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Judy BF, Pennington Z, Botros D, Tsehay Y, Kopparapu S, Liu A, Theodore N, Zakaria HM. Spine Image Guidance and Robotics: Exposure, Education, Training, and the Learning Curve. Int J Spine Surg 2021; 15:S28-S37. [PMID: 34675029 DOI: 10.14444/8138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The use of intraoperative robotics and imaging for spine surgery has been shown to be safe, efficacious, and beneficial to patients, offering accurate placement of instrumentation, decreased operative time and blood loss, and improved postoperative outcomes. Despite these proven benefits, it has yet to be uniformly adopted. One of the major barriers for universal adoption of intraoperative robotics is the learning curve for this complex technology, in conjunction with a lack of formalized training. These same obstacles for universal adoption were faced in the introduction of surgical technology in other disciplines, and the use of this technology has become the standard of care in some of those specialties. Part of the success and widespread implementation of prior novel technology was the introduction of formalized training systems, which are currently lacking in advanced spine surgical technology. Therefore, the future success of intraoperative robotics and imaging for spine surgery depends on the creation of a formalized training system. We detail the best techniques for surgical pedagogy, as well as propose a comprehensive curriculum.
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Affiliation(s)
- Brendan F Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - David Botros
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Yohannes Tsehay
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Srujan Kopparapu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hesham M Zakaria
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Chan E, Botelho MG, Wong GTC. A flipped classroom, same-level peer-assisted learning approach to clinical skill teaching for medical students. PLoS One 2021; 16:e0258926. [PMID: 34679098 PMCID: PMC8535182 DOI: 10.1371/journal.pone.0258926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Clinical procedural skills are vital components of medical education. Increased student intake and limited capacity of medical schools necessitate more efficient ways to deliver clinical skill teaching. This study employed a flipped classroom, peer-assisted learning approach to deliver clinical skill teaching. It aimed to determine the influence of pre-class demonstration video watching and in-class student-student interactions on clinical skill acquisition. METHODS In 2017, a cohort of 205 medical students in their penultimate year of undergraduate medical study were recruited, and they learned bag mask ventilation and intravenous cannulation during this study. The participants watched a demonstration video before class, and then underwent self-directed practice as triads. Afterwards, each participant video-recorded their skill performance and completed post-class questionnaires. The videos were evaluated by two blinded assessors. RESULTS A hundred and thirty-one participants (63.9%) completed the questionnaire. For bag mask ventilation, participants who claimed to have watched the corresponding demonstration video before class achieved higher performance scores (those who watched before class: 7.8 ± 1.0; those who did not: 6.3 ± 1.7; p < 0.01). For intravenous cannulation, while there is no significant difference in performance scores (those who watched before class: 14.3 ± 1.3; those who did not: 14.1 ± 1.4; p = 0.295), those who watched the video before class received less interventions from their peers during triad practice (those who watched before class: 2.9 ± 1.8; those who did not: 4.3 ± 2.9; p < 0.05). The questionnaire results showed that most participants preferred the new approach of clinical skill teaching and perceived it to be useful for skill acquisition. CONCLUSION The flipped classroom, same-level peer-assisted learning model is potentially an effective way to address the current challenges and improve the efficiency of clinical procedural skill teaching in medical schools.
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Affiliation(s)
- Enoch Chan
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Michael George Botelho
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Gordon Tin Chun Wong
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Anaesthesiology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Lukanović D, Laganà AS. The impact of Covid-19 on simulation-based learning of gynecology and obstetrics skills. MINIM INVASIV THER 2021; 31:684-689. [PMID: 34651559 DOI: 10.1080/13645706.2021.1987923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Simulation-based learning can be defined as a modern learning and training method. The pan-European curriculum for training in obstetrics and gynecology PACT (Project for Achieving Consensus in Training) incorporates medical simulation and recommends its urgent implementation in the national residency programs of individual countries. The current Covid-19 pandemic presents challenges to the medical community. During the first wave of the pandemic, Italy was the most severely affected EU country, whereas during the second wave Slovenia was among those most affected. The severe limitations of the lockdown and post-lockdown led to significant changes in all healthcare organizations and, consequently, also training activities in obstetrics and gynecology. Limitations on training during the Covid-19 pandemic may have severely impacted the opportunity to learn basic clinical and surgical skills. A potential strategy for overcoming these limitations was offered by simulation activities, which allowed trainees to receive basic training in our discipline and prevented an additional "lockdown" of their learning and development of skills. This type of simulation training will be of paramount importance, considering the paradigm shift caused by the Covid-19 pandemic in lifestyle and healthcare activities.Abbreviations: ACOG: American college of obstetricians and gynecologists; EBCOG: European board and college of obstetrics and gynaecology; ICU: intensive care unit; OR: operating room; PACT: project for achieving consensus in training; PUI: patient under investigation.
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Affiliation(s)
- David Lukanović
- Division of Gynecology and Obstetrics, Ljubljana University Medical Center, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Shukla A, Sethi G, Dutta A, Aggarwal P, Gupta A. A new model of inexpensive portable homemade PERC Mentor (IPHOM) and its validation. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Percutaneous nephrolithotomy (PCNL) is a complex surgery and has a flat learning curve. Due to this and the ethical issues, trainees do not get enough hands on exposure. Virtual simulator is very expensive and bulky. Animal model requires legal clearance. This inexpensive portable homemade PERC Mentor (IPHOM) teaches all the major aspects of PCNL surgery. This article has shown the way to make this model and its validation study.
Methods
IPHOM can be made at home with carton box, ball bearings, LED torch and some hospital wastes. After a short demonstration of IPHOM, 14 residents and 4 urologists were given 8 tasks to perform on it followed by 15-min supervised practice exercise on day 0 and day 1. Their performance was reassessed on day 2 and 3. Response to 17 feedback points was recorded on a seven-point Likert scale.
Results
There was significant difference between the performance of expert and novice on day 0. Expert completed all the tasks in less time and no. of attempts. The time for tract dilatation and duration of radiation exposure were significantly less in the expert group. The performance of both expert and novice improved on day 2 and 3, but the improvement was significantly more in novice. Response to the feedback points showed no difference between expert and novice (p > .05).
Conclusions
We have found that training on IPHOM has improved the concept and skills of PCNL in residents. The simplicity and low cost of the model make it constructible at home.
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Mastering microsurgery: A novel benchmarking tool for microsurgical training. J Plast Reconstr Aesthet Surg 2021; 75:811-816. [PMID: 34753684 DOI: 10.1016/j.bjps.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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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Motaharifar M, Norouzzadeh A, Abdi P, Iranfar A, Lotfi F, Moshiri B, Lashay A, Mohammadi SF, Taghirad HD. Applications of Haptic Technology, Virtual Reality, and Artificial Intelligence in Medical Training During the COVID-19 Pandemic. Front Robot AI 2021; 8:612949. [PMID: 34476241 PMCID: PMC8407078 DOI: 10.3389/frobt.2021.612949] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 07/29/2021] [Indexed: 12/15/2022] Open
Abstract
This paper examines how haptic technology, virtual reality, and artificial intelligence help to reduce the physical contact in medical training during the COVID-19 Pandemic. Notably, any mistake made by the trainees during the education process might lead to undesired complications for the patient. Therefore, training of the medical skills to the trainees have always been a challenging issue for the expert surgeons, and this is even more challenging in pandemics. The current method of surgery training needs the novice surgeons to attend some courses, watch some procedure, and conduct their initial operations under the direct supervision of an expert surgeon. Owing to the requirement of physical contact in this method of medical training, the involved people including the novice and expert surgeons confront a potential risk of infection to the virus. This survey paper reviews recent technological breakthroughs along with new areas in which assistive technologies might provide a viable solution to reduce the physical contact in the medical institutes during the COVID-19 pandemic and similar crises.
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Affiliation(s)
- Mohammad Motaharifar
- Advanced Robotics and Automated Systems (ARAS), Industrial Control Center of Excellence, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
- Department of Electrical Engineering, University of Isfahan, Isfahan, Iran
| | - Alireza Norouzzadeh
- Advanced Robotics and Automated Systems (ARAS), Industrial Control Center of Excellence, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Parisa Abdi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Iranfar
- School of Electrical and Computer Engineering, University College of Engineering, University of Tehran, Tehran, Iran
| | - Faraz Lotfi
- Advanced Robotics and Automated Systems (ARAS), Industrial Control Center of Excellence, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Behzad Moshiri
- School of Electrical and Computer Engineering, University College of Engineering, University of Tehran, Tehran, Iran
- Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Alireza Lashay
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid D. Taghirad
- Advanced Robotics and Automated Systems (ARAS), Industrial Control Center of Excellence, Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
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107
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Dave A, Singhal M, Tiwari R, Chauhan S, De M. Effectiveness of a microsurgery training program using a chicken wing model. J Plast Surg Hand Surg 2021; 56:191-197. [PMID: 34339351 DOI: 10.1080/2000656x.2021.1953043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Microsurgical skills are essential for plastic surgeons in the modern times. Chicken wing model for microsurgery training offers an easy and cost-effective alternative to the traditional live rat model. A prospective study was conducted over a period of 6 months. Fifteen resident doctors in the department of plastic surgery were enrolled. Each of them underwent one session of microsurgery training on chicken wings (ulnar artery) every week for 15 weeks. The pre-training and post-training microvascular anastomosis were recorded and analyzed by two blinded investigators using a modification of the Structured Assessment of Microsurgery Skills (SAMS) tool. The pre- and post-training scores were compared. Twelve residents completed the requisite number of training sessions and were included in the final analysis. The mean diameter of the chicken wing ulnar artery was 1.04 mm (SD:0.11). All trainees demonstrated an improvement in the total scores. There was significant improvement in the mean scores (Pre-training: 33.46 vs. post-training: 41.42, p = 0.002). There was also a significant decrease in the total number of errors (Pre-training: 6.75 vs. post-training: 4.79, p = 0.012). However, there was no significant improvement in the average time taken to perform anastomosis (Pre-training: 58.03 mins vs. post-training: 52.51 mins, p = 0.182). We concluded that chicken wing is a useful training model for microsurgery. It helps in improving the overall microsurgical skill as well as reducing the average number of errors. This model is cost-effective, easily available, and easy to set-up. The wide assortment of vessels with varying diameters provides opportunities for training of microsurgeons of different skill levels.
