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Corvetto MA, Kattan E, Ramírez G, Besa P, Abbott E, Zamorano E, Contreras V, Altermatt FR. Simulation-Based Training Program for Peripherally Inserted Central Catheter Placement: Randomized Comparative Study of in-Person Training With Synchronous Feedback Versus Distance Training With Asynchronous Feedback. Simul Healthc 2024:01266021-990000000-00126. [PMID: 38888993 DOI: 10.1097/sih.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Simulation training that includes deliberate practice is effective for procedural skill training. Delivering feedback remotely and asynchronously has been examined for more cost-efficient training. This prospective randomized study aimed to compare 2 feedback techniques for simulation training: synchronous direct feedback versus asynchronous distance feedback (ASYNC). METHODS Forty anesthesia and internal medicine residents were recruited after study approval by the institutional ethics committee. Residents reviewed instructional material on an online platform and performed a pretraining assessment (PRE) for peripherally inserted central catheter (PICC) placement. Each resident was then randomly assigned to 1 of 2 training types, practice with synchronous direct feedback (SYNC) or practice with ASYNC. Training consisted of four, 1-hour practice sessions; each was conducted once per week. Both groups underwent posttraining evaluation (POST). The PRE and POST assessments were videotaped and evaluated by 2 independent, blinded reviewers using a global rating scale. RESULTS Thirty-five residents completed the training program and both evaluations. Both groups had significantly improved global rating scale scores after 4 sessions. The SYNC group improved from 28 to 45 points (P < 0.01); the ASYNC group improved from 26.5 to 46 points (P < 0.01). We found no significant between-group differences for the PRE (P = 0.42) or POST assessments (P = 0.13). CONCLUSION This simulation-based training program significantly improved residents' peripherally inserted central venous catheter placement skills using either modality. With these results, we are unable to demonstrate the superiority of synchronous feedback over ASYNC. Asynchronous feedback training modality represents a new, innovative approach for health care procedural skills training.
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Affiliation(s)
- Marcia A Corvetto
- From the División de Anestesiología (M.A.C., G.R., F.R.A.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Medicina Intensiva (E.K.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Traumatología (P.B.), Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; and Experimental Surgery and Simulation Center (M.A.C., E.A., E.Z., V.C.), Escuela de Medicina, 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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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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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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Belmar F, Gaete MI, Durán V, Chelebifski S, Jarry C, Ortiz C, Escalona G, Villagrán I, Alseidi A, Zamorano E, Pimentel F, Crovari F, Varas J. Taking advantage of asynchronous digital feedback: development of an at-home basic suture skills training program for undergraduate medical students that facilitates skills retention. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:32. [PMID: 38013870 PMCID: PMC9900196 DOI: 10.1007/s44186-023-00112-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/27/2022] [Accepted: 01/28/2023] [Indexed: 02/08/2023]
Abstract
Purpose To date, there are no training programs for basic suturing that allow remote deliberate practice. This study seeks to evaluate the effectiveness of a basic suture skills training program and its 6-month skill retention applying unsupervised practice and remote digital feedback. Methods Fourth-year medical-student trainees reviewed instructional videos from a digital platform and performed unsupervised practice as needed at their homes. When they felt competent, trainees uploaded a video of themselves practicing the skill. In < 72 h, they received expert asynchronous digital feedback. The course had two theoretical stages and five video-based assessments, where trainees performed different suturing exercises. For the assessment, a global (GRS) and specific rating scale (SRS) were used, with a passing score of 20 points (max:25) and 15 (max:20), respectively. Results were compared to previously published work with in-person expert feedback (EF) and video-guided learning without feedback (VGL). A subgroup of trainees underwent a 6-month skills retention assessment. Results Two-hundred and forty-three trainees underwent the course between March and December 2021. A median GRS of 24 points was achieved in the final assessment, showing significantly higher scores (p < 0.001) than EF and VGL (20.5 and 15.5, respectively). Thirty-seven trainees underwent a 6-month skills retention assessment, improving in GRS (23.38 vs 24.03, p value = 0.06) and SRS (18.59 vs 19, p value = 0.07). Conclusion It is feasible to teach basic suture skills to undergraduate medical students using an unsupervised training course with remote and asynchronous feedback through a digital platform. This methodology allows continuous training with the repetition of quality practice, personalized feedback, and skills retention at 6 months.
