprehension of the surgical process map. Integrated multi-modality 'Bootcamp-style' training activities constructed around trainees' needs may provide a sustainable solution to bridge the experience gap related to reduced exposure to elective orthopaedic practice.
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Affiliation(s)
- Andrew J Hall
- Chief Resident & Research Fellow, Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK; MBChB Module Organiser, Department of Orthopaedics & Trauma, University of Edinburgh, UK; Clinical Teaching Fellow, Medical Education Directorate, NHS Lothian, UK.
| | - Phil Walmsley
- Consultant Orthopaedic Surgeon, Department of Trauma & Orthopaedics, NHS Fife, UK; Honorary Senior Lecturer, University of St Andrews Medical School, UK; Associate Postgraduate Dean (Quality), NHS Education for Scotland, UK.
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159
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Lenz M, Kahmann S, Behbahani M, Pennig L, Hackl M, Leschinger T, Müller LP, Wegmann K. Influence of rotator cuff preload on fracture configuration in proximal humerus fractures: a proof of concept for fracture simulation. Arch Orthop Trauma Surg 2022; 143:2467-2474. [PMID: 35579703 PMCID: PMC10110707 DOI: 10.1007/s00402-022-04471-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/07/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In regard of surgical training, the reproducible simulation of life-like proximal humerus fractures in human cadaveric specimens is desirable. The aim of the present study was to develop a technique that allows simulation of realistic proximal humerus fractures and to analyse the influence of rotator cuff preload on the generated lesions in regards of fracture configuration. MATERIALS AND METHODS Ten cadaveric specimens (6 left, 4 right) were fractured using a custom-made drop-test bench, in two groups. Five specimens were fractured without rotator cuff preload, while the other five were fractured with the tendons of the rotator cuff preloaded with 2 kg each. The humeral shaft and the shortened scapula were potted. The humerus was positioned at 90° of abduction and 10° of internal rotation to simulate a fall on the elevated arm. In two specimens of each group, the emergence of the fractures was documented with high-speed video imaging. Pre-fracture radiographs were taken to evaluate the deltoid-tuberosity index as a measure of bone density. Post-fracture X-rays and CT scans were performed to define the exact fracture configurations. Neer's classification was used to analyse the fractures. RESULTS In all ten cadaveric specimens life-like proximal humerus fractures were achieved. Two III-part and three IV-part fractures resulted in each group. The preloading of the rotator cuff muscles had no further influence on the fracture configuration. High-speed videos of the fracture simulation revealed identical fracture mechanisms for both groups. We observed a two-step fracture mechanism, with initial impaction of the head segment against the glenoid followed by fracturing of the head and the tuberosities and then with further impaction of the shaft against the acromion, which lead to separation of the tuberosities. CONCLUSION A high energetic axial impulse can reliably induce realistic proximal humerus fractures in cadaveric specimens. The preload of the rotator cuff muscles had no influence on initial fracture configuration. Therefore, fracture simulation in the proximal humerus is less elaborate. Using the presented technique, pre-fractured specimens are available for real-life surgical education. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maximilian Lenz
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann Strasse 24, 50931, Cologne, Germany.
| | - Stephanie Kahmann
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann Strasse 24, 50931, Cologne, Germany
| | - Mehdi Behbahani
- Department for Bioengineering, University of Applied Sciences Aachen, Heinrich-Mußmann-Straße 1, 52428, Jülich, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Michael Hackl
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann Strasse 24, 50931, Cologne, Germany
| | - Tim Leschinger
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann Strasse 24, 50931, Cologne, Germany
| | - Lars Peter Müller
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann Strasse 24, 50931, Cologne, Germany
| | - Kilian Wegmann
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann Strasse 24, 50931, Cologne, Germany.,Orthopaedic Surgery Munich, OCM Clinic, Steinerstrasse 6, 81369, Munich, Germany
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160
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Huber T, Hanke LI, Boedecker C, Vradelis L, Baumgart J, Heinrich S, Bartsch F, Mittler J, Schulze A, Hansen C, Hüttl F, Lang H. Patient-individualized resection planning in liver surgery using 3D print and virtual reality (i-LiVR)-a study protocol for a prospective randomized controlled trial. Trials 2022; 23:403. [PMID: 35562806 PMCID: PMC9100295 DOI: 10.1186/s13063-022-06347-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background A multitude of different diseases—benign and malign—can require surgery of the liver. The liver is an especially challenging organ for resection planning due to its unique and interindividually variable anatomy. This demands a high amount of mental imagination from the surgeon in order to plan accordingly - a skill, which takes years of training to acquire and which is difficult to teach. Since the volume of the functional remnant liver is of great importance, parenchyma sparing resections are favoured. 3D reconstructions of computed tomography imaging enable a more precise understanding of anatomy and facilitate resection planning. The modality of presentation of these 3D models ranges from 2D monitors to 3D prints and virtual reality applications. Methods The presented trial compares three different modes of demonstration of a 3D reconstruction of CT scans of the liver, which are 3D print, a demonstration on a regular computer screen or using a head-mounted virtual reality headset, with the current gold standard of viewing the CT scan on a computer screen. The group size was calculated with n=25 each. Patients with major liver resections in a laparoscopic or open fashion are eligible for inclusion. Main endpoint is the comparison of the quotient between planned resection volume and actual resection volume between these groups. Secondary endpoints include usability for the surgical team as well as patient specifics and perioperative outcome measures and teaching issues. Discussion The described study will give insight in systematic planning of liver resections and the comparison of different demonstration modalities of 3D reconstruction of preoperative CT scans and the preference of technology. Especially teaching of these demanding operations is underrepresented in prior investigations. Trial registration Prospective trials registration at the German Clinical Trials register with the registration number DRKS00027865. Registration Date: January 24, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06347-0.
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Affiliation(s)
- Tobias Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany.
| | - Laura Isabel Hanke
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Christian Boedecker
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Lukas Vradelis
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Janine Baumgart
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Stefan Heinrich
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Fabian Bartsch
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Jens Mittler
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Alicia Schulze
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Christian Hansen
- Institute of Simulation and Graphics, Faculty of Informatics, University Magdeburg, Magdeburg, Germany
| | - Florentine Hüttl
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
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161
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Kadooka Y. Ethical perspectives on the Japanese guidelines for cadaver surgical training (CST). Anat Sci Int 2022. [PMID: 35534715 DOI: 10.1007/s12565-022-00670-x] [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: 03/26/2022] [Accepted: 04/23/2022] [Indexed: 11/01/2022]
Abstract
Cadaver surgical training (CST), which aims to maintain patient safety, provided anatomists with new duties and increased their workload. In Japan, with development of relevant guidelines, CST programs have been implemented and promoted mainly by surgical societies. This paper examines ethics of and anatomists' attitude toward the Japanese CST guidelines. The guidelines were well established to ensure that ethical issues such as financial exploitation and commercialism involved in procurement of cadavers for training do not emerge, as these can create the dilemma of how to allocate cadavers for undergraduate education and postgraduate surgical training, given the increase in demand for cadavers. Fair allocation must accommodate and respect the donor's advance will. Also, the guidelines must offer more detailed commentary on informed consent, particularly with regard to disclosure of information to donor candidates. The guidelines should explain better the legality of CST, the roles of anatomists, and surgeon preparedness.
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162
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Criscito MC, Wilken R, Stevenson ML, Carucci JA. Deliberate practice-based surgical curriculum leads to enhanced technical proficiency among dermatology residents. Arch Dermatol Res 2022; 314:905-908. [PMID: 35476153 DOI: 10.1007/s00403-022-02355-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/06/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
Abstract
Deliberate practice-based medical education has demonstrated superiority in trainee acquisition and maintenance of skills in several surgical subspecialties. In an effort to highlight the impact of a deliberate practice-based surgical curriculum on the technical proficiency of dermatology residents, a prospective cohort study including first- and second-year dermatology residents was performed. A total of 87.5% (7 of 8) first-year dermatology residents completed three hands-on simulations at 6-week intervals. Additionally, six of eight (75.0%) second-year dermatology residents at the same institution were evaluated at a single point-in-time session without accessing the surgical curriculum prior. A 5-point global rating scale (GRS) was used to assess resident performance on six core surgical techniques. Nonparametric ANOVA statistical methods using the Kruskal-Wallis test was performed. The residents' overall GRS increased from a median of 1-2.75 after completion of the curriculum (p < 0.01). There was a significant improvement in the median scores of each tested surgical technique. The first-year residents had a greater overall GRS after completion of the curriculum compared to the second-year residents (median of 2.13 versus 1.88, p < 0.001). Limitations include the small sample size and lack of a synchronized control group. Our study highlights the use of deliberate practice-based strategies as an effective modality in teaching surgical skills to dermatology residents.
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Affiliation(s)
- Maressa C Criscito
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 222 East 41st Street, New York, NY, 10016, USA.
| | - Reason Wilken
- Department of Dermatology, Northwell Health, New York, NY, 10042, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 222 East 41st Street, New York, NY, 10016, USA
| | - John A Carucci
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 222 East 41st Street, New York, NY, 10016, USA
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Morizane S, Honda M, Kihara K, Yamamoto M, Komatsu H, Sato S, Hikita K, Tanishima S, Nakane H, Kurosaki M, Kaidoh T, Takenaka A. Laparoscopic pelvic lymph node dissection in cadaver surgical training from the combined perspectives of urologists, gastroenterologists and gynecologists improves overall knowledge and technique: initial experience of multidisciplinary cadaver surgical training at a single institution in Japan. Anat Sci Int 2022; 97:303-306. [PMID: 35258811 DOI: 10.1007/s12565-022-00655-w] [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] [Received: 12/29/2021] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
Surgeons in Japan have recently become more familiar with cadaver surgical training (CST). Extended pelvic lymph node dissection (PLND) considering the vesicohypogastric fascia and ureterohypogastric nerve fascia is gradually being performed not only in urology, but also in gynecology and gastroenterology. We performed CST using a 76-year-old female cadaver who was fixed by the Thiel method, with the aim of confirming the differences in the extent of PLND performed by certified laparoscopic specialists in urology, gastroenterology and gynecology. Even in the common surgeries, there are still several areas where anatomical structures are poorly understood. In recent years, with the spread of robotic surgery, the techniques related to PLND in these three departments have gradually become similar. Through this CST program, we were able to understand the differences in procedures and the extent of PLND in these three departments. By continuing these CSTs, we hope that a standardized PLND procedure will be performed not only within the same department, but also between different departments, and that high-quality PLND will be safely performed.
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Affiliation(s)
- Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan.
