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Brian R, Cowan B, Knox JA, O'Sullivan PS, Bayne D, Ito T, Lager J, Chern H. Comparing Peer and Faculty Feedback for Asynchronous Laparoscopic Skill Acquisition. JOURNAL OF SURGICAL EDUCATION 2024; 81:1154-1160. [PMID: 38824090 DOI: 10.1016/j.jsurg.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/27/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE Traditionally, expert surgeons have provided surgical trainees with feedback about their simulation performance, including for asynchronous practice. Unfortunately, innumerable time demands may limit experts' ability to provide feedback. It is unknown whether and how peer feedback is an effective mechanism to help residents acquire laparoscopic skill in an asynchronous setting. As such, we aimed to assess the effect of peer feedback on laparoscopic performance and determine how residents perceive giving and receiving peer feedback. DESIGN We conducted a convergent mixed methods study. In the quantitative component, we randomized residents to receive feedback on home laparoscopic tasks from peers or faculty. We then held an end-of-curriculum, in-person laparoscopic assessment with members from both groups and compared performance on the in-person assessment between the groups. In the qualitative component, we conducted interviews with resident participants to explore experiences with feedback and performance. Three authors coded and rigorously reviewed interview data using a directed content analysis. SETTING We performed this study at a single tertiary academic institution: the University of California, San Francisco. PARTICIPANTS We invited 47 junior residents in general surgery, obstetrics-gynecology, and urology to participate, of whom 37 (79%) participated in the home curriculum and 25 (53%) participated in the end-of-curriculum assessment. RESULTS Residents in the peer feedback group scored similarly on the final assessment (mean 70.7%; SD 16.1%) as residents in the faculty feedback group (mean 71.8%; SD 11.9%) (p = 0.86). Through qualitative analysis of interviews with 13 residents, we identified key reasons for peer feedback's efficacy: shared mental models, the ability to brainstorm and appreciate new approaches, and a low-stakes learning environment. CONCLUSIONS We found that peer and faculty feedback led to similar performance in basic laparoscopy and that residents engaged positively with peer feedback, suggesting that peer feedback can be used when residents learn basic laparoscopy.
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Affiliation(s)
- Riley Brian
- Department of Surgery, University of California San Francisco, San Francisco California.
| | - Brandon Cowan
- Department of Surgery, University of California San Francisco, San Francisco California
| | - Jacquelyn A Knox
- Department of Surgery, University of California San Francisco, San Francisco California
| | - Patricia S O'Sullivan
- Department of Surgery, University of California San Francisco, San Francisco California
| | - David Bayne
- Department of Urology, University of California San Francisco, San Francisco California
| | - Traci Ito
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco California
| | - Jeannette Lager
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco California
| | - Hueylan Chern
- Department of Surgery, University of California San Francisco, San Francisco California
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Gigena C, Díaz I, Valverde S, Portu AM, Fortunato AC, Kaller R, Bosich M, Bellía Munzon G, Millán C. Results of a Novel Long-Term Method for Laparoscopic Skills Online Training. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38526573 DOI: 10.1089/lap.2023.0464] [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: 03/26/2024] Open
Abstract
Introduction: Ensuring patient safety in minimally invasive surgery (MIS) within the field of pediatric surgery requires systematic and extensive practice. Many groups have proposed mastery learning programs encompassing a range of training methods. However, short courses often have a narrow focus on specific objectives, limiting opportunities for sustained training. Our aim was to analyze our results with an online long-term competency-based and supervised training. Methods: This is a retrospective cohort study with prospective data collection of scores and performance of trainees during online courses from October 2020 to April 2023. Results: All participants (n = 76) were able to set up their personal training gym and complete the intensive stage of the course. The total score evolved from 2.60 ± 0.56 at the first meeting to 3.67 ± 0.61 at the fourth meeting, exhibiting a significant difference (P < .013). A considerable drop out was observed in the follow-up stage, with only 53.8% of the participants completing the course. When compared with the first meeting, they also showed a significant improvement with a mean general score of 3.85 ± 0.25 (P < .013) Conclusion: We have presented a novel online training program, based on continuous training that demonstrated that the unlimited access to a personal training gym allows surgeons to improve and maintain MIS skills.
