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Castaldi MT, Palmer M, Con J, Bergamaschi R. Robotic-Assisted Surgery Training (RAST): Assessment of Surgeon Console Ergonomic Skills. JOURNAL OF SURGICAL EDUCATION 2023; 80:1723-1735. [PMID: 37770293 DOI: 10.1016/j.jsurg.2023.08.019] [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: 03/19/2023] [Revised: 07/27/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the responsiveness of postgraduate year (PGY) general surgery residents (GSRs) to surgeon console ergonomics within the robotic-assisted surgery training (RAST) program. DESIGN This was a prospective educational study. GSRs were prepared with a pretraining educational video. Faculty provided one-on-one resident hands-on training and testing. Nine proficiency criteria (emergency stop & recover; left side pod adjustments; touchpad controls; footswitch panel; energy control pedals; camera control & focus; arm swap; master & finger clutch; dual console settings control) were assessed with a 5-point Likert-scale. Responsiveness was defined as change in performance over time. The robotic platform was Da Vinci Xi (Intuitive Surgical, Sunnyvale, CA). The Dundee ready educational environment measure (DREEM) inventory was used by GSRs to assess the educational environment. SETTING Tertiary care academic teaching institution. PARTICIPANTS A total of 22 GSRs: 4 PGY 1, 4 PGY 2, 4 PGY 3, 5 PGY 4, 5 PGY 5. RESULTS From June 2022 to March 2023 the hands-on console time decreased at testing when compared to baseline: median 39.0 (range 37-41) vs 20.1 (range 19-22) minutes, respectively. There was no difference in mean hands-on testing scores stratified by PGY: 4.85±0.4 PGY1; 4.98 ± 0.3 PGY2; 4.86 ± 0.4 PGY3, 4.88 ± 0.2 PGY4, and 4.91 ± 0.1 PGY5 (ANOVA test; p = 0.095). The overall DREEM score was 167.1 ± 16.9 with CAC = 0.908 (excellent internal consistency). CONCLUSIONS Training in ergonomics on the surgeon console impacted the responsiveness of the GSRs with 51% console time reduction. There were no differences in hands-on testing scores among PGYs. Perception of the educational environment by the GSRs was high.
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Affiliation(s)
- M T Castaldi
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - M Palmer
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - J Con
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - R Bergamaschi
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York.
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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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Buscaglia JM, Fakhoury J, Loyal J, Denoya PI, Kazi E, Stein SA, Scriven R, Bergamaschi R. Simulated colonoscopy training using a low-cost physical model improves responsiveness of surgery interns. Colorectal Dis 2015; 17:530-5. [PMID: 25537052 DOI: 10.1111/codi.12883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/11/2014] [Indexed: 02/08/2023]
Abstract
AIM Surgery residents are required to become proficient in colonoscopy before completing training. The aim of this study was to evaluate the responsiveness of surgery interns to simulated colonoscopy training. METHOD Interns, defined as postgraduate year 1 residents without exposure to endoscopy, underwent training in a physical model including colonoscopy, synthetic anatomy trays with luminal tattoos and a hybrid simulator. After baseline testing and mentored training, final testing was performed using five predetermined proficiency criteria. Content-valid metrics defined by the extent of departure from clinical reality were evaluated by two blinded assessors. Responsiveness was defined as change in performance over time and assessed comparing baseline testing with nonmentored final testing. RESULTS Twelve interns (eight male, mean age 26, 80% right-handed) performed 48 colonoscopies each over 1 year. Improvement was seen in the overall procedure time (24 min 46 s vs 20 min 54 s; P = 0.03), passing the splenic flexure (20 min 33 s vs 10 min 45 s; P = 0.007), passing the hepatic flexure (23 min 31 s vs 12 min 45 s; P = 0.003), caecal intubation time (23 min 38 s vs 13 min 26 s; P = 0.008), the duration of loss of view of the lumen (75% vs 8.3%; P = 0.023), incomplete colonoscopy (100% vs 33.3%; P = 0.042), colonoscope withdrawal < 6 min (16.7% vs 8.3%; P = 0.052). Tattoo identification time (9 min 16 s vs 12 min 25 s; P = 0.50), colon looped time (2 min 12 s vs 1 min 45 s; P = 0.50) and rate of colon perforation (8.3% vs 8.3%; P = 1) remained unchanged. Interrater reliability was 1.0 for all measures. CONCLUSION Simulated colonoscopy training in a low-cost physical model improved the performance of surgery interns with decreased procedure time, increased rates of complete colonoscopy and appropriate scope withdrawal.