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 86 Nishi-cho, Yonago, Japan
| | - Shinya Sato
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 86 Nishi-cho, Yonago, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan
| | - Shinji Tanishima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Japan
| | - Hironobu Nakane
- Department of Anatomy, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Japan
| | - Masamichi Kurosaki
- Division of Neurosurgery, Department of Brain and Neurosciences, School of Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Japan
| | - Toshiyuki Kaidoh
- Department of Anatomy, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan
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164
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Guttman MP, Haas B, Kim M, Mador B, Nathens AB, Ahmed N, Wheeler S, Gotlib Conn L. Innovative curriculum is needed to address residents' attitudes toward older adults: the case of geriatric trauma. BMC Med Educ 2022; 22:130. [PMID: 35219294 PMCID: PMC8881881 DOI: 10.1186/s12909-022-03196-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 07/22/2021] [Accepted: 02/15/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND Medical trainees' negative perceptions towards older adult care have been widely reported, catalyzing targeted curricula in geriatric medicine. Little is known about surgical residents' attitudes toward and perceptions of the educational value of caring for injured older adults. This information is needed to ensure the surgical workforce is adequately trained to care for this growing patient population. In this study, we assessed surgical trainees' attitudes towards geriatric trauma care to inform a curriculum in geriatric trauma. METHODS We surveyed North American general surgery trainees' beliefs and attitudes toward caring for older trauma patients, and the educational value they ascribed to learning about older trauma patient care. Descriptive statistics were used to report participant characteristics and responses. RESULTS Three hundred general surgery trainees from 94 post-graduate programs responded. Respondents reported too much time co-ordinating care (56%), managing non-operative patients (56%), and discharge planning (65%), all activities important to the care of older trauma patients. They recognized the importance of geriatric trauma care for their future careers (52%) but were least interested in reading about managing geriatric trauma patients (28%). When asked to rank clinical vignettes by educational value, respondents ranked the case of an older adult as least interesting (74%). As respondents progressed through their training, they reported less interest in geriatric trauma care. CONCLUSIONS Our survey results demonstrate the generally negative attitudes and beliefs held by postgraduate surgical trainees towards the care of older adult trauma patients. Future work should focus on identifying specific changes to the postgraduate surgical curriculum which can effectively alter these attitudes and beliefs and improve the care for injured older adults.
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Affiliation(s)
- Matthew P Guttman
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Haas
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michael Kim
- Department of Surgery, University of Alberta, Alberta, Canada
| | - Brett Mador
- Department of Surgery, University of Alberta, Alberta, Canada
| | - Avery B Nathens
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- American College of Surgeons, Chicago, IL, United States
| | - Najma Ahmed
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Sarah Wheeler
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Ontario Health, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Sunnybrook Research Institute, Toronto, Ontario, Canada.
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165
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Leon MG, Carrubba AR, DeStephano CC, Heckman MG, Craver EC, Dinh TA. Impact of robotic single and dual console systems in the training of minimally invasive gynecology surgery (MIGS) fellows. J Robot Surg 2022; 16:1273-1280. [PMID: 35025036 DOI: 10.1007/s11701-022-01369-x] [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] [Received: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
The advantages of dual console use in robotic surgical education have not been described. The aims of this study are to compare fellow console time, surgical steps performed, and surgical takeovers between attending and fellow surgeons using dual versus single console robotic systems. Participants included minimally invasive gynecologic surgery (MIGS) fellows (N = 3) and subspecialty trained gynecologic surgeons (N = 5). Prospective data were obtained on 126 patients (N = 77 single console, N = 49 dual console) undergoing robotic hysterectomy. Variables included demographics, surgical characteristics (fellow, month of fellowship, attending surgeon, concomitant oophorectomy, additional surgical procedures, estimated blood loss, specimen weight), and outcomes (console time, docking time, console time/docking time ratio, total case time, number of surgical steps performed by the fellow, number of surgical takeovers, complications). After controlling for potential confounders, fellows spent a mean of 25.8 min longer (P < 0.001) at the console in dual console operations compared to single. Dual console surgeries had a greater number of steps performed by the fellow (OR[> 5 steps]: 3.37, P = 0.009), a higher console time/docking time ratio (P < 0.001), and more surgical takeovers between fellow and attending (OR [> 1 takeover]: 3.53, P < 0.001). There were no significant differences between the two groups regarding docking time (P = 0.15), case time (P = 0.79), or complications (P = 0.30). Our findings suggest dual console robotic training provide fellows the opportunity for more "hands-on" experience with longer console time, higher number of surgical steps performed, and added interaction with the attending surgeon when compared with single console training. These surgical metrics provide objectivity in competency-based robotic training without increasing the complications or surgical time.
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Affiliation(s)
- Mateo G Leon
- McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St # 1014, Houston, TX, 77030, USA.
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Tri A Dinh
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
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166
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Mori T, Ikeda K, Takeshita N, Teramura K, Ito M. Validation of a novel virtual reality simulation system with the focus on training for surgical dissection during laparoscopic sigmoid colectomy. BMC Surg 2022; 22:12. [PMID: 34998376 PMCID: PMC8742568 DOI: 10.1186/s12893-021-01441-7] [Citation(s) in RCA: 4] [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: 06/02/2021] [Accepted: 12/18/2021] [Indexed: 01/22/2023] Open
Abstract
Background Mastery of technical skills is one of the fundamental goals of surgical training for novices. Meanwhile, performing laparoscopic procedures requires exceptional surgical skills compared to open surgery. However, it is often difficult for trainees to learn through observation and practice only. Virtual reality (VR)-based surgical simulation is expanding and rapidly advancing. A major obstacle for laparoscopic trainees is the difficulty of well-performed dissection. Therefore, we developed a new VR simulation system, Lap-PASS LP-100, which focuses on training to create proper tension on the tissue in laparoscopic sigmoid colectomy dissection. This study aimed to validate this new VR simulation system. Methods A total of 50 participants were asked to perform medial dissection of the meso-sigmoid colon on the VR simulator. Forty-four surgeons and six non-medical professionals working in the National Cancer Center Hospital East, Japan, were enrolled in this study. The surgeons were: laparoscopic surgery experts with > 100 laparoscopic surgeries (LS), 21 were novices with experience < 100 LS, and five without previous experience in LS. The participants’ surgical performance was evaluated by three blinded raters using Global Operative Assessment of Laparoscopic Skills (GOALS). Results There were significant differences (P-values < 0.044) in all GOALS items between the non-medical professionals and surgeons. The experts were significantly superior to the novices in one item of GOALS: efficiency ([4(4–5) vs. 4(3–4)], with a 95% confidence interval, p = 0.042). However, both bimanual dexterity and total score in the experts were not statistically different but tended to be higher than in the novices. Conclusions Our study demonstrated a full validation of our new system. This could detect the surgeons' ability to perform surgical dissection and suggest that this VR simulator could be an effective training tool. This surgical VR simulator might have tremendous potential to enhance training for surgeons.
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Affiliation(s)
- Takashi Mori
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Koji Ikeda
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. .,, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Nobuyoshi Takeshita
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Koichi Teramura
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. .,, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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167
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Puliatti S, Amato M, Farinha R, Paludo A, Rosiello G, De Groote R, Mari A, Bianchi L, Piazza P, Van Cleynenbreugel B, Mazzone E, Migliorini F, Forte S, Rocco B, Kiely P, Mottrie A, Gallagher AG. Does quality assured eLearning provide adequate preparation for robotic surgical skills; a prospective, randomized and multi-center study. Int J Comput Assist Radiol Surg 2022; 17:457-465. [PMID: 34997525 PMCID: PMC8740863 DOI: 10.1007/s11548-021-02545-4] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022]
Abstract
Purpose In particular after the onset of the COVID-19 pandemic, there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. It is essential to understand whether this approach is sufficient and adequate to allow the development of robotic basic surgical skills. The main aim of the authors was to verify if the quality assured eLearning is sufficient to prepare individuals to perform a basic surgical robotic task.
Methods A prospective, randomized and multi-center study was conducted in September 2020 in the ORSI Academy, International surgical robotic training center. Forty-seven participants, with no experience but a special interest in robotic surgery, were matched and randomized into four groups who underwent a didactic preparation with different formats before carrying out a robotic suturing and anastomosis task. Didactic preparation methods ranged from a complete eLearning path to peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics. Results The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after learning to complete an assisted but unaided robotic vesico-urethral anastomosis task. The quantitatively defined benchmark was based on the objectively assessed performance (i.e., procedure steps completed, errors and critical errors) of experienced robotic surgeons for a proficiency-based progression (PBP) training course. None of the trainees in this study demonstrated the proficiency benchmarks in completing the robotic surgery task. Conclusions PBP-based e-learning methodology is an effective training method avoiding critical errors in the suturing and knotting task. Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills. Trial registration ClinicalTrials.gov Identifier: NCT04541615.
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Affiliation(s)
- Stefano Puliatti
- ORSI Academy, Melle, Belgium.
- Department of Urology, OLV, Aalst, Belgium.
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
- Department of Urology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Marco Amato
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Rui Farinha
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Artur Paludo
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
- Department of Urology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Giuseppe Rosiello
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Ruben De Groote
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Andrea Mari
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Lorenzo Bianchi
- Office for the Vice President for Learning and Teaching, University College Cork, Cork, Ireland
- Department of Urology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Pietro Piazza
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
- Office for the Vice President for Learning and Teaching, University College Cork, Cork, Ireland
| | | | - Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Migliorini
- Urology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Saverio Forte
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Bernardo Rocco
- Urology Department, ASST Santi Paolo e Carlo - Milano, Università Statale di Milano, Milan, Italy
| | - Patrick Kiely
- ORSI Academy, Melle, Belgium
- Office for the Vice President for Learning and Teaching, University College Cork, Cork, Ireland
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium
- Department of Urology, OLV, Aalst, Belgium
| | - Anthony G Gallagher
- ORSI Academy, Melle, Belgium
- Faculty of Life and Health Sciences, Ulster University, Derry, Northern Ireland, UK
- Faculty of Medicine, KU Leuven, Leuven, Belgium
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168
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Feenstra TM, van Felius LP, Vriens MR, Stassen LPS, van Acker GJD, van Dijkum EJMN, Schijven MP, Bonjer HJ. Does livestreaming surgical education have the future? Development and participant evaluation of a national COVID-19 livestreaming initiative. Surg Endosc 2022; 36:6214-6222. [PMID: 34988742 PMCID: PMC8731219 DOI: 10.1007/s00464-021-08922-z] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
Backgrounds COVID-19 related reduction of surgical procedures jeopardizes learning on the job of surgical residents. Many educators resorted to digital resources in the search for alternatives. However, these resources are often limited to the extent they offer resident-surgeon interaction like a joint surgical performance does. Here we present a roadmap of livestreaming surgical procedures, and evaluate how surgical livestreams on human cadavers address the unmet educational needs of surgical residents in our Dutch nationwide initiative. Methods Technical and organizational feasibility, and definition of outcome deliverables for the livestream series and per livestream were essential in livestream development. Faculty selected interventions, lecture contents, and participant preparations. Appropriate location, technical setup, and support were imperative for a stable, high-quality stream with integrated interaction, while maintaining digital privacy. A survey was sent to livestream participants to evaluate each livestream, and allow for constant improvement during the broadcasting of the series. Only surveys which were completed by surgical residents were included in the analysis of this study. Results Each livestream attracted 139–347 unique viewers and a total of 307 surveys were completed by participants (response rate of 23–38% per livestream). Sixty percent of surveys (n = 185) were completed by surgical residents. Livestreams were highly valued (appreciation 7.7 ± 1.1 and recommendation 8.6 ± 1.1), especially the live procedures combined with interaction and theoretical backgrounds. Criticized were technical difficulties and timing of the livestreams between 5 and 7 pm, which interfered with clinical duties. Conclusion Livestreaming surgical procedures on human cadavers is a valid and valued solution to augment resident education. Digital privacy and a stable, high-quality interactive stream are essential, as are appropriate moderation and relevant lectures. While livestreaming cannot replace hands-on training in the operating room, it enables surgeon-resident interaction which is key in education—and missed in pre-recorded surgical procedures which are currently available online.