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Affiliation(s)
- Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Slavka Chelebifski
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Cristián Jarry
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Catalina Ortiz
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA USA
| | - Elga Zamorano
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Fernando Pimentel
- Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
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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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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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Harrell Shreckengost CS, Reitz A, Ludi E, Rojas Aban R, Jáuregui Paravicini L, Serrot F. Lessons learned during the COVID-19 pandemic using virtual basic laparoscopic training in Santa Cruz de la Sierra, Bolivia: effects on confidence, knowledge, and skill. Surg Endosc 2022; 36:9379-9389. [PMID: 35419639 PMCID: PMC9007578 DOI: 10.1007/s00464-022-09215-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND An international surgical team implemented a virtual basic laparoscopic surgery course for Bolivian general and pediatric surgeons and residents during the COVID-19 pandemic. This simulation course aimed to enhance training in a lower-resource environment despite the challenges of decreased operative volume and lack of in-person instruction. METHODS The course was developed by surgeons from Bolivian and U.S.-based institutions and offered twice between July-December 2020. Didactic content and skill techniques were taught via weekly live videoconferences. Additional mentorship was provided through small group sessions. Participants were evaluated by pre- and post-course tests of didactic content as well as by video task review. RESULTS Of the 24 enrolled participants, 13 were practicing surgeons and 10 were surgery residents (one unspecified). Fifty percent (n = 12) indicated "almost never" performing laparoscopic surgeries pre-course. Confidence significantly increased for five laparoscopic tasks. Test scores also increased significantly (68.2% ± 12.5%, n = 21; vs 76.6% ± 12.6%, n = 19; p = 0.040). While challenges impeded objective evaluation for the first course iteration, adjustments permitted video scoring in the second iteration. This group demonstrated significant improvements in precision cutting (11.6% ± 16.7%, n = 9; vs 62.5% ± 18.6%, n = 6; p < 0.001), intracorporeal knot tying (36.4% ± 38.1%, n = 9; vs 79.2% ± 17.2%, n = 7; p = 0.012), and combined skill (40.3% ± 17.7%; n = 8 vs 77.2% ± 13.6%, n = 4; p = 0.042). Collectively, combined skill scores improved by 66.3% ± 10.4%. CONCLUSION Virtual international collaboration can improve confidence, knowledge, and basic laparoscopic skills, even in resource-limited settings during a global pandemic. Future efforts should focus on standardizing resources for participants and enhancing access to live feedback resources between classes.
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Affiliation(s)
| | - Alexandra Reitz
- Department of Surgery, Emory University, 1364 Clifton Road Suite B206, Atlanta, GA, 30322, USA
| | - Erica Ludi
- Department of Surgery, Emory University, 1364 Clifton Road Suite B206, Atlanta, GA, 30322, USA
| | - Raúl Rojas Aban
- Department of Pediatric Surgery, Caja de Salud de la Banca Privada, Santa Cruz de la Sierra, Bolivia
| | | | - Federico Serrot
- Department of Surgery, Emory University, 1364 Clifton Road Suite B206, Atlanta, GA, 30322, USA
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9
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Ortiz C, Vela J, Contreras C, Belmar F, Paul I, Zinco A, Ramos JP, Ottolino P, Achurra P, Jarufe N, Alseidi A, Varas J. A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program. Surg Endosc 2022; 36:8441-8450. [PMID: 35237901 PMCID: PMC8890468 DOI: 10.1007/s00464-022-09098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents' exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. METHODS A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 different programs were recruited. Each station was videotaped in high definition and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specific rating scales alongside procedural times. Self-confidence to perform the procedure as the leading surgeon was evaluated before and after training. RESULTS Statistically significant differences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants significantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A significant improvement in self-confidence was shown in all stations. CONCLUSION An OSCE scenario for training surgical skills in trauma was effective in improving proficiency level and self-confidence. Low pre-training scores and level of confidence in the cardiac and lung injury stations represent a deficit in residency programs that should be addressed. The incorporation of simulation-based teaching tools at early stages in residency would be beneficial when future surgeons face extremely severe trauma scenarios.
