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Hewitson CL, Crossley MJ, Cartmill J, Kaplan DM. Sensorimotor Challenges in Minimally Invasive Surgery: A Theoretically-Oriented Review. HUMAN FACTORS 2024:187208241263684. [PMID: 39038166 DOI: 10.1177/00187208241263684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVE This review surveys the literature on sensorimotor challenges impacting performance in laparoscopic minimally invasive surgery (MIS). BACKGROUND Despite its well-known benefits for patients, achieving proficiency in MIS can be challenging for surgeons due to many factors including altered visual perspectives and fulcrum effects in instrument handling. Research on these and other sensorimotor challenges has been hindered by imprecise terminology and the lack of a unified theoretical framework to guide research questions in the field. METHOD We conducted a systematic survey of the MIS literature, focusing on studies investigating sensorimotor challenges affecting laparoscopic performance. To provide a common foundation for cross-study comparisons, we propose a standardized taxonomy that distinguishes between different experimental paradigms used in the literature. We then show how the computational motor learning perspective provides a unifying theoretical framework for the field that can facilitate progress and motivate future research along clearer, hypothesis-driven lines. RESULTS The survey identified diverse sensorimotor perturbations in MIS, which can be effectively categorized according to our proposed taxonomy. Studies investigating monitor-, camera-, and tool-based perturbations were systematically analyzed, elucidating their impact on surgical performance. We also show how the computational motor learning perspective provides deeper insights and potential strategies to mitigate challenges. CONCLUSION Sensorimotor challenges significantly impact MIS, necessitating a systematic, empirically informed approach. Our proposed taxonomy and theoretical framework shed light on the complexities involved, paving the way for more structured research and targeted training approaches to enhance surgical proficiency. APPLICATION Understanding the sensorimotor challenges inherent to MIS can guide the design of improved training curricula and inform the configuration of setups in the operating room to enhance surgeon performance and ultimately patient outcomes. This review offers key insights for surgeons, educators, and researchers in surgical performance and technology development.
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Jarry C, Vela J, Varas J, Soza F, Corvetto M, Heriot A, Warrier S, Larach JT. Innovative perfused cadaveric model for complete mesocolic excision. Br J Surg 2024; 111:znae139. [PMID: 38922236 DOI: 10.1093/bjs/znae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024]
Abstract
A high-fidelity cadaver-based training scenario for right colectomy with complete mesocolic excision is presented (Video 1). A feasible perfusion strategy that allows a near-to-reality experience is demonstrated.
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Affiliation(s)
- Cristián Jarry
- Experimental Surgery and Simulation Centre, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Vela
- Experimental Surgery and Simulation Centre, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Centre, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Soza
- Department of Orthopaedics and Trauma, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcia Corvetto
- Experimental Surgery and Simulation Centre, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexander Heriot
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Satish Warrier
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - José Tomás Larach
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Brian R, Bayne D, Ito T, Lager J, Edwards A, Kumar S, Soriano I, O'Sullivan P, Varas J, Chern H. An At-Home Laparoscopic Curriculum for Junior Residents in Surgery, Obstetrics/Gynecology, and Urology. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11405. [PMID: 38957528 PMCID: PMC11219092 DOI: 10.15766/mep_2374-8265.11405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/27/2024] [Indexed: 07/04/2024]
Abstract
Introduction Laparoscopic surgery requires significant training, and prior studies have shown that surgical residents lack key laparoscopic skills. Many educators have implemented simulation curricula to improve laparoscopic training. Given limited time for dedicated, in-person simulation center practice, at-home training has emerged as a possible mechanism by which to expand training and promote practice. There remains a gap in published at-home laparoscopic curricula employing embedded feedback mechanisms. Methods We developed a nine-task at-home laparoscopic curriculum and an end-of-curriculum assessment following Kern's six-step approach. We implemented the curriculum over 4 months with first- to third-year residents. Results Of 47 invited residents from general surgery, obstetrics/gynecology, and urology, 37 (79%) participated in the at-home curriculum, and 25 (53%) participated in the end-of-curriculum assessment. Residents who participated in the at-home curriculum completed a median of six of nine tasks (interquartile range: 3-8). Twenty-two residents (47%) responded to a postcurriculum survey. Of these, 19 (86%) reported that their laparoscopic skills improved through completion of the curriculum, and the same 19 (86%) felt that the curriculum should be continued for future residents. Residents who completed more at-home curriculum tasks scored higher on the end-of-curriculum assessment (p = .009 with adjusted R 2 of .28) and performed assessment tasks in less time (p = .004 with adjusted R 2 of .28). Discussion This learner-centered laparoscopic curriculum provides guiding examples, spaced practice, feedback, and graduated skill development to enable junior residents to improve their laparoscopic skills in a low-stakes, at-home environment.
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Affiliation(s)
- Riley Brian
- Research Resident, Department of Surgery, University of California, San Francisco
| | - David Bayne
- Assistant Professor, Department of Urology, University of California, San Francisco
| | - Traci Ito
- Assistant Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Jeannette Lager
- Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Anya Edwards
- First-Year Resident, Department of Surgery, University of California, San Francisco
| | - Sandhya Kumar
- Assistant Professor, Department of Surgery, University of California, San Francisco
| | - Ian Soriano
- Associate Professor, Department of Surgery, University of California, San Francisco
| | | | - Julian Varas
- Associate Professor, Surgical Division, Faculty of Medicine, Pontificia Universidad Católica de Chile
| | - Hueylan Chern
- Professor, Department of Surgery, University of California, San Francisco
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Rojas MF, Torres J, Figueroa Ú, Varas J, Achurra P, Navia A, Cuadra Á, Searle S. Validation of a synthetic simulation model of endoscopic rectus sheath plication. Hernia 2024:10.1007/s10029-024-03059-z. [PMID: 38767716 DOI: 10.1007/s10029-024-03059-z] [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: 02/14/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. METHODS A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. RESULTS Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24-25) vs 14 (range 5-22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10-11) vs 8 (range 3-10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. CONCLUSION Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication.
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Affiliation(s)
- María Fernanda Rojas
- General Surgeon at Clínica Bupa Santiago, Vaticano 4008, Las Condes, Región Metropolitana, Santiago, Chile.
| | - Javier Torres
- Plastic and Reconstructive Surgeon at Hospital Dr. Victor Ríos Ruiz, Los Angeles, Chile
| | - Úrsula Figueroa
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julian Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfonso Navia
- Plastic and Reconstructive Surgeon at Pontificia, Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Cuadra
- Plastic and Reconstructive Surgeon at Pontificia, Universidad Católica de Chile, Santiago, Chile
| | - Susana Searle
- Plastic and Reconstructive Surgeon at Pontificia, Universidad Católica de Chile, Santiago, Chile
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Charondo LB, Brian R, Syed S, Chern H, Lager J, Alseidi A, O'Sullivan P, Bayne D. Confronting new challenges: Faculty perceptions of gaps in current laparoscopic curricula in a changing training landscape. Surg Open Sci 2023; 16:1-7. [PMID: 37731731 PMCID: PMC10507640 DOI: 10.1016/j.sopen.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
Background Opportunities for residents to develop laparoscopic skills have decreased with the rise in robotic operations and the development of complex, subspecialized laparoscopic operations. Given the changing training landscape, this study aimed to identify laparoscopic surgeons' perceptions of gaps in current laparoscopic skills in general surgery, obstetrics-gynecology, and urology residency programs. Methods Laparoscopic surgeons who operate with residents participated in semi-structured interviews. Questions addressed expectations for resident proficiency, deficits in laparoscopic surgical skills, and barriers to learning and teaching. Two authors independently coded de-identified transcripts followed by a conventional content analysis. Results Fourteen faculty members from thirteen subspecialties participated. Faculty identified three main areas to improve laparoscopic training across specialties: foundational knowledge, technical skills, and cognitive skills. They also recognized an overarching opportunity to address faculty development. Conclusions This qualitative study highlighted key deficiencies in laparoscopic training that have emerged in the current, changing era of minimally invasive surgery. Key message This qualitative study identified laparoscopic educators' perceptions of deficiencies in laparoscopic training. Findings emphasized the importance of incorporating high quality educational practices to optimize training in the current changing landscape of laparoscopic surgery.