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Affiliation(s)
- Cecilia Gigena
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
- Deparment of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ignacio Díaz
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Soledad Valverde
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Agustina Mariana Portu
- School of Science and Technology, National University of San Martín (UNSAM), Buenos Aires, Argentina
- National Research Council (CONICET), Buenos Aires, Argentina
| | - Ana Clara Fortunato
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Ruth Kaller
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Mariano Bosich
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Gastón Bellía Munzon
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
| | - Carolina Millán
- Deparment of Pediatric Surgery, Mother and Child Medical Center, Fundación Hospitalaria, Buenos Aires, Argentina
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Knudsen JE, Ma R, Hung AJ. Simulation training in urology. Curr Opin Urol 2024; 34:37-42. [PMID: 37909886 PMCID: PMC10842538 DOI: 10.1097/mou.0000000000001141] [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] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW This review outlines recent innovations in simulation technology as it applies to urology. It is essential for the next generation of urologists to attain a solid foundation of technical and nontechnical skills, and simulation technology provides a variety of safe, controlled environments to acquire this baseline knowledge. RECENT FINDINGS With a focus on urology, this review first outlines the evidence to support surgical simulation, then discusses the strides being made in the development of 3D-printed models for surgical skill training and preoperative planning, virtual reality models for different urologic procedures, surgical skill assessment for simulation, and integration of simulation into urology residency curricula. SUMMARY Simulation continues to be an integral part of the journey towards the mastery of skills necessary for becoming an expert urologist. Clinicians and researchers should consider how to further incorporate simulation technology into residency training and help future generations of urologists throughout their career.
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Affiliation(s)
| | - Runzhuo Ma
- Department of Urology, Cedars-Sinai Medical Center; Los Angeles, California, USA
| | - Andrew J Hung
- Department of Urology, Cedars-Sinai Medical Center; Los Angeles, California, USA
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Feenstra TM, van der Storm SL, Barsom EZ, Bonjer JH, Nieveen van Dijkum EJ, Schijven MP. Which, how, and what? Using digital tools to train surgical skills; a systematic review and meta-analysis. Surg Open Sci 2023; 16:100-110. [PMID: 37830074 PMCID: PMC10565595 DOI: 10.1016/j.sopen.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
Background Digital tools like digital box trainers and VR seem promising in delivering safe and tailored practice opportunities outside of the surgical clinic, yet understanding their efficacy and limitations is essential. This study investigated Which digital tools are available to train surgical skills, How these tools are used, How effective they are, and What skills they are intended to teach. Methods Medline, Embase, and Cochrane libraries were systematically reviewed for randomized trials, evaluating digital skill-training tools based on objective outcomes (skills scores and completion time) in surgical residents. Digital tools effectiveness were compared against controls, wet/dry lab training, and other digital tools. Tool and training factors subgroups were analysed, and studies were assessed on their primary outcomes: technical and/or non-technical. Results The 33 included studies involved 927 residents and six digital tools; digital box trainers, (immersive) virtual reality (VR) trainers, robot surgery trainers, coaching and feedback, and serious games. Digital tools outperformed controls in skill scores (SMD 1.66 [1.06, 2.25], P < 0.00001, I2 = 83 %) and completion time (SMD -1.05 [-1.72, -0.38], P = 0.0001, I2 = 71 %). There were no significant differences between digital tools and lab training, between tools, or in other subgroups. Only two studies focussed on non-technical skills. Conclusion While the efficacy of digital tools in enhancing technical surgical skills is evident - especially for VR-trainers -, there is a lack of evidence regarding non-technical skills, and need to improve methodological robustness of research on new (digital) tools before they are implemented in curricula. Key message This study provides critical insight into the increasing presence of digital tools in surgical training, demonstrating their usefulness while identifying current challenges, especially regarding methodological robustness and inattention to non-technical skills.