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Affiliation(s)
- Tim M Feenstra
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | | | - Menno R Vriens
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gijs J D van Acker
- Department of Surgery, Haaglanden Medical Centre, Den Haag, Zuid-Holland, The Netherlands
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - H Jaap Bonjer
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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169
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Nüssler NC, Klier T, Ruppert R. [Minimum volume requirements-perspective of a tertiary care hospital]. Chirurg 2022; 93:356-361. [PMID: 34985547 DOI: 10.1007/s00104-021-01557-9] [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] [Accepted: 12/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The increase of minimum volumes for complex esophageal resections decided by the Federal Joint Committee (GBA) in Germany is currently the subject of intensive discussions. OBJECTIVE To shed light on the effects of minimum volume requirements from the perspective of a tertiary care hospital. RESULTS Strict adherence to the valid minimum volume requirements for esophageal surgery would significantly reduce the number of hospitals offering these procedures in Germany. The associated loss of revenue should not have any relevant negative economic consequences for most hospitals; however, the loss of complex esophageal surgery may result in a competitive disadvantage for these hospitals in times of shortage of qualified medical personnel. Another point of criticism is the assumption that the treatment quality can be recognized based solely on the numbers of patients. CONCLUSION Despite the well-known volume-outcome relationship, minimum volume requirements do not define the lower limit of quality of surgical treatment. Therefore, additional evidence of treatment quality, such as structural or process quality as well as outcome parameters should be required, e.g. through certification. An obligatory synchronous certification could contribute to increasing the acceptance of minimum volume requirements in Germany.
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Affiliation(s)
- Natascha C Nüssler
- Klinik für Allgemein‑, Viszeralchirurgie und Coloproktologie, München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, München, Deutschland.
| | - Thomas Klier
- Klinik für Allgemein‑, Viszeralchirurgie und Coloproktologie, München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, München, Deutschland
| | - Reinhard Ruppert
- Klinik für Allgemein‑, Viszeralchirurgie und Coloproktologie, München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, München, Deutschland
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Feeley AA, Gibbons JP, Feeley IH, Fitzgerald E, Merghani K, Sheehan E. Hand dominance and experience improve bimanual performance on arthroscopic simulator task. Knee Surg Sports Traumatol Arthrosc 2022; 30:3328-3333. [PMID: 35212804 PMCID: PMC9464134 DOI: 10.1007/s00167-022-06920-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to identify if experience in arthroscopy confers ambidexterity to the operator and the role of baseline characteristics in arthroscopic simulator performance. METHODS A prospective comparative study was carried out across four regional Orthopaedic training centres. Participants were divided into novice, intermediate or experienced groups based on arthroscopic experience. Baseline demographics including age, sex, handedness, and gaming history were also collected. Following familiarisation with the procedure, participants were asked to complete a simulated task requiring bimanual control consisting of visualisation with camera control and manipulation of highlighted objects using a grasping instrument. One attempt using camera control and grasping accuracy per hand was performed by each participant, with scores for each hand collected for analysis. Performance scores for camera alignment, camera path length, grasper path length and grasping efficiency were collected. Time taken to completion was also noted for each attempt. RESULTS Fifty-six participants were recruited to the study. A significant difference in grasping efficiency between groups in the dominant hand was demonstrated (p = 0.013). Novices demonstrated laterality with superior performance in grasping efficiency in the dominant hand (p = 0.001). No significant difference was noted between dominant and non-dominant hand performance in the experienced group. CONCLUSION Arthroscopic simulation-based training is a valuable learning tool for orthopaedic training. This study demonstrated that experienced orthopaedic surgeons have a greater degree of ambidexterity than intermediate or novice groups, hypothesised by authors to be conferred through conventional orthopaedic training. Dedicated bimanual control tasks to reduce laterality in trainees should be incorporated in simulated surgical curricula. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Aoife A. Feeley
- Department of Orthopaedics, Midlands Regional Hospital Tullamore, Arden Road, Tullamore, Co. Offaly Ireland ,Royal College of Surgeons Ireland, Dublin, Ireland
| | - John P. Gibbons
- Department of Orthopaedics, Tallaght University Hospital, Dublin, Ireland
| | - Iain H. Feeley
- Department of Orthopaedics, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | - Eilis Fitzgerald
- Department of Orthopaedics, Tallaght University Hospital, Dublin, Ireland
| | - Khalid Merghani
- Department of Orthopaedics, Midlands Regional Hospital Tullamore, Arden Road, Tullamore, Co. Offaly Ireland
| | - Eoin Sheehan
- Department of Orthopaedics, Midlands Regional Hospital Tullamore, Arden Road, Tullamore, Co. Offaly Ireland
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Sutcliffe A, Koshy K. A commentary on 'Improving surgical training: Establishing a surgical anatomy programme in Scotland'. Int J Surg 2022; 97:106205. [PMID: 34990830 DOI: 10.1016/j.ijsu.2021.106205] [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] [Received: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
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Abstract
Pursuing a career in surgery is a rigorous process that demands commitment and hard work. Surgeons in the United Kingdom must go overcome a myriad of competitive stages prior to becoming a consultant. In the United Kingdom, the most common pathway to become a surgeon is via the 'direct route' which encompasses completing multiple training programs, namely, the Foundation Program, followed by Core Surgical Training, and then onto Higher Speciality Training, with the aim of obtaining the Certificate of Completion of Training (CCT). More recently, certain specialities have introduced the 'Improving Surgical Training' (IST) pathway. IST is a competence-based, run through surgical program that was introduced by the Royal College of Surgeons of England (RCS) and Health Education England (HEE). "The pilot trials improvements in the quality of training, a better balance between service and training for trainees, and professionalisation of the role of the surgical trainers" [1]. However, there are alternative pathways that have been designed for those who prefer a different route to training or have been unsuccessful during the selection stages. These pathways are not well-advertised, but with the competitive rates now higher than before, it is becoming a more attractive pathway for junior doctors, hence the increasing the demand for clearer instructions on potential routes for aspiring surgeons.
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Affiliation(s)
- D. Motter
- Grange University Hospital, United Kingdom
| | - F. Salimi
- Grange University Hospital, United Kingdom
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173
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Amare EM, Siebeck M, Sendekie TY, Fischer MR, Berndt M. Development of an Entrustable Professional Activities (EPA) Framework to Inform Surgical Residency Training Programs in Ethiopia: A Three-round National Delphi Method Study. J Surg Educ 2022; 79:56-68. [PMID: 34294572 DOI: 10.1016/j.jsurg.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/15/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Entrustable Professional Activities (EPAs) have been proposed as a means to translate competencies into clinical practice. Although EPAs for residency training have become available, 1 set of core EPAs cannot automatically be transferred from one context to another due to cultural variability. Further, there is a lack of African- and Asian-based EPA development and implementation studies. We developed an end-of-training EPAs framework to inform surgical residency training programs in the local context of Ethiopian medical education. METHODS A three-round Delphi method was used to establish consensus about important surgical EPAs among experts. A total of 136 experts representing all surgical residency training institutions in Ethiopia were invited to participate. Round 1 & 2 consisted of senior expert panelists (n = 8) to identify potential EPAs and determine the content validity. Round 3 consisted of a survey (n = 128) to further validate the identified EPAs by attending surgeons who work with them. Each EPA had to achieve at least 80% or higher agreement among experts to be considered having acceptable content validity. RESULTS In round 1, a total of 272 EPAs were proposed, reduced, and grouped to 39 consented EPAs. In round 2, the same experts rated each EPA's relevance, resulting in 32 EPAs with a satisfactory item-level content validity index (I-CVI > 0.83). Overall, in the survey in round 3, 29 EPAs met the standard criterion for acceptability (S-CVI/Ave = 0.90) and achieved a high degree of final consensus (ICC = 0.998, 95% CI [0.996, 0.999]; (F = 439.2, p < 0.0001). CONCLUSIONS The framework of 29 validated and accepted EPAs can guide future surgical residency training programs in the Ethiopian medical education context. The framework allows programs to move from a time-dependent to an outcome-based model and transforms traditional assessment into entrustment decisions. Thus, the use of the framework can improve the quality of training and patient care in Ehtiopia.
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Affiliation(s)
| | - Matthias Siebeck
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | | | - Martin R Fischer
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Markus Berndt
- Institute of Medical Education, University Hospital, LMU Munich, Munich, Germany
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174
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Anteby R, Sinyard RD, Jogerst KM, McKinley SK, Coe TM, Petrusa E, Phitayakorn R, Scott DJ, Brunt LM, Gee DW. Challenges of virtual interviewing for surgical fellowships: a qualitative analysis of applicant experiences. Surg Endosc 2022; 36:3763-3771. [PMID: 34448935 PMCID: PMC8393782 DOI: 10.1007/s00464-021-08691-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/24/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The COVID-19 pandemic forced surgical fellowship programs to transition from in-person to remote applicant interviews; the virtual interviewing format presented new and unique challenges. We sought to understand applicants' perceived challenges to virtual interviewing for a surgical fellowship program. METHOD A grounded theory-based qualitative study was performed utilizing semi-structured interviews with fellowship applicants from the 2020 fellowship match. All Fellowship Council-registered applicants were eligible. We purposefully sampled participants to balance across gender, specialty-choice, and academic versus community-program affiliation. Interviews were inductively analyzed by two researchers for prominent themes. RESULTS Fifteen interviews were conducted. Participants were 60% male (n = 9), with 33% (n = 5) from non-academic institutions. They applied for the following fellowships: Advanced Gastrointestinal/Minimal Invasive (55%), Bariatric (30%), Hepatopancreatobiliary (10%) and Surgical Oncology (5%). Four main themes emerged to describe virtual interview process challenges: (1) perceived data deficiency, (2) superficial personal connections, (3) magnification of non-professionalism, and (4) logistical frustrations. Applicants recommend program directors provide more information about the fellowship prior to interview day and offer informal independent interactions with current and previous fellows. CONCLUSIONS According to fellowship applicants, virtual interviews resulted in a lack of information for rank-list decision making ultimately requiring them to rely on other information avenues to base their decisions. These applicants have offered advice to fellowship program directors and future applicants to better optimize this process.