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Affiliation(s)
- Catalina Ortiz
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Vela
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Caterina Contreras
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Belmar
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ivan Paul
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Analia Zinco
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Juan Pablo Ramos
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Pablo Ottolino
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Jarufe
- Department of Surgery, Clínica Las Condes, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Julian Varas
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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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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Evidence-based Guidelines on the Use of Virtual Surgical Education Pertaining to the Domains of Cognition and Curriculum, Psychomotor Skills Training, and Faculty Development and Mentorship. Ann Surg 2022; 276:e6-e15. [PMID: 34171862 DOI: 10.1097/sla.0000000000005014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify, categorize, and evaluate the quality of literature, and to provide evidence-based guidelines on virtual surgical education within the cognitive and curricula, psychomotor, and faculty development and mentorship domains. SUMMARY OF BACKGROUND DATA During the coronavirus disease 2019 pandemic, utilizing virtual learning modalities is expanding rapidly. Although the innovative methods must be considered to bridge the surgical education gap, a framework is needed to avoid expansion of virtual education without proper supporting evidence in some areas. METHODS The Association for Surgical Education formed an ad-hoc research group to evaluate the quality and methodology of the current literature on virtual education and to build evidence-based guidelines by utilizing the SiGN methodology. We identified patient/problem-intervention-comparison-outcome-style questions, conducted systematic literature reviews using PubMed, EMBASE, and Education Resources information Center databases. Then we formulated evidence-based recommendations, assessed the quality of evidence using Grading of Recommendations, Assessment, Development, and Evaluation, Newcastle-Ottawa Scale for Education, and Kirkpatrick ratings, and conducted Delphi consensus to validate the recommendations. RESULTS Eleven patient/problem-intervention-comparison-outcome-style questions were designed by the expert committees. After screening 4723 articles by the review committee, 241 articles met inclusion criteria for full article reviews, and 166 studies were included and categorized into 3 domains: cognition and curricula (n = 92), psychomotor, (n = 119), and faculty development and mentorship (n = 119). Sixteen evidence-based recommendations were formulated and validated by an external expert panel. CONCLUSION The evidence-based guidelines developed using SiGN methodology, provide a set of recommendations for surgical training societies, training programs, and educators on utilizing virtual surgical education and highlights the area of needs for further investigation.
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Chandran VP, Balakrishnan A, Rashid M, Pai Kulyadi G, Khan S, Devi ES, Nair S, Thunga G. Mobile applications in medical education: A systematic review and meta-analysis. PLoS One 2022; 17:e0265927. [PMID: 35324994 PMCID: PMC8947018 DOI: 10.1371/journal.pone.0265927] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This review evaluates the effectiveness of smartphone applications in improving academic performance and clinical practice among healthcare professionals and students. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were retrieved from PubMed, Scopus, and Cochrane library through a comprehensive search strategy. Studies that included medical, dental, nursing, allied healthcare professional, undergraduates, postgraduates, and interns from the same disciplines who used mobile applications for their academic learning and/or daily clinical practice were considered. Results 52 studies with a total of 4057 learner participants were included in this review. 33 studies (15 RCTs, 1 cluster RCT, 7 quasi-experimental studies, 9 interventional cohort studies and 1 cross-sectional study) reported that mobile applications were an effective tool that contributed to a significant improvement in the knowledge level of the participants. The pooled effect of 15 studies with 962 participants showed that the knowledge score improved significantly in the group using mobile applications when compared to the group who did not use mobile applications (SMD = 0.94, 95% CI = 0.57 to1.31, P<0.00001). 19 studies (11 RCTs, 3 quasi-experimental studies and 5 interventional cohort studies) reported that mobile applications were effective in significantly improving skills among the participants. Conclusion Mobile applications are effective tools in enhancing knowledge and skills. They can be considered as effective adjunct tools in medical education by considering their low expense, high versatility, reduced dependency on regional or site boundaries, online and offline, simulation, and flexible learning features of mobile apps.