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Affiliation(s)
- Tim M. Feenstra
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Sebastiaan L. van der Storm
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Esther Z. Barsom
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
| | - Jaap H. Bonjer
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Els J.M. Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
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Denisov D, Castro-Olmo C, Charondo LB, Yang H, Van Schaik S, Bayne D. Effects of standardized language on remote ultrasound-guided percutaneous nephrolithotomy training: A mixed-methods explorative pilot study. Heliyon 2023; 9:e19629. [PMID: 37809923 PMCID: PMC10558858 DOI: 10.1016/j.heliyon.2023.e19629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Remote teaching of procedural skills has demonstrated equivalence in knowledge acquisition compared to in-person teaching. Variations in terminology for probe and needle movements may serve as a barrier in remote training of ultrasound (US)-guided renal access for percutaneous nephrolithotomy (PCNL). This pilot study investigated the utility of standardized terminology in remote training of US-guided renal access for PCNL. Hypothesis Standardization of verbal terminology to describe US probe and needle movement instruction improves remote teaching of US-guided renal access. Methods Fifteen urology residents (PGY1-6) were stratified by year and randomized into two groups. We provided participants with images illustrating US probe and needle movements labeled with predetermined standardized terminology for the intervention group and images without labels for the control group. Both groups were asked to perform US-guided renal access on a training mannequin with a remote faculty educator with (intervention) or without (control) use of standardized movement instructions. Quantitative outcomes included number of attempts and time to achieve access. All trainees completed pre- and post-session surveys and participated in focus groups; authors conducted thematic analysis of focus group transcripts. Results Differences in primary outcomes between groups, including number of attempts and time to achieve access of the renal pole, were not statistically significant. Analysis of focus group interviews revealed that the use of standardized terminology in the setting of remote training can reduce trainee confusion by clarifying ambiguity in educator feedback. Discussion Use of standardized terminology during remote surgical skills training allows for more effective feedback to trainees.
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Affiliation(s)
- David Denisov
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Coral Castro-Olmo
- School of Medicine, Universidad Central del Caribe, Bayamón, PR, Puerto Rico
| | | | - Heiko Yang
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Sandrijn Van Schaik
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - David Bayne
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
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Shah AP, Cleland J, Hawick L, Walker KA, Walker KG. Integrating simulation into surgical training: a qualitative case study of a national programme. Adv Simul (Lond) 2023; 8:20. [PMID: 37596692 PMCID: PMC10436455 DOI: 10.1186/s41077-023-00259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Applying simulation-based education (SBE) into surgical curricula is challenging and exacerbated by the absence of guidance on implementation processes. Empirical studies evaluating implementation of SBE interventions focus primarily on outcomes. However, understanding the processes involved in organising, planning, and delivering SBE adds knowledge on how best to develop, implement, and sustain surgical SBE. This study used a reform of early years surgical training to explore the implementation of a new SBE programme in Scotland. It aimed to understand the processes that are involved in the relative success (or failure) when implementing surgical SBE interventions. METHODS This qualitative case study, underpinned by social constructionism, used publicly available documents and the relevant surgical SBE literature to inform the research focus and contextualise data obtained from semi-structured interviews with core surgical trainees (n = 46), consultant surgeons (n = 25), and key leaders with roles in surgical training governance in Scotland (n = 7). Initial data coding and analysis were inductive. Secondary data analysis was then undertaken using Normalisation Process Theory (NPT). NPTs' four constructs (coherence, cognitive participation, collective action, reflexive monitoring) provided an explanatory framework for scrutinising how interventions are implemented, embedded, and integrated into practice, i.e. the "normalisation" process. RESULTS Distributed leadership (individual SBE initiatives assigned to faculty but overall programme overseen by a single leader) and the quality improvement practise of iterative refinement were identified as key novel processes promoting successful normalisation of the new SBE programme. Other processes widely described in the literature were also identified: stakeholder collaboration, personal contacts/relational processes, effective communication, faculty development, effective leadership, and tight programme management. The study also identified that learners valued SBE activities in group- or team-based social environments over isolated deliberate practice. CONCLUSIONS SBE is most effective when designed as a comprehensive programme aligned to the curriculum. Programmes incorporating both group-based and isolated SBE activities promote deliberate practice. Distributed leadership amongst faculty attracts wide engagement integral to SBE programme implementation, while iterative programme refinement through regular evaluation and action on feedback encourages integration into practice. The knowledge contributed by critically analysing SBE programme implementation processes can support development of much needed guidance in this area.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorraine Hawick
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK.