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Affiliation(s)
- Aniket Dave
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India.,Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Maneesh Singhal
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Tiwari
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Chauhan
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Moumita De
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India.,Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, India
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Beal B, Du AL, Urman RD, Gabriel RA. Frameworks for trainee education in the nonoperating room setting. Curr Opin Anaesthesiol 2021; 34:470-475. [PMID: 34052824 DOI: 10.1097/aco.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW As the volume and types of procedures requiring anesthesiologist involvement in the nonoperating room anesthesia (NORA) setting continue to grow, it is important to create a formal curriculum and clearly define educational goals. RECENT FINDINGS A NORA rotation should be accompanied by a dedicated curriculum that should include topics such as education objectives, information about different interventional procedures, anesthesia techniques and equipment, and safety principles. NORA environment may be unfamiliar to anesthesia residents. The trainees must also learn the principles of efficiency, rapid recovery from anesthesia, and timely room turnover. Resident education in NORA should be an essential component of their training. The goals and objectives of the NORA educational experience should include not only developing the clinical knowledge necessary to implement the specific type of anesthetic desired for each procedure, but also the practical knowledge of care coordination needed to safely and efficiently work in the NORA setting. SUMMARY As educators, we must foster and grow a resident's resilience by continually challenging them with new clinical scenarios and giving them appropriate autonomy to take risks and move outside of their comfort zone. Residents should understand that exposure to such unique and demanding environment can be transformative.
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Affiliation(s)
| | - Austin L Du
- School of Medicine, University of California, San Diego, La Jolla, California
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rodney A Gabriel
- Department of Anesthesiology
- Division of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
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What Is Your Reality? Virtual, Augmented, and Mixed Reality in Plastic Surgery Training, Education, and Practice. Plast Reconstr Surg 2021; 147:505-511. [PMID: 33235047 DOI: 10.1097/prs.0000000000007595] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY Virtual reality and other technological advancements both inside and outside the operating room have shown an exponential increase in the past two decades. Surgical technique and finesse in delicate procedures have become ever more important, and the onus is on plastic surgeons and plastic surgery residents to meet these needs to provide the best outcomes possible to patients. The ability to learn, simulate, and practice operating in a fashion that poses no harm to any patient is truly a gift from technology to surgery that any surgeon could benefit from, whether trainee or attending. This application of technology and simulation has been demonstrated in other fields such as in the airline industry with flight simulation. The ability to learn, synthesize, and incorporate learned materials and ideas through virtual, augmented, and mixed reality tools offers a great opportunity to put our field at the forefront of a paradigm shift in surgical education. The critical utility of digital education could not be further emphasized any more than in the unfortunate and infrequent situation of a worldwide pandemic. This article reviews some of the important recent technologies that have developed and their applications in plastic surgery education and offers a look into what we can expect in the future.
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Reimberg J, Lopes LR, Passeri SMRR, Menezes FH. The electronic media and the study profile of the surgical resident. Rev Col Bras Cir 2021; 48:e20212941. [PMID: 34287548 PMCID: PMC10683418 DOI: 10.1590/0100-6991e-20212941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/10/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE this study analyzed the surgical resident's study profile by assessing the use of electronic media. 44.76% of the physicians agreed on participating. METHODS observational, cross-sectional non-controlled study. Statistical analysis was performed using Pearson's correlation coefficient and the significance level for the statistical tests was p <0.001. RESULTS 87.2% of the residents believed that it is interesting to use e-learning together with the classical theoretic classes. 45% of the interviewed claimed to spend more than 3 hours on the Internet daily. CONCLUSION residents recognize the importance of technology for education, but not as a way of replacing the traditional teaching methods.
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Affiliation(s)
- Julia Reimberg
- - Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Departamento de Cirurgia - Campinas - SP - Brasil
| | - Luiz Roberto Lopes
- - Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Departamento de Cirurgia - Campinas - SP - Brasil
| | | | - Fábio Husemann Menezes
- - Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Departamento de Cirurgia - Campinas - SP - Brasil
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111
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Reguera EAM, Lopez M. Using a digital whiteboard for student engagement in distance education. COMPUTERS & ELECTRICAL ENGINEERING : AN INTERNATIONAL JOURNAL 2021; 93:107268. [PMID: 34642507 PMCID: PMC8494483 DOI: 10.1016/j.compeleceng.2021.107268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/06/2021] [Accepted: 06/14/2021] [Indexed: 05/22/2023]
Abstract
The COVID-19 pandemic transformed educational processes across different educational levels. As institutions and faculty members effort focused on guaranteeing academic continuity, the challenge was how to translate the learning methodologies applied in the classroom to virtual settings. A digital whiteboard was integrated to synchronous class sessions to complement the educational experience. During these sessions, students and teachers interacted to co-construct ideas and socialize learning. The objective of this study was to assess the impact of introducing a digital whiteboard in student engagement. The quantitative approach integrated student's perception through an online survey with 12 items. The results show that the students enjoyed the dynamic(4.56), students believe that the incorporation of digital whiteboard contributed to understanding abstract concepts(4.83), and perceived the resource contributed for class engagement(4.72). The design of educational projects that incorporate these resources translate to active learning dynamics which foster student engagement.
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Affiliation(s)
| | - Mildred Lopez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud
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112
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Lowe S, Mares K, Khadjesari Z. Immersive technology in ophthalmology education: a systematic review. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:600-604. [PMID: 35520978 PMCID: PMC8936631 DOI: 10.1136/bmjstel-2021-000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/18/2021] [Indexed: 11/03/2022]
Abstract
Background Despite the increasing use of immersive technology (IT) in ophthalmology, the effectiveness of this approach compared to other teaching practices is unclear. This systematic review aimed to determine the value of IT to teach students ophthalmic skills and whether it can supplement or replace conventional teaching practices. Methods A systematic search was performed of CENTRAL, MEDLINE, EMBASE, ERIC and PsychINFO databases. Randomised controlled trials comparing IT interventions versus (1) no training, (2) standard training, (3) different types of IT interventions, (4) different doses of IT interventions were eligible for inclusion. Results Seven trials involving 177 participants were included. IT offered some benefit compared to standard training as most trials demonstrated evidence of learning represented by composite performance score and performance time. Repetitive training with IT displayed similar results. Conclusion IT appears to improve the ophthalmic skill of healthcare trainees and should be considered as a supplement to training.
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Affiliation(s)
- Shakeel Lowe
- Norwich Medical School, University of East Anglia, Norwich, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Kathryn Mares
- School of Health Sciences, University of East Anglia, Norwich, UK
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Prudhomme T, Matillon X, Dengu F, de Mazancourt E, Pinar U, Gondran-Tellier B, Freton L, Vallée M, Dominique I, Felber M, Khene ZE, Fortier E, Lannes F, Michiels C, Grevez T, Szabla N, Bardet F, Kaulanjan K, Pradère B, Deschamps JY, Branchereau J. Residents and patients benefit from surgical simulation on a live porcine model, could we consider it as ethical? Prog Urol 2021; 31:618-626. [PMID: 34158220 DOI: 10.1016/j.purol.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/16/2021] [Accepted: 01/29/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The objective was to evaluate, by self-questionnaire, the feeling of participants in surgical training sessions on a live porcine model. METHODS A computerized questionnaire (GoogleForm ©) was sent to the members of the French Association of Urologists-in-Training (AFUF) (fellows and residents). Only questionnaires from Urologists-in-training who had participated in surgical training sessions were included. The sessions consisted of performing surgeries such as laparoscopic nephrectomies or laparoscopic cystectomies. RESULTS Overall, 198 met the inclusion criteria. A total of 36.4% (72/198) of the participants were fellows and 63.6% (126/198) were residents. According to the participants, the main interest of sessions was to be able to train for emergency situations. A total of 79.8% (158/198) of the participants wanted surgical simulation to become compulsory. To their opinion, the main advantage of surgical simulation on a live porcine model was: technical progress in 87.4% (173/198) of cases. A total of 13.1% (26/198) of the participants found it was unethical to perform the first technical procedures on live animal models. A total of 65.7% (130/198) of the participants considered that there is currently no system of substitution. CONCLUSION For the participants, surgical training on a live porcine model allows technical progress while training for serious emergency situations. Surgeons and patients could benefit from this risk-free mock surgical scenario. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- T Prudhomme
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, 44093 Nantes, France; Centre de Recherche en Transplantation et Immunologie (CRTI), UMR1064, INSERM, Université de Nantes, Nantes, France; Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France.
| | - X Matillon
- Department of Urology and Transplantation, Hospices civils de Lyon, Lyon, France
| | - F Dengu
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - E de Mazancourt
- Department of Urology and Transplantation, Hospices civils de Lyon, Lyon, France
| | - U Pinar
- Department of Urology, University Paris Saclay, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - B Gondran-Tellier
- Department of Urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France
| | - L Freton
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - M Vallée
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - I Dominique
- Department of Urology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - M Felber
- Department of Urology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Z-E Khene
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - E Fortier
- Department of Urology, Montpellier University Hospital, Montpellier, France
| | - F Lannes
- Department of Urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France
| | - C Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - T Grevez
- Department of Urology, Tours University Hospital, Tours, France
| | - N Szabla
- Department of Urology and Transplantation, Caen University Hospital, Caen, France
| | - F Bardet
- Department of Urology, Dijon University Hospital, Dijon, France
| | - K Kaulanjan
- Department of Urology, Pointe à Pitre University Hospital, Guadeloupe, France
| | - B Pradère
- Department of Urology, Tours University Hospital, Tours, France
| | - J-Y Deschamps
- Emergency and Critical Care Unit, ONIRIS, School of Veterinary Medecine, La Chantrerie, Nantes, France
| | - J Branchereau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, 44093 Nantes, France; Centre de Recherche en Transplantation et Immunologie (CRTI), UMR1064, INSERM, Université de Nantes, Nantes, France; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Amiras D, Hurkxkens TJ, Figueroa D, Pratt PJ, Pitrola B, Watura C, Rostampour S, Shimshon GJ, Hamady M. Augmented reality simulator for CT-guided interventions. Eur Radiol 2021; 31:8897-8902. [PMID: 34109488 PMCID: PMC8589738 DOI: 10.1007/s00330-021-08043-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/18/2021] [Accepted: 05/04/2021] [Indexed: 01/20/2023]
Abstract
Introduction CT-guided interventions are taught using a mentored approach on real patients. It is well established that simulation is a valuable training tool in medicine. This project assessed the feasibility and acceptance of replicating a CT-guided intervention using a bespoke software application with an augmented reality head-mounted display (ARHMD). Methods A virtual patient was generated using a CT dataset obtained from The Cancer Imaging Archive. A surface mesh of a virtual patient was projected into the field-of-view of the operator. ChArUco markers, placed on both the needle and agar jelly phantom, were tracked using RGB cameras built into the ARHMD. A virtual CT slice simulating the needle position was generated on voice command. The application was trialled by senior interventional radiologists and trainee radiologists with a structured questionnaire evaluating face validity and technical aspects. Results Sixteen users trialled the application and feedback was received from all. Eleven felt the accuracy and realism was adequate for training and twelve felt more confident about their CT biopsy skills after this training session. Discussion The study showed the feasibility of simulating a CT-guided procedure with augmented reality and that this could be used as a training tool. Key Points • Simulating a CT-guided procedure using augmented reality is possible. • The simulator developed could be an effective training tool for clinical practical skills. • Complexity of cases can be tailored to address the training level demands.