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Affiliation(s)
- Viji Pulikkel Chandran
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Athira Balakrishnan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Pai Kulyadi
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sohil Khan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
- School of Pharmacy and Medical Sciences, Quality Use of Medicines Network, Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Elsa Sanatombi Devi
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sreedharan Nair
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
- * E-mail: ,
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13
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Zaghal A, Marley C, Rahhal S, Hassanieh J, Saadeh R, El-Rifai A, Qaraqe T, ElBejjani M, Jaafar R, Hoballah JJ. Face-to-face versus distance learning of basic suturing skills in novice learners: a quantitative prospective randomized trial. BMC MEDICAL EDUCATION 2022; 22:290. [PMID: 35436934 PMCID: PMC9014782 DOI: 10.1186/s12909-022-03353-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIM Traditionally, practical skills are taught on face-to-face (F-F) basis. COVID-19 pandemic brought distance learning (DL) to the spotlight because of the social distancing mandates. We sought to determine the acceptability and effectiveness of DL of basic suturing in novice learners. METHODS A prospective randomized controlled trial involving 118 students was conducted. Participants were randomized into two groups for learning simple interrupted suturing: F-F and DL-groups. Evaluation was conducted by two assessors using a performance checklist and a global rating tool. Agreement between the assessors was calculated, and performance scores of the participants were compared. Participants' satisfaction was assessed via a questionnaire. RESULTS Fifty-nine students were randomized to the F-F group and 59 to the DL-group. Satisfactory agreement between the assessors was demonstrated. All participants were successful in placing three interrupted sutures, with no significant difference in the performance between the groups. 25(44.6%) of the respondents in the DL-group provided negative comments related to the difficulties of remotely learning visuospatial concepts, 16(28.5%) preferred the F-F approach. CONCLUSION DL of basic suturing is as effective as the F-F approach in novice learners. It is acceptable by the students despite the challenges related to the remote learning of practical skills.
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Affiliation(s)
- Ahmad Zaghal
- Department of Surgery, Division of General Surgery, American University of Beirut-Medical Center, Beirut, Lebanon.
| | - Charles Marley
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Salim Rahhal
- Department of Surgery, Division of General Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Joelle Hassanieh
- Department of Surgery, Division of General Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Rami Saadeh
- Department of Surgery, Division of General Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Arwa El-Rifai
- Department of Surgery, Division of General Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Taha Qaraqe
- Department of Surgery, Division of General Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Martine ElBejjani
- Clinical Research Unit and Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Rola Jaafar
- Department of Surgery, Division of General Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Jamal J Hoballah
- Department of Surgery, Division of General Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
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14
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Vera M, Kattan E, Cerda T, Niklitshek J, Montaña R, Varas J, Corvetto MA. Implementation of Distance-Based Simulation Training Programs for Healthcare Professionals: Breaking Barriers During COVID-19 Pandemic. Simul Healthc 2021; 16:401-406. [PMID: 33913677 DOI: 10.1097/sih.0000000000000550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY STATEMENT The sudden rise of critically ill patients secondary to the SARS-CoV-2 pandemic has triggered a surge in healthcare response. This project's goal was to provide essential cognitive and technical skills to healthcare professionals returning to the workforce or reassigned to critical care clinical duties during the COVID-19 pandemic. The plan included the implementation of 4 distance-based simulation training programs, with asynchronous personalized feedback. The courses allowed the acquisition of skills for the complete critical care patient management chain: use of personal protection equipment, use of a high-flow nasal cannula, endotracheal intubation, and prone positioning. Participants logged into the platform, reviewed material, practiced while recording the session, and uploaded the video through the training platform. The expert tutor remotely delivered asynchronous feedback. Participants trained remotely until achieving course approval. Remote-based simulation seems a feasible and attractive alternative to provide adequate educational solutions, especially for remote and rural areas.