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Affiliation(s)
| | - Riley Brian
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Shareef Syed
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Hueylan Chern
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Jeannette Lager
- University of California, San Francisco, Department of Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, CA, USA
| | - Adnan Alseidi
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Patricia O'Sullivan
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - David Bayne
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
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Hoagland D, Olasky J, Kent TS, Vosburg RW. The Impact of Trainee Involvement on Outcomes in Metabolic and Bariatric Surgery. Obes Surg 2023; 33:3454-3462. [PMID: 37755646 DOI: 10.1007/s11695-023-06831-9] [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: 07/11/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The number of bariatric operations performed in the USA rises annually. Trainee exposure to this field is necessary to ensure competency in future surgical generations. However, the safety of trainee involvement of these operations has been called into question. OBJECTIVES The aim of our study is to describe differences in outcomes between trainees and non-trainees as first assistants (FA) in sleeve gastrectomy (SG). SETTING The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database METHODS: Patients from the MBSAQIP database who underwent primary SG from 2015 to 2020 were identified. Statistical analysis included two-tailed t-tests and χ2-tests to evaluate the impact of trainees (residents and fellows) compared to non-trainees on post-operative morbidity and operative time. RESULTS Of the 559,324 cases, 25.8% were performed with trainees as FA. Operative length was 27.9% longer in trainee cases. In the trainee group, there was a higher risk of conversion to open procedure (OR 1.32), readmission (OR 1.19), and specific complications (cardiac arrest, myocardial infarction, progressive renal insufficiency, pulmonary embolism, sepsis, transfusion, intubation, UTI, VTE, ICU admission, and reintervention), though overall rates were < 1% in each group. Non-trainees had a higher rate of septic shock (OR 1.4). No significant difference was seen in all other perioperative outcomes. CONCLUSION Trainee involvement in SG leads to longer operative times without a clinically significant increase in morbidity and mortality. Such findings should be used to counsel patients and shape expectations for surgeons and hospitals. A focused bariatric surgery trainee curriculum may lessen this gap.
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Affiliation(s)
- Darian Hoagland
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Jaisa Olasky
- Department of Surgery, Lenox Hill Hospital, New York, USA
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - R Wesley Vosburg
- Department of surgery Mount Auburn Hospital, Harvard Medical School, 355 Waverley Oaks rd, suite 100, Waltham, MA, 02452, USA.
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Clarke SO, Ilgen JS, Regehr G. Fostering Adaptive Expertise Through Simulation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:994-1001. [PMID: 37094295 DOI: 10.1097/acm.0000000000005257] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Technology-enhanced simulation has been used to tackle myriad challenges within health professions education. Recently, work has typically adopted a mastery learning orientation that emphasizes trainees' sequential mastery of increasingly complex material. Doing so has privileged a focus on performance and task completion, as captured by trainees' observable behaviors and actions. Designing simulation in these ways has provided important advances to education, clinical care, and patient safety, yet also placed constraints around how simulation-based activities were enacted and learning outcomes were measured. In tracing the contemporary manifestations of simulation in health professions education, this article highlights several unintended consequences of this performance orientation and draws from principles of adaptive expertise to suggest new directions. Instructional approaches grounded in adaptive expertise in other contexts suggest that uncertainty, struggle, invention, and even failure help learners to develop deeper conceptual understanding and learn innovative approaches to novel problems. Adaptive expertise provides a new lens for simulation designers to think intentionally around how idiosyncrasy, individuality, and inventiveness could be enacted as central design principles, providing learners with opportunities to practice and receive feedback around the kinds of complex problems they are likely to encounter in practice. Fostering the growth of adaptive expertise through simulation will require a fundamental reimagining of the design of simulation scenarios, embracing the power of uncertainty and ill-defined problem spaces, and focusing on the structure and pedagogical stance of debriefing. Such an approach may reveal untapped potential within health care simulation.
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Affiliation(s)
- Samuel O Clarke
- S.O. Clarke is associate professor, Department of Emergency Medicine, University of California, Davis, Sacramento, California; ORCID: https://orcid.org/my-orcid?orcid=0000-0003-3762-1727
| | - Jonathan S Ilgen
- J.S. Ilgen is professor, Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington; ORCID: https://orcid.org/0000-0003-4590-6570
| | - Glenn Regehr
- G. Regehr is professor, Department of Surgery, and senior scientist, Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-3144-331X
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Manavalan V, Dutt RA. Skill-Based Surgical Training: the Need of the Hour. Indian J Surg Oncol 2023; 14:531-536. [PMID: 37900648 PMCID: PMC10611636 DOI: 10.1007/s13193-023-01820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/06/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Vijayakumar Manavalan
- Department of Surgical Oncology, Yenepoya Medical College, Yenepoya (Deemed to Be University), Mangalore, Karnataka India
| | - R. Aswini Dutt
- Department of Physiology, Yenepoya Medical College, Yenepoya (Deemed to Be University), Mangalore, Karnataka India
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Varas J, Coronel BV, Villagrán I, Escalona G, Hernandez R, Schuit G, Durán V, Lagos-Villaseca A, Jarry C, Neyem A, Achurra P. Innovations in surgical training: exploring the role of artificial intelligence and large language models (LLM). Rev Col Bras Cir 2023; 50:e20233605. [PMID: 37646729 PMCID: PMC10508667 DOI: 10.1590/0100-6991e-20233605-en] [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: 06/07/2023] [Accepted: 07/14/2023] [Indexed: 09/01/2023] Open
Abstract
The landscape of surgical training is rapidly evolving with the advent of artificial intelligence (AI) and its integration into education and simulation. This manuscript aims to explore the potential applications and benefits of AI-assisted surgical training, particularly the use of large language models (LLMs), in enhancing communication, personalizing feedback, and promoting skill development. We discuss the advancements in simulation-based training, AI-driven assessment tools, video-based assessment systems, virtual reality (VR) and augmented reality (AR) platforms, and the potential role of LLMs in the transcription, translation, and summarization of feedback. Despite the promising opportunities presented by AI integration, several challenges must be addressed, including accuracy and reliability, ethical and privacy concerns, bias in AI models, integration with existing training systems, and training and adoption of AI-assisted tools. By proactively addressing these challenges and harnessing the potential of AI, the future of surgical training may be reshaped to provide a more comprehensive, safe, and effective learning experience for trainees, ultimately leading to better patient outcomes. .
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Affiliation(s)
- Julian Varas
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Brandon Valencia Coronel
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Ignacio Villagrán
- - Pontificia Universidad Católica de Chile, Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina - Santiago - Región Metropolitana - Chile
| | - Gabriel Escalona
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Rocio Hernandez
- - Pontificia Universidad Católica de Chile, Computer Science Department, School of Engineering - Santiago - Región Metropolitana - Chile
| | - Gregory Schuit
- - Pontificia Universidad Católica de Chile, Computer Science Department, School of Engineering - Santiago - Región Metropolitana - Chile
| | - Valentina Durán
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Antonia Lagos-Villaseca
- - Pontificia Universidad Católica de Chile, Department of Otolaryngology - Santiago - Región Metropolitana - Chile
| | - Cristian Jarry
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Andres Neyem
- - Pontificia Universidad Católica de Chile, Computer Science Department, School of Engineering - Santiago - Región Metropolitana - Chile
| | - Pablo Achurra
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
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Habti M, Bénard F, Meloche-Dumas L, Bérubé S, Cadoret D, Arutiunian A, Papas Y, Torres A, Kapralos B, Mercier F, Dubrowski A, Patocskai E. Hand Sewn Anastomosis Skill Acquisition and In Vivo Transfer Using 3D-Printed Small Bowel Simulator. J Surg Res 2023; 288:225-232. [PMID: 37030179 DOI: 10.1016/j.jss.2023.03.004] [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: 06/09/2022] [Revised: 02/21/2023] [Accepted: 03/08/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION General surgery residents need to master the hand-sewn bowel anastomosis (HSBA) technique. However, practice opportunities outside of the operating room are rare, and commercial simulators are often costly. The objective of this study is to assess the efficacy of a new, affordable silicone small bowel simulator, made with a three-dimensional (3D) printed mold, as a training tool to learn this technique. METHODS This was a single-blinded pilot randomized controlled trial comparing two groups of eight junior surgical residents. All participants completed a pretest using an inexpensive, custom developed 3D-printed simulator. Next, participants randomized to the experimental group practiced the HSBA skill at home (eight sessions), while those randomized to the control group did not receive any hands-on practice opportunities. A posttest was done using the same simulator as for the pretest and practice sessions, and the retention-transfer test was performed on an anesthetized porcine model. Pretests, posttests and retention-transfer tests were filmed and graded by a blinded evaluator using assessments of technical skills, quality of final product, and tests of procedural knowledge. RESULTS The experimental group significantly improved after practicing with the model (P = 0.01), while an equivalent improvement was not noted in the control group (P = 0.07). Moreover, the experimental group's performance remained stable between the posttest and the retention-transfer test (P = 0.95). CONCLUSIONS Our 3D-printed simulator is an affordable and efficacious tool to teach residents the HSBA technique. It allows development of surgical skills that are transferable to an in vivo model.