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Affiliation(s)
- Roi Anteby
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
- School of Public Health, Harvard University, Boston, MA, USA.
| | - Robert D Sinyard
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
- Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - L Michael Brunt
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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Rozaire J, Naaim A, Dubuis L, Lamblin G. Development of an innovative surgical navigation system for sacrospinous fixation in pelvic surgery. J Minim Invasive Gynecol 2021; 29:549-558. [PMID: 34958953 DOI: 10.1016/j.jmig.2021.12.012] [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] [Received: 11/02/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To validate the use of an innovative navigation method for sacrospinous fixation in surgery-like conditions as a new teaching tool and surgical method. DESIGN 2-month-experiment prospective pilot study between July and August 2021. SETTING Biomechanics laboratory academic research. POPULATION 29 participants: 9 gynecological surgeons and 20 participants with no medical background. MEASUREMENT AND MAIN RESULTS The experiment was composed of two training phases dedicated to improve the hand-eye coordination and suture skills on a training mock-up, and of a suturing phase on a pelvic mock-up designed to recreate the surgery-like conditions of a sacrospinous fixation. The surgeons provided qualitative feedback on the bio-accuracy of the mock-ups and evaluated the ease-of-use of the navigation software. Non-surgeons were included to assess the progression of the suture performance between two experiments performed one week apart (Session 1 & 2). The main objective for participants was to reach a virtual target and to stitch sacrospinous ligaments. For Session 1, an overall comfort score of 7.2/10 was attributed to the tool; 14 (42%) surgeon suture attempts and 63 (65%) non-surgeon suture attempts were accurate (i.e. below the 5-mm threshold). 22 (67%) surgeon suture attempts and 28 (34%) non-surgeon suture attempts were fast (i.e. in the first two quantiles of the duration dataset). An improvement of the non-surgeon performance was observed between the two sessions in terms of duration (Session 1: 46±20 sec; Session 2: 37±18 sec; p=0.047) and distance (Session 1: 3.8±1.3 mm; Session 2: 3.2±1.4 mm; p=10-5) for the last suturing exercise. CONCLUSION This new motion-capture-based navigation method for sacrospinous fixation tested under surgery-like conditions seemed to be accurate and effective. The next step will be to design a pelvis model more adapted to the constraints of a sacrospinous fixation and to validate the benefits of this method compared to current techniques.
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Affiliation(s)
- Julie Rozaire
- Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC UMR_T9406, F69622, Lyon, France
| | - Alexandre Naaim
- Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC UMR_T9406, F69622, Lyon, France
| | - Laura Dubuis
- Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC UMR_T9406, F69622, Lyon, France
| | - Gery Lamblin
- Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC UMR_T9406, F69622, Lyon, France; Hôpital Femme Mère Enfant, Service de Chirurgie Urogynécologique, Hospices Civils de Lyon, Bron, France.
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Mulwafu W, Fualal J, Bekele A, Itungu S, Borgstein E, Erzingatsian K, Nungu S, Chikoya L, White R, Muguti G. The impact of COSECSA in developing the surgical workforce in East Central and Southern Africa. Surgeon 2021; 20:2-8. [PMID: 34955410 DOI: 10.1016/j.surge.2021.11.003] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Association of Surgeons of East Africa (ASEA) was formed in 1952. In 1996 a Steering Committee was formed to transform ASEA into a surgical college. The College of Surgeons of East Central and Southern Africa was officially launched in December 1999 in Nairobi, Kenya. Today the College consists of 14 constituent member countries but trains in 20 countries in Sub-Saharan Africa. PROGRAMMES COSECSA runs a 5 year training programme in all the surgical specialties. In the first 2 years trainees do the Membership (MCS) programme. This is followed by 3 years of the Fellowship (FCS) programme. More recently the College has started a 2 year sub-specialty Fellowship in paediatric orthopaedics. GRADUATES The main aim of the College was to expand and improve surgical training in the COSECSA region. This goal was partially realised in December 2020 when the total number of surgeons produced by the College from inception reached 557. RETENTION Another key success story of COSECSA is that the majority of graduates have remained in the region leading to a high retention rate of 88.3%. WOMEN IN SURGERY AFRICA (WISA) Since the formation of WISA in 2015 the College has witnessed an increase in the number of female trainees. Currently only 9% of surgeons in the region are women. CONCLUSION In its current Strategic Plan (2021-2025) COSECSA aims not only to increase the surgical workforce in the region but also to modernise its training programmes and strengthen its governance structures.
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Affiliation(s)
- Wakisa Mulwafu
- Kamuzu University of Health Sciences, P Bag 360, Blantyre, Malawi.
| | - Jane Fualal
- University of Makere, Mulago Hospital, Kampala, Uganda.
| | - Abebe Bekele
- University of Global Equity, P.O.Box 6955, Kigali, Rwanda.
| | - Stella Itungu
- College of Surgeons of East Central and Southern Africa, East Central and Southern Africa Health Community, Plot No.157 Oloirien-Njiro Road, P.O.Box 1009, Arusha, Tanzania.
| | - Eric Borgstein
- Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, P.Bag 360, Blantyre, Malawi.
| | - Krikor Erzingatsian
- University of Zambia, School of Medicine, Department of Surgery, Nationalist Road, P.O. Box 50110, Lusaka, Zambia.
| | - Samwel Nungu
- Muhimbili Orthopaedic and Neurological Institute, P.O.Box 65474, Dar Es Salaam, Tanzania.
| | - Laston Chikoya
- Levy Mwanawasa Medical University, P.O. Box 33991, Lusaka, Zambia.
| | - Russell White
- Department of Surgery, Tenwek Hospital, Bonnet, Kenya.
| | - Godfrey Muguti
- Department of Surgery, College of Health Sciences, University of Zimbabwe, P.O.Box A178, Avondale, Harare, Zimbabwe.
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Allgaier M, Amini A, Neyazi B, Sandalcioglu IE, Preim B, Saalfeld S. VR-based training of craniotomy for intracranial aneurysm surgery. Int J Comput Assist Radiol Surg 2021; 17:449-456. [PMID: 34931299 PMCID: PMC8873137 DOI: 10.1007/s11548-021-02538-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Intracranial aneurysms can be treated micro-surgically. This procedure involves an appropriate head position of the patient and a proper craniotomy. These steps enable a proper access, facilitating the subsequent steps. To train the access planning process, we propose a VR-based training system. METHOD We designed and implemented an immersive VR access simulation, where the user is surrounded by a virtual operating room, including medical equipment and virtual staff. The patient's head can be positioned via hand rotation and an arbitrary craniotomy contour can be drawn. The chosen access can be evaluated by exposing the aneurysm using a microscopic view. RESULTS The evaluation of the simulation took place in three stages: testing the simulation using the think-aloud method, conducting a survey and examining the precision of drawing the contour. Although there are differences between the virtual interactions and their counterparts in reality, the participants liked the immersion and felt present in the operating room. The calculated surface dice similarity coefficient, Hausdorff distance and feedback of the participants show that the difficulty of drawing the craniotomy is appropriate. CONCLUSION The presented training simulation for head positioning and access planning benefits from the immersive environment. Thus, it is an appropriate training for novice neurosurgeons and medical students with the goal to improve anatomical understanding and to become aware of the importance of the right craniotomy hole.
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Affiliation(s)
- Mareen Allgaier
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.
| | - Amir Amini
- University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Belal Neyazi
- University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | | | - Bernhard Preim
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Sylvia Saalfeld
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
- Forschungscampus STIMULATE, Magdeburg, Germany
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178
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Mooney C, Mangaoang D, O'Flynn E, Bekele A, Tierney S, Borgstein E. A thematic review of the use of electronic logbooks for surgical assessment in sub-Saharan Africa. Surgeon 2021:S1479-666X(21)00187-6. [PMID: 34922837 DOI: 10.1016/j.surge.2021.10.002] [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: 10/01/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Ensuring that surgical training programmes in low- and middle-income countries (LMICs) provide high quality training, including adequate operative experience, is of crucial importance in meeting the goals set out in the Lancet Global Surgery 2030. Electronic logbooks (eLogbooks) have been adopted to monitor both individual trainee progression and the performance of surgical training programmes. METHODS We performed a thematic review of the current evidence base surrounding the use of eLogbooks for the assessment of surgeons in training in sub-Saharan Africa, with a view to identifying the learning to date and areas for future research. RESULTS Whilst there are multiple papers highlighting the use of surgical eLogbooks in high-income countries, we identified only three papers which discussed their use in sub-Saharan Africa. Four common themes emerged which related to the use of surgical eLogbooks throughout sub-Saharan Africa: ease of analysis, centralised databases, discrepancies in reporting and technology limitations. CONCLUSIONS Robust data to demonstrate trainee progression and the quality of surgical training programmes are of crucial importance in ensuring that surgical training programmes can rapidly scale up to deliver large numbers of well-trained surgical providers to address the unmet patient need in LMICs in the next decade. The limited data on the use of well designed, centralised electronic surgical logbooks indicate that this tool may play an important role in providing key data to underpin these training programmes.
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179
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Heskin L, Simms C, Traynor O, Galvin R. Designing a synthetic simulator to teach open surgical skills for limb exploration in trauma: a qualitative study exploring the experiences and perspectives of educators and surgical trainees. BMC Surg 2021; 21:417. [PMID: 34911527 PMCID: PMC8672577 DOI: 10.1186/s12893-021-01417-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to adequately enable trainees to learn, practice and be assessed in surgical skills need to be of the highest standards. This study investigates the perceived requirements of simulation and simulators used to acquire skills in limb exploratory procedures in trauma. Methods Semi-structured interviews were conducted with an international group of 11 surgical educators and 11 surgical trainees who had experience with surgical simulation. The interviews focused on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. Interviews were recorded, transcribed and underwent thematic analysis. Results Analysis of the perspectives of surgical educators and surgical trainees on simulated training in limb trauma surgery yielded three main themes: (1) Attitudes to simulation. (2) Implementing simulation. (3) Features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt simulation could be improved with increased accessibility and variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost effectiveness, easy set up and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement. Conclusion There is a clear positive appetite for the incorporation of simulation into limb trauma training. The findings of this will inform the optimal requirements for high quality implementation of simulation into a surgical trauma curriculum and a reference to optimal features desired in simulator or task trainer design. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01417-7.