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Affiliation(s)
- D Amiras
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK.
- Department of Surgery, Imperial College London, London, UK.
| | - T J Hurkxkens
- Digital Learning Hub, Imperial College London, London, UK
| | - D Figueroa
- Digital Learning Hub, Imperial College London, London, UK
| | - P J Pratt
- Digital Learning Hub, Imperial College London, London, UK
- Imperial College London, London, UK
- Medical iSight Corporation, New York, USA
| | - B Pitrola
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - C Watura
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - S Rostampour
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | | | - M Hamady
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery, Imperial College London, London, UK
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Comprehensive metrics for evaluating surgical microscope use during tympanostomy tube placement. Int J Comput Assist Radiol Surg 2021; 16:1587-1594. [PMID: 34089123 DOI: 10.1007/s11548-021-02428-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/28/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Learning to use a surgical microscope is a fundamental step in otolaryngology training; however, there is currently no objective method to teach or assess this skill. Tympanostomy tube placement is a common otologic procedure that requires skilled use of a surgical microscope. This study was designed to (1) implement metrics capable of evaluating microscope use and (2) establish construct validity. STUDY DESIGN This was a prospective cohort study. METHODS Eight otolaryngology trainees and three otolaryngology experts were asked to use a microscope to insert a tympanostomy tube into a cadaveric myringotomy in a standardized setting. Microscope movements were tracked in a three-dimensional space, and tracking metrics were applied to the data. The procedure was video-recorded and then analyzed by blinded experts using operational metrics. Results from both groups were compared, and discriminatory metrics were determined. RESULTS The following tracking metrics were identified as discriminatory between the trainee and expert groups: total completion time, operation time, still time, and jitter (movement perturbation). Many operational metrics were found to be discriminatory between the two groups, including several positioning metrics, optical metrics, and procedural metrics. CONCLUSIONS Performance metrics were implemented, and construct validity was established for a subset of the proposed metrics by discriminating between expert and novice participants. These discriminatory metrics could form the basis of an automated system for providing feedback to residents during training while using a myringotomy surgical simulator. Additionally, these metrics may be useful in guiding a standardized teaching and evaluation methodology for training in the use of surgical microscopes.
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Frame LA. Nutrition, a Tenet of Lifestyle Medicine but Not Medicine? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115974. [PMID: 34199529 PMCID: PMC8199717 DOI: 10.3390/ijerph18115974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022]
Abstract
Nutrition is a foundation of health and one of six pillars of Lifestyle Medicine. The importance of nutrition in clinical care is now widely recognized by health care professionals and the public. However, clinicians are not comfortable counselling their patients on nutrition due to inadequate or lack of training, leaving a significant need in patient care. This gap can be closed with evidence-based curricula in medical schools and in the trainings of other health care professionals. This communication presents the current state of nutrition knowledge in health care, emphasizing nutrition education for physicians, and presents a model of how pre- through post-professional health care providers may become proficient in nutrition counseling including appropriate referral to more specialized providers. With these skills, health care professionals will be able to initiate patient-centered lifestyle plans. This includes improving diet and utilization of team-based medicine and referrals.
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Affiliation(s)
- Leigh A Frame
- The George Washington School of Medicine and Health Sciences, Washington, DC 20037, USA
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A conceptual model of Lean culture adoption in healthcare. INTERNATIONAL JOURNAL OF PRODUCTIVITY AND PERFORMANCE MANAGEMENT 2021. [DOI: 10.1108/ijppm-06-2020-0345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis work seeks to offer a greater understanding of Lean healthcare implementation challenges conceptually taking a situated cultural organizational change perspective.Design/methodology/approachA descriptive model of healthcare organizations’ Lean adoption trajectories is built using ripple and bridging modelization strategies from elements of three classic organizational change theories and knowledge from Lean, organizational culture, healthcare and operations management literature.FindingsThe “contingent Lean culture adoption” (CLCA) model suggests five theoretical trajectories the healthcare organizations may experience when conducting a Lean transformation. These trajectories evolve from a new concept of Lean cultural friction (LCF) which represents cultural friction that a healthcare organization encounters toward an ultimate Lean culture proficiency state through time. From high to low initial LCF, a healthcare organization may in its Lean proficiency course end up in three states: lower, similar or higher LCF situation.Research limitations/implicationsThe CLCA model demonstrates the potential to be developed into a framework and possibly a Lean cultural friction theory pending further qualitative and quantitative validation.Practical implicationsThe CLCA model may help healthcare managers to use more appropriate cultural change strategies during their organization’s Lean journey.Originality/valueThis work enriches the concept of Lean cultural change which may apply not only to healthcare organizations but also to other ones. It suggests the existence of a healthcare organization Lean culture proficiency archetype and introduces the notion of Lean cultural friction.
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Domínguez LC, Dolmans D, Restrepo J, de Grave W, Sanabria A, Stassen L. How Surgical Leaders Transform Their Residents to Craft Their Jobs: Surgeons' Perspective. J Surg Res 2021; 265:233-244. [PMID: 33957575 DOI: 10.1016/j.jss.2021.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/03/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgeons should transform their residents to take the lead in their jobs and optimize their working conditions, so-called job crafting. We investigated the actions undertaken by surgeons with a transformational leadership style to encourage residents' job crafting, about which there is at present a paucity of information. METHODS We performed a qualitative study based on principles of constructivist grounded theory. In-depth interviews were held with a purposive sample of surgeons who were perceived as transformational leaders by their residents. During data analysis (open, axial, and selective coding), we compared inductive codes with deductive codes drawn from the job demands-resources and transformational leadership theories to reach a consensus on the interpretation of data and identification of the main themes. RESULTS Sixteen surgeons participated. Surgeons undertook five actions that enhanced job crafting in residents. They: one) modeled positive behaviors of a good surgeon; two) used a stepwise individual approach toward autonomy; three) connected with the resident as a person; four) supported residents in handling complications and errors; and five) they coached the resident to deal with competing interests. These actions had four consequences for residents. They led to: one) more responsibilities in patient care; two) more constructive relationships in the workplace; three) less pressure from workload and surgical care duties; and four) less personal difficulties and errors in patient care. CONCLUSIONS The actions undertaken by surgeons with a transformational leadership style have a positive association with the residents' ability to craft their jobs. This knowledge has implications for surgeons' leadership development with a view to workplace education.
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Affiliation(s)
| | - Diana Dolmans
- Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jorge Restrepo
- Department of Medical Education, Universidad de la Sabana, Chía, Colombia
| | - Willem de Grave
- Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Alvaro Sanabria
- Department of Surgery, Universidad de la Sabana, Chía, Colombia
| | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
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Siow WT, Tan GL, Loo CM, Khoo KL, Kee A, Tee A, Bin Mohamed Noor I, Tay N, Lee P. Impact of structured curriculum with simulation on bronchoscopy. Respirology 2021; 26:597-603. [PMID: 33876525 DOI: 10.1111/resp.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/16/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Simulation enhances a physician's competency in procedural skills by accelerating ascent of the learning curve. Training programmes are moving away from the Halstedian model of 'see one, do one, teach one', also referred as medical apprenticeship. We aimed to determine if a 3-month structured bronchoscopy curriculum that incorporated simulator training could improve bronchoscopy competency among pulmonary medicine trainees. METHODS We prospectively recruited trainees from hospitals with accredited pulmonary medicine programmes. Trainees from hospitals (A, B and C) were assigned to control group (CG) where they received training by traditional apprenticeship while trainees from hospital D were assigned to intervention group (IG) where they underwent 3-month structured curriculum that incorporated training with the bronchoscopy simulator. Two patient bronchoscopy procedures per trainee were recorded on video and scored independently by two expert bronchoscopists using the modified Bronchoscopy Skills and Tasks Assessment Tool (BSTAT) forms. A 25 multiple choice questions (MCQ) test was administered to all participants at the end of 3 months. RESULTS Eighteen trainees participated; 10 in CG and eight in IG with equal female:male ratio. Competency assessed by modified BSTAT and MCQ tests was variable and not driven by volume as IG performed fewer patient bronchoscopies but demonstrated better BSTAT, airway anaesthesia and MCQ scores. Bronchoscopy simulator training was the only factor that correlated with better BSTAT (r = 0.80), MCQ (r = 0.85) and airway anaesthesia scores (r = 0.83), and accelerated the learning curve of IG trainees. CONCLUSION An intensive 3-month structured bronchoscopy curriculum that incorporated simulator training led to improved cognitive and technical skill performance as compared with apprenticeship training.
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Affiliation(s)
- Wen Ting Siow
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| | - Gan-Liang Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Chian-Min Loo
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Kay-Leong Khoo
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| | - Adrian Kee
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| | - Augustine Tee
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Imran Bin Mohamed Noor
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Noel Tay
- Division of Respiratory and Critical Care Medicine, Ng Teng Fong Hospital, Singapore
| | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
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Froschauer SM, Holzbauer M, Jachs P, Schnelzer RF, Schmidt M, Pollhammer MS, Kwasny O, Pretterkleber ML, Pretterklieber B, Duscher D, Schöffl H, Huemer GM. [An innovative concept for microsurgical training: a feedback analysis]. HANDCHIR MIKROCHIR P 2021; 53:119-124. [PMID: 33860489 DOI: 10.1055/a-1291-7725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND There has been a shift in microsurgical education towards simulation training. Hence a number of training programs are being proposed to educate aspiring microsurgeons. However, it is challenging to master the skill of microsurgery and no program has proposed a fully satisfactory training model to date. Therefore, we present an innovative course concept and assess the participants' feedback. METHODS Being offered a four-step modular curriculum, participants can tailor their program to their individual needs and reinforce specific aspects of their training. The program is characterised by exercises ranging from basic techniques performed on avital biologic models to specific surgical techniques performed on human anatomic specimens. In our feedback questionnaire we ask participants to evaluate the parameters "course design", "expectations" and "overall satisfaction" based on a Likert scale with 5 items (100 %, 75 %, 50 %, 25 % and 0 %). RESULTS From 2015 to 2017, 274 students completed and evaluated individual courses. The average values exceeded 90 % for all three parameters. DISCUSSION In conclusion, we have developed and evaluated an innovative training program with a constantly high satisfaction rate and a rising number of participants, thus contributing to the advancement of microsurgical skills in Central Europe.