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Sloth SB, Jensen RD, Seyer-Hansen M, De Win G, Christensen MK. Ticket to perform: an explorative study of trainees' engagement in and transfer of surgical training. BMC MEDICAL EDUCATION 2023; 23:64. [PMID: 36698177 PMCID: PMC9878748 DOI: 10.1186/s12909-023-04048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/20/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Research suggests that simulation-based surgical skills training translates into improved operating room performance. Previous studies have predominantly focused on training methods and design and subsequent assessable performances and outcomes in the operating room, which only covers some aspects of training engagement and transfer of training. The purpose of this qualitative study was to contribute to the existing body of literature by exploring characteristics of first-year trainees' engagement in and perceptions of transfer of surgical skills training. METHODS We conducted an explorative study based on individual interviews with first-year trainees in General Surgery, Urology, and Gynaecology and Obstetrics who participated in a laparoscopic skills training program. Informants were interviewed during and two months after the training program. A thematic cross-case analysis was conducted using systematic text condensation. RESULTS We interviewed 12 informants, which produced 24 transcripts for analysis. We identified four main themes: (1) sportification of training, (2) modes of orientation, (3) transferrable skills, and (4) transfer opportunities. Informants described their surgical training using sports analogies of competition, timing, and step-by-step approaches. Visual orientations, kinaesthetic experiences, and elicited dialogues characterised training processes and engagement. These characteristics were identified in both the simulated and the clinical environment. Experiences of specific skills transfer included ambidexterity, coordination, instrument handling, and visuospatial ability. General transfer experiences were salient in informants' altered training approaches. Informants considered the simulation-based training an entry ticket to perform in the operating room and mentioned supervisor-trainee relationships and opportunities in the workplace as critical conditions of transfer. CONCLUSIONS Our findings elucidate characteristics of surgical training engagement that can be interpreted as self-regulated learning processes that transcend surgical training environments. Despite appreciating the immediate skills improvements resulting from training, trainees' narratives reflected a struggle to transfer their training to the clinical setting. Tensions existed between perceptions of transferable skills and experiences of transfer within the clinical work environments. These results resonate with research emphasising the importance of the work environment in the transfer process. Our findings provide insights that may inform the development of training programs that support self-regulated learning and transfer of training from the simulated to the clinical environment.
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Affiliation(s)
- Sigurd Beier Sloth
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus, Denmark.
| | - Rune Dall Jensen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus, Denmark
- Corporate HR, MidtSim, Central Denmark Region, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - Mikkel Seyer-Hansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Gunter De Win
- Antwerp Surgical Training, Anatomy and Research Center (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Department of Urology, University Hospital Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Mette Krogh Christensen
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8200, Aarhus, Denmark
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Greenberg AL, Karimzada MM, Brian R, Yap A, Luu HY, Ahmed S, Huang CY, Waits SA, Hirose R, Alseidi A, Rapp JH, O’Sullivan PS, Chern H, Syed SM. Assessment of Surgeon Performance of Advanced Open Surgical Skills Using a Microskills-Based Novel Curriculum. JAMA Netw Open 2022; 5:e2229787. [PMID: 36053533 PMCID: PMC9440404 DOI: 10.1001/jamanetworkopen.2022.29787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The increase in minimally invasive surgical procedures has eroded exposure of general surgery residents to open operations. High-fidelity simulation, together with deliberate instruction, is needed for advanced open surgical skill (AOSS) development. OBJECTIVE To collect validity evidence for AOSS tools to support a shared model for instruction. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included postresidency surgeons (PRSs) and second-year general surgery residents (R2s) at a single academic medical center who completed simulated tasks taught within the AOSS curriculum between June 1 and October 31, 2021. EXPOSURES The AOSS curriculum includes 6 fine-suture and needle handling tasks, including deep suture tying (with and without needles) and continuous suturing using the pitch-and-catch and push-push-pull techniques (both superficial and deep). Teaching and assessment are based on specific microskills using a 3-dimensional printed iliac fossa model. MAIN OUTCOMES AND MEASURES The PRS group was timed and scored (5-point Likert scale) on 10 repetitions of each task. Six months after receiving instruction on the AOSS tasks, the R2 group was similarly timed and scored. RESULTS The PRS group included 14 surgeons (11 male [79%]; 8 [57%] attending surgeons) who completed the simulation; the R2 group, 9 surgeons (5 female [55%]) who completed the simulation. Score and time variability were greater for the R2s compared with the PRSs for all tasks. The R2s scored lower and took longer on (1) deep pitch-and-catch suturing (69% of maximum points for a mean [SD] of 142.0 [31.7] seconds vs 77% for a mean [SD] of 95.9 [29.4] seconds) and deep push-push-pull suturing (63% of maximum points for a mean [SD] of 284.0 [72.9] seconds vs 85% for a mean [SD] of 141.4 [29.1] seconds) relative to the corresponding superficial tasks; (2) suture tying with a needle vs suture tying without a needle (74% of maximum points for a mean [SD] of 64.6 [19.8] seconds vs 90% for a mean [SD] of 54.4 [15.6] seconds); and (3) the deep push-push-pull vs pitch-and-catch techniques (63% of maximum points for a mean [SD] of 284.0 [72.9] seconds vs 69% of maximum points for a mean [SD] of 142.0 [31.7] seconds). For the PRS group, time was negatively associated with score for the 3 hardest tasks: superficial push-push-pull (ρ = 0.60; P = .02), deep pitch-and-catch (ρ = 0.73; P = .003), and deep push-push-pull (ρ = 0.81; P < .001). For the R2 group, time was negatively associated with score for the 2 easiest tasks: suture tying without a needle (ρ = 0.78; P = .01) and superficial pitch-and-catch (ρ = 0.79; P = .01). CONCLUSIONS AND RELEVANCE The findings of this cohort study offer validity evidence for a novel AOSS curriculum; reveal differential difficulty of tasks that can be attributed to specific microskills; and suggest that position on the surgical learning curve may dictate the association between competency and speed. Together these findings suggest specific, actionable opportunities to guide instruction of AOSS, including which microskills to focus on, when individual rehearsal vs guided instruction is more appropriate, and when to focus on speed.
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Affiliation(s)
| | | | - Riley Brian
- Department of Surgery, University of California, San Francisco
| | - Ava Yap
- Department of Surgery, University of California, San Francisco
| | - Hubert Y. Luu
- Department of Surgery, University of California, San Francisco
| | - Saira Ahmed
- Department of Surgery, University of Illinois at Chicago
| | - Chiung-Yu Huang
- Department of Surgery, University of California, San Francisco
| | - Seth A. Waits
- Department of Surgery, University of Michigan, Ann Arbor
| | - Ryutaro Hirose
- Department of Surgery, University of California, San Francisco
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco
| | - Joseph H. Rapp
- Department of Surgery, University of California, San Francisco
| | | | - Hueylan Chern
- Department of Surgery, University of California, San Francisco
| | - Shareef M. Syed
- Department of Surgery, University of California, San Francisco
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Virtual orthopaedic surgery away rotation benefits both the program and applicant. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Chang Y, Tang C, Shui X, Zhou Y, Jiang X, Liu J, Sun Y. A multi-screen collaboration-based low-cost portable dry-lab simulator for basic laparoscopic skills training: A technical note. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022. [DOI: 10.1016/j.lers.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hertz P, Houlind K, Jepsen J, Bundgaard L, Jensen P, Friis M, Konge L, Bjerrum F. Identifying curriculum content for a cross-specialty robotic-assisted surgery training program: a Delphi study. Surg Endosc 2021; 36:4786-4794. [PMID: 34708292 DOI: 10.1007/s00464-021-08821-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robotic-assisted surgery is increasing and there is a need for a structured and evidence-based curriculum to learn basic robotic competencies. Relevant training tasks, eligible trainees, realistic learning goals, and suitable training methods must be identified. We sought to develop a common curriculum that can ensure basic competencies across specialties. METHODS Two robotic surgeons from all departments in Denmark conducting robotic-assisted surgery within gynecology, urology, and gastrointestinal surgery, were invited to participate in a three-round Delphi study to identify learning goals and rank them according to relevance for a basic curriculum. An additional survey was conducted after the Delphi rounds on what training methods were considered best for each learning goal and who (console surgeon/patient-side assistant) should master each learning goal. RESULTS Fifty-six robotic surgeons participated and the response rates were 86%, 89%, and 77%, for rounds 1, 2 and 3, respectively. The Delphi study identified 40 potential learning goals, of which 29 were ranked as essential, e.g., Understand the link between arm placement and freedom of movement or Be able to perform emergency un-docking. In the additional survey, the response rate was 70%. Twenty-two (55%) of the identified learning goals were found relevant for the patient-side assistant and twenty-four (60%) were linked to a specific suitable learning method with > 75% agreement. CONCLUSIONS Our findings can help training centers plan their training programs concerning educational content and methods for training/learning. Furthermore, patient-side assistants should also receive basic skills training in robotic surgery.