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Affiliation(s)
- L Heskin
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), 2nd Floor, 121 St Stephens Green, Dublin, Ireland.
| | - C Simms
- Trinity College Dublin, Dublin, Ireland
| | - O Traynor
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), 2nd Floor, 121 St Stephens Green, Dublin, Ireland
| | - R Galvin
- University of Limerick, Limerick, Ireland
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180
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Almaliotis D, Athanasopoulos GP, Almpanidou S, Papadopoulou EP, Karampatakis V. The contribution of wet labs in the education of ophthalmologists. Ann Med Surg (Lond) 2021; 72:103034. [PMID: 34824838 PMCID: PMC8604746 DOI: 10.1016/j.amsu.2021.103034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/07/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background The need for pre-training in experimental eye surgery is considered necessary. It is an essential way to assess trainees in ophthalmology based on their instrument and tissue handling and skills. This article aims to underline this necessity and demonstrate the ocular health professionals' opinion on this issue. Methods 74 participants (45 females and 29 males) were included in the study. Ophthalmology residents, ophthalmologists participated in the wet lab session. The evaluation of the contribution of the wet labs were provided by filling a new questionnaire form. In this way, an interactive questionnaire was developed. Results Regarding trainees' grading of wet labs' significance as a first step for guiding their surgical career, it was positively correlated with their subjective view of labs' utility to both improve their surgical skills (p = 0.001) and maintain pre-existing ones (p < 0.001). We should also note that all of them (100%) stated that wet labs were necessary during residency, especially in repeated sessions, and that they would recommend them to their colleagues. Conclusion The surgical skills improved significantly after participation in a wet lab, according to participants, who rated the experience as highly educational. Wet labs can reduce the learning curve of difficult surgical techniques, accelerate the rate for trainees to achieve surgical competency, and treat patients safely and effectively. Pre-training in experimental eye surgery is considered to be necessary. Health professionals evaluated the role of wet labs by filling a new questionnaire. Participants had a positive opinion on wet labs' role, especially during residency. Wet labs can reduce the learning curve of difficult surgical techniques. Safe and effective treatment of ophthalmology patients is more feasible.
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Affiliation(s)
- Diamantis Almaliotis
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Georgios P Athanasopoulos
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Stavroula Almpanidou
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Eleni P Papadopoulou
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Vasileios Karampatakis
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Greece
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Trelles Guzmán CR, Mainez Rodríguez JA, Aguado-Maestro I, Cansino Alcaide R, Pérez-Carral JR, Martínez-Piñeiro L. 3D printed model for flexible ureteroscopy training, a low-cost option for surgical training. Actas Urol Esp 2021:S2173-5786(21)00141-4. [PMID: 34844902 DOI: 10.1016/j.acuroe.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Training in experimental models is a valid option that improves the outcomes and shortens surgical learning curves. Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique. METHODS A 3D printed model was developed based on a CT scan from a real-life patient's upper urinary tract. Horos™ software was used for segmentation and an FDM-Ultimaker for 3D printing. Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4. The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast). RESULTS Printing time was 19 h, with a total cost of €8.77. The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty. The model also allowed the use of baskets and the mobilization and removal of previously placed stones. CONCLUSION We unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario.
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182
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Kelly MA, Vukanic D, McAnena P, Quinlan JF. The opportunity cost of arthroplasty training in orthopaedic surgery. Surgeon 2021; 20:297-300. [PMID: 34801411 DOI: 10.1016/j.surge.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/23/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Training the next generation of surgeons is a crucial role fulfilled by consultant orthopaedic surgeons. However we are increasingly constrained by limited time and resources. We sought to compare operative time and length of stay (LOS) for total hip and total knee arthroplasties (THA, TKA) performed by a consultant orthopaedic surgeon with those performed by supervised trainees. MATERIALS AND METHODS A prospective database of arthroplasty procedures performed from 2015 to 2018 was collated. Primary surgeon grade was recorded. Patient demographics, ASA grade, LOS and operative time were recorded. For THA both cemented and uncemented arthroplasties were used. SPSS version 23 was used for statistical analysis. RESULTS 394 arthroplasty procedures were carried out during the study period. Trainee surgeons performed a high proportion of both THA (53.2%, n = 123) and TKA (44.8%, n = 73) surgeries. Trainees performed 57% of cemented THA procedures. LOS did not differ between consultant and trainee surgeons for THA (5.9 ± 4.8 days) or TKA (5.6 ± 4.1 days). Age had a significant effect on LOS (p < 0.001). For THA the mean operative time for trainees was 90.3 ± 19.23 min, 18.2 min longer than the consultant group. For TKA the mean operative time was 89.06 ± 18.87 min for trainees, 24.4 min longer than the consultant group. DISCUSSION At our institution trainee surgeons can be expected to take between 18 and 24 min longer to perform arthroplasty procedures. This should be factored into resource planning, as the training of orthopaedic surgeons is crucial to sustaining and improving health service provision.
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Affiliation(s)
- M A Kelly
- Specialist Registrar in Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland.
| | - D Vukanic
- Specialist Registrar in Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland.
| | - P McAnena
- Surgical Registrar & Clinical Researcher, Lambe Institute for Translational Research, University Hospital Galway, Ireland.
| | - J F Quinlan
- Consultant Trauma and Orthopaedic Surgeon, Tallaght University Hospital, Dublin, Ireland.
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Sung S, Hørthe H, Svendsen ØV, van Duinen AJ, Salvesen Ø, Vandi A, Bolkan HA. Early evaluation of the transition from an analog to an electronic surgical logbook system in Sierra Leone. BMC Med Educ 2021; 21:578. [PMID: 34781930 PMCID: PMC8591157 DOI: 10.1186/s12909-021-03012-z] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/26/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Surgical logbooks are a commonly used tool for quality assurance of surgical training. Electronic logbooks are increasingly applied in low-resource settings, but there is limited research on their quality. The aim of this study is to evaluate the quality of an app-based surgical e-logbook system shortly after its implementation in a low-income country and to identify potential areas of improvement for the system. METHODS Entries in the e-logbook system were cross-checked with hospital records and categorized as matched or overreported. Moreover, the hospital records were checked for underreported procedures. Additionally, semi-structured interviews were conducted with users of the e-logbook system. RESULTS A total of 278 e-logbook database entries and 379 procedures in the hospital records from 14 users were analyzed. Matches were found in the hospital records for 67.3% of the database entries. Moreover, 32.7% of the database entries were overreported and 50.7% of the procedures in the hospital records were underreported. A previous study of an analog surgical logbook system in the same setting estimated that 73.1% of the entries were matches or close matches. Interviews with 12 e-logbook users found overall satisfaction but also identified potential areas of improvement, including the need for more training in the use of the system, modifications to improve user-friendliness, and better access to the necessary technology. CONCLUSIONS A reliable documentation system is necessary to evaluate the quality of health workforce training. The early evaluation of a surgical e-logbook system in a low-income country showed that the collected data should be approached with caution. The quantitative analysis suggests that the e-logbook system needs to be improved in terms of accuracy. In interviews, users reported that digitalization of the logbook system was a much-needed innovation but also identified important areas of improvement. Recognition of these aspects at an early stage facilitates guidance and adjustment of further implementation and might improve the accuracy of the system.
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Affiliation(s)
- Sophia Sung
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
| | - Hilde Hørthe
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
| | - Øyvind Veel Svendsen
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
- Clinic of Internal Medicine and Rehabilitation, Levanger Hospital, P.O. Box 333, 7601 Levanger, Norway
| | - Alex J. van Duinen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
| | - Øyvind Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
| | - Alphonsus Vandi
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
| | - Håkon A. Bolkan
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905 MTFS, 7491 Trondheim, Norway
- CapaCare, c/o Dr Håkon Bolkan, Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway
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Akladios C, Daraï É, Golfier F, Lecuru F, Collinet P, Uzan C, Lavoué V, Guyon F, Ferron G, Querleu D. [A curriculum based certification of competence in gynaecologic surgical oncology]. ACTA ACUST UNITED AC 2021; 50:26-32. [PMID: 34774853 DOI: 10.1016/j.gofs.2021.07.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/04/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies, the SFOG, the CNGOF, the SFCO and the SCGP, supported by the CNU of Obstetrics &Gynaecology- and UNICANCER, agreed to materialize this course and attest it by a certification awarded by a national jury. MATERIAL AND METHODS The national committee of certification in gynaecological oncology made up of 10 members, representing the 6 concerned organizations, set itself 5 objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification. RESULTS Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including 20 advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including 4 parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021. CONCLUSION The optimisation of the surgical management of patients treated for gynaecological cancer is achieved through the identification of a training course and the certification, by a national jury, of the skills of surgeons who have completed it.
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Affiliation(s)
- C Akladios
- Hôpitaux universitaires de Strasbourg, CHU de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - É Daraï
- Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Golfier
- Centre hospitalier Lyon Sud CHEM Grand Revoyet, hôpital Lyon Sud-Lyon, 69310 Pierre-Bénite, France
| | - F Lecuru
- Institut Curie-Paris, institut Curie Ensemble hospitalier - site de Paris, 26, rue d'Ulm, 75005 Paris, France
| | - P Collinet
- Hôpital Jeanne-de-Flandre-Lille, avenue Eugene-Avinée, 59000 Lille, France
| | - C Uzan
- Hôpital de la Pitié Salpêtrière, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Lavoué
- Centre Eugène-Marquis, hôpital Sud, CHU de Rennes, avenue Bataille Flandres-Dunkerque C S 44229, 35042 Rennes, France
| | - F Guyon
- Institut Bergonié, centre de lutte contre le cancer (CLCC) de la région Nouvelle-Aquitaine, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - G Ferron
- Institut universitaire du cancer de Toulouse ONCOPOLE Iuct O, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - D Querleu
- Société européenne d'oncologie gynécologique, 7, allée du Niger, 31000 Toulouse, France
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Park C, Grant J, Garigipati P, Kuhlenschmidt K, Black G, Bhat S, Abdelfattah K, Cripps M, Dumas RP. Resuscitative endovascular balloon occlusion of the aorta: simulation improves performance but may require interval training to prevent skill degradation. Eur J Trauma Emerg Surg 2021; 48:1955-1959. [PMID: 34731285 DOI: 10.1007/s00068-021-01815-9] [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] [Received: 07/27/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Surgical trainees are exposed to less procedures with increasing need for simulation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become increasingly implemented for hemorrhage control, yet most courses are catered to faculty level with little data on trainees. We propose that routine training in this critical procedure will improve trainee performance over time. METHODS This is a prospective, observational study at a level I trauma center involving a monthly trauma procedural program. Early in the month, trainees received hands-on REBOA training; at the end, trainees underwent standardized, class-based evaluation on a perfused trainer. Score percentages were recorded (0-100%). Endpoints included early, mid and late performance (2-12 months). Paired T-test and Pearson's coefficient were used to evaluate differences and strength of association between time between training and performance. RESULTS 25 trainees participated with 5 and 11 repeat learners in the PGY-2 and PGY-3 classes, respectively. Median early performance score was 62.5% (IQR 56-81) for PGY-2s and 91.6% (IQR 75-100) in PGY-3s. Pearson's coefficient between time between and training and score demonstrated a weak correlation in the PGY-2s (r2 = - 0.13), but was more pronounced in the PGY-3s (r2 = - 0.44) with an inflection point at 5 months. CONCLUSIONS Routine REBOA training in trainees is associated with improvement in performance within a short period of time. Skill degradation was most pronounced in trainees who did not receive training for more than 5 months. Trainees can be successfully trained in REBOA; however, this should be done at shorter intervals to prevent skill degradation.