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Affiliation(s)
- Merieme Habti
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
| | - Florence Bénard
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Surgery, Surgical Oncology Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Léamarie Meloche-Dumas
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Surgery, Surgical Oncology Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Simon Bérubé
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Dominic Cadoret
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Artur Arutiunian
- Department of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Yasmina Papas
- Department of Surgery, Surgical Oncology Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Andrei Torres
- Software Informatics Research Centre, Ontario Tech University, Oshawa, Ontario, Canada
| | - Bill Kapralos
- Software Informatics Research Centre, Ontario Tech University, Oshawa, Ontario, Canada
| | - Frédéric Mercier
- Department of Surgery, Surgical Oncology Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Adam Dubrowski
- Department of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Erica Patocskai
- Department of Surgery, Surgical Oncology Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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Duran Espinoza V, Belmar Riveros F, Jarry Trujillo C, Gaete Dañobeitia MI, Montero Jaras I, Miguieles Schilling M, Valencia Coronel B, Escalona G, Tirado PA, Quezada N, Crovari F, Cohen JV. Five-Year Experience Training Surgeons with a Laparoscopic Simulation Training Program for Bariatric Surgery: a Quasi-experimental Design. Obes Surg 2023:10.1007/s11695-023-06616-0. [PMID: 37118641 DOI: 10.1007/s11695-023-06616-0] [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: 12/18/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE Nearly 200,000 laparoscopic Roux-en-Y gastric bypass (LRYGB) are performed yearly. Reported learning curves range between 50 and 150, even 500 cases to decrease the operative risk. Simulation programs could accelerate this learning curve safely; however, trainings for LRYGB are scarce. This study aims to describe and share our 5-year experience of a simulated program designed to achieve proficiency in LRYGB technical skills. MATERIALS AND METHODS A quasi-experimental design was used. All recruited participants were previously trained with basic and advanced laparoscopic simulation curriculum completing over 50 h of practical training. Ex vivo animal models were used to practice manual and stapled gastrojejunostomy (GJ) and stapled jejunojejunostomy (JJO) in 10, 3, and 4 sessions, respectively. The main outcome was to assess the manual GJ skill acquisition. Pre- and post-training assessments using a Global Rating Scale (GRS; max 25 pts), Specific Rating Scale (SRS; max 20 pts), performance time, permeability, and leakage rates were analyzed. For the stapled GJ and JJO, execution time was registered. Data analysis was performed using parametric tests. RESULTS In 5 years, 68 trainees completed the program. For the manual GJ's pre- vs post-training assessment, GRS and SRS scores increased significantly (from 17 to 24 and from 13 to 19 points respectively, p-value < 0.001). Permeability rate increased while leakage rate and procedural time decreased significantly. CONCLUSION This simulated training program showed effectiveness in improving laparoscopic skills for manual GJ and JJO in a simulated scenario. This new training program could optimize the clinical learning curve. Further studies are needed to assess the transfer of skills to the operating room.
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Affiliation(s)
- Valentina Duran Espinoza
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Francisca Belmar Riveros
- Surgery Resident, Universidad de Chile, Av. Independencia 1027 Independencia, Santiago, Región Metropolitana, 8380453, Chile
| | - Cristian Jarry Trujillo
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Maria Ines Gaete Dañobeitia
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Av. Libertador Bernardo O'Higgins 340, 8331150, Santiago, Región Metropolitana, Chile
| | - Isabella Montero Jaras
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Mariana Miguieles Schilling
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Brandon Valencia Coronel
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Pablo Achurra Tirado
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Av. Libertador Bernardo O'Higgins 340, 8331150, Santiago, Región Metropolitana, Chile
| | - Nicolas Quezada
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Av. Libertador Bernardo O'Higgins 340, 8331150, Santiago, Región Metropolitana, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Av. Libertador Bernardo O'Higgins 340, 8331150, Santiago, Región Metropolitana, Chile
| | - Julian Varas Cohen
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile.
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12
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Villagrán I, Rammsy F, Del Valle J, Gregorio de Las Heras S, Pozo L, García P, Torres G, Varas J, Mandrusiak A, Corvetto M, Fuentes-Cimma J. Remote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students. BMC MEDICAL EDUCATION 2023; 23:267. [PMID: 37081551 PMCID: PMC10116106 DOI: 10.1186/s12909-023-04229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students. METHODS Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric. RESULTS Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality. CONCLUSION The remote, asynchronous training and feedback model proved to be an effective strategy for students' development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.
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Affiliation(s)
- Ignacio Villagrán
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Francisca Rammsy
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Javiera Del Valle
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Sofía Gregorio de Las Heras
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Liliana Pozo
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Patricio García
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Gustavo Torres
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Julián Varas
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Marcia Corvetto
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Fuentes-Cimma
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
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13
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Gaete MI, Belmar F, Cortés M, Alseidi A, Asbun D, Durán V, Escalona G, Achurra P, Villagrán I, Crovari F, Pimentel F, Varas J. Remote and asynchronous training network: from a SAGES grant to an eight-country remote laparoscopic simulation training program. Surg Endosc 2023; 37:1458-1465. [PMID: 35764838 DOI: 10.1007/s00464-022-09386-5] [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: 03/21/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Limitations in surgical simulation training include lack of access to validated training programs with continuous year-round training and lack of experts' ongoing availability for feedback. A model of simulation training was developed to address these limitations. It incorporated basic and advanced laparoscopic skills curricula from a previously validated program and provided instruction through a digital platform. The platform allowed for remote and asynchronous feedback from a few trained instructors. The instructors were continuously available and provided personalized feedback using a variety of different media. We describe the upscaling of this model to teach trainees at fourteen centers in eight countries. METHODS Institutions with surgical programs lacking robust simulation curricula and needing instructors for ongoing education were identified. The simulation centers ("skills labs") at these sites were equipped with necessary simulation training hardware. A remote training-the-administrators (TTA) program was developed where personnel were trained in how to manage the skills lab, schedule trainees, set up training stations, and use the platform. A train-the-trainers (TTT) program was created to establish a network of trained instructors, who provided objective feedback through the platform remotely and asynchronously. RESULTS Between 2019 and 2022, seven institutions in Chile and one in each of the USA, Bolivia, Brazil, Ecuador, El Salvador, México, and Perú implemented a digital platform-based remote simulation curriculum. Most administrators were not physicians (19/33). Eight Instructors were trained with the TTT program and became active proctors. The platform has been used by 369 learners, of whom 57% were general surgeons and general surgery residents. A total of 6729 videos, 28,711 feedback inputs, and 233.7 and 510.2 training hours in the basic and advanced programs, respectively, were registered. CONCLUSION A remote and asynchronous method of giving instruction and feedback through a digital platform has been effectively employed in the creation of a robust network of continuous year-round simulation-based training in laparoscopy. Training centers were successfully run only with trained administrators to assist in logistics and setup, and no on-site instructors were necessary.
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Affiliation(s)
- María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Matías Cortés
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, USA
| | - Domenech Asbun
- Hepatobiliary & Pancreatic Surgery, Miami Cancer Institute, Miami, USA
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Fernando Crovari
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Fernando Pimentel
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile.