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Affiliation(s)
- J M Buscaglia
- Divisions of Gastroenterology, State University of New York, Stony Brook, New York, USA
| | - J Fakhoury
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - J Loyal
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - P I Denoya
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - E Kazi
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - S A Stein
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
| | - R Scriven
- Department of Surgery, State University of New York, Stony Brook, New York, USA
| | - R Bergamaschi
- Divisions of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
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Sachdeva AK, Buyske J, Dunnington GL, Sanfey HA, Mellinger JD, Scott DJ, Satava R, Fried GM, Jacobs LM, Burns KJ. A new paradigm for surgical procedural training. Curr Probl Surg 2011; 48:854-968. [PMID: 22078788 DOI: 10.1067/j.cpsurg.2011.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, Illinois, USA
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Essani R, Scriven RJ, McLarty AJ, Merriam LT, Ahn H, Bergamaschi R. Simulated laparoscopic sigmoidectomy training: responsiveness of surgery residents. Dis Colon Rectum 2009; 52:1956-61. [PMID: 19934915 DOI: 10.1007/dcr.0b013e3181b9e831] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aimed to evaluate the responsiveness of surgery residents to simulated laparoscopic sigmoidectomy training. METHODS Residents underwent simulated laparoscopic sigmoidectomy training for previously tattooed sigmoid cancer with use of disposable abdominal trays in a hybrid simulator to perform a seven-step standardized technique. After baseline testing and training, residents were tested with predetermined proficiency criteria. Content validity was defined as the extent to which outcome measures departed from clinical reality. Content-valid measures of trays were evaluated by two blinded raters. Simulator-generated metrics included path length and smoothness of instrument movements. Responsiveness was defined as change in performance over time and was assessed by comparing baseline testing with unmentored final testing. RESULTS For eight weeks, eight postgraduate year 3/4 residents performed 34 resections. Overall operating time (67 vs. 37 min; P = 0.005), flexure (10 vs. 5 min; P = 0.005), inferior mesenteric vessel (8 vs. 5 min; P = 0.04), and ureter (7 vs. 1 min; P = 0.003) times improved significantly. Content-valid measures from trays remained unchanged. Path length (27,155.2 mm) and smoothness (3,575.5 cm/s3) of instrument movement remained unchanged. There were two bowel perforations and 19 anastomotic leaks. Leak rate decreased from 87% to 12.5%. Strong correlation was found between path length and smoothness of instrument movements (r = 0.9; P < 0.001). There was no correlation between simulator-generated metrics and content-valid outcome measures. Interrater reliability was 1.0 for all measures except anastomotic leak (k = 0.56). There was a linear relationship between residents' clinical advanced laparoscopic case volume and responsiveness (r = -0.7; P = 0.04). CONCLUSIONS Simulated laparoscopic sigmoidectomy training affected responsiveness in surgery residents with significantly decreased operating time and anastomotic leak rate.
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Affiliation(s)
- Rahila Essani
- Division of Colon and Rectal Surgery, State University of New York, Stony Brook, New York 11794-8191, USA
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Cesanek P, Uchal M, Uranues S, Patruno J, Gogal C, Kimmel S, Bergamaschi R. Do hybrid simulator-generated metrics correlate with content-valid outcome measures? Surg Endosc 2008; 22:2178-83. [DOI: 10.1007/s00464-008-0018-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 05/02/2008] [Accepted: 05/05/2008] [Indexed: 11/30/2022]
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Brunner WC, Korndorffer JR, Sierra R, Dunne JB, Yau CL, Corsetti RL, Slakey DP, Townsend MC, Scott DJ. Determining standards for laparoscopic proficiency using virtual reality. Am Surg 2005; 71:29-35. [PMID: 15757053 DOI: 10.1177/000313480507100105] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Laparoscopic training using virtual reality has proven effective, but rates of skill acquisition vary widely. We hypothesize that training to predetermined expert levels may more efficiently establish proficiency. Our purpose was to determine expert levels for performance-based training. Four surgeons established as laparoscopic experts performed 11 repetitions of 12 tasks. One surgeon (EXP-1) had extensive Minimally Invasive Surgical Trainer-Virtual Reality (MIST VR) exposure and formal laparoscopic fellowship training. Trimmed mean scores for each were determined as expert levels. A composite score (EXP-C) was defined as the average of all four expert levels. Thirty-seven surgery residents without prior MIST VR exposure and two research residents with extensive MIST VR exposure completed three repetitions of each task to determine baseline performance. Scores for EXP-1 and EXP-C were plotted against the best score of each participant. On average, the EXP-C level was reached or exceeded by 7 of the 37 (19%) residents. In contrast, the EXP-1 level was reached or exceeded by 1 of 37 (3%) residents and both research residents on all tasks. These data suggest the EXP-C level may be too lenient, whereas the EXP-1 level is more challenging and should result in adequate skill acquisition. Such standards should be further developed and integrated into surgical education.
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Affiliation(s)
- William C Brunner
- Department of Surgery, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA
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Moran ME, Abrahams HM, Kim DH. Laparoscopic radical nephrectomy: financial disincentives by the Health Care Financing Administration. J Endourol 2003; 17:133-5. [PMID: 12803984 DOI: 10.1089/089277903321618680] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopic radical nephrectomy is a minimally invasive alternative to open radical nephrectomy. We have noticed that since the beginning of 2001, when the Current Procedural Terminology (CPT) code 50545 became available for laparoscopic nephrectomy, the reimbursement for the laparoscopic operation was significantly lowered. This led us to survey 25 laparoscopic urologic surgeons to assess trends in reimbursement from all over the United States. MATERIALS AND METHODS During this period, the records of reimbursements for radical nephrectomy were available from a single practice to compare that for the open and laparoscopic techniques. The 19 open and 10 laparoscopic operations were entered in a database for statistical analysis. Endourologists around the country also were polled on the subject. RESULTS The average reimbursement for an open radical nephrectomy was $1581 +/- 325 (SD), while the average reimbursement for a laparoscopic radical nephrectomy was $1192 +/- 184. Twenty-five polled endourologists had noted similar reductions in reimbursement for laparoscopic procedures. Many of those polled had participated in the Specialty Society Relative Value Unit (RVU) survey for laparoscopic radical nephrectomy and stated that their recommendations were that the value be considered greater than that of the open counterpart. CONCLUSION The highly significant difference in reimbursement reflects a financial disincentive to surgeons performing laparoscopic procedures. It is obvious that in the U.S., the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) is devaluating all surgical procedures, and financial pressures of this type are disturbing.
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Affiliation(s)
- Michael E Moran
- St. Peter's Hospital, Albany Medical Center, Albany, New York 12208, USA.
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van der Zee DC, Bax KMA. The Necessity for Training in Pediatric Endoscopic Surgery. ACTA ACUST UNITED AC 2003. [DOI: 10.1089/10926410360560980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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