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Affiliation(s)
- Stefan M Froschauer
- Kepler Universitätsklinikum GmbH, Department for Traumasurgery and Sporttraumatology.,maz-mikrochirurgisches Ausbildungszentrum Linz
| | - Matthias Holzbauer
- Kepler Universitätsklinikum GmbH, Department for Traumasurgery and Sporttraumatology.,maz-mikrochirurgisches Ausbildungszentrum Linz
| | - Patrick Jachs
- Kepler Universitätsklinikum GmbH, Department for Traumasurgery and Sporttraumatology.,maz-mikrochirurgisches Ausbildungszentrum Linz
| | - Richard F Schnelzer
- Kepler Universitätsklinikum GmbH, Department for Traumasurgery and Sporttraumatology.,maz-mikrochirurgisches Ausbildungszentrum Linz
| | - Manfred Schmidt
- Kepler Universitätsklinikum GmbH, Klinik für Plastische, Ästhetische und Rekonstruktive Chirurgie.,maz-mikrochirurgisches Ausbildungszentrum Linz
| | - Michael S Pollhammer
- Universitätsklinikum St. Pölten, Klinik für Plastische, Ästhetische und Rekonstruktive Chirurgie
| | - Oskar Kwasny
- Kepler Universitätsklinikum GmbH, Department for Traumasurgery and Sporttraumatology.,maz-mikrochirurgisches Ausbildungszentrum Linz
| | - Michael L Pretterkleber
- Medizinische Universität Wien, Zentrum für Anatomie und Zellbiologie.,maz-mikrochirurgisches Ausbildungszentrum Linz
| | - Bettina Pretterklieber
- Kepler Universitätsklinikum GmbH, Department for Traumasurgery and Sporttraumatology.,maz-mikrochirurgisches Ausbildungszentrum Linz
| | - Dominik Duscher
- Plastische Chirurgie, Hand-, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls Universität/BG Unfallklinik Tübingen, Deutschland.,Kepler Universitätsklinikum GmbH, Klinik für Plastische, Ästhetische und Rekonstruktive Chirurgie.,maz-mikrochirurgisches Ausbildungszentrum Linz
| | | | - Georg M Huemer
- Kepler Universitätsklinikum GmbH, Klinik für Plastische, Ästhetische und Rekonstruktive Chirurgie.,maz-mikrochirurgisches Ausbildungszentrum Linz
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Abdel-Dayem M, Maradi Thippeswamy K, Haray P. A Structured Modular Approach: The Answer to Training in Laparoscopic Colorectal Surgery. Surg Innov 2021; 28:479-484. [PMID: 33829917 DOI: 10.1177/15533506211008079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bakground: Laparoscopic techniques are now an integral part of the operative management of colorectal diseases. However, the specialist training that is required for this is not uniformly available. There is, therefore, a need for a structured competency-based training method so that trainees can navigate the learning curve safely. Aim. To develop a modular structured training programme for laparoscopic colorectal surgery (LCS) with the capability of ensuring competency-based progression from a novice level to independent operator. Methodology. Over the past decade, we have developed a structured approach, starting with junior surgical trainees and progressing through to consultant level, with 7 clearly defined levels of progression attending courses to achieving a trainer status. This approach allows trainees to maintain objective records of their progression and trainers to provide targeted learning opportunities. It also allows for several trainees of varying experience to be trained during the same procedure. Conclusion. Our structured training module for junior surgeons has successfully produced several competent laparoscopic colorectal surgeons in the United Kingdom and around the world. This approach may also be adaptable to training in other laparoscopic procedures as the levels of progression are generic and not procedure-specific.
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Affiliation(s)
- Mahmoud Abdel-Dayem
- Department of Colorectal Surgery, 8911Prince Charles Hospital- Merthyr Tydfil, Merthyr Tydfil, UK
| | | | - Puthucode Haray
- Department of Colorectal Surgery, 8911Prince Charles Hospital- Merthyr Tydfil, Merthyr Tydfil, UK.,Department of Surgery, 6654University of South Wales, Pontypridd, UK
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Craig J, Walsh I. A scoping review of high-fidelity bench models for teaching closed reduction of distal radial fractures. MEDEDPUBLISH 2021; 10:88. [PMID: 38486554 PMCID: PMC10939654 DOI: 10.15694/mep.2021.000088.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. INTRODUCTION Simulation training can be beneficial for developing clinical skills without risks to patients. This review considers the literature on simulation models used for teaching closed reduction (manipulation) procedures for distal radius (wrist) fractures, particularly high-fidelity models, and the evidence supporting the use of such models. METHODS A scoping review of Medline and Embase was performed. RESULTS Five articles described low-fidelity models, predominantly focussing on low costs and teaching basic principles. Three articles and two commentary pieces discussing high-fidelity models were identified. DISCUSSION Attitudes towards a high-fidelity simulator were assessed by Egan et al. (2013), who found the majority of participants to be in favour of the model's use as a teaching tool, although participant selection may have been subject to bias. Mayne et al. (2016) subsequently used a high-fidelity model including radio-opaque markers and more objective measurements tools to assess orthopaedic trainees' closed reduction technique and adequacy of the achieved fracture position and casting. Seniority correlated with higher scores on objective structured assessment of technical skills (OSATS) and global rating scores (GRS) but not radiological measures of fracture position or cast quality, and over 90% of all participants achieved an adequate reduction. Seeley et al. (2017) used radiological measurements and time to task completion with another high-fidelity reduction model. The two most experienced participant groups could not be differentiated on any radiological measures of fracture reduction or on the time taken for reduction, although these groups were significantly better than the most junior participants. CONCLUSION The discussed models appear helpful to teach inexperienced participants the basic principles and steps in a procedures but a plateau effect appears to limit the potential benefit to more experienced learners. The constraints of educators' time and financial costs may influence the usage of such models in this type of training.
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Bielsa VF. Virtual reality simulation in plastic surgery training. Literature review. J Plast Reconstr Aesthet Surg 2021; 74:2372-2378. [PMID: 33972199 DOI: 10.1016/j.bjps.2021.03.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 11/07/2020] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
Major changes have occurred in the medical environment leading to an evolution from the traditional residency programmes to competency-based ones. Virtual reality (VR) represents a promising simulation resource for surgical training. Several types of VR simulators can be considered, depending on the level of immersion they offer. The goal of the article is to review the progress of VR simulation in plastic surgery (PS) training. A systematic search of the literature was performed on PUBMED/MEDLINE with the following key words: (Simulation OR Virtual Reality) AND (Education OR Training) AND Plastic Surgery from January 1998 to September 2019. A total of 244 results were found, and 80 of them were selected for abstract review. Sixty-four articles were selected for complete reading. Several attempts have been made to create VR simulators and most of them are non-immersive or partially immersive. The main conclusions of them are summarized. VR simulation has been proven to have a role in PS training, offering many advantages. Furthermore, VR simulation can be used for safety training, team interaction and decision-making education. Validation is a key point for acceptance of simulators. Further efforts are required to include simulation in PS curricula.
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Affiliation(s)
- V Fuertes Bielsa
- Plastic Surgery Department University Hospital Miguel Servet Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
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Nebbia M, Kotze PG, Spinelli A. Training on Minimally Invasive Colorectal Surgery during Surgical Residency: Integrating Surgical Education and Advanced Techniques. Clin Colon Rectal Surg 2021; 34:194-200. [PMID: 33815002 DOI: 10.1055/s-0041-1722843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Surgery is an ever-evolving discipline and continually incorporates new technologies that have improved the ability of the operating room surgeon to perform. The next generation of minimally invasive surgery includes laparoscopic and robotic-assisted procedures. Graduating residents may be expected to have the skills to perform common colorectal procedures using these technologies, and residency programs are developing curriculums to teach these skills. Minimally invasive techniques are challenging and learning only by observation and practice alone is difficult. This requires dedicated training and mentoring. New simulation methods have been conceived specifically for minimally invasive procedures, and these embrace a combination of virtual reality simulators and box trainers, with animal and human tissue, as well as synthetic materials. The aim of this review is to provide an overview of training in minimally invasive colorectal surgery with a focus on different types of simulators that build the basis to develop and include a multistep training approach in a structured training curriculum for minimally invasive colorectal procedures.
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Affiliation(s)
- Martina Nebbia
- Department of Surgery, Colon and Rectal Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, IBD Outpatient Clinics, Health Sciences Postgraduate Program, Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, IRCCS Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy
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Sanguin S, Roman H, Foulon A, Gondry J, Havet E, Klein C. Deep infiltrating endometriosis with sacral plexus involvement: Improving knowledge through human cadaver dissection. J Gynecol Obstet Hum Reprod 2021; 50:102129. [PMID: 33781973 DOI: 10.1016/j.jogoh.2021.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/19/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of this study was to assess a human cadaver model of sacral plexus dissection for learning about deep innervation in the female pelvis, and the latter's relationship with deep infiltrating endometriosis. METHODS This was a prospective, observational study. Eight residents in obstetrics and gynecology were tested before and after a lecture on innervation of the female pelvis and a cadaver dissection class. Standardized cadaver dissection was used to identify the sacral nerve roots S2 to S4, superior and inferior hypogastric plexuses, hypogastric nerve, and splanchnic nerves. RESULTS The residents' level of knowledge improved significantly after a one-hour lecture (p = 0.9.10-5) and after a cadaver dissection class (p = 0.6.10-6). The improvement was significantly greater for the dissection class (p = 0.0003). All the pelvic nerve structures were identified in all but one of the cadavers and had similar measurements. A vascular anatomical variant was observed in one case. CONCLUSION A human cadaver model is of value for learning about deep pelvic innervation and the latter's relationship with deep infiltrating endometriosis. The reproducibility and safety of cadaver dissection might improve surgical skills.
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Affiliation(s)
- Sophie Sanguin
- Department of Gynecology and Obstetrics, Amiens University Medical Center, Amiens, F-80054, France
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, F- 33000, Bordeaux, France; Department of Gynecology and Obstetrics, Aarhus University Medical Center, Nordre Ringgade 1, 8000 Aarhus C, Denmark
| | - Arthur Foulon
- Department of Gynecology and Obstetrics, Amiens University Medical Center, Amiens, F-80054, France
| | - Jean Gondry
- Department of Gynecology and Obstetrics, Amiens University Medical Center, Amiens, F-80054, France
| | - Eric Havet
- Anatomy Laboratory, Jules Verne University of Picardie, Amiens, F-80054, France
| | - Céline Klein
- Anatomy Laboratory, Jules Verne University of Picardie, Amiens, F-80054, France; Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, F-80054, France.