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14
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Varela E, Castelli I, Szwarcfiter V, Turner L, Gaete MI, Belmar F, Cortés M, Jiménez G, Corvetto M, Varas J. LATIN AMERICAN RESIDENTS' SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1708. [PMID: 36542006 PMCID: PMC9767423 DOI: 10.1590/0102-672020220002e1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice. AIMS This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America. METHOD A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world. RESULTS In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested. CONCLUSIONS Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.
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Affiliation(s)
- Eduardo Varela
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Ignacio Castelli
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Vania Szwarcfiter
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Lawrence Turner
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - María Inés Gaete
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Francisca Belmar
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Matías Cortés
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Gerónimo Jiménez
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Marcia Corvetto
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Julián Varas
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
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15
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Belmar F, Gaete MI, Escalona G, Carnier M, Durán V, Villagrán I, Asbun D, Cortés M, Neyem A, Crovari F, Alseidi A, Varas J. Artificial intelligence in laparoscopic simulation: a promising future for large-scale automated evaluations. Surg Endosc 2022:10.1007/s00464-022-09576-1. [PMID: 36192656 PMCID: PMC9529161 DOI: 10.1007/s00464-022-09576-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022]
Abstract
Introduction A limitation to expanding laparoscopic simulation training programs is the scarcity of expert evaluators. In 2019, a new digital platform for remote and asynchronous laparoscopic simulation training was validated. Through this platform, 369 trainees have been trained in 14 institutions across Latin America, collecting 6729 videos of laparoscopic training exercises. The use of artificial intelligence (AI) has recently emerged in surgical simulation, showing usefulness in training assessment, virtual reality scenarios, and laparoscopic virtual reality simulation. An AI algorithm to assess basic laparoscopic simulation training exercises was developed. This study aimed to analyze the agreement between this AI algorithm and expert evaluators in assessing basic laparoscopic-simulated training exercises. Methods The AI algorithm was trained using 400-bean drop (BD) and 480-peg transfer (PT) videos and tested using 64-BD and 43-PT randomly selected videos, not previously used to train the algorithm. The agreement between AI and expert evaluators from the digital platform (EE) was then analyzed. The exercises being assessed involve using laparoscopic graspers to move objects across an acrylic board without dropping any objects in a determined time (BD < 24 s, PT < 55 s). The AI algorithm can detect object movement, identify if objects have fallen, track grasper clamps location, and measure exercise time. Cohen’s Kappa test was used to evaluate the agreement between AI assessments and those performed by EE, using a pass/fail nomenclature based on the time to complete the exercise. Results After the algorithm was trained, 79.69% and 93.02% agreement were observed in BD and PT, respectively. The Kappa coefficients test observed for BD and PT were 0.59 (moderate agreement) and 0.86 (almost perfect agreement), respectively. Conclusion This first approach of AI use in basic laparoscopic skills simulated training assessment shows promising results, providing a preliminary framework to expand the use of AI to other basic laparoscopic skills exercises. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09576-1.
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Affiliation(s)
- Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Martín Carnier
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile.,Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Domenech Asbun
- Hepatobiliary & Pancreatic Surgery, Miami Cancer Institute, Miami, USA
| | - Matías Cortés
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Andrés Neyem
- Department of Computer Science, Engineering Faculty, Catholic University of Chile, Santiago, Chile
| | - Fernando Crovari
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile.,Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile. .,Faculty of Medicine, Catholic University of Chile, Santiago, Chile.
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16
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Armijo-Rivera S, Machuca-Contreras F, Raul N, de Oliveira SN, Mendoza IB, Miyasato HS, Díaz-Guio DA. Characterization of simulation centers and programs in Latin America according to the ASPIRE and SSH quality criteria. Adv Simul (Lond) 2021; 6:41. [PMID: 34772461 PMCID: PMC8588659 DOI: 10.1186/s41077-021-00188-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/03/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Latin American clinical simulation has had an important development; there are no studies that characterize simulation centers and programs in the entire region. The aims of this work are to characterize the current state of simulation-based education in the health sciences, to determine the structure of Latin American simulation centers in terms of teaching, research, and continuing medical education (CME), as well as to determine the perception of quality based on international standards of simulation practices for the directors of Latin American centers. METHODS A quantitative, descriptive, cross-sectional study with a demographic questionnaire and a Likert-type survey was conducted to the directors of the simulation centers found in Latin America. RESULTS Four hundred eight simulation centers were documented, the survey was answered by 240 directors, and the data from 149 were complete responses on the 42 quality self-perception scale and considered valid on further analyses related to the quality of the programs. Most of the centers that responded correspond to Chile, Brazil, and Mexico (37.5%, 18.1%, 12.7%). 84% of the centers are university-based, and 71% of the centers are medium-sized, with less than 10 instructors (54%). The directors are mostly women (61.7%), medical doctors (50%), and nurses (40%), with clinical specialization (37%), master's degree (53%), and doctorate (13%). 75% have completed a simulation instructor course, and 6% have developed a fellowship. Most consider the maintenance of international quality standards to be relevant in their centers, mainly in reflective training techniques, ethical aspects, and adequate learning environments. CONCLUSIONS Simulation-based education in health sciences has had an increasing development in Latin America, within a university environment, in an important academic specialization process that seeks to adhere to high-quality standards to improve training and development of clinical skills, human factors, and critical thinking. We recommend starting accreditation processes in Latin America and studies that measure the quality of simulation-based education in our region, based on objective observations more than in self-reporting.
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Affiliation(s)
- Soledad Armijo-Rivera
- Núcleo de Simulación Interdisciplinar, Facultad de Medicina Clínica Alemana de Santiago Universidad del Desarrollo, Avenida Las Condes 12438 Lo Barnechea, Santiago, Chile.
| | | | - Norma Raul
- Clinical Simulation Training Center, Hospital de Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner, Ministry of Health, Buenos Aires, Argentina
| | | | | | - Héctor Shibao Miyasato
- Simulation Center, Integrated School of Medicine, Nursing and Dentistry, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Diego Andrés Díaz-Guio
- Education and Simulation Research Group, VitalCare Centro de Simulación Clínica, Faculty of Medicine Universidad Alexander von Humboldt, Armenia, Colombia
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17
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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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18
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Ortiz C, Belmar F, Rebolledo R, Vela J, Contreras C, Inzunza M, Ramos JP, Zinco A, Alseidi A, Varas J, Jarufe N, Achurra P. Validity Argument for a Simulation-Based Objective Structured Clinical Examination Scenario for Evaluation of Surgical Skills in Trauma. J Surg Res 2021; 268:507-513. [PMID: 34450554 DOI: 10.1016/j.jss.2021.06.069] [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: 03/29/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Trauma is one of the main causes of death globally, and appropriate surgical care is crucial to impact mortality. However, resident-performed trauma cases have diminished in the last 10 years. Simulation-based tools have proven to be effective to evaluate practical skills in a variety of settings. However, there is a lack of evidence regarding proper validation of trauma surgery models. OBJECTIVE The aim of this study was to evaluate under a contemporary validity framework, an objective structured clinical evaluation (OSCE) scenario for the assessment of basic and advanced surgical skills in trauma and emergency surgery. METHODS An OSCE-type simulation assessment program was developed incorporating six stations representing basic and advanced surgical skills that are essential in trauma surgery. Each station was designed using ex-vivo animal tissue. The stations included basic knots and sutures, bowel resection and anastomosis, vascular end-to-end anastomosis, lung injury repair, cardiac injury repair, and laparoscopic suturing. Eight postgraduate year 2 (PY-2), eight recently graduated surgeons (RGS), and 3 experts were recruited, and their performance was blindly assessed by experts using the validated general rating scale OSATS (Objective Structured Assessment of Technical Skills) as well as the time taken to complete the procedure. RESULTS Significant differences were identified among groups. The average OSATS score was 82 for the PY2 group, 113 for the RGS group, and 147 for the experts (P < 0.01). The average procedural time to complete all the stations was 98 minutes for the PY2 group, 68 minutes for the RGS group, and 35 minutes for the expert surgeons (P < 0.01). CONCLUSION An OSCE scenario designed using ex-vivo tissue met 4 out of 5 criteria of the Messick validity framework: content, relation to other variables, response process and consequences of the test. The results show it is a valid strategy for the evaluation of practical skills in trauma surgery.