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Affiliation(s)
- Magdalena Vera
- From the División de Anestesiología, Facultad de Medicina (R.M., M.A.C.); Departamento de Medicina Intensiva, Facultad de Medicina (M.V., E.K.); Escuela de Medicina, Facultad de Medicina (T.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; División de Pediatria, Facultad de Medicina (J.N.); Pontificia Universidad Católica de Chile; and Departamento de Cirugía Digestiva, Facultad de Medicina (J.V.), Pontificia Universidad Católica de Chile, Santiago, Chile
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15
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Raborn LN, Janis JE. Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery. JOURNAL OF SURGICAL EDUCATION 2021; 78:1948-1964. [PMID: 34059480 PMCID: PMC8894132 DOI: 10.1016/j.jsurg.2021.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Mentorship in the surgical field has been increasingly recognized as a crucial component of career success. Distance mentorship models may be utilized to overcome geographic limitations, increase mentorship access, and strengthen mentoring relationships in surgery. OBJECTIVE This review aimed to identify the scope of literature on distance mentoring in surgery, the range of its application, its effectiveness, and any gaps in the literature that should be addressed in order to enhance mentorship in the surgical field. DESIGN A comprehensive PubMed review was performed in January 2021 on distance mentorship of students, trainees, and surgeons in the surgical field. Reviews, replies, and non-English articles were excluded. Data was extracted regarding publication year, author's country, specialty, subjects, aim of mentorship model, and efficacy. RESULTS 134 total studies met inclusion and exclusion criteria. Most studies were published in 2020, written by authors in the United States, from general surgery, and featured an expert surgeon paired with a more junior fully trained surgeon. In all, 93.3% of studies utilized distance mentorship to enhance surgical skill through telementoring and only 4.5% were focused on mentorship to enhance careers through professional development. The remaining studies utilized distance mentorship models to increase surgical research (0.7%) and clinical knowledge (1.5%). CONCLUSION The results of this review suggest successful implementation of distance mentoring in surgery through telementoring, but a lack of professionally aimed distance mentorship programs. Amidst COVID-19, distance mentorship is particularly important because of decreased face-to-face opportunity. Future studies in the surgical field should investigate distance mentoring as a means of increasing mentorship for professional development.
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Affiliation(s)
- Layne N Raborn
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center Columbus, Columbus, Ohio.
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16
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Navia A, Tejos R, Canahuate S, Machuca E, Searle S, Cuadra A, Dagnino B. MicrosimUC: Validation of a Low-Cost, Portable, Do-It-Yourself Microsurgery Training Kit. J Reconstr Microsurg 2021; 38:409-419. [PMID: 34688217 DOI: 10.1055/s-0041-1735593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Microsurgery depends largely on simulated training to acquire skills. Courses offered worldwide are usually short and intensive and depend on a physical laboratory. Our objective was to develop and validate a portable, low-cost microsurgery training kit. METHODS We modified a miniature microscope. Twenty general surgery residents were selected and divided into two groups: (1) home-based training with the portable microscope (MicrosimUC, n = 10) and (2) the traditional validated microsurgery course at our laboratory (MicroLab, n = 10). Before the intervention, they were assessed making an end-to-end anastomosis in a chicken wing artery. Then, each member of the MicrosimUC group took a portable kit for remote skill training and completed an eight-session curriculum. The laboratory group was trained at the laboratory. After completion of training, they were all reassessed. Pre- and posttraining procedures were recorded and rated by two blind experts using time, basic, and specific scales. Wilcoxon's and Mann-Whitney tests were used to compare scores. The model was tested by experts (n = 10) and a survey was applied to evaluate face and content validity. RESULTS MicrosimUC residents significantly improved their median performance scores after completion of training (p < 0.05), with no significant differences compared with the MicroLab group. The model was rated very useful for acquiring skills with 100% of experts considering it for training. Each kit had a cost of U.S. $92, excluding shipping expenses. CONCLUSION We developed a low-cost, portable microsurgical training kit and curriculum with significant acquisition of skills in a group of residents, comparable to a formal microsurgery course.