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Nelskamp A, Schnurr B, Germanyuk A, Sterz J, Lorenz J, Sader R, Rüsseler M, Seifert LB. Comparison of 'Mental training' and physical practice in the mediation of a structured facial examination: a quasi randomized, blinded and controlled study. BMC MEDICAL EDUCATION 2021; 21:178. [PMID: 33757503 PMCID: PMC7986263 DOI: 10.1186/s12909-021-02603-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The correct performance of a structured facial examination presents a fundamental clinical skill to detect facial pathologies. However, many students are not adequately prepared in this basic clinical skill. Many argue that the traditional 'See One, Do One' approach is not sufficient to fully master a clinical skill. 'Mental Training' has successfully been used to train psychomotor and technical skills in sports and other surgical fields, but its use in Oral and Maxillofacial Surgery is not described. We conducted a quasi-experimental to determine if 'Mental Training' was effective in teaching a structured facial examination. METHODS Sixty-seven students were randomly assigned to a 'Mental Training' and 'See One, Do One' group. Both groups received standardized video instruction on how to perform a structured facial examination. The 'See One, Do One' group then received 60 min of guided physical practice while the 'Mental Training' group actively developed a detailed, stepwise sequence of the performance of a structured facial examination and visualized this sequence subvocally before practicing the skill. Student performance was measured shortly after (T1) and five to 10 weeks (T2) after the training by two blinded examiners (E1 and E2) using a validated checklist. RESULTS Groups did not differ in gender, age or in experience. The 'Mental Training' group averaged significantly more points in T1 (pE1 = 0.00012; pE2 = 0.004; dE1 = 0.86; dE2 = 0.66) and T2 (pE1 = 0.04; pE2 = 0.008, dE1 = 0.37; dE2 = 0.64) than the 'See One, Do One' group. The intragroup comparison showed a significant (pE1 = 0.0002; pE2 = 0.06, dE1 = 1.07; dE2 = 0.50) increase in clinical examination skills in the 'See One, Do One' group, while the 'Mental Training' group maintained an already high level of clinical examination skills between T1 and T2. DISCUSSION 'Mental Training' is an efficient tool to teach and maintain basic clinical skills. In this study 'Mental Training' was shown to be superior to the commonly used 'See One, Do One' approach in learning how to perform a structured facial examination and should therefore be considered more often to teach physical examination skills.
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Affiliation(s)
- Arne Nelskamp
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Benedikt Schnurr
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Alexandra Germanyuk
- Department of Urology, Medical Faculty of Saarland University, Saarbrücken, Germany
| | - Jasmina Sterz
- Department of Trauma, Reconstructive and Hand Surgery, Goethe University, Frankfurt, Germany
| | - Jonas Lorenz
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Robert Sader
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Miriam Rüsseler
- Department of Trauma, Reconstructive and Hand Surgery, Goethe University, Frankfurt, Germany
| | - Lukas B Seifert
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Lakhani S, Selim OA, Saeed MZ. Arthroscopic Simulation: The Future of Surgical Training: A Systematic Review. JBJS Rev 2021; 9:01874474-202103000-00006. [PMID: 33750750 DOI: 10.2106/jbjs.rvw.20.00076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Arthroscopic simulation has rapidly evolved recently with the introduction of higher-fidelity simulation models, such as virtual reality simulators, which provide trainees an environment to practice skills without causing undue harm to patients. Simulation training also offers a uniform approach to learn surgical skills with immediate feedback. The aim of this article is to review the recent research investigating the use of arthroscopy simulators in training and the teaching of surgical skills. METHODS A systematic review of the Embase, MEDLINE, and Cochrane Library databases for English-language articles published before December 2019 was conducted. The search terms included arthroscopy or arthroscopic in combination with simulation or simulator. RESULTS We identified a total of 44 relevant studies involving benchtop or virtually simulated ankle, knee, shoulder, and hip arthroscopy environments. The majority of these studies demonstrated construct and transfer validity; considerably fewer studies demonstrated content and face validity. CONCLUSIONS Our review indicates that there is a considerable evidence base regarding the use of arthroscopy simulators for training purposes. Further work should focus on the development of a more uniform simulator training course that can be compared with current intraoperative training in large-scale trials with long-term follow-up at tertiary centers.
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Affiliation(s)
- Saad Lakhani
- Division of Surgical & Interventional Sciences, University College London, London, United Kingdom
| | - Omar A Selim
- Division of Surgical & Interventional Sciences, University College London, London, United Kingdom
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Listijono DR, Rosen DMB, Choi S, Bukhari M, Cario GM, Chou D. Cultivating the Apprentice-Mentor Model for Minimally Invasive Gynaecology in the Era of Surgically Scarce Training: A Case Report of Laparoscopic Cornuostomy for Interstitial Ectopic Pregnancy by a Trainee. Case Rep Obstet Gynecol 2021; 2021:5560309. [PMID: 33747585 PMCID: PMC7960069 DOI: 10.1155/2021/5560309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/13/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022] Open
Abstract
Over the last few years, there is an apparent growing concern amongst O&G trainees of the inadequacy in exposure to minimally invasive gynaecology surgical training, which has been inadvertently compounded by the more stringent working hour regulations and disproportionately increasing number of trainees relative to surgical volume. Therefore, it is vitally important for trainees to maximise opportunities in the operating theatre and develop autonomy in carrying out more complex surgical procedures. This case report outlines the step-by-step approach of laparoscopic excision of a cornual ectopic pregnancy performed by a trainee under the supervision of a surgical mentor. This manuscript highlights key characteristic traits of a trainee that serve to foster surgical trust and simple but effective steps to foster surgical preparedness.
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Affiliation(s)
- Dave R. Listijono
- Sydney Women's Endosurgery Centre (SWEC), Sydney, Australia
- IVF Australia, Sydney, Australia
| | | | - Sarah Choi
- Sydney Women's Endosurgery Centre (SWEC), Sydney, Australia
| | | | | | - Danny Chou
- Sydney Women's Endosurgery Centre (SWEC), Sydney, Australia
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129
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Tang B, Lin D, Zhang F, Yan M, Shao A. The "Plan-Do-Check-Action" Plan Helps Improve the Quality of the "Standardized Training of Resident Physicians": An Analysis of the Results of the First Pass Rate. Front Public Health 2021; 8:598774. [PMID: 33708754 PMCID: PMC7940191 DOI: 10.3389/fpubh.2020.598774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Medical education is a demanding lifelong learning process, which includes three tightly connected stages: college education, post-graduate education, and continuous education. Residency, the first several years after a college education, is a pivotal time in the development of a qualified doctor. Additionally, residents are the main force that undertakes much of the clinical work in hospitals. Therefore, guaranteeing and improving residents' clinical skills and abilities through the standardized training of resident physicians (STRP) is important. However, compared with other hospitals in the Zhejiang Province, the STRP assessment results of residents in our hospital were not satisfactory in recent years. Therefore, the objective of this study was to find the problems causing the unsatisfactory performance and identify the role of the “Plan-Do-Check-Action” (PDCA) plan in providing a valuable framework for future training. Methods: Relevant studies of STRP in China and abroad were investigated by the literature review. According to published data by the Health Commision of Zhejiang Province, we collected the STRP assessment rsults of a total number of 12,036 residents. The inclusion cretria of these residents include: (1) 3rd-year residents. (2) taking STRP in the Zhejiang Province during 2016–2018 or 2017–2019. (3) the first time taking the clinical practice ability examination (CPAE) in 2018 or 2019. The results of 634 3rd-year residents from The Second Affiliated Hospital of Zhejiang University (SAHZU) were provided by the Department of Medical Education and were analyzed in depth. Three hundred and eight residents from SAHZU received normal training and took the CPAE in 2018, whereas 326 residets received PDCA and took the CPAE in 2019. PDCA is a program designed to improve the performance of residency in SAHZU. It includes the formulation and implementation of specific training plans, the check of effects, and continuous improvements. There was no change in the STRP assessment in these 2 years and the indicator of performance in the STRP assessment was the first pass rate (FPR). Statistical analyses were performed using Pearson's chi-squared test, Yates-corrected chi-square test, or Fisher's exact test (SPSS Statistics, version 25). A P-value of < 0.05 was considered significant. Results: A total number of 6,180 and 5,856 examinees in the Zhejiang Province took the clinical practice ability examination in 2018 and 2019, respectively. In 2018, a total of 308 residents from 20 departments of the SAHZU took the STRP assessment. In 2019, a total of 326 residents from 22 departments of the SAHZU underwent the PDCA plan and took the STRP assessment. Compared with the results in 2018, the average FPR in the Zhejiang Province increased by 2.92% from 87.87 to 90.79% (P < 0.001). The FPR of the SAHZU increased by 7.88% from 85.06 to 92.94% (P = 0.001). In the SAHZU, the FPRs of the Department of Emergency and Department of Anesthesiology improved 34.51% (P = 0.024) and 20.36% (P = 0.004), respectively. There were no significant differences between the performances in the 2 years of the other 20 departments. There were improved results in the “Clinical Thinking and Decision-Making” and “Operation of Basic Skills” assessment stations with increases of 3.01% (P = 0.002) and 3.94% (P = 0.002), respectively. No statistically significant differences in the FPRs of the other six stations were found. The performances in all the stations in the final tests were better than in the stimulation tests (P < 0.001). Conclusions: Although our sample size was relatively small, our results showed a small success of the PDCA plan in improving the quality of the STRP, especially for the residents in the Departments of Emergency and Anesthesiology. The PDCA plan also contributed to enhancing residents' abilities in the “Clinical Thinking and Decision-Making” and “Operation of Basic Skills” stations. Taken together, the PDCA plan may provide a practical framework for developing future training plans.
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Affiliation(s)
- Biyun Tang
- Clinical Skills Training Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Danfeng Lin
- Department of Surgical Oncology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fengjiang Zhang
- Clinical Skills Training Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengling Yan
- Clinical Skills Training Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Anwen Shao
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Roehr M, Wu T, Maykowski P, Munter B, Hoebee S, Daas E, Kang P. The Feasibility of Virtual Reality and Student-Led Simulation Training as Methods of Lumbar Puncture Instruction. MEDICAL SCIENCE EDUCATOR 2021; 31:117-124. [PMID: 34457871 PMCID: PMC8368585 DOI: 10.1007/s40670-020-01141-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is limited data assessing simulation and virtual reality training as a standardized tool in medical education. This feasibility study aimed to evaluate the effectiveness of virtual reality training and a student-led simulation module in preparing medical students to perform a lumbar puncture. METHODS Twenty-five medical students completed a pre-intervention survey, and a baseline video recorded lumbar puncture procedure on a task trainer. Students were randomly distributed into the virtual reality group, or the curriculum's standard student-led procedural instruction group. Participants were then given 45 min to practice the lumbar puncture procedure. After the intervention, all participants were video recorded again as they performed a post-intervention lumbar puncture and completed a post-intervention survey. Pre- and post-intervention videos were scored using a critical action checklist in conjunction with time needed to complete the procedure to evaluate proficiency. RESULTS At baseline, there were no major statistically significant differences between groups. Assessing overall post-intervention performance, both groups showed improvement in aggregate score (p < 0.001) and time required to complete (p = 0.002) the lumbar puncture. Following interventions, the student-led group improved over the virtual reality group in a variety of metrics. The student-led group increased their aggregate score by 3.49 and decreased their time to completion by 34 s over the VR group when controlling for baseline measures. CONCLUSIONS Both virtual reality and student-led simulation training were useful training modalities, with hands-on simulation showing better results versus virtual reality training in this setting. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01141-6.