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Affiliation(s)
- Catalina Ortiz
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rolando Rebolledo
- Institute for Biomedical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Vela
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Caterina Contreras
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Ramos
- Trauma Surgery and Emergency Medicine Department, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Analía Zinco
- Trauma Surgery and Emergency Medicine Department, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Jarufe
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile.
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19
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Giménez ME, Garcia Vazquez A, Davrieux CF, Verde JM, Serra E, Palermo M, Houghton EJ, Dallemagne B, Perretta S, Acquafresca PA, Diana M, Marescaux J. Image-Guided Surgical Training in Percutaneous Hepatobiliary Procedures: Development of a Realistic and Meaningful Bile Duct Dilatation Porcine Model. J Laparoendosc Adv Surg Tech A 2021; 31:790-795. [DOI: 10.1089/lap.2020.0680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Mariano Eduardo Giménez
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Alain Garcia Vazquez
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Carlos Federico Davrieux
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Juan M. Verde
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Edgardo Serra
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Mariano Palermo
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Eduardo Javier Houghton
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Bernard Dallemagne
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Silvana Perretta
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Pablo Agustín Acquafresca
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
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Achievement of effective cardiopulmonary trauma surgical skills training throughout the incorporation of a low-cost and easy to implement pulsatile simulation model. Injury 2021; 52:1215-1220. [PMID: 33422290 DOI: 10.1016/j.injury.2020.12.004] [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] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES . In the last decade, concern regarding the preparedness of general surgery graduates to effectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experience implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation. DESIGN . Firstly, for validation purposes 8 junior residents, 8 recently graduated general surgeons, and 3 cardiothoracic surgery attendings from Pontificia Universidad Católica de Chile Clinical Hospital were recruited. Proficiency in performing a pulmonary tractotomy and a myocardial injury repair was assessed with global and specific rating scales. Secondly, to evaluate the effectiveness of the model as a learning tool, 16 general surgery residents from different programs across the country were recruited receiving intensive, personalized training on the models. Proficiency was measured before and after the training. RESULTS . For the validation phase, significant differences among groups according to the previous level of expertise were shown, and therefore construct validity was established. The results of the second phase showed a significant overall improvement in participant's performance. CONCLUSION . Effective training and assessment for advanced surgical skills in cardiothoracic trauma can be achieved using a low-cost pulsatile simulation model.
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Oshiro K, Endo K, Morishima K, Kaneda Y, Koizumi M, Sasanuma H, Sakuma Y, Lefor AK, Sata N. A structured program for teaching pancreatojejunostomy to surgical residents and fellows outside the operating room: a pilot study. BMC Surg 2021; 21:102. [PMID: 33632184 PMCID: PMC7908720 DOI: 10.1186/s12893-021-01101-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background Pancreatojejunostomy (PJ) is one of the most difficult and challenging abdominal surgical procedures. There are no appropriate training systems available outside the operating room (OR). We developed a structured program for teaching PJ outside the OR. We describe its development and results of a pilot study. Methods We have created this structured program to help surgical residents and fellows acquire both didactic knowledge and technical skills to perform PJ. A manual was created to provide general knowledge about PJ and the specific PJ procedure used in our institution. Based on questionnaires completed by trainers and trainees, the procedure for PJ was divided into twelve steps and described in detail. After creating the manual, we developed organ models, needles and a frame box for simulation training. Three residents (PGY3-5) and three fellows (PGY6 or above) participated in a pilot study. Objective and subjective evaluations were performed. Results Trainees learn about PJ by reading the procedure manual, acquiring both general and specific knowledge. We conducted simulation training outside the OR using the training materials created for this system. They simulate the procedure with surgical instruments as both primary and assistant surgeon. In this pilot study, as objective assessments, the fellow-group took less time to complete one anastomosis (36 min vs 48 min) and had higher scores in the objective structured assessment of technical skill (average score: 4.1 vs 2.0) compared to the resident-group. As a subjective assessment, the confidence to perform a PJ anastomosis increased after simulation training (from 1.6 to 2.6). Participants considered that this structured teaching program is useful. Conclusion We developed a structured program for teaching PJ. By implementing this program, learning opportunities for surgical residents and fellows can be increased as a complement to training in the OR.
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Affiliation(s)
- Kenichi Oshiro
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kazuhiro Endo
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Kazue Morishima
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuji Kaneda
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masaru Koizumi
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hideki Sasanuma
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yasunaru Sakuma
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Identifying technical skills and clinical procedures in surgery for a simulation-based curriculum: a national general needs assessment. Surg Endosc 2021; 36:47-56. [PMID: 33398569 DOI: 10.1007/s00464-020-08235-7] [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: 08/18/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The efficacy of simulation-based training in surgical education is well known. However, the development of training programs should start with problem identification and a general needs assessment to ensure that the content is aligned with current surgical trainee needs. The objective of the present study is to identify the technical skills and clinical procedures that should be included in a simulation-based curriculum in general surgery. METHODS A national, three-round Delphi process was conducted to achieve consensus on which technical skills and clinical procedures should be included in a simulation-based curriculum in general surgery. In total, 87 key opinion leaders were identified and invited to the study. RESULTS Round 1 of the Delphi process had a response rate of 64% (56/87) and a total of 245 suggestions. Based on these suggestions, a consolidated list of 51 technical skills or clinical procedures was made. The response rate in Delphi round 2 was 62% (54/87) resulting in a pre-prioritized order of procedures for round 3. The response rate in Delphi round 3 was 65% (35/54). The final list included 13 technical skills and clinical procedures. Training was predominantly requested within general open surgical skills, laparoscopic skills, and endoscopic skills, and a few specific procedures such as appendectomy and cholecystectomy were included in the final prioritized list. CONCLUSION Based on the Delphi process 13 technical skills and clinical procedures were included in the final prioritized list, which can serve as a point of departure when developing simulation-based training in surgery.
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Johnston JL, Kearney GP, Gormley GJ, Reid H. Into the uncanny valley: Simulation versus simulacrum? MEDICAL EDUCATION 2020; 54:903-907. [PMID: 32314435 DOI: 10.1111/medu.14184] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Jennifer Laura Johnston
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Grainne P Kearney
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Gerard J Gormley
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Helen Reid
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Tejos R, Crovari F, Achurra P, Avila R, Inzunza M, Jarry C, Martinez J, Riquelme A, Alseidi A, Varas J. Video-Based Guided Simulation without Peer or Expert Feedback is Not Enough: A Randomized Controlled Trial of Simulation-Based Training for Medical Students. World J Surg 2020; 45:57-65. [PMID: 32892271 DOI: 10.1007/s00268-020-05766-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Feedback is a pivotal cornerstone and a challenge in psychomotor training. There are different teaching methodologies; however, some may be less effective. METHODS A prospective randomized controlled trial was conducted in 130 medical students to compare the effectiveness of the video-guided learning (VLG), peer-feedback (PFG) and the expert feedback (EFG) for teaching suturing skills. The program lasted 4 weeks. Students were recorded making 3-simple stitches (pre-assessment and post-assessment). The primary outcome was a global scale (OSATS). The secondary outcomes were performance time, specific rating scale (SRS) and the impact of the intervention (IOI), defined as the variation between the final and initial OSATS and SRS scores. RESULTS No significant differences were found between PFG and EFG in post-assessment results of OSATS, SRS scores or in the IOI for OSATS and SRS scores. Post-assessment results of PFG and EFG were significantly superior to VLG in OSATS and SRS scores [(19.8 (18.5-21); 16.6 (15.5-17.5)) and (20.3 (19.88-21); 16.8 (16-17.5)) vs (15.7 (15-16); 13.3 (12.5-14)) (p < 0.05)], respectively. The results of PFG and EFG were significantly superior to VLG in the IOI for OSATS [7 (4.5-9) and 7.4 (4.88-10) vs 3.5 (1.5-6) (p < 0.05)] and SRS scores [5.4 (3.5-7) and 6.3 (4-8.5) vs 3.1 (1.13-4.88) (p < 0.05)], respectively. CONCLUSION The video-guided learning methodology without any kind of feedback is not enough for teaching suturing skills compared to expert or peer feedback. The peer feedback methodology appears to be a viable alternative to handling the emerging demands in medical education.