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Affiliation(s)
- Peter Hertz
- Department of Surgery, Hospital Lillebaelt, University of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Kolding, Denmark.
| | - Kim Houlind
- Department of Regional Health Research, University of Southern Denmark, Kolding, Denmark
- Department of Vascular Surgery, Hospital Lillebaelt, University of Southern Denmark, Kolding, Denmark
| | - Jan Jepsen
- Department of Urology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Center for HR and Education, Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Denmark
| | - Lars Bundgaard
- Department of Surgery, Hospital Lillebaelt, University of Southern Denmark, Vejle, Denmark
| | - Pernille Jensen
- Department of Gynecology, Faculty of Health, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mikkel Friis
- Department of Skills Training and Simulation, NordSim, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Konge
- Center for HR and Education, Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Center for HR and Education, Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Denmark
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Suzuki M, Vyskocil E, Ogi K, Matoba K, Nakamaru Y, Homma A, Wormald PJ, Psaltis AJ. Remote Training of Functional Endoscopic Sinus Surgery With Advanced Manufactured 3D Sinus Models and a Telemedicine System. Front Surg 2021; 8:746837. [PMID: 34660685 PMCID: PMC8517106 DOI: 10.3389/fsurg.2021.746837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Traditionally, cadaveric courses have been an important tool in surgical education for Functional Endoscopic Sinus Surgery (FESS). The recent COVID-19 pandemic, however, has had a significant global impact on such courses due to its travel restrictions, social distancing regulations, and infection risk. Here, we report the world-first remote (Functional Endoscopic Sinus Surgery) FESS training course between Japan and Australia, utilizing novel 3D-printed sinus models. We examined the feasibility and educational effect of the course conducted entirely remotely with encrypted telemedicine software. Methods: Three otolaryngologists in Hokkaido, Japan, were trained to perform frontal sinus dissections on novel 3D sinus models of increasing difficulty, by two rhinologists located in Adelaide, South Australia. The advanced manufactured sinus models were 3D printed from the Computed tomography (CT) scans of patients with chronic rhinosinusitis. Using Zoom and the Quintree telemedicine platform, the surgeons in Adelaide first lectured the Japanese surgeons on the Building Block Concept for a three Dimensional understanding of the frontal recess. They in real time directly supervised the surgeons as they planned and then performed the frontal sinus dissections. The Japanese surgeons were asked to complete a questionnaire pertaining to their experience and the time taken to perform the frontal dissection was recorded. The course was streamed to over 200 otolaryngologists worldwide. Results: All dissectors completed five frontal sinusotomies. The time to identify the frontal sinus drainage pathway (FSDP) significantly reduced from 1,292 ± 672 to 321 ± 267 s (p = 0.02), despite an increase in the difficulty of the frontal recess anatomy. Image analysis revealed the volume of FSDP was improved (2.36 ± 0.00 to 9.70 ± 1.49 ml, p = 0.014). Questionnaires showed the course's general benefit was 95.47 ± 5.13 in dissectors and 89.24 ± 15.75 in audiences. Conclusion: The combination of telemedicine software, web-conferencing technology, standardized 3D sinus models, and expert supervision, provides excellent training outcomes for surgeons in circumstances when classical surgical workshops cannot be realized.
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Affiliation(s)
- Masanobu Suzuki
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia.,Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Erich Vyskocil
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - Kazuhiro Ogi
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - Kotaro Matoba
- Department of Forensic Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Peter J Wormald
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - Alkis J Psaltis
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
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