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Affiliation(s)
- Caroline Park
- Division of Acute Care Surgery, Department of General Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Jennifer Grant
- Division of Acute Care Surgery, Department of General Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Priya Garigipati
- Division of Acute Care Surgery, Department of General Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Kali Kuhlenschmidt
- Division of Acute Care Surgery, Department of General Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - George Black
- Division of Acute Care Surgery, Department of General Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Sneha Bhat
- Division of Acute Care Surgery, Department of General Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Kareem Abdelfattah
- Division of Acute Care Surgery, Department of General Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Michael Cripps
- Division of Acute Care Surgery, Department of General Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Ryan P Dumas
- Division of Acute Care Surgery, Department of General Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Ludwig J, Jakobsen RB, Charles YP, Seifert J, Incoll I, Wood ML, Parmar D, Canter R. What it takes to become an orthopaedic surgeon: A comparison of orthopaedic surgical training programmes in 10 countries focusing on structure and fellowship requirements. Int J Surg 2021; 95:106150. [PMID: 34715383 DOI: 10.1016/j.ijsu.2021.106150] [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] [Received: 08/04/2021] [Revised: 09/28/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of surgical training has been highlighted as one of the most important patient safety issues in the future. Training surgeons and supporting them to do their best should be considered integral in providing optimum and safe care for the individual patient and the best possible return on investment in training medical professionals. In 2011, an international consensus statement defined fundamental principles for surgical training. PURPOSE This study examines orthopaedic surgical training to explore the similarities and differences in the requirements for trainees to obtain board certification in ten countries. METHODS Countries of the Commonwealth Health Care Comparison: Canada, the United Kingdom, the United States of America, Australia, New Zealand, Germany, France, the Netherlands, Norway and Switzerland were chosen to be compared. The relevant information was extracted from official information from authorities and administrative bodies. RESULTS The study revealed significant differences in duration, organisation and assessment of training. So-called "competency-based" training is not featured in every country, and the manner of its implementation is variable. In particular, the numbers in surgical cases required to be accredited varies by country ranging from 1260 (UK) to 340 (Norway). CONCLUSION Despite the recommendation in 2011 for some degree of uniformity across surgical training in industrialised countries, evidence suggests wide variation in the training programmes which is likely to be a concern in both quality of training as well as present and future patient safety.
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Affiliation(s)
- Johanna Ludwig
- BG Klinikum, Unfallkrankenhaus Berlin, Germany Kellogg College, University of Oxford, Oxford, United Kingdom Department of orthopedic surgery, Department of Health Management and Health Economics, Akershus University hospital and Institute of Health and Society, University Oslo, OSLO, Norway Hôpitaux Universitaires de Strasbourg, Department of Spine Surgery, Faculté de Médecine, Université de Strasbourg, France Department of Traumatology, University medicine, Universitätsmedizin Greifswald, University Greifswald, Greifswald, Germany University of Newcastle, District Clinical Director of Surgery; Clinical Lead, Quality & Innovation - Central Coast Local Health District, Graduate Programs in Surgical Education -University of Melbourne, Australia Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
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S Schmiederer I, Torices-Dardon A, M Ferrari-Light D, Charbel Abboud E, Villani V, N Lau J, M Foglia C. Developing a Robotic General Surgery Training Curriculum: Identifying Key Elements Through a Delphi Process. J Surg Educ 2021; 78:e129-e136. [PMID: 34456170 DOI: 10.1016/j.jsurg.2021.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE A national robotic surgery curriculum is still developing for general surgery residents as robotic surgery becomes increasingly accessible. One general surgery residency program utilized a Delphi process to optimize a robotic surgery curriculum and to determine key factors that might affect robotic proficiency and intraoperative independence. DESIGN Delphi methodology was used to gain consensus amongst robotic surgery faculty and trainees. Consensus was defined as agreement of 66.7% or above in factors that would allow a resident to independently operate in a robotic case. A panel of diverse representatives proposed factors that might affect resident robotic learning and operative experience. In a subsequent round, questions were sent through an anonymous online survey for respondents to identify factors that affect resident robotic independence. Respondents were also given the ability to write in pertinent factors. SETTING This study was conducted from July 2020 to September 2020 via anonymous web-based questionnaires for education researchers, faculty members, and residents of a university-affiliated independent general surgery residency program. PARTICIPANTS The initial panel consisted of a robotic surgeon, a 2020 graduate, a 2019 graduate and/or robotic fellow, a research resident, and a current resident. The subsequent survey was completed by 8 faculty members, 6 recent graduates, and 15 current residents within the general surgery residency program. RESULTS Proposed items fell into 3 categories: institutional resources, individual qualities, and curricular elements. Consensus within groups was achieved in the following items: dual robotic console models, robotic-focused faculty, resident interest, PGY level, and resident time spent on a simulator. CONCLUSIONS This Delphi exercise has informed this general surgery residency program in the development of a robotic surgery curriculum, through contribution from multiple stakeholders. While curricular elements for baseline robotic knowledge are necessary, institutional resources, deliberate practice, resident entrustment and faculty teaching proficiency warrant further study.
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Affiliation(s)
- Ingrid S Schmiederer
- Department of Surgery, Stanford University Medical Center, Stanford, California.
| | | | | | - Elia Charbel Abboud
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vincenzo Villani
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - James N Lau
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
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Dickinson KJ, Bass BL, Graviss EA, Nguyen DT, Pei KY. Independent Operating by General Surgery Residents: An ACS-NSQIP Analysis. J Surg Educ 2021; 78:2001-2010. [PMID: 33879397 DOI: 10.1016/j.jsurg.2021.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/15/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Surgical resident autonomy during training is paramount to independent practice. We sought to determine prevalence of general surgery resident autonomy for surgeries commonly performed on emergency general surgery services and identify trends with time. DESIGN We queried ACS-NSQIP for patients undergoing one of 7 emergency general surgery operations. We evaluated trends in independent operating (defined as a resident operating alone, without attending having scrubbed) over the study period. Other outcomes of interest: operative time, 30-day-mortality and complications. SETTING The ACS-NSQIP database. PARTICIPANTS Patients undergoing one of 7 emergency general surgery operations. RESULTS Data regarding resident involvement was only available for the years 2005-2010. 90,790 operations were performed, 922 (1%) by residents operating independently. Appendectomy accounted for 61% independent cases. Independent resident operating was associated with a longer operative time (65 versus 58 minutes, p < 0.001), but lower risk of bleeding requiring transfusion (p < 0.001) and progressive renal insufficiency (p = 0.02). Independent operating was not associated with increased risk of complications/mortality. CONCLUSION Independent resident operating is rare, even with increasing attention to its importance, and is not associated with increased complications or mortality. National data on this subject is old and not currently collected. There is need for a national registry on resident involvement to understand the current effect of independent operating on outcomes.
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Affiliation(s)
- Karen J Dickinson
- Department of Surgery, Houston Methodist Hospital, Houston, Texas; Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Barbara L Bass
- George Washington University School of Medicine and Health Services, Washington DC
| | - Edward A Graviss
- Department of Surgery, Houston Methodist Hospital, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Kevin Y Pei
- Department of Graduate Medical Education, Parkview Health, Fort Wayne, Indiana
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Papalois ZA, Aydın A, Khan A, Mazaris E, Rathnasamy Muthusamy AS, Dor FJMF, Dasgupta P, Ahmed K. HoloMentor: A Novel Mixed Reality Surgical Anatomy Curriculum for Robot-Assisted Radical Prostatectomy. Eur Surg Res 2021; 63:40-45. [PMID: 34724676 DOI: 10.1159/000520386] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The disruption to surgical training and medical education caused by the global COVID-19 pandemic highlighted the need for realistic, reliable, and engaging educational opportunities available outside of the operating theatre and accessible for trainees of all levels. This article presents the design and development of a virtual reality curriculum which simulates the surgical mentorship experience outside of the operating theatre, with a focus on surgical anatomy and surgical decision-making. METHOD This was a multi-institutional study between London's King's College and Imperial College. The index procedure selected for the module was robotic radical prostatectomy. For each stage of the surgical procedure, subject-matter experts (N = 3) at King's College London, identified (1) the critical surgical-decision making points, (2) critical anatomical landmarks, and (3) tips and techniques for overcoming intraoperative challenges. Content validity was determined by an independent panel of subject-matter experts (N = 8) at Imperial College, London, using Fleiss' kappa statistic. The experts' teaching points were combined with operative footage and illustrative animations, and projected onto a virtual reality headset. The module was piloted to surgical science students (N = 15). Quantitative analysis compared participants' confidence regarding their anatomical knowledge before and after taking the module. Qualitative data were gathered from students regarding their views on using the virtual reality model. RESULTS Multi-rater agreement between experts was above the 70.0% threshold for all steps of the procedure. Seventy-three percentage of pilot study participants "agreed" or "strongly agreed" that they achieved a better understanding of surgical anatomy and the rationale behind each procedural step. This was reflected in an increase in the median knowledge score after trialing the curriculum (p < 0.001). 100% of subject-matter experts and 93.3% of participants "agreed" or "strongly agreed" that virtual mentorship would be useful for future surgical training. CONCLUSIONS This study demonstrated that virtual surgical mentorship could be a feasible and cost-effective alternative to traditional training methods with the potential to improve technical skills, such as operative proficiency and nontechnical skills such as decision-making and situational judgement.