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Affiliation(s)
- Rodrigo Tejos
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Fernando Crovari
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Ruben Avila
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Martín Inzunza
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Cristian Jarry
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Jorge Martinez
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Arnoldo Riquelme
- Department of Gastroenterology and Centre for Medical Education, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Julian Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile.
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Jarry Trujillo C, Achurra Tirado P, Escalona Vivas G, Crovari Eulufi F, Varas Cohen J. Surgical training during COVID-19: a validated solution to keep on practicing. Br J Surg 2020; 107:e468-e469. [PMID: 32790174 PMCID: PMC7436361 DOI: 10.1002/bjs.11923] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Cristian Jarry Trujillo
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile
| | - Pablo Achurra Tirado
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile
| | - Gabriel Escalona Vivas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile
| | - Fernando Crovari Eulufi
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile
| | - Julian Varas Cohen
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile
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Quezada J, Achurra P, Asbun D, Polom K, Roviello F, Buckel E, Inzunza M, Escalona G, Jarufe N, Varas J. Smartphone application supplements laparoscopic training through simulation by reducing the need for feedback from expert tutors. Surg Open Sci 2020; 1:100-104. [PMID: 32754701 PMCID: PMC7391878 DOI: 10.1016/j.sopen.2019.05.006] [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: 02/18/2019] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022] Open
Abstract
Background Simulation training is a validated, highly effective tool for learning laparoscopy. Feedback plays a crucial role in motor skills training. We present an app to guide students during advanced laparoscopy simulation training and evaluate its effect on training. Methods A smartphone(iOS)-app was developed. A group of trainees were randomized to use the app (YAPP) or not use the app (NAPP). We used blinded analysis with validated rating scales to assess their performance before and after the training. The number of requests for tutor feedback per session was recorded. Finally, the participants in the YAPP group completed a survey about their experience with the app. Results Fifteen YAPP and 10 NAPP completed the training program. There were no statistically significant differences between their skills performance scores (P = .338). The number of tutor feedback requests in the YAPP and NAPP was of 4 (3–6) and 13 (10–14) (P < .001), respectively. All participants in the YAPP group found the app was useful. Conclusion The use of a smartphone app reduces the need for expert tutor feedback without decreasing the degree of skills acquisition. Simulation training is a validated, highly effective tool for learning laparoscopy. Feedback plays a crucial role in motor skills training. Expert feedback is often scarce, and tutors are usually not always available. Simulation and mobile technology must be further combined to improve training efficacy.
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Affiliation(s)
- Jose Quezada
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Karol Polom
- General Surgery and Surgical Oncology Department, University of Siena, Siena, Italy.,Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Franco Roviello
- General Surgery and Surgical Oncology Department, University of Siena, Siena, Italy
| | - Erwin Buckel
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Escalona
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Jarufe
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julian Varas
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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Aslam W, Lee HJ, Lamb CR. Standardizing education in interventional pulmonology in the midst of technological change. J Thorac Dis 2020; 12:3331-3340. [PMID: 32642256 PMCID: PMC7330781 DOI: 10.21037/jtd.2020.03.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Interventional pulmonology (IP) is a maturing subspecialty of pulmonary medicine. The robust innovation in technology demands standardization in IP training with both disease and technology driven training. Simulation based training should be considered a part of IP training as seen in other procedural and surgical subspecialties. Procedure volume is a component of training; however, this does not guarantee or translate into competency for learners. Basic competency skills can be assessed using standardized well validated assessment tools designed for various IP procedures including flexible bronchoscopy, endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA), rigid bronchoscopy and chest tube placement; however, further work is needed to validate tools in all procedures as new technologies are introduced beyond fellowship training. Currently there are at least 39 IP fellowship programs in the United States (US) and Canada which has led to improved training by accreditation of programs who meet rigorous requirements of standardized curriculum and procedural volume. The challenge is to be innovative in how we teach globally with intention and how to best integrate new evolving technology training for those not only during fellowship training but also beyond fellowship training.
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Affiliation(s)
- Waqas Aslam
- Department of Interventional Pulmonary, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Hans J Lee
- Department of Interventional Pulmonary, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carla R Lamb
- Department of Interventional Pulmonary, Lahey Hospital & Medical Center, Burlington, MA, USA
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Moekotte AL, Rawashdeh A, Asbun HJ, Coimbra FJ, Edil BH, Jarufe N, Jeyarajah DR, Kendrick ML, Pessaux P, Zeh HJ, Besselink MG, Abu Hilal M, Hogg ME. Safe implementation of minimally invasive pancreas resection: a systematic review. HPB (Oxford) 2020; 22:637-648. [PMID: 31836284 DOI: 10.1016/j.hpb.2019.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimally invasive pancreas resection (MIPR) has been expanding in the past decade. Excellent outcomes have been reported, however, safety concerns exist. The aim of this study was to define prerequisites for performing MIPR with the objective to guide safe implementation of MIPR into clinical practice. METHODS This systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). PubMed, Embase and Cochrane databases were searched for literature concerning the implementation of MIPR between 1946 and November 2018. Quality assessment was according to The Scottish Intercollegiate Guidelines Network (SIGN). RESULTS Overall, 1150 studies were screened, of which 32 studies with 8519 patients were included in this systematic review. Training programs for minimally invasive distal pancreatectomy, laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy have been described with acceptable outcomes during the learning curve and improved outcomes after training. Learning curve studies have revealed an association between growing experience and improving perioperative outcomes. In addition, the association between higher center volume and lower mortality and morbidity has been reported by several studies. CONCLUSION When embarking on MIPR, it is recommended to participate in a dedicated training program, to assure a sufficient volume, especially when implementing minimally invasive pancreatoduodenectomy, (20 procedures recommended annually), and prospectively collect and closely monitor outcomes for continuous quality assessment, this can be achieved through institutional databases and participation in national or international registries.
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Affiliation(s)
- Alma L Moekotte
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Arab Rawashdeh
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Horacio J Asbun
- Department of Hepatopancreatobiliary Surgery, Baptist Health South Florida, Miami, USA
| | - Felipe J Coimbra
- Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, Brazil
| | - Barish H Edil
- Department of Surgery University of Oklahoma, Oklahoma City, USA
| | - Nicolás Jarufe
- Department of Digestive Surgery, Pontifical Catholic University of Chile, Santiago, Chile
| | - D Rohan Jeyarajah
- Gastrointestinal Surgical Services, Methodist Richardson Medical Center, Richardson, TX, USA
| | | | - Patrick Pessaux
- Department of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Mohammed Abu Hilal
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK; Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Melissa E Hogg
- Department of Surgery, Northshore University HealthSystem, Evanston, IL, USA.
