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Hutchinson K, Reyes I, Li Z, Alemzadeh H. COMPASS: a formal framework and aggregate dataset for generalized surgical procedure modeling. Int J Comput Assist Radiol Surg 2023; 18:2143-2154. [PMID: 37145250 DOI: 10.1007/s11548-023-02922-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE We propose a formal framework for the modeling and segmentation of minimally invasive surgical tasks using a unified set of motion primitives (MPs) to enable more objective labeling and the aggregation of different datasets. METHODS We model dry-lab surgical tasks as finite state machines, representing how the execution of MPs as the basic surgical actions results in the change of surgical context, which characterizes the physical interactions among tools and objects in the surgical environment. We develop methods for labeling surgical context based on video data and for automatic translation of context to MP labels. We then use our framework to create the COntext and Motion Primitive Aggregate Surgical Set (COMPASS), including six dry-lab surgical tasks from three publicly available datasets (JIGSAWS, DESK, and ROSMA), with kinematic and video data and context and MP labels. RESULTS Our context labeling method achieves near-perfect agreement between consensus labels from crowd-sourcing and expert surgeons. Segmentation of tasks to MPs results in the creation of the COMPASS dataset that nearly triples the amount of data for modeling and analysis and enables the generation of separate transcripts for the left and right tools. CONCLUSION The proposed framework results in high quality labeling of surgical data based on context and fine-grained MPs. Modeling surgical tasks with MPs enables the aggregation of different datasets and the separate analysis of left and right hands for bimanual coordination assessment. Our formal framework and aggregate dataset can support the development of explainable and multi-granularity models for improved surgical process analysis, skill assessment, error detection, and autonomy.
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Affiliation(s)
- Kay Hutchinson
- Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, 22903, USA.
| | - Ian Reyes
- Department of Computer Science, University of Virginia, Charlottesville, VA, 22903, USA
- IBM, RTP, Durham, NC, 27709, USA
| | - Zongyu Li
- Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, 22903, USA
| | - Homa Alemzadeh
- Department of Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, 22903, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA, 22903, USA
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Pan-Doh N, Sikder S, Woreta FA, Handa JT. Using the language of surgery to enhance ophthalmology surgical education. Surg Open Sci 2023; 14:52-59. [PMID: 37528917 PMCID: PMC10387608 DOI: 10.1016/j.sopen.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023] Open
Abstract
Background Currently, surgical education utilizes a combination of the apprentice model, wet-lab training, and simulation, but due to reliance on subjective data, the quality of teaching and assessment can be variable. The "language of surgery," an established concept in engineering literature whose incorporation into surgical education has been limited, is defined as the description of each surgical maneuver using quantifiable metrics. This concept is different from the traditional notion of surgical language, generally thought of as the qualitative definitions and terminology used by surgeons. Methods A literature search was conducted through April 2023 using MEDLINE/PubMed using search terms to investigate wet-lab, virtual simulators, and robotics in ophthalmology, along with the language of surgery and surgical education. Articles published before 2005 were mostly excluded, although a few were included on a case-by-case basis. Results Surgical maneuvers can be quantified by leveraging technological advances in virtual simulators, video recordings, and surgical robots to create a language of surgery. By measuring and describing maneuver metrics, the learning surgeon can adjust surgical movements in an appropriately graded fashion that is based on objective and standardized data. The main contribution is outlining a structured education framework that details how surgical education could be improved by incorporating the language of surgery, using ophthalmology surgical education as an example. Conclusion By describing each surgical maneuver in quantifiable, objective, and standardized terminology, a language of surgery can be created that can be used to learn, teach, and assess surgical technical skill with an approach that minimizes bias. Key message The "language of surgery," defined as the quantification of each surgical movement's characteristics, is an established concept in the engineering literature. Using ophthalmology surgical education as an example, we describe a structured education framework based on the language of surgery to improve surgical education. Classifications Surgical education, robotic surgery, ophthalmology, education standardization, computerized assessment, simulations in teaching. Competencies Practice-Based Learning and Improvement.