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Affiliation(s)
- Mark Roehr
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Teresa Wu
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
- Department of Emergency Medicine, Banner University Medical Center – Phoenix, Phoenix, AZ USA
| | - Philip Maykowski
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Bryce Munter
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Shelby Hoebee
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Eshaan Daas
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Paul Kang
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
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131
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Ruggeri B, Vega A, Liveris M, St. George TE, Hopp J. A Strategy for Teaching Health Literacy to Physician Assistant Students. Health Lit Res Pract 2021; 5:e70-e77. [PMID: 34251914 PMCID: PMC8075100 DOI: 10.3928/24748307-20210201-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This brief report presents a model that incorporates an analogous “see-one,” “do-one,” “teach-one” pedagogical strategy and experiential learning for mastery of health literacy principles by first-year Master of Science in Physician Assistant Studies students. Students completed a series of health literacy activities including classroom-based lecture (see-one), hands-on application of health literacy activities (do-one), and application and peer-instruction of health literacy best practices with other health science students (teach-one) as part of a two-semester hands-on learning experience. A health literacy knowledge examination, qualitative student feedback, and faculty review of content application were used to assess for effectiveness. Students demonstrated a significant and sustained positive change in knowledge examination scores complemented by positive faculty poster review. Physician Assistant student health literacy knowledge is increased and sustained after application of see-one, do-one, teach-one strategy with students demonstrating health literacy considerations in real-client application during experiential learning. Education programs seeking to meet the call for health professionals prepared to address gaps in health literacy should consider a see-one, do-one, teach-one and experiential learning approach over multiple semesters. [HLRP: Health Literacy Research and Practice. 2021;5(1):e70–e77.]
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Affiliation(s)
- Barbara Ruggeri
- Address correspondence to Barbara Ruggeri, MLIS, Carroll University, 100 N. East Avenue, Waukesha, WI 53186;
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132
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Hybrid Spine Simulator Prototype for X-ray Free Pedicle Screws Fixation Training. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11031038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Simulation for surgical training is increasingly being considered a valuable addition to traditional teaching methods. 3D-printed physical simulators can be used for preoperative planning and rehearsal in spine surgery to improve surgical workflows and postoperative patient outcomes. This paper proposes an innovative strategy to build a hybrid simulation platform for training of pedicle screws fixation: the proposed method combines 3D-printed patient-specific spine models with augmented reality functionalities and virtual X-ray visualization, thus avoiding any exposure to harmful radiation during the simulation. Software functionalities are implemented by using a low-cost tracking strategy based on fiducial marker detection. Quantitative tests demonstrate the accuracy of the method to track the vertebral model and surgical tools, and to coherently visualize them in either the augmented reality or virtual fluoroscopic modalities. The obtained results encourage further research and clinical validation towards the use of the simulator as an effective tool for training in pedicle screws insertion in lumbar vertebrae.
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133
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Smith BQ, Woelfel I, Salani R, Harzman A, Chen X. Resident Self-Entrustment and Expectations of Autonomy: OB > GYN? JOURNAL OF SURGICAL EDUCATION 2021; 78:275-281. [PMID: 32753260 DOI: 10.1016/j.jsurg.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/17/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Entrustment is a key component connecting to resident preparedness for surgical practice in the operating room (OR). Residents' self-entrustment of their surgical competencies closely associates with their OR training experience and granted autonomy. Some recent studies have investigated how attending surgeons entrusted residents in the OR. There is little to no data, however, in examining these issues from the resident perspective. The goal of this study was to identify the perception and expectations of autonomy from residents' perspective, as well as the self-entrustment of their surgical competencies in obstetrics (OB) and gynecologic (GYN) procedures. METHODS Focus group interviews of OB/GYN residents were performed. Residents were selected by convenience sampling. Audio recordings of each interview were transcribed, iteratively analyzed, and emergent themes identified, using a framework method. RESULTS A total of 123 minutes of interviews were recorded. Eight junior residents (PGY1-2) and 12 senior residents (PGY3-4) participated. Our data illustrated that (1) the perception of autonomy shifted significantly throughout residency training; (2) residents demonstrated higher expectations and self-entrustment for OB surgical procedures than for GYN surgical procedures upon graduation; and (3) case volume, modalities of OR teaching and mutual communication are 3 factors influencing resident self-entrustment of their surgical competencies. CONCLUSIONS Residents showed disparities in their self-entrustment and expectations of autonomy between OB and GYN surgical procedures. Better understanding these differences and the 3 influencing factors could help programs develop a potential solution for improvement in resident entrustment and autonomy upon graduation.
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Affiliation(s)
- Brentley Q Smith
- Division of Gynecologic Oncology, The Ohio State University The James Comprehensive Cancer Center, Columbus, Ohio.
| | - Ingrid Woelfel
- Department of General Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ritu Salani
- Division of Gynecologic Oncology, The Ohio State University The James Comprehensive Cancer Center, Columbus, Ohio
| | - Alan Harzman
- Department of General Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Xiaodong Chen
- Department of General Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Sadati L, Yazdani S, Heidarpoor P. Surgical residents' challenges with the acquisition of surgical skills in operating rooms: A qualitative study. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2021; 9:34-43. [PMID: 33521139 PMCID: PMC7846717 DOI: 10.30476/jamp.2020.87464.1308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/10/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Training in operating rooms is challenging. Specifically, surgical residents often experience a stressful environment in training arenas that, in turn, might affect their ability in the acquisition of the required qualifications. This study aims at the qualitative explanation of how the surgical residents acquire the surgical skills in operating rooms. METHODS This qualitative study was conducted in 2019-2020 using the conventional content analysis method. Participants were selected using purposive sampling. Data were collected through 25 semi-structured in-depth interviews. Then, the interview transcriptions were analyzed in MaxQDA2 software using the content analysis method. RESULTS The data were classified into two main categories, namely challenges/obstacles and strategies for dealing with the challenges. The data in the first category were further classified into four subcategories, including burnout, confusion in technique selection, unequal learning opportunities, ignorance, and responsibility misassignment. Similarly, four subcategories of establishing communication channels with chief residents and faculty members, learning by the non-surgeon pathway, covert progress in the learning path, and taking advantage of force from a position of power in the learning path were considered for the second category. CONCLUSION Based on the findings of the study, surgical residents face serious challenges and obstacles in their training course. To address these challenges, the curriculum of the surgical course needs to be improved with the emphasis on the balanced responsibility assignment and enhanced human communication.
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Affiliation(s)
- Leila Sadati
- Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Yazdani
- Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peigham Heidarpoor
- Department of Community- Based Health Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran
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Giacomino K, Caliesch R, Sattelmayer KM. The effectiveness of the Peyton's 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression. PeerJ 2020; 8:e10129. [PMID: 33083149 PMCID: PMC7549471 DOI: 10.7717/peerj.10129] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/17/2020] [Indexed: 01/14/2023] Open
Abstract
Background Acquisition of procedures is an important element in health professions education. Traditionally procedures are taught using a "see one - do one" approach. That is a teacher demonstrates and describes a procedure and afterwards the students practice the procedure. A more recent teaching approach for the acquisition of procedural skills was presented by Walker and Peyton. Peyton's teaching approach is a stepwise teaching approach and consists of the following four steps: demonstration, deconstruction, comprehension and performance. The aims of this study were (i) to systematically evaluate the effectiveness of Peyton's 4-step teaching approach on the acquisition of procedural skills in health professions education and (ii) to evaluate whether studies with fewer students per teacher showed a larger between group difference than studies with more students per teacher. Methods We searched in Medline, PsycInfo, Embase and ERIC for eligible studies. Records were screened by two independent reviewers. A random effects meta-analysis was performed to evaluate skill acquisition and time needed to perform the procedures at post-acquisition and retention tests. A meta-regression was used to explore the effect of the number of students per teacher on the estimated effect of the educational interventions. Results An effect size of 0.45 SMD (95% CI [0.15; 0.75]) at post-acquisition and 0.7 SMD (95% CI [-0.09; 1.49]) at retention testing were in favour of Peyton's teaching approach for skill acquisition. The groups using Peyton's teaching approach needed considerably less time to perform the procedure at post-acquisition (SMD: -0.8; 95% [CI -2.13 to 1.62]) and retention (SMD: -2.65; 95% CI [-7.77 to 2.47]) testing. The effectiveness of Peyton's teaching approach was less clear in subgroup analyses using peer teachers. Meta-regression showed that the number of students per teacher was an important moderator variable. Conclusion Peyton's teaching approach is an effective teaching approach for skill acquisition of procedural skills in health professions education. When peer students or student tutors are used as teachers the effectiveness of Peyton's teaching approach is less clear. Peyton's teaching approach is more effective when small groups with few students per teacher are used.
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Affiliation(s)
- Katia Giacomino
- School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland
| | - Rahel Caliesch
- School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland
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Tatum SA. The Art of Teaching, Training, and Putting the Scalpel in Residents' Hands. Facial Plast Surg Clin North Am 2020; 28:469-475. [PMID: 33010865 DOI: 10.1016/j.fsc.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Surgical education is under tremendous pressure due to ever-increasing medical knowledge and demands on trainees' time. They must continually learn more in less time due to work hour limitations, regulations, and electronic medical record demands. Surgical training must become more efficient. There is an unprecedented array of education and training opportunities for resident preparation. The preparation for each case has to be maximal. Preoperative, intraoperative, and postoperative simulation and discussions improve the educational benefit of the trainee experience. For the teaching surgeon, putting a scalpel in residents' hands requires patience, knowledge, judgment, and a leap of faith in the resident.
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Affiliation(s)
- Sherard Austin Tatum
- Department of Otolaryngology, Cleft and Craniofacial Center, Division of Facial Plastic and Reconstructive Surgery, Upstate Medical University, State University of New York, 750 East Adams Street, CWB, Syracuse, NY 13210, USA.