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van Dalen ASHM, Jansen M, van Haperen M, van Dieren S, Buskens CJ, Nieveen van Dijkum EJM, Bemelman WA, Grantcharov TP, Schijven MP. Implementing structured team debriefing using a Black Box in the operating room: surveying team satisfaction. Surg Endosc 2020; 35:1406-1419. [PMID: 32253558 PMCID: PMC7886753 DOI: 10.1007/s00464-020-07526-3] [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: 12/19/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
Background Surgical safety may be improved using a medical data recorder (MDR) for the purpose of postoperative team debriefing. It provides the team in the operating room (OR) with the opportunity to look back upon their joint performance objectively to discuss and learn from suboptimal situations or possible adverse events. The aim of this study was to investigate the satisfaction of the OR team using an MDR, the OR Black Box®, in the OR as a tool providing output for structured team debriefing. Methods In this longitudinal survey study, 35 gastro-intestinal laparoscopic operations were recorded using the OR Black Box® and the output was subsequently debriefed with the operating team. Prior to study, a privacy impact assessment was conducted to ensure alignment with applicable legal and regulatory requirements. A structured debrief model and an OR Back Box® performance report was developed. A standardized survey was used to measure participant’s satisfaction with the team debriefing, the debrief model used and the performance report. Factor analysis was performed to assess the questionnaire’s quality and identified contributing satisfaction factors. Multivariable analysis was performed to identify variables associated with participants’ opinions. Results In total, 81 team members of various disciplines in the OR participated, comprising 35 laparoscopic procedures. Mean satisfaction with the OR Black Box® performance report and team debriefing was high for all 3 identified independent satisfaction factors. Of all participants, 98% recommend using the OR Black Box® and the outcome report in team debriefing. Conclusion The use of an MDR in the OR for the purpose of team debriefing is considered to be both beneficial and important. Team debriefing using the OR Black Box® outcome report is highly recommended by 98% of team members participating. Electronic supplementary material The online version of this article (10.1007/s00464-020-07526-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A S H M van Dalen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Haperen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dieren
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C J Buskens
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T P Grantcharov
- International Centre for Surgical Safety, St Michael's Hospital, Toronto, Canada
| | - M P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Orthopaedic Residents' Transfer of Knee Arthroscopic Abilities from the Simulator to the Operating Room. J Am Acad Orthop Surg 2020; 28:194-199. [PMID: 31415299 DOI: 10.5435/jaaos-d-19-00245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The ultimate goal for any surgical simulation program is to prove the capability of transferring the skills learned to real-life surgical scenarios. We designed an arthroscopic partial meniscectomy (APM) training program and sought to determine its ability to transfer skills to real patients. METHODS Eleven junior orthopaedic residents and three expert knee surgeons were included. A low-fidelity knee simulator was used. Trainees had two baseline assessments of completing APM on a supervised real patient and on the simulator, measured using the Arthroscopic Surgical Skill Evaluation Tool (ASSET). After baseline, the trainees completed an APM training program and had a final evaluation of proficiency on the simulator and in real patients. Experts were also assessed for comparison. Statistical analysis was performed, assuming nonparametric behavior of variables. RESULTS All trainees improved from a base score of 14 points in real patients and 10 points on the simulator to a final score of 39 points and 36 points, respectively (P < 0.01). The final trainee simulator score did not differ from experts on the simulator and was lower in real patients (36 versus 39 points, respectively, P ≤ 0.01), which resulted in a 92% transfer ratio for the simulator. DISCUSSION Simulated training of APM in orthopaedic residents using a low-fidelity knee simulator proved to not only improve simulated proficiency but also successfully transfer skills to a real clinical scenario with a high model transfer ratio. LEVEL OF EVIDENCE Level II (Prospective Cohort Study).
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Zevin B, Sheahan G, Ashamalla S, Dedy NJ, Jalink D, Grantcharov T. Implementation and evaluation of a comprehensive proficiency-based curriculum in an advanced, minimally invasive procedure: a multi-institutional Canadian experience. Surg Obes Relat Dis 2019; 15:1956-1964. [DOI: 10.1016/j.soard.2019.09.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/24/2019] [Accepted: 09/03/2019] [Indexed: 02/02/2023]
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Quezada J, Achurra P, Jarry C, Asbun D, Tejos R, Inzunza M, Ulloa G, Neyem A, Martínez C, Marino C, Escalona G, Varas J. Minimally invasive tele-mentoring opportunity—the mito project. Surg Endosc 2019; 34:2585-2592. [DOI: 10.1007/s00464-019-07024-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
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Tejos R, Avila R, Inzunza M, Achurra P, Castillo R, Rosberg A, Cordero O, Kusanovich R, Bellolio F, Varas J, Martínez J. IMPACT OF A SIMULATED LAPAROSCOPIC TRAINING PROGRAM IN A THREE-YEAR GENERAL SURGERY RESIDENCY. ACTA ACUST UNITED AC 2019; 32:e1436. [PMID: 31038561 PMCID: PMC6488269 DOI: 10.1590/0102-672020190001e1436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022]
Abstract
Background: A General Surgery Residency may last between 2-6 years, depending on the
country. A shorter General Surgery Residency must optimize residents’
surgical exposure. Simulated surgical training is known to shorten the
learning curves, but information related to how it affects a General Surgery
Residency regarding clinical exposure is scarce. Aim: To analyze the effect of introducing a validated laparoscopic simulated
training program in abdominal procedures performed by residents in a
three-year General Surgery Residency program. Methods: A non-concurrent cohort study was designed. Four-generations (2012-2015) of
graduated surgeons were included. Only abdominal procedures in which the
graduated surgeons were the primary surgeon were described and analyzed. The
control group was of graduated surgeons from 2012 without the laparoscopic
simulated training program. Surgical procedures per program year, surgical
technique, emergency/elective intervention and hospital-site (main/community
hospitals) were described. Results: Interventions of 28 graduated surgeons were analyzed (control group=5;
laparoscopic simulated training program=23). Graduated surgeons performed a
mean of 372 abdominal procedures, with a higher mean number of
medium-to-complex procedures in laparoscopic simulated training program
group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic
simulated training program performed a higher number of total abdominal
procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148,
p<0.05). Conclusions: The introduction of laparoscopic simulated training program may increase the
number and complexity of total and laparoscopic procedures in a three-year
General Surgery Residency.
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Affiliation(s)
- Rodrigo Tejos
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén Avila
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Richard Castillo
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Anne Rosberg
- International Internship, School of Medicine, Albert-Ludwigs-University of Freiburg, Baden-Württemberg, Germany
| | - Octavio Cordero
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Kusanovich
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Bellolio
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julián Varas
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Martínez
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Tejos R, Chahuán J, Uslar T, Inzunza M, Villagrán I, Riquelme V, Padilla O, Pizarro M, Corvetto M, Varas J, Riquelme A. Simulated training program in abdominal paracentesis for undergraduate medical students. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:239-247. [PMID: 30471721 DOI: 10.1016/j.gastrohep.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Abdominal paracentesis is an area that every general physician should know about, and the current learning model is unsafe for patients. Simulation allows students to develop their skills prior to clinical confrontation with minimal risks. The aims of this study were to design and evaluate a paracentesis simulation workshop for undergraduate students. METHODS A workshop was implemented using a specially designed and validated simulation model for abdominal paracentesis. The simulated technique considered the recognition of materials, operator equipment, asepsis, anesthesia, puncture and obtaining liquid, collecting samples for analysis, withdrawal of the material and occlusion. A 24-point direct observation checklist was administered to assess the student. We assessed two students at the beginning of the workshop and all the students at the end. A perception survey was applied to attendees at the end of the workshop. RESULTS 247 students were included and a workshop that involved 8 students per session was held. Students significantly improved their skills comparing pre- and post-evaluation results [13.36±4.46 (55.7%) vs. 22.3±1.83 (92.9%) respectively (n=69) p<0.001]. The students' perception questionnaire (n=38) showed that the training sessions were highly valued, averaging 4.8±0.38 on a Likert scale of 1-5. CONCLUSIONS Simulated training in abdominal paracentesis is a very good teaching method. This teaching methodology should be highly recommended as an educational strategy in medicine because it could accelerate the acquisition of clinical skills in a safe learning environment.
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Affiliation(s)
- Rodrigo Tejos
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Javier Chahuán
- Departamento Medicina Interna, Escuela de Medicina. Pontificia Universidad Católica de Chile, Chile
| | - Thomas Uslar
- Departamento Medicina Interna, Escuela de Medicina. Pontificia Universidad Católica de Chile, Chile
| | - Martin Inzunza
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Ignacio Villagrán
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Valentina Riquelme
- Escuela de Arte, Facultad de Artes, Pontificia Universidad Católica de Chile, Chile
| | - Oslando Padilla
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Margarita Pizarro
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Marcia Corvetto
- Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Julián Varas
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Arnoldo Riquelme
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Educación Médica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile.