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Affiliation(s)
- Nathan Pan-Doh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika A. Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James T. Handa
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Pfaff MJ, Bruce MK, Erpenbeck S, Mittal A, Beiriger JW, Zhu X, Dvoracek L, Goldstein JA. A Three-Dimensional-Based Morphometric Analysis of a Standardized Overcorrection Technique for Fronto-Orbital Advancement in Metopic Craniosynostosis. Cleft Palate Craniofac J 2023; 60:268-273. [PMID: 34870484 DOI: 10.1177/10556656211062843] [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] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The concept of "overcorrection" for trigonocephaly has been reported to achieve both anterior cranial fossa expansion and normalization of craniofacial form. The purpose of this study is to describe in detail a standardized technique to fronto-orbital advancement utilizing the concept of "overcorrection" and objectively evaluate intermediate results. METHODS This retrospective study included patients with isolated metopic synostosis who underwent surgery via the proposed surgical technique and age and sex-matched unaffected controls. Craniofacial morphometric analysis was performed on pre-, immediate post-, and intermediate postoperative (>2 years) three-dimensional (3D)-rendered computed tomographic (CT) scans and photographs. Key CT-based measurements included interzygomaticofrontal suture distance (IZFS), endocranial bifrontal angle (ECA), and temporal expansion. 3D photogrammetry was performed using established measurements and associated Z-scores converted. A Paired t-test and analysis of variance were performed when appropriate. RESULTS Forty-one patients were included. A comparison of pre- and immediate postoperative CT scans demonstrated statistically significant increases in all measurements. Subset analysis of 12 patients with intermediate follow-up (age: 39.6 ± 3.6 months) demonstrated significant differences from preoperative values except for IZFS, which decreased from immediate postoperative values and was smaller than age- and sex-matched controls. 3D photogrammetry demonstrated a mean Z-score above the norm for frontal breath. 3D photogrammetry is also positively correlated with CT-based measurements. CONCLUSIONS This standardized "overcorrection" approach for trigonocephaly can provide the appropriate changes to maintain a normal ECA despite a reduction in bifrontal width over time. 3D photogrammetry positively correlated with CT-based measurements and may provide useful information when following patients clinically. Long-term follow-up assessment to determine the necessary degree of overcorrection at skeletal mature is needed.
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Affiliation(s)
- Miles J Pfaff
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Madeleine K Bruce
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Sarah Erpenbeck
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Aditya Mittal
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Justin W Beiriger
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Xiao Zhu
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Lucas Dvoracek
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
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Dias RD, Zenati MA, Conboy HM, Clarke LA, Osterweil LJ, Avrunin GS, Yule SJ. Dissecting Cardiac Surgery: A Video-based Recall Protocol to Elucidate Team Cognitive Processes in the Operating Room. Ann Surg 2021; 274:e181-e186. [PMID: 31348036 PMCID: PMC7241253 DOI: 10.1097/sla.0000000000003489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes. SUMMARY BACKGROUND DATA Nontechnical skills play a crucial role in surgical team performance and understanding the cognitive processes underlying the intraoperative phase of surgery is essential to improve patient safety in the operating room (OR). METHODS A mixed-methods approach encompassing semistructured interviews with 9 subject-matter experts. A cognitive task analysis was built upon a hierarchical segmentation of coronary artery bypass grafting procedures and a cued-recall protocol using video vignettes was used. RESULTS A total of 137 unique surgical cognitive processes were identified, including 33 decision points, 23 critical communications, 43 pitfalls, and 38 strategies. Self-report cognitive workload varied substantially, depending on team role and surgical step. A web-based dashboard was developed, providing an integrated visualization of team cognitive processes in the OR that allows readers to intuitively interact with the study findings. CONCLUSIONS This study advances the current body of knowledge by making explicit relevant cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple OR team members. By displaying the research findings in an interactive dashboard, we provide trainees with new knowledge in an innovative fashion that could be used to enhance learning outcomes. In addition, the approach used in the present study can be used to deeply understand the cognitive factors underlying surgical adverse events and errors in the OR.