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Affiliation(s)
| | - Abdullatif Aydın
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Azhar Khan
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Evangelos Mazaris
- Department of Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Frank J M F Dor
- Department of Surgery and Cancer Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.,Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Shafi SQ, Brown S, Khaw RA, Hirniak J, Burke JR, Giwa L, Marson L, Hill A, Lobo D, Glasbey JC, McLean KA, Patel T, Liu G, Singal A, Nam R, Kathiravelupillai A, Chia WL, Ooi SZY, Matthews M, Ponniah SH, Komor J, Heyes A, Tushingham S, Hettiarachchi DS, K T, Gaier S, Jordan C, Joyce A, Johnston E, Valentine K, Nagassima K, Reis RD, O'Sullivan M, Tittawella A, Geary E, Thorpe C, Jalal AHB, Georgi M, Mergo A, Ramsay E, Sheikh J, Ashok A, Lee KS, Risquet R, Kathiravelupillai S, Chia D, Al Majid S, Matloob Ahmad AE, Hounat A, Shafi S, Wang J, Cambridge WA, Kawar L, Maseland T, Sharma K, Moses J, Patsalides MA, Brown S, Jaffer A, Feeney K, Richardson G, Joseph JP, Argus L, Sara X, Antypas A, de Andres Crespo M, Daly E, Abraha S. Medical student engagement with surgery and research during the COVID-19 pandemic: Supporting the future workforce for post-pandemic surgical recovery. Int J Surg 2021; 95:106105. [PMID: 34597820 PMCID: PMC8479464 DOI: 10.1016/j.ijsu.2021.106105] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Shiraz Q Shafi
- University of Dundee, United Kingdom University of Leicester, United Kingdom Newcastle University, United Kingdom St George's, University of London, United Kingdom University of Leeds, United Kingdom Queen Victoria Hospital NHS Foundation Trust, United Kingdom University of Edinburgh, United Kingdom Royal College of Surgeons in Ireland, Ireland University of Nottingham, United Kingdom University of Birmingham, United Kingdom Anglia Ruskin University, United Kingdom Aston University, United Kingdom Brighton and Sussex Medical School, United Kingdom Cardiff University, United Kingdom Hull-York Medical School, United Kingdom Imperial College London, United Kingdom Keele University, United Kingdom Queen Mary University of London, United Kingdom Queen's University Belfast, United Kingdom Trinity College Dublin, Ireland University College Cork, Ireland University College Dublin, Ireland University College London, United Kingdom University of Aberdeen, United Kingdom University of Bristol, United Kingdom University of Buckingham, United Kingdom University of Cambridge, United Kingdom University of Central Lancashire, United Kingdom University of Glasgow, United Kingdom University of Limerick, Ireland University of Liverpool, United Kingdom University of Manchester, United Kingdom University of Oxford, United Kingdom University of Warwick, United Kingdom
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Negash S, Tigabe W, Kiflu W, Derbew M. Pediatric Surgical Volume at the TASH: Experience after the Expansion of Pediatric Surgery Program. Ethiop J Health Sci 2021; 31:1193-1198. [PMID: 35392327 PMCID: PMC8968358 DOI: 10.4314/ejhs.v31i6.14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ethiopia has a high unmet need for pediatric surgical conditions. Over the past 5 years, new changes have been introduced to the pediatric surgery division at Addis Ababa University to overcome this issue. The changes include initiation of pediatric surgery residency, allocating operating room for pediatric surgery, weekend surgical campaign and starting ultrasound guided hydrostatic reduction. We conducted this study to evaluate the pattern and outcome of pediatric surgical cases after these changes. METHODS The study was a retrospective review conducted at Tikur Anbessa Hospital from Jan - Dec 2019. Data was collected from duty report forms that included emergency procedures, admissions and mortalities. Data on elective procedures was collected from operation theater log books. RESULTS Overall, a total of 1590 pediatric surgical procedures were performed during 2019 of which 942 cases were elective and 648 were emergency. This was an increment in number of surgeries performed by 75%. The leading emergency procedure was aerodigestive foreign body removal which increased by 46%. Surgery for intussusception has decreased by 30% with increasing use of hydrostatic reduction. Overall, average morbidity and mortality was 3.5% and 6.9% respectively. Morbidity and mortality rates were similar throughout the year. CONCLUSION The study shows increased productivity over the past year with the changes made in the department. There is also no increment in morbidity and mortality during the start of the academic year. This implies adequate consultant supervision of residents during transition.
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Affiliation(s)
- Samuel Negash
- Division of Pediatric Surgery, Department of Surgery, Addis Ababa University, Ethiopia
| | - Workiye Tigabe
- Division of Pediatric Surgery, Department of Surgery, Addis Ababa University, Ethiopia
| | - Woubedel Kiflu
- Division of Pediatric Surgery, Department of Surgery, Addis Ababa University, Ethiopia
| | - Miliard Derbew
- Division of Pediatric Surgery, Department of Surgery, Addis Ababa University, Ethiopia
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Colombo G, Di Bari M, Canzano F, De Virgilio A, Cugini G, Mercante G, Spriano G, Ferreli F. 3D-4K exoscope-assisted temporal bone dissection: a new frontier in surgical training. Eur Arch Otorhinolaryngol 2021; 279:3875-3880. [PMID: 34719728 DOI: 10.1007/s00405-021-07137-1] [Citation(s) in RCA: 3] [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: 08/06/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess if 3D-4K exoscope is a valuable tool for temporal bone dissection and to evaluate its teaching potential. METHODS Six consecutive 3D-4K-exoscope-assisted cortical mastoidectomies were performed by a novice, an intermediate and an expert surgeon (two dissections each). All dissections were entirely recorded and later evaluated independently by three other experienced surgeons. The dissection end-product was evaluated according to the Melbourne Mastoidectomy Scale (MMS). Paired t test was used to assess whether novice and intermediate surgeons have a score improvement in the second dissection compared to the first one. Surgeons' interactions, depth effect, and 3D impression were also assessed to perform a subjective analysis. RESULTS Mean MMS scores for the novice, intermediate and expert surgeon were 11.3 ± 2.8, 13.8 ± 3.9 and 19 ± 1.3, respectively. Paired t test demonstrated a statically significant improvement between the first and the second dissection both for the novice and the intermediate surgeon (+ 4.7 and + 7 points; p = 0.0002). A high-quality magnification of the temporal bone was obtained, allowing the expert surgeon to identify all the anatomical structures without injuring them. The exoscope was capable of providing a high involvement in the dissections with very effective interactions between the expert surgeon and the trainees, that had access to the same surgical field view. CONCLUSION 3D-4K-exoscope resulted adequate for a safe and effective mastoidectomy and showed a high potential for training and educational purposes. It can represent a valid option for surgical training of temporal bone dissection and a new interactive tool to understand the complex temporal bone anatomy.
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Affiliation(s)
- Giovanni Colombo
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Matteo Di Bari
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy. .,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy.
| | - Federica Canzano
- Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Armando De Virgilio
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giovanni Cugini
- Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giuseppe Mercante
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giuseppe Spriano
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Fabio Ferreli
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
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193
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Oliveira MM, Quittes L, Costa PHV, Ramos TM, Rodrigues ACF, Nicolato A, Malheiros JA, Machado C. Computer vision coaching microsurgical laboratory training: PRIME (Proficiency Index in Microsurgical Education) proof of concept. Neurosurg Rev 2021; 45:1601-1606. [PMID: 34718926 DOI: 10.1007/s10143-021-01663-6] [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] [Received: 04/07/2021] [Revised: 08/17/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
Computer vision (CV) feedback could be aimed as a constant tutor to guide ones proficiency during microsurgical practice in controlled environments. Five neurosurgeons with different levels of microsurgical expertise performed simulated vessel dissection and micro-suture in an ex vivo model for posterior computer analysis of recorded videos. A computer program called PRIME (Proficiency Index of Microsurgical Education) used in this research recognized color-labeled surgical instruments, from downloading videos into a platform, with a range of motion greater than 3 mm, for objective evaluation of number of right and left hand movements. A proficiency index of 0 to 1 was pre-established in order to evaluate continuous training improvement. PRIME computer program captured all hand movements executed by participants, except for small tremors or inconsistencies that have a range of motion inferior to 3 mm. Number of left and right hand movements were graphically expressed in order to guide more objective and efficacious training for each trainee, without requiring body sensors and cameras around the operating table. Participants with previous microsurgical experience showed improvement from 0.2 to 0.6 (p < 0.05), while novices had no improvement. Proficiency index set by CV was suggested, in a self-challenge and self-coaching manner. PRIME would offer the capability of constant laboratory microsurgical practice feedback under CV guidance, opening a new window for oriented training without a tutor or specific apparatus regarding all levels of microsurgical proficiency. Prospective, large data study is needed to confirm this hypothesis.
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Affiliation(s)
- Marcelo Magaldi Oliveira
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil.
| | - Lucas Quittes
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Pollyana Helena Vieira Costa
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Taise Mosso Ramos
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Ana Clara Fidelis Rodrigues
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Arthur Nicolato
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Jose Augusto Malheiros
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
| | - Carla Machado
- Placentarium Department, Federal University of Minas Gerais, Rua Montes Claros 1442 - 101 Anchieta, Belo Horizonte, Minas Gerais, 30310370, Brazil
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194
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Wang Y, Dai J, Morgan TN, Elsaied M, Garbens A, Qu X, Steinberg R, Gahan J, Larson EC. Evaluating robotic-assisted surgery training videos with multi-task convolutional neural networks. J Robot Surg 2021; 16:917-925. [PMID: 34709538 DOI: 10.1007/s11701-021-01316-2] [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] [Received: 07/02/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
We seek to understand if an automated algorithm can replace human scoring of surgical trainees performing the urethrovesical anastomosis in radical prostatectomy with synthetic tissue. Specifically, we investigate neural networks for predicting the surgical proficiency score (GEARS score) from video clips. We evaluate videos of surgeons performing the urethral anastomosis using synthetic tissue. The algorithm tracks surgical instrument locations from video, saving the positions of key points on the instruments over time. These positional features are used to train a multi-task convolutional network to infer each sub-category of the GEARS score to determine the proficiency level of trainees. Experimental results demonstrate that the proposed method achieves good performance with scores matching manual inspection in 86.1% of all GEARS sub-categories. Furthermore, the model can detect the difference between proficiency (novice to expert) in 83.3% of videos. Evaluation of GEARS sub-categories with artificial neural networks is possible for novice and intermediate surgeons, but additional research is needed to understand if expert surgeons can be evaluated with a similar automated system.
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Affiliation(s)
- Yihao Wang
- Department of Computer Science, Southern Methodist University, Dallas, USA
| | - Jessica Dai
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Tara N Morgan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Mohamed Elsaied
- Department of Computer Science, Southern Methodist University, Dallas, USA
| | - Alaina Garbens
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Xingming Qu
- Department of Computer Science, Southern Methodist University, Dallas, USA
| | - Ryan Steinberg
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Jeffrey Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Eric C Larson
- Department of Computer Science, Southern Methodist University, Dallas, USA.
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195
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Sánchez-Gómez S, Maza-Solano JM, Flórez LL, Arias PP, Duro DL, María Palacios-García J. [Impact Of The Covid-19 Pandemic On The Training Of Otorhinolaryngology Residents]. Acta Otorrinolaringol Esp 2021; 73:235-245. [PMID: 34658369 PMCID: PMC8501264 DOI: 10.1016/j.otorri.2021.09.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022]
Abstract
Antecedentes y objetivos La pandemia COVID-19 ha alterado todas las actividades sanitarias, entre ellas la formación especializada de los residentes. Se llevó a cabo un estudio para analizar en profundidad el impacto de la pandemia COVID-19 en aspectos específicos de las actividades clínicas, formativas e investigadoras que realizan los residentes de otorrinolaringología (ORL) en España durante un año completo de formación. Métodos Se realizó un estudio cualitativo transversal durante las últimas dos semanas de febrero de 2021. El estudio consistió en una encuesta en línea realizada por residentes de ORL que habían realizado un año continuado de formación desde el 15 de febrero de 2020 al 15 de febrero de 2021 y consistió en 26 preguntas que exploraban el impacto del COVID-19 en la salud de los residentes de ORL, en su dedicación laboral y en las actividades de formación. Las variables categóricas se informaron como frecuencia y porcentaje. Cuando se indicó, se utilizó la prueba chi-cuadrado de Pearson con la corrección de Yates y el coeficiente de correlación de Pearson (r). Resultados Se recibieron 143 encuestas cumplimentadas de 264 residentes (54,17%). Treinta y seis residentes (25,2%) habían padecido la enfermedad por SARS-CoV-2. La mayoría de ellos solo desarrollaron síntomas leves (86,1%) y 3 requirieron hospitalización (8,3%). Los residentes encuestados que resultaron positivos para SARS-CoV-2 no fueron capaces de identificar la fuente de su contagio y la necesidad de confinamiento se debió principalmente a la atención de un paciente asintomático en 9 casos (6,3%) o al contacto estrecho con un asintomático en situaciones no identificadas distintas de la atención sanitaria en 22 (15,4%). El 60,1% de los residentes encuestados reportaron haber perdido más de 6 meses de su período de formación, y en el 18,8% de los casos llegaron a 10 y 12 meses. Se ha producido una reducción de más del 75% de lo previsto en formación quirúrgica (p < 0,05) de timpanoplastia, mastoidectomía, estapedectomía, implantes cocleares, cirugía endoscópica nasosinusal y de base de cráneo anterior, septoplastia y turbinoplastia. Conclusiones El descenso de la actividad ORL y la necesidad de prestar asistencia en otros servicios y unidades durante los momentos más críticos de la pandemia han causado la principal reducción de su capacidad de formación. El contagio fundamentalmente ocurrió por el contacto con portadores asintomáticos durante la atención a pacientes y por contacto estrecho con portadores asintomáticos. Las actividades virtuales han sido ampliamente aceptadas, pero no han reemplazado por completo las necesidades de formación de todos los residentes. Se deberán implementar medidas para recuperar la formación perdida, especialmente el aprendizaje práctico quirúrgico en otología y rinología.