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Lichtman AS, Parker W, Goff B, Mehra N, Shore EM, Lefebvre G, Chiang A, Lenihan J, Schreuder HWR. A Randomized Multicenter Study Assessing the Educational Impact of a Computerized Interactive Hysterectomy Trainer on Gynecology Residents. J Minim Invasive Gynecol 2018; 25:1035-1043. [PMID: 29410142 DOI: 10.1016/j.jmig.2018.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To assess the improvement of cognitive surgical knowledge of laparoscopic hysterectomy in postgraduate year (PGY) 1 and 2 gynecology residents who used an interactive computer-based Laparoscopic Hysterectomy Trainer (Red Llama, Inc., Seattle, WA). DESIGN A multicenter, randomized, controlled study (Canadian Task Force classification I). SETTING Five departments of obstetrics and gynecology: Keck School of Medicine of the University of Southern California, Los Angeles, CA; University of California, Los Angeles, Los Angeles, CA; University of Washington, Seattle, WA; University of British Columbia, Vancouver, British Columbia, Canada; and University of Toronto, Toronto, Ontario, Canada. PARTICIPANTS Gynecology residents, fellows, faculty, and minimally invasive surgeons. INTERVENTIONS The use of an interactive computer-based Laparoscopic Hysterectomy Trainer. MEASUREMENTS AND MAIN RESULTS In phase 1 of this 3-phase multicenter study, 2 hysterectomy knowledge assessment tests (A and B) were developed using a modified Delphi technique. Phase 2 administered these 2 online tests to PGY 3 and 4 gynecology residents, gynecology surgical fellows, faculty, and minimally invasive surgeons (n = 60). In phase 3, PGY 1 and 2 gynecology residents (n = 128) were recruited, and 101 chose to participate, were pretested (test A), and then randomized to the control or intervention group. Both groups continued site-specific training while the intervention group additionally used the Laparoscopic Hysterectomy Trainer. Participant residents were subsequently posttested (test B). Phase 2 results showed no differences between cognitive tests A and B when assessed for equivalence, internal consistency, and reliability. Construct validity was shown for both tests (p < .001). In phase 3, the pretest mean score for the control group was 242 (standard deviation [SD] = 56.5), and for the intervention group it was 217 (SD = 57.6) (nonsignificant difference, p = .089). The t test comparing the posttest control group (mean = 297, SD = 53.6) and the posttest intervention group (mean = 343, SD = 50.9) yielded a significant difference (p < .001, 95% confidence interval, 48.4-108.8). Posttest scores for the intervention group were significantly better than for the control group (p < .001). CONCLUSION Using the Laparoscopic Hysterectomy Trainer significantly increased knowledge of the hysterectomy procedure in PGY 1 and 2 gynecology residents.
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Affiliation(s)
- Allan S Lichtman
- Keck School of Medicine of the University of Southern California, Los Angeles, California.
| | - William Parker
- Geffen School of Medicine at the University of California, Los Angeles, California
| | - Barbara Goff
- University of Washington School of Medicine, Seattle, Washington
| | - Neeraj Mehra
- University of British Columbia School of Medicine, Vancouver, British Columbia, Canada
| | - Eliane M Shore
- University of Toronto School of Medicine, Toronto, Ontario, Canada
| | | | - Alexander Chiang
- Geffen School of Medicine at the University of California, Los Angeles, California
| | - John Lenihan
- Multicare Womens Specialists, Tacoma, Washington
| | - Henk W R Schreuder
- Department of Gynaecolgic Oncology, University Medical Center, Utrecht, Netherlands
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Choe JK, Ibarra C, Feinn RS, Rodriguez-Davalos MI, Carter CW. Concurrent Surgery and the Role of the Pediatric Attending Surgeon: Comparing Parents' and Surgeons' Expectations. J Am Coll Surg 2018; 226:1022-1029. [DOI: 10.1016/j.jamcollsurg.2018.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
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A scoping review of assessment tools for laparoscopic suturing. Surg Endosc 2018; 32:3009-3023. [PMID: 29721749 DOI: 10.1007/s00464-018-6199-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A needs assessment identified a gap in teaching and assessment of laparoscopic suturing (LS) skills. The purpose of this review is to identify assessment tools that were used to assess LS skills, to evaluate validity evidence available, and to provide guidance for selecting the right assessment tool for specific assessment conditions. METHODS Bibliographic databases were searched till April 2017. Full-text articles were included if they reported on assessment tools used in the operating room/simulation to (1) assess procedures that require LS or (2) specifically assess LS skills. RESULTS Forty-two tools were identified, of which 26 were used for assessing LS skills specifically and 26 for procedures that require LS. Tools had the most evidence in internal structure and relationship to other variables, and least in consequences. CONCLUSION Through identification and evaluation of assessment tools, the results of this review could be used as a guideline when implementing assessment tools into training programs.
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Mora MC, Wong KE, Fernandez GL, Tirabassi MV. Single incision laparoscopic proficiency correlates with residency training level. J Surg Res 2017; 221:211-215. [PMID: 29229130 DOI: 10.1016/j.jss.2017.08.050] [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: 02/10/2017] [Revised: 07/29/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND With experience, certain psychomotor skills should translate from standard laparoscopy to single-incision laparoscopy (SIL). We proposed to compare all surgical postgraduate year (PGY) levels and determine if experience translated to improved SIL skills. METHODS Surgical residents of all PGY levels (1-5) at our institution were included. Baseline surveys were obtained to determine resident level of exposure to both SIL and standard laparoscopic cases. Participants performed the following tasks: running of the bowel, endoloop placement, extracorporeal suture tying, and intracorporeal suture tying. Tasks were performed on a commercially provided simulated inanimate organ model. Participants were given 5 min to complete each task. Data were collected and analyzed by an impartial-certified Fundamentals of Laparoscopic Surgery proctor. RESULTS A total of 31 residents participated in the study. Overall, there was minimal SIL exposure among all residents. As expected, PGY level correlated with increased ability to complete assigned tasks within the allotted time. There was a statistically significant difference in the number of individuals able to complete a task based on PGY level for all given tasks (P = 0.005). With increased difficulty, the percentage of higher level residents able to complete the task decreased (100% PGY5 completed running of bowel versus 0% intracorporeal knot tying). CONCLUSIONS Certain psychomotor skills did appear to translate to SIL skills. However, further dedicated SIL training may help to better develop certain laparoscopic skills devoted to SIL.
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Affiliation(s)
- Maria Carmen Mora
- Department of Surgery, Baystate Medical Center, UMass Medical School, Springfield, Massachusetts.
| | - Kaitlyn E Wong
- Department of Surgery, Baystate Medical Center, UMass Medical School, Springfield, Massachusetts
| | - Gladys L Fernandez
- Department of Surgery, Baystate Medical Center, UMass Medical School, Springfield, Massachusetts
| | - Michael V Tirabassi
- Department of Surgery, Baystate Children's Hospital, UMass Medical School, Springfield, Massachusetts
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Achurra P, Lagos A, Avila R, Tejos R, Buckel E, Alvarado J, Boza C, Jarufe N, Varas J. Allowing New Opportunities in Advanced Laparoscopy Training Using a Full High-Definition Training Box. Surg Innov 2016; 24:66-71. [PMID: 27729567 DOI: 10.1177/1553350616672963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Simulated laparoscopy training is limited by its low-quality image. A high-definition (HD) laparoscopic training box was developed under the present necessity of simulating advanced surgery. OBJECTIVE To describe and test a new HD laparoscopic training box for advanced simulation training. METHODS We describe the features and image quality of the new training box. The simulator was tested and then evaluated by a group of 76 expert surgeons using a 4-item questionnaire. To assess the effectiveness of training using this simulation box, 15 general surgery residents were trained to perform a laparoscopic jejuno-jejunostomy in a validated simulation program. They were assessed with objective rating scales before and after the training program, and their results were compared with that of experts. RESULTS The training box was assembled using high-density fiberglass shaped as an insufflated abdomen. It has an adapted full-HD camera with a LED-based illumination system. A manually self-regulated monopod attached to the camera enables training without assistance. Of the expert surgeons who answered the questionnaire, 91% said that the simulation box had a high-quality image and that it was very similar to real laparoscopy. All residents trained improved their rating scores significantly when comparing their initial versus final assessment ( P < .001). Their performance after completing the training in the box was similar to that of experts ( P > .2). CONCLUSIONS This novel laparoscopic training box presents a high-resolution image and allows training different types of advanced laparoscopic procedures. The simulator box was positively assessed by experts and demonstrated to be effective for laparoscopy training in resident surgeons.
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Affiliation(s)
- Pablo Achurra
- 1 Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Lagos
- 1 Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ruben Avila
- 1 Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Tejos
- 1 Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erwin Buckel
- 1 Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Alvarado
- 1 Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camilo Boza
- 1 Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Jarufe
- 1 Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julian Varas
- 1 Pontificia Universidad Católica de Chile, Santiago, Chile
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