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Davey MS, Cassidy JT, Lyons RF, Cleary MS, Niocaill RFM. Changes to Training Practices during a Pandemic - The Experience of the Irish National Trauma & Orthopaedic Training Scheme. Injury 2020; 51:2087-2090. [PMID: 32654851 PMCID: PMC7345416 DOI: 10.1016/j.injury.2020.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/07/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Martin S. Davey
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland,Corresponding author at: Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - J. Tristan Cassidy
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rebecca F. Lyons
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - May S. Cleary
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland,University College Cork, Cork, Ireland
| | - Ruairi F. Mac Niocaill
- University Hospital Waterford, Waterford, Ireland,Royal College of Surgeons in Ireland, Dublin, Ireland
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Ahmed TM, Hussain B, Siddiqui MAR. Can simulators be applied to improve cataract surgery training: a systematic review. BMJ Open Ophthalmol 2020; 5:e000488. [PMID: 32953997 PMCID: PMC7481074 DOI: 10.1136/bmjophth-2020-000488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/29/2020] [Accepted: 08/13/2020] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of this paper was to conduct a systematic review of existing literature on simulation-based training of cataract surgery. Available literature was evaluated and projections on how current findings could be applied to cataract surgery training were summarised. The quality of included literature was also assessed. Methods and analysis The PubMed, Embase and Cochrane Library databases were searched for articles pertaining to simulation training in cataract surgery on 18 November 2019. Selected articles were qualitatively analysed. Results A total of 165 articles were identified out of which 10 met inclusion criteria. Four studies reported construct validity of the EyeSi simulator. Six studies demonstrated improved surgical outcomes corresponding to training on the simulator. Quality assessment of included studies was satisfactory. Conclusion Current studies on simulation training in cataract surgery all point towards it being an effective training tool with low risk of study biases confounding this conclusion. As technology improves, surgical training must embrace and incorporate simulation technology in training.
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Affiliation(s)
| | - Badrul Hussain
- Cataract Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - M A Rehman Siddiqui
- Department of Surgery, Section of Ophthalmology, Aga Khan University Hospital, Karachi, Pakistan
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Okusanya O, Bartow A, Aranda-Michel E, Kinnunen A, Schuchert M, Kilic A, Sanchez P, Dhupar R, Luketich J, Sultan I. Resident perception of standardization and credentialing for high-risk bedside procedures in cardiothoracic surgery: Results from an institutional pilot study. J Card Surg 2020; 35:2902-2907. [PMID: 32906194 DOI: 10.1111/jocs.15007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Though clear-guidelines are set by the American Board of Thoracic Surgery (ABTS) for the operative cases that cardiothoracic surgery residents must perform to be board-eligible, no such recommendations exist to assess competency for the wide range of high-risk bedside procedures. Our department created and implemented a multidisciplinary course designed to standardize common high-risk bedside procedures and credential our trainees. The aim of this study was to survey the attitudes of residents towards and query the efficacy of such a course. METHODS The course was designed with the goal of standardizing endotracheal intubation, arterial line insertion (radial and femoral), central venous line insertion, pigtail tube thoracostomy, thoracentesis and nasogastric tube placement. The course consisted of an online module followed by a 4-hour hands-on simulation session. Knowledge-based pre- and post-evaluations were administered as well as a Likert-based survey regarding multiple aspects of the residents' perceptions of the course and the procedures. RESULTS Twenty-three (7 traditional and 16 integrated) cardiothoracic surgical residents participated in the course. Residents reported that 48% of the time, bedside procedures were historically taught by other trainees rather than by faculty. All residents endorsed increased standardization of all procedures after the course. Likewise, residents showed increased confidence in all procedures except for pigtail tube thoracostomy, thoracentesis as well as nasogastric tube placement. 43.5% of the participants demonstrated improvement in the pretest and posttest knowledge-based evaluations. CONCLUSION Cardiothoracic residents have favorable attitudes towards standardization and credentialing for high-risk bedside procedures and utilizing such courses may help standardize procedural techniques.
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Affiliation(s)
- Olugbenga Okusanya
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexandrea Bartow
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edgar Aranda-Michel
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Angela Kinnunen
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Arman Kilic
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pablo Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Britz V, Sterz J, Voß SH, Carstensen P, Germanyuk A, Ruesseler M. Influence of the Instructional Approach "Mastery Learning" versus "See One, Do One" on Acquiring Competencies in Abdomen Sonography: A Comparative Effectiveness Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1934-1940. [PMID: 32446675 DOI: 10.1016/j.ultrasmedbio.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Ultrasound is an important diagnostic tool in patients with abdominal pain and after injury. However, it is highly dependent on the skills and training of the examiner. Thus, ultrasound competencies should be acquired early during medical education. The instructional approach affects the retention and performance of skills. A promising approach is "mastery learning." The aim of the study was to evaluate the effectiveness of "mastery learning" compared with the "see one, do one" approach by performing a focused assessment of sonography for trauma (FAST) in undergraduate medical students based using an academic assessment tool (Objective Structured Clinical Examination [OSCE]). In a prospective controlled trial, 146 participants were randomly allocated to two groups (see one, do one and mastery learning) and trained in a 90-min module. In the see one, do one group, the trainer demonstrated the complete FAST routine, and then the students trained each other on it under supervision and received direct oral feedback from the tutors. In the mastery learning group, each student received a routing slip. The routing slip contained five levels of competence for the FAST routine, each of which had to be achieved (e.g., choosing the correct probe) and verified by the trainer before working toward the next competency level. The acquired competencies were assessed after training using the OSCE, which is a standardized practical exam using checklists. The mastery learning group attained 40.69 ± 5.6 points on average (of a maximum of 46 points), and the see one, do one group, 33.85 ± 7.7 points (p < 0.001). Mastery learning is an effective teaching method for undergraduate medical students performing FAST and is superior to the see one, do one approach, as assessed with the OSCE.
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Affiliation(s)
- Vanessa Britz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Jasmina Sterz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | | | - Patrick Carstensen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Aleksandra Germanyuk
- Department of Urology and Pediatric Urology, University of Saarland, Homburg, Germany
| | - Miriam Ruesseler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
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Lee JY, Gallo RA, Alabiad CR. Evaluating the Effectiveness of Small-Group Training in Teaching Medical Students Integral Clinical Eye Examination Skills. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2020; 12:e79-e86. [PMID: 32728655 DOI: 10.1055/s-0040-1712175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective The aim of this study is to evaluate the effectiveness of an interactive, small-group ophthalmology clinical training session by assessing medical students' self-confidence with eye examination skills and long-term retention of direct ophthalmoscopy skills. Methods The second-year medical students participated in a one-time small-group clinical training session that taught essential components of the eye examination. Students reported their confidence with each component in pre- and postsession surveys. Eight months later, direct ophthalmoscopy skills were reassessed by having students visualize the optic nerves of standardized patients and identify the matching optic nerve photograph in a multiple-choice quiz. Results Among 197 second-year medical students who participated in the training session, 172 students completed the presession survey (87.3% response rate) and 108 students completed the postsession survey (54.8% response rate). Following the training session, students reported increased self-confidence (p < 0.01) overall. A total of 107 (107/108; 99.1%) students reported that they visualized the optic nerve head, and 80 out of 85 (94.1%) students stated that they preferred the PanOptic ophthalmoscope over the traditional direct ophthalmoscope. Students reported greater self-confidence using the PanOptic ophthalmoscope (p < 0.01). In the 8-month follow-up assessment, 42 medical students (42/197; 21.3%) completed the exercise. A total of 41 (41/42; 97.6%) students stated that they saw the optic nerve with the PanOptic ophthalmoscope; 24 (24/42; 57.1%) students identified the correct optic nerve image using the PanOptic ophthalmoscope on a standardized patient; 14 (14/42; 33.3%) students stated that they saw the optic nerve with the traditional direct ophthalmoscope; and 4 (4/42; 9.1%) students from the same cohort identified the correct optic nerve image with the traditional direct ophthalmoscope on a standardized patient. Conclusion Our comprehensive, one-time eye examination skills training session seeks to prepare students to incorporate these skills in future patient care. Students' overall confidence improved in each aspect of the eye examination that was covered. A follow-up assessment on students' direct ophthalmoscopy skills suggests that the PanOptic ophthalmoscope allows for superior skills retention as compared with the traditional direct ophthalmoscope. We believe that the PanOptic ophthalmoscope should be further integrated into medical education and clinical practice.
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Affiliation(s)
- John Y Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ryan A Gallo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Chrisfouad R Alabiad
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Domen CH, Collins RL, Davis JJ. The APPCN multisite didactic initiative: Development, benefits, and challenges. Clin Neuropsychol 2020; 35:115-132. [DOI: 10.1080/13854046.2020.1785013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christopher H. Domen
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert L. Collins
- Private Practice, Neurocognitive Specialty Group, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Jeremy J. Davis
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
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Kapila AK, Schettino M, Farid Y, Ortiz S, Hamdi M. The Impact of Coronavirus Disease 2019 on Plastic Surgery Training: The Resident Perspective. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3054. [PMID: 32802694 PMCID: PMC7413754 DOI: 10.1097/gox.0000000000003054] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/24/2020] [Indexed: 12/25/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to marked changes in surgical training, including that of plastic surgery residents. We performed a survey to gain an insight into the self-reported current and future impact of COVID-19 on plastic surgery residents. METHODS A 20-point questionnaire was designed by a panel of surgical trainees and trainers, which was filled in by Belgian plastic surgery residents and their international network of peers between 19 and 26 April 2020-week 6 of stringent Belgian lockdown measures. Questions covered the impact of COVID-19 on surgical activity, surgical training, and the future of training. RESULTS Thirty-five of 38 plastic surgery residents in Belgium filled in the questionnaire, as did 51 of their international peers from 9 other countries. Decreased surgical activity of >75% was reported by 86% of Belgian trainees and by 73% of international colleagues. All consultations were stopped for 26% of Belgian trainees and 37% of international peers. Forty-six percents of Belgian trainees and 27% of international peers were reassigned to different departments. Eighty-five percent of all trainees felt surgical training had suffered, yet 54% of Belgian residents and 39% of international peers felt training should not be prolonged. Anxiety regarding the pandemic was present in 54% of Belgian residents and 69% of international colleagues. CONCLUSIONS This is the first report, expressing the voice of a representative group of plastic surgery residents, showing a significant impact of COVID-19 on training and activity. A joint effort is needed to provide continued forms of education by virtual education and skills-based learning.