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Affiliation(s)
- Roger D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Marco A Zenati
- Medical Robotics and Computer Assisted Surgery (MRCAS) Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Heather M Conboy
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - Lori A Clarke
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - Leon J Osterweil
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - George S Avrunin
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - Steven J Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
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Global versus task-specific postoperative feedback in surgical procedure learning. Surgery 2021; 170:81-87. [PMID: 33589246 DOI: 10.1016/j.surg.2020.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Task-specific checklists and global rating scales are both recommended assessment tools to provide constructive feedback on surgical performance. This study evaluated the most effective feedback tool by comparing the effects of the Observational Clinical Human Reliability Analysis (OCHRA) and the Objective Structured Assessment of Technical Skills (OSATS) on surgical performance in relation to the visual-spatial ability of the learners. METHODS In a randomized controlled trial, medical students were allocated to either the OCHRA (n = 25) or OSATS (n = 25) feedback group. Visual-spatial ability was measured by a Mental Rotation Test. Participants performed an open inguinal hernia repair procedure on a simulation model twice. Feedback was provided after the first procedure. Improvement in performance was evaluated blindly using a global rating scale (performance score) and hand-motion analysis (time and path length). RESULTS Mean improvement in performance score was not significantly different between the OCHRA and OSATS feedback groups (P = .100). However, mean improvement in time (371.0 ± 223.4 vs 274.6 ± 341.6; P = .027) and path length (53.5 ± 42.4 vs 34.7 ± 39.0; P = .046) was significantly greater in the OCHRA feedback group. When stratified by mental rotation test scores, the greater improvement in time (P = .032) and path length (P = .053) was observed only among individuals with low visual-spatial abilities. CONCLUSION A task-specific (OCHRA) feedback is more effective in improving surgical skills in terms of time and path length in novices compared to a global rating scale (OSATS). The effects of a task-specific feedback are present mostly in individuals with lower visual-spatial abilities.
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Bogomolova K, van Merriënboer JJG, Sluimers JE, Donkers J, Wiggers T, Hovius SER, van der Hage JA. The effect of a three-dimensional instructional video on performance of a spatially complex procedure in surgical residents in relation to their visual-spatial abilities. Am J Surg 2021; 222:739-745. [PMID: 33551116 DOI: 10.1016/j.amjsurg.2021.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/17/2021] [Accepted: 01/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effect of three-dimensional (3D) vs. two-dimensional (2D) video on performance of a spatially complex procedure and perceived cognitive load were examined among residents in relation to their visual-spatial abilities (VSA). METHODS In a randomized controlled trial, 108 surgical residents performed a 5-Flap Z-plasty on a simulation model after watching the instructional video either in a 3D or 2D mode. Outcomes included perceived cognitive load measured by NASA-TLX questionnaire, task performance assessed using Observational Clinical Human Reliability Analysis and the percentage of achieved safe lengthening of the scar. RESULTS No significant differences were found between groups. However, when accounted for VSA, safe lengthening was achieved significantly more often in the 3D group and only among individuals with high VSA (OR = 6.67, 95%CI: 1.23-35.9, p = .027). CONCLUSIONS Overall, 3D instructional videos are as effective as 2D videos. However, they can be effectively used to enhance learning in high VSA residents.
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Affiliation(s)
- Katerina Bogomolova
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands; Center for Innovation of Medical Education, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, the Netherlands.