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Affiliation(s)
| | | | | | | | - David Lobo Duro
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
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196
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Kim E, Chawla S, Ghanem A. Mastering microsurgery: A novel benchmarking tool for micro surgical training. J Plast Reconstr Aesthet Surg 2021:S1748-6815(21)00449-6. [PMID: 34753684 DOI: 10.1016/j.bjps.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/19/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVE The shift of surgical training from apprenticeship model towards competency-based training requires objective assessments of microsurgical skills to achieve mastery. Our objective was to create a novel platform to provide feedback to surgical trainees relative to competency expected at their level of exposure. METHODS A 5-day simulated microsurgery course was run between 2013 and 2016 with 118 participants. Video recordings of end-to-end micro-anastomoses were collected on days 1, 3, and 5, along with analysis of hand motion . Videos were assessed to calculate the QMUL Global Rating Scale (QMUL GRS). Two charts were created to track the acquisition of microsurgical skills. One to plot the number of hand movements and the other for QMUL GRS, against the participants' cumulative number of micro-anastomoses performed. Participant data were used to calculate a skills acquisition line for each quartile, analogous to percentiles on a growth chart. RESULTS For a cumulative number of 0 prior micro-anastomoses, the GRS score at the 25th, 50th, and 75th percentile was 45.5, 55, and 62, respectively. As the number of cumulative anastomoses increased, there was a distinct increase in the GRS score to 89.5, 93, and 92 for the group with 55-100 previous micro-anastomoses. This was in keeping with a decreased number of hand movements with increasing experience. CONCLUSION In conclusion, our tool allows trainees to track where they lie in the skill spectrum relative to prior experience which permits the provision of focused training to trainees at lower percentiles, which has potential to translate to improved clinical outcomes.
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197
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Aryal K, Hamed M, Currow C. The usefulness of work-based assessments in higher surgical training: A systematic review. Int J Surg 2021; 94:106127. [PMID: 34597821 DOI: 10.1016/j.ijsu.2021.106127] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Work-based assessments including procedure based assessments, case based discussions, clinical evaluation exercises and direct observation of procedural skills are used in Higher Surgical Training Program. This systematic review aims to investigate the trainer and trainee's perception of the usefulness of workplace based assessments in Higher Surgical Training Programme. MATERIALS AND METHODS Embase, MEDLINE and PubMed databases were searched for relevant studies published up to Jan 15, 2021. The following search terms were used: procedure based assessments, case based discussions, clinical evaluation exercises, direct observation of procedural skills, Higher Surgical Training Program (with and without their abbreviations), surgical training, formative assessment. Usefulness was analysed according to van der Vleuten's utility formula, which is the product of educational impact, validity, reliability, acceptability, cost-effectiveness and feasibility. RESULTS 23 studies were included; Six on procedure based assessments, two on case based discussions, one on mini clinical evaluation exercises, three on direct observation of procedural skills and eleven on multiple methods. Overall, procedure based assessments had positive Kirkpatrick level 1 or 2 impact were valid, reliable and acceptable. Mini clinical evaluation exercises showed positive Kirkpatrick level 1 satisfaction in trainees and trainers and were feasible. Case based discussions were shown to have both positive and negative Kirkpatrick levels 1 and 2 impact and were rated valid and reliable. Direct observation of procedural skills were valid with favourable Kirkpatrick level 1 impact with more usage and modification of the forms. Multiple methods as used in the intercollegiate surgical curriculum programme portfolio was found to be less encouraging in achieving positive higher level of educational impact. The barriers included lack of time, lack of faculty development and lack of engagement. CONCLUSION It is important that work-based assessments are used properly, so that trainees get the maximum benefit from them. None of the studies included in our systematic review demonstrated an impact on behaviour or society (Kirkpatrick level 3 and 4), towards which future research should be directed to.
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Affiliation(s)
- Kamal Aryal
- Department of General Surgery, James Paget University Hospital, Great Yarmouth, NR31 6LA, UK
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198
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Mnouskin Y, Assaf D, Barkon-Steinberg G, Rachmuth J, Carmeli I, Keidar A, Rayman S. Proctored preceptorship model for learning eTEP repair for inguinal hernia for general surgery residents. Hernia 2021; 26:1053-1062. [PMID: 34591214 DOI: 10.1007/s10029-021-02507-4] [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] [Received: 06/06/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Enhanced-view total extra-peritoneal (eTEP) inguinal hernia repair is a technically demanding procedure with a steep learning curve. AIM Examine the feasibility and effectiveness of an instructor approach to teaching residents how to perform laparoscopic eTEP independently following a dedicated course of individual teaching. METHODS Prospective analysis of eTEP procedures performed by residents between March 2018 and September 2020. Six residents dispersed into three groups-Group A: two junior residents, Group B: two mid-level residents and Group C: two senior residents. All residents performed a unilateral IHR comprised of five core steps. Data reviewed for each procedure included the time of each step, total time and autonomy degree as assessment for every step: 1st degree-dependent (physical assistance), 2nd degree-partially dependent (vocal assistance) and 3rd degree-independent. Early and late procedures were divided at 50% of cases. RESULTS Participants performed 44 procedures (220 steps). Late procedures presented with a significant improvement in all degrees of autonomy (1st degree p = 0.002, 2nd degree p = 0.007 and 3rd degree p < 0.0001) and in every step (Step 1 p = 0.015, Step 2 p = 0.006, Step 3 p < 0.0001, Step 4 p < 0.0001, Step 5 p = 0.002). There was no significant difference in surgery duration between early and late procedures (p = 0.32). At early procedures, junior residents needed significantly higher rates of physical intervention (1st degree) compared to the senior residents (p = 0.004). Conversely, there was no significant difference in 2nd degree of autonomy (p = 0.46), 3rd degree (p = 0.06) and surgery duration (p = 0.16). The last three procedures performed by all participants had no significant difference between the seniority groups in autonomy (1st degree p = 0.1, 2nd degree p = 0.18 and 3rd degree p = 0.1). CONCLUSION Dedicated course with an individual instructor's approach is effective in achieving competence, autonomy and confidence in performing eTEP in a short time.
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Affiliation(s)
- Y Mnouskin
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - D Assaf
- Department of Surgery C, Chaim Sheba Medical Center, (Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 2 Sheba Rd., 52610, Ramat Gan, Israel
| | - G Barkon-Steinberg
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - J Rachmuth
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - I Carmeli
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - A Keidar
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel
| | - S Rayman
- Department of General Surgery, Assuta Ashdod Public Hospital, (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel), Ashdod, Israel.
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Alrishan Alzouebi I, Saad S, Farmer T, Green S. Is the use of augmented reality-assisted surgery beneficial in urological education? A systematic review. Curr Urol 2021; 15:148-52. [PMID: 34552454 DOI: 10.1097/CU9.0000000000000036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Google Glass is an optical head-mounted display that has been used in multiple medical and surgical settings to enhance delivery of education and training. This systematic review focuses solely on the use of this technology in urology operating theaters for the purpose of surgical education. Materials and methods: A systematic search strategy was employed using EMBASE (1996–2019), Medline (1946–2019) and PubMed. Search terms included optical head-mounted displays, Google Glass and urological surgical training. Use of this technology in a nonurological setting, nonteaching sessions, case reports, reviews, editorials, abstracts, and articles not in English were rejected. Three studies were identified following the exclusion criteria. Results: All 3 studies received positive feedback from trainees regarding this technology in relation to enhanced surgical education. In addition, in all studies the trainees felt the technology had a place for educational training in the future. All studies described disadvantages to the technology as well including battery life, comfort, and cost. Conclusions: Studies describe a big potential for Google Glass and similar head-mounted devices for the role of surgical training in urology, however, larger studies looking at more varied operations can help reinforce this viewpoint.
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200
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Salazar J, Gras JR, Sanchez-Guillen L, Sánchez-Del-Campo F, Arroyo A. Phonosurgery Training in Human Larynx Preserved with Thiel's Embalming Method. ORL J Otorhinolaryngol Relat Spec 2021; 83:412-419. [PMID: 34530430 DOI: 10.1159/000512725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/05/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND To describe the suitability of larynges preserved with Thiel's embalming method for phonosurgery training. METHODS A training model for phonosurgery techniques simulating vocal pathology and glottal insufficiency is developed to compare and evaluate the perception of embalmed vocal cords through a voluntary and anonymous survey rated on a scale of 1-5. A total of 10 residents and young otolaryngologists participated in the surgical training in phonosurgery. RESULTS Ten larynges preserved in formalin and 10 Thiel's embalmed larynges were used for the investigation. Phonosurgery procedures were performed following microflap and injection laryngoplasty techniques. The larynges preserved with Thiel's method demonstrated vocal cords that maintain their pliability and good tissue quality allowing a sensation of realism compared to the living body and providing suitable conditions for realistic laryngeal training. Participants held a positive experience, believed them to be useful and that these models of embalmed larynges were similar to the clinical setting and improved skills and confidence in performing phonosurgery. CONCLUSIONS The human larynges embalmed with Thiel's method maintain the pliability of the vocal cords, thus representing a unique model to practice and reproduce training for endolaryngeal procedures without the risks of contamination, anatomical variation, or rigidity of other models.
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Affiliation(s)
- Jhonder Salazar
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Vall d`Hebron, Barcelona, Spain.,Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain
| | - Juan-Ramón Gras
- Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain
| | - Luis Sanchez-Guillen
- Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain.,Department of Surgery, University General Hospital of Elche, Elche, Spain
| | - Francisco Sánchez-Del-Campo
- Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain
| | - Antonio Arroyo
- Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain.,Department of Surgery, University General Hospital of Elche, Elche, Spain
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