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Affiliation(s)
- Alfonso Navia
- Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Tejos
- Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastian Canahuate
- Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Machuca
- Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susana Searle
- Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alvaro Cuadra
- Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Dagnino
- Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Waye JD, Marin ML, Damoi JO, Lumala IF. Remote training in flexible gastrointestinal endoscopy. VideoGIE 2021; 6:439-442. [PMID: 34667911 PMCID: PMC8505227 DOI: 10.1016/j.vgie.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jerome D Waye
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael L Marin
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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18
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Williams TP, Klimberg V, Perez A. Tele-education assisted mentorship in surgery (TEAMS). J Surg Oncol 2021; 124:250-254. [PMID: 34245580 DOI: 10.1002/jso.26495] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/03/2021] [Indexed: 12/14/2022]
Abstract
Tele-education assisted mentorship in surgery (TEAMS) is a novel methodology for surgical skills training with remote, hands-on, high-fidelity, and low-cost simulation-based education and one-to-one mentorship with longitudinal assessments. We review the background, methodology, and our experience with implementing TEAMS as an adjunct to traditional methods of surgical education and mentorship.
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Affiliation(s)
- Taylor P Williams
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Vicki Klimberg
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Alexander Perez
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
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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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Abstract
Principles of surgical training have not changed, but methods of training are evolving very fast. Online tools are being adopted in both knowledge and skills training for surgical residents. As a result, to evaluate the outcome of these tools, online assessment is also developing. Knowledge resources are very diverse ranging from lectures, webinars, surgical videos to three-dimensional planning and printing. Skills resources include virtual reality simulators, remote skills training and interdisciplinary teamwork. Assessment of E-learning tools can be performed using online questions, task-based simulations, branching scenarios and online interviews/discussions. In thoracic surgery, video assisted thoracic surgery (VATS) lobectomy simulator has been developed and it appears to be an important tool for minimally invasive thoracic surgery education. Training programs incorporate e-Learning in their curriculum and online training and assessment will become an important part of thoracic surgical training as well.
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Affiliation(s)
| | - Jalal Assouad
- Sorbonne University, Tenon University Hospital, Department of Thoracic and Vascular Surgery, Paris, France
| | - Harry Etienne
- Sorbonne University, Tenon University Hospital, Department of Thoracic and Vascular Surgery, Paris, France
| | - Xavier Benoit D'Journo
- Aix-Marseille University, Thoracic surgery department, North Hospital, Marseille, France
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Macchini F, Leva E, Gentilino V, Morandi A, Rothenberg SS. Mentoring in Pediatric Thoracoscopy: From Theory to Practice. Front Pediatr 2021; 9:630518. [PMID: 33665177 PMCID: PMC7920985 DOI: 10.3389/fped.2021.630518] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Thoracoscopy represents the most challenging area of pediatric minimally invasive surgery due to its technical difficulty. A standardized training program would be advisable. The aim of this study is to evaluate the results of our surgical training. Materials and Methods: A retrospective, single-center, cohort study was performed. The following four-step program was tested: (1) theoretical part; (2) experimental training; (3) training in centers of reference; (4) personal operative experience. Particular attention was focused on the choice of mentor. Times and modality of adherence to the program were evaluated. The effectiveness and safety of the training were evaluated according to the surgical results of esophageal atresia (EA/TEF) repair and resection of congenital lung malformations (CLM). The study was conducted from January 2014 to May 2020. Attending surgeons with previous experience in neonatal and pediatric laparoscopy were selected for the training program after being evaluated by the head of Department. Results: The training program was fully completed in 2 years. Twenty-four lobectomies, 9 sequestrectomies, 2 bronchogenic cyst resections and 20 EA/TEF repair were performed. Thoracoscopy was always feasible and effective, with no conversion. The operative times progressively decreased. Only three minor complications were recorded, all treated conservatively. Conclusions: A standardized training program is highly desirable to learn how to safely perform advanced pediatric thoracoscopy. The 4-steps design seems a valid educational option. The choice of the mentor is crucial. An experience-based profile for pediatric surgeons who may teach thoracoscopy is advisable.
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Affiliation(s)
- Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valerio Gentilino
- Department of Pediatric Surgery, Ospedale Filippo Del Ponte, Azienda Socio Sanitaria Territoriale Sette Laghi, Varese, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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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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