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, Faculty of Health, Medicine & Life Sciences, Maastricht University, Universiteitssingel 60, UNS60 6229 ER, Maastricht, the Netherlands
| | - Jan E Sluimers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Jeroen Donkers
- Department of Educational Development and Research, Faculty of Health, Medicine & Life Sciences, Maastricht University, Universiteitssingel 60, UNS60 6229 ER, Maastricht, the Netherlands
| | - Theo Wiggers
- Incision Academy, Mauritskade 63, 1092 AD, Amsterdam, the Netherlands
| | - Steven E R Hovius
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Jos A van der Hage
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands; Center for Innovation of Medical Education, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, the Netherlands
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7
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Nazari T, Dankbaar MEW, Sanders DL, Anderegg MCJ, Wiggers T, Simons MP. Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents. Hernia 2020; 24:995-1002. [PMID: 32889641 PMCID: PMC7520418 DOI: 10.1007/s10029-020-02270-y] [Citation(s) in RCA: 5] [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: 03/23/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022]
Abstract
Purpose During surgical residency, many learning methods are available to learn an inguinal hernia repair (IHR). This study aimed to investigate which learning methods are most commonly used and which are perceived as most important by surgical residents for open and endoscopic IHR. Methods European general surgery residents were invited to participate in a 9-item web-based survey that inquired which of the learning methods were used (checking one or more of 13 options) and what their perceived importance was on a 5-point Likert scale (1 = completely not important to 5 = very important). Results In total, 323 residents participated. The five most commonly used learning methods for open and endoscopic IHR were apprenticeship style learning in the operation room (OR) (98% and 96%, respectively), textbooks (67% and 49%, respectively), lectures (50% and 44%, respectively), video-demonstrations (53% and 66%, respectively) and journal articles (54% and 54%, respectively). The three most important learning methods for the open and endoscopic IHR were participation in the OR [5.00 (5.00–5.00) and 5.00 (5.00–5.00), respectively], video-demonstrations [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively], and hands-on hernia courses [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively]. Conclusion This study demonstrated a discrepancy between learning methods that are currently used by surgical residents to learn the open and endoscopic IHR and preferred learning methods. There is a need for more emphasis on practising before entering the OR. This would support surgical residents’ training by first observing, then practising and finally performing the surgery in the OR. Electronic supplementary material The online version of this article (10.1007/s10029-020-02270-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Nazari
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M E W Dankbaar
- The Institute of Medical Education Research Rotterdam (iMERR), Rotterdam, The Netherlands
- Department of Education, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D L Sanders
- North Devon District Hospital, Barnstaple, UK
| | - M C J Anderegg
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - T Wiggers
- Incision Academy, Amsterdam, The Netherlands
| | - M P Simons
- Department of Surgery, OLVG, Amsterdam, The Netherlands
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Accuracy and usefulness in assessing proficiency of the observational clinical human reliability assessment checklist of the open inguinal hernia repair procedure: A cross-sectional study. Int J Surg 2020; 82:156-161. [PMID: 32882402 DOI: 10.1016/j.ijsu.2020.08.032] [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: 06/10/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Observational Clinical Human Reliability Assessment (OCHRA) can be used to score errors during surgical procedures. To construct an OCHRA-checklist, steps, substeps, and hazards of a surgical procedure need to be defined. A step-by-step framework was developed to segment surgical procedures into steps, substeps, and hazards. The first aim of this study was to investigate if the step-by-step framework could be used to construct an accurate Lichtenstein open inguinal hernia repair (LOIHR) stepwise description. The second aim was to investigate if the OCHRA-checklist based on this stepwise description was accurate and useful for surgical training and assessment. MATERIALS AND METHODS Ten expert surgeons rated statements regarding the accuracy of the LOIHR stepwise description, the accuracy, and the usefulness of the LOIHR OCHRA-checklist (eight, seven, and six statements, respectively) using a 5-point Likert scale. One-sample Wilcoxon signed-rank test was used to compare the outcomes to the neutral value of 3. RESULTS The accuracy of the stepwise description and the accuracy and usefulness of the OCHRA-checklist were rated statistically significantly higher than the neutral value of 3 (median 4.75 [5.00-4.00] with p = .009, median 5.00 [5.00-4.00] with p = .012, median 4.00 [5.00-4.00] with p = .047, respectively). The experts rated the OCHRA-checklist to be useful for the training (5.00 [5.00-4.00], p = .009), and assessment (4.50 [5.00-4.00], p = .010) of surgical residents. CONCLUSION This preliminary study showed that the stepwise LOIHR description constructed using the step-by-step framework was found to be accurate. The LOIHR OCHRA-checklist developed using the stepwise description was also accurate, and particularly useful for the training and assessment of proficiency of surgical residents.