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Affiliation(s)
- Ayush K. Kapila
- From the Department of Plastic and Reconstructive Surgery, University Hospital (UZ) Brussels, Brussels, Belgium
| | - Michela Schettino
- Department of Plastic and Reconstructive Surgery, Erasme Hospital Brussels, Brussels, Belgium
| | - Yasser Farid
- Department of Plastic and Reconstructive Surgery, Brugmann Hospital Brussels, Brussels, Belgium
| | - Socorro Ortiz
- Department of Plastic and Reconstructive Surgery, Brugmann Hospital Brussels, Brussels, Belgium
| | - Moustapha Hamdi
- From the Department of Plastic and Reconstructive Surgery, University Hospital (UZ) Brussels, Brussels, Belgium
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Seifert LB, Schnurr B, Stefanescu MC, Sader R, Ruesseler M, Sterz J. Comparing video-based versions of Halsted's 'see one, do one' and Peyton's '4-step approach' for teaching surgical skills: a randomized controlled trial. BMC MEDICAL EDUCATION 2020; 20:194. [PMID: 32552805 PMCID: PMC7298758 DOI: 10.1186/s12909-020-02105-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Teaching complex motor skills at a high level remains a challenge in medical education. Established methods often involve large amounts of teaching time and material. The implementation of standardized videos in those methods might help save resources. In this study, video-based versions of Peyton's '4-step Approach' and Halsted's 'See One, Do One' are compared. We hypothesized that the video-based '4-step Approach' would be more effective in learning procedural skills than the 'See One, Do One Approach'. METHODS One-hundred-two naïve students were trained to perform a structured facial examination and a Bellocq's tamponade with either Halsted's (n = 57) or Peyton's (n = 45) method within a curricular course. Steps 1 (Halsted) and 1-3 (Peyton) were replaced by standardized teaching videos. The performance was measured directly (T1) and 8 weeks (T2) after the intervention by blinded examiners using structured checklists. An item-analysis was also carried out. RESULTS At T1, performance scores significantly differed in favor of the video-based '4-step Approach' (p < 0.01) for both skills. No differences were found at T2 (p < 0.362). The item-analysis revealed that Peyton's method was significantly more effective in the complex subparts of both skills. CONCLUSIONS The modified video-based version of Peyton's '4-step Approach' is the preferred method for teaching especially complex motor skills in a large curricular scale. Furthermore, an effective way to utilize Peyton's method in a group setting could be demonstrated. Further studies have to investigate the long-term learning retention of this method in a formative setting.
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Affiliation(s)
- Lukas B Seifert
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Benedikt Schnurr
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Maria-Christina Stefanescu
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Robert Sader
- Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Miriam Ruesseler
- Department of Trauma, Reconstructive and Hand Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Jasmina Sterz
- Department of Trauma, Reconstructive and Hand Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Graves MT, Castro JR, Anderson DE. Veterinary Intern Program for Entrustable Professional Activities Skills, a.k.a. Intern Boot Camp. JOURNAL OF VETERINARY MEDICAL EDUCATION 2020; 47:321-326. [PMID: 31194630 DOI: 10.3138/jvme.0518-066r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The University of Tennessee College of Veterinary Medicine (UTCVM) Department of Large Animal Clinical Sciences has developed an intensive training program that all large animal veterinary interns are required to complete at the onset of their internship year. This program was designed to establish a uniform approach to entrustable professional activity (EPA) skills deemed essential by the large animal faculty. These EPA skills emphasize the clinical approaches and skills that interns should understand and demonstrate competency in early in their internship year. The EPA program, completed over 4 consecutive days, was coined the "Intern Boot Camp" and structured to fuse case-based lecture discussions and hands-on wet labs designed to develop or improve skills and techniques. At the conclusion of the boot camp, participants were given an evaluation survey to provide feedback on the program. The results were overwhelmingly positive, with 90% of the participants giving the program a rating of 5 on a scale ranging from 1 (poor opinion or experience) to 5 (excellent opinion or experience). Nearly 95% of participants stated that they felt more prepared for their internship year after attending the boot camp, and 100% of the participants indicated that they would recommend this program to future candidates. Given the positive outcomes over the past 4 years, the implementation of the Veterinary Intern Entrustable Professional Activities program (Intern Boot Camp) is considered a valuable component of the veterinary intern training program and could readily be adapted to other programs.
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The AaLplus near-peer teaching program in Family Medicine strengthens basic medical skills-A five-year retrospective study. PLoS One 2020; 15:e0233748. [PMID: 32470972 PMCID: PMC7259978 DOI: 10.1371/journal.pone.0233748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Basic medical skills such as history taking and physical examination are essential components of clinical work profiles, but nevertheless have been neglected by conventional preclinical curricula. The near-peer-teaching program AaLplus [living anatomy plus] teaches basic medical skills, especially history taking, physical examination, and venepuncture, to preclinical students. It is a highly popular compulsory course in the first four semesters (320 students/year, 9h/semester) at Heidelberg University and ends with a formative Objective Structured Clinical Examination (OSCE) during which students receive structured in-depth feedback on their performance. AaLplus is part of the Department of General Practice’s longitudinal curriculum for Family Medicine. Objectives This study aims to assess whether the AaLplus program has positive effects on students’ clinical skill development and subjective confidence in history taking, physical examination and venepuncture. Methods From 2015 to 2019, we asked all AaLplus participants to rate the program and self-assess their medical skills on 5-point Likert scales (min 1, max 5). In 4-station OSCEs, trained tutors rated the students’ performance in all taught skills using standardized checklists. Results From 2015 to 2019 n = 1534 questionnaires returned (response rate = 98.6%, 52.7% females). After course completion, students felt able to take a patient’s history (mean 3.97, SD = 0.75) and perform physical examinations (means range 3.82–4.36, SDs range 0.74–0.89) as well as venepuncture (mean 4.12, SD = 0.88). A large majority of students claimed they acquired these skills in the AaLplus program. During OSCE, 81.9% passed anamnesis, 93.1% passed physical examination, and 95.4% passed venepuncture (of n = 1556). Students mostly rated the feedback they received during the OSCE as “helpful” or “very helpful” (means for different stations 4.69–4.76, SDs 0.50–0.70). Conclusions AaLplus is a positive example of a peer teaching program in the preclinical stage of medical studies. It successfully trains junior students in essential medical abilities and increases their confidence in their skills. A high percentage of students pass the formative OSCE and evaluate it positively. Consistently high ratings indicate the program’s routine viability. Further studies are needed to analyze if programs like AaLplus could have an impact on the number of graduates choosing career in Family Medicine.
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Establishment and evaluation of a training course in advanced laparoscopic surgery based on human body donors embalmed by ethanol-glycerol-lysoformin fixation. Surg Endosc 2020; 35:1385-1394. [PMID: 32444969 PMCID: PMC7886762 DOI: 10.1007/s00464-020-07523-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 02/05/2023]
Abstract
Background Education of clinical anatomy and training of surgical skills are essential prerequisites for any surgical intervention in patients. Here, we evaluated a structured training program for advanced gynecologic laparoscopy based on human body donors and its impact on clinical practice. Methods The three-step training course included: (1) anatomical and surgical lectures, (2) demonstration and hands-on study of pre-dissected anatomical specimens, and (3) surgical training of a broad spectrum of gynecological laparoscopic procedures on human body donors embalmed by ethanol-glycerin-lysoformin. Two standardized questionnaires (after the course and 6 months later) evaluated the effectiveness of each of the training modules and the benefits to surgical practice. Results Eighty participants took part in 6 training courses using a total number of 24 body donors (3 trainees/body donor). Based on a 91.3% (73/80) response rate, participants rated high or very high the tissue and organ properties of the body donors (n = 72, 98.6%), the technical feasibility to perform laparoscopic surgery (n = 70, 95.9%), and the overall learning success (n = 72, 98.6%). Based on a 67.5% (54/80) response rate at 6 months, participants rated the benefit of the course to their daily routine as very high (mean 80.94 ± 24.61%, n = 53), and this correlated strongly with the use of body donors (r = 0.74) and the ability to train laparoscopic dissections (r = 0.77). Conclusions This study demonstrates the technical feasibility and didactic effectiveness of laparoscopic training courses in a professional and true-to-life setting by using ethanol-glycerol-lysoformin embalmed body donors. This cost-efficient fixation method offers the option to integrate advanced surgical training courses into structured postgraduate educational curricula to meet both the technical demands of minimal invasive surgery and the ethical concerns regarding patients´ safety.
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Development of a low-cost strabismus surgery simulation model. Eye (Lond) 2020; 35:805-810. [PMID: 32427966 DOI: 10.1038/s41433-020-0966-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES Strabismus surgery training has historically focussed on the "see one, do one and teach one" approach. Simulation training offers an alternative to practice surgical skills without direct patient involvement. However, current simulation models for strabismus surgery are limited due to concerns regarding use of animal or human tissue and financial cost limiting practice. Our aim was to build and validate a low-cost model for obtaining the core skills required in strabismus surgery. SUBJECTS/METHODS A low-cost strabismus model was developed using commercially available materials. Ophthalmic trainees, fellows and consultants were surveyed using a questionnaire to assess the realism and training utility of the model using a five-point Likert scale (1 = unacceptable, 2 = poor, 3 = acceptable, 4 = favourable and 5 = excellent) whilst simulating a horizontal muscle resection task. RESULTS Forty-two ophthalmologists completed the questionnaire. The model scored highly for muscle securing and suturing (median: 4.00) and suturing. Muscle dissection and conjunctiva were considered poor (median: 3.00, 2.50, respectively). Overall, participants felt that the model simulated strabismus surgery well (median: 4.00) and was comparable to other dry simulation models (median: 4.00). CONCLUSION Our study describes a favourable training model that can be used for independent practice of core strabismus surgical techniques. However, it remains a technical challenge to replicate certain ocular anatomy using commercially available materials.
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Three-Dimensionally–Printed Hand Surgical Simulator for Resident Training. Plast Reconstr Surg 2020; 146:1100-1102. [DOI: 10.1097/prs.0000000000007025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
Annually, an estimated 234 million major surgical operations occur worldwide, with concomitant seven million complications and one million deaths. It is now well established that technical competence is necessary, but not sufficient for modern surgical practice and outcomes. Breakdown in non-technical skills has been attributed as a key root cause for near misses and patient harm in the operating room. This article discusses the multi-faceted skills-set that is necessary for the modern surgeon to succeed and for optimal patient outcomes. This includes technical skills, non-technical skills, with a focus on key CanMEDS framework domains, including leadership, communication, evidence-based surgery and mentorship.
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Affiliation(s)
- Ankur Khajuria
- Department of Surgery and Cancer, Imperial College London, UK.,Kellogg College, University of Oxford, UK
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