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Nazari T, van de Graaf FW, Dankbaar MEW, Lange JF, van Merriënboer JJG, Wiggers T. One Step at a Time: Step by Step Versus Continuous Video-Based Learning to Prepare Medical Students for Performing Surgical Procedures. JOURNAL OF SURGICAL EDUCATION 2020; 77:779-787. [PMID: 32171749 DOI: 10.1016/j.jsurg.2020.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of this study was to compare the effects of cognitive load and surgical performance in medical students that performed the open inguinal hernia repair after preparation with step-by-step video-demonstration versus continuous video-demonstration. Hypothetically, the step-by-step group will perceive lower extraneous load during the preparation of the surgical procedure compared to the continuous group. Subsequently, fewer errors will be made in the surgical performance assessment by the step-by-step group, resulting in better surgical performance. DESIGN In this prospective study, participants were randomly assigned to the step-by-step or continuous video-demonstration. They completed questionnaires regarding perceived cognitive load during preparation (10-point Likert scale). Their surgical performance was assessed on a simulation hernia model using the Observational Clinical Human Reliability Assessment. SETTING Erasmus University Medical Center, Rotterdam, the Netherlands. PARTICIPANTS Participants included medical students who were enrolled in extracurricular anatomy courses. RESULTS Forty-three students participated; 23 students in the step-by-step group and 20 in the continuous group. As expected, the step-by-step group perceived a lower extraneous cognitive load (2.92 ± 1.21) compared to the continuous group (3.91 ± 1.67, p = 0.030). The surgical performance was not statistically significantly different between both groups; however, in subanalyses on a selection of students that prepared for 1 to 2 hours, the step-by-step group made less procedural errors, 1.67 ± 1.11, compared to the continuous group, 3.06 ± 1.91, p = 0.018. CONCLUSIONS Our results suggest that preparation using step-by-step video-based learning results in lower extraneous cognitive load and subsequently fewer procedural errors during the surgical performance. For learning purposes, demonstration videos of surgical procedures should be presented in a segmented format.
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Affiliation(s)
- Tahmina Nazari
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Incision Academy, Amsterdam, the Netherlands.
| | - Floyd W van de Graaf
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mary E W Dankbaar
- The institute of Medical Education Research Rotterdam (iMERR), the Netherlands; Department of Education, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
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Nazari T, Simons MP, Zeb MH, van Merriënboer JJG, Lange JF, Wiggers T, Farley DR. Validity of a low-cost Lichtenstein open inguinal hernia repair simulation model for surgical training. Hernia 2019; 24:895-901. [PMID: 31792800 PMCID: PMC7395906 DOI: 10.1007/s10029-019-02093-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Simulation training allows trainees to gain experience in a safe environment. Computer simulation and animal models to practice a Lichtenstein open inguinal hernia repair (LOIHR) are available; however, a low-cost model is not. We constructed an inexpensive model using fabric, felt, and yarn that simulates the anatomy and hazards of the LOIHR. This study examined the fidelity, and perceived usefulness of our developed simulation model by surgical residents and expert surgeons. METHODS A total of 66 Dutch surgical residents and ten international expert surgeons were included. All participants viewed a video-demonstration of LOIHR on the simulation model and subsequently performed the surgery themselves on the model. Afterward, they assessed the model by rating 13 statements concerning its fidelity (six model, three equipment, and four psychological) and six usefulness statements on a five-point Likert scale. One-sample Wilcoxon signed-rank test was used to compare to the neutral value of 3. RESULTS The fidelity was assessed as being high by residents [model 4.00 (3.00-4.00), equipment 4.00 (3.00-4.00), psychological 4.00 (3.00-4.00); all p's < 0.001] and by expert surgeons [model 4.00 (3.00-4.00), p = 0.025; equipment 4.00 (3.00-5.00), p < 0.001; psychological 4.00 (3.00-4.00), p = 0.053]. The usefulness was rated high by residents and experts, especially the usefulness for training of residents [residents 4.00 (4.00-5.00), p < 0.001; experts 4.50 (3.75-5.00), p = 0.015]. CONCLUSION Our developed Lichtenstein open inguinal hernia repair simulation model was assessed by surgical residents and expert surgeons as a model with high fidelity and high potential usefulness, especially for the training of surgical residents.
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Affiliation(s)
- T Nazari
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M P Simons
- Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - M H Zeb
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - J J G van Merriënboer
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences Maastricht University, Maastricht University, Maastricht, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T Wiggers
- Incision Academy, Amsterdam, The Netherlands
| | - D R Farley
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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11
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Lai PB. Standardisation. SURGICAL PRACTICE 2019. [DOI: 10.1111/1744-1633.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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