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Khan ZN, Shrestha D, Shugaba A, Lambert JE, Clark J, Haslett E, Afors K, Bampouras TM, Gaffney CJ, Subar DA. Comparing proficiency of obstetrics and gynaecology trainees with general surgery trainees using simulated laparoscopic tasks in Health Education England, North-West: a prospective observational study. BMJ Open 2023; 13:e075113. [PMID: 37949619 PMCID: PMC10649792 DOI: 10.1136/bmjopen-2023-075113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Training programmes for obstetrics and gynaecology (O&G) and general surgery (GS) vary significantly, but both require proficiency in laparoscopic skills. We sought to determine performance in each specialty. DESIGN Prospective, observational study. SETTING Health Education England North-West, UK. PARTICIPANTS 47 surgical trainees (24 O&G and 23 GS) were subdivided into four groups: 11 junior O&G, 13 senior O&G, 11 junior GS and 12 senior GS trainees. OBJECTIVES Trainees were tested on four simulated laparoscopic tasks: laparoscopic camera navigation (LCN), hand-eye coordination (HEC), bimanual coordination (BMC) and suturing with intracorporeal knot tying (suturing). RESULTS O&G trainees completed LCN (p<0.001), HEC (p<0.001) and BMC (p<0.001) significantly slower than GS trainees. Furthermore, O&G found fewer number of targets in LCN (p=0.001) and dropped a greater number of pins than the GS trainees in BMC (p=0.04). In all three tasks, there were significant differences between O&G and GS trainees but no difference between the junior and senior groups within each specialty. Performance in suturing also varied by specialty; senior O&G trainees scored significantly lower than senior GS trainees (O&G 11.4±4.4 vs GS 16.8±2.1, p=0.03). Whilst suturing scores improved with seniority among O&G trainees, there was no difference between the junior and senior GS trainees (senior O&G 11.4±4.4 vs junior O&G 3.6±2.1, p=0.004). DISCUSSION GS trainees performed better than O&G trainees in core laparoscopic skills, and the structure of O&G training may require modification. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05116332).
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Affiliation(s)
- Zaibun N Khan
- Department of Gynaecology, Royal Lancaster Infirmary, Lancaster, UK
| | - Donna Shrestha
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Joel E Lambert
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Justin Clark
- Department of Gynaecology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Haslett
- North West School of Obstetrics & Gynaecology, Blackpool Victoria Hospital, Blackpool, UK
| | - Karolina Afors
- Obstetrics & Gynaecology, Whittington Health NHS Trust, London, UK
| | - Theodoros M Bampouras
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Daren A Subar
- Department of General Surgery, East Lancashire Hospitals NHS Trust, Blackburn, UK
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Tica VI, Tica AA, De Wilde RL. The Future in Standards of Care for Gynecologic Laparoscopic Surgery to Improve Training and Education. J Clin Med 2022; 11:jcm11082192. [PMID: 35456285 PMCID: PMC9028106 DOI: 10.3390/jcm11082192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy is, now, a standard procedure in operative gynecology, standards are embedded in many laparoscopic procedures, standardization of the skills/competency assessment has been progressively developed, and the proof of competency in laparoscopy may become a standard of care. A continuous development of surgical education includes standard equipment (that may bring value for future advance), standardized training, testing (and performance) assessment, educational process and outcome monitoring/evaluation, patients’ care, and protection, etc. Standards of care and training have a reciprocally sustaining relationship, as training is an essential component of standards of care while care is provided at higher standards after a structured training and as credentialing/certification reunites the two. It is envisaged that through development and implementation, the European wide standards of care in laparoscopic surgery (in close harmonization with personalized medicine) would lead to effective delivery of better clinical services and provide excellent training and education.
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Affiliation(s)
- Vlad I. Tica
- Department of Obstetrics and Gynecology, Doctoral School, University “Ovidius”—Constanta, University Emergency County Hospital of Constanta—Bul. Tomis, 140, Academy of Romanian Scientists, 900591 Constanta, Romania;
| | - Andrei A. Tica
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital of Craiova, Str. Tabaci, nb. 1, 200534 Craiova, Romania
- Correspondence:
| | - Rudy L. De Wilde
- Pius Hospital, Carl von Ossietzky University, 26121 Oldenburg, Germany;
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A randomized control trial to evaluate the importance of pre-training basic laparoscopic psychomotor skills upon the learning curve of laparoscopic intra-corporeal knot tying. ACTA ACUST UNITED AC 2017; 14:29. [PMID: 29290752 PMCID: PMC5738461 DOI: 10.1186/s10397-017-1031-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/19/2017] [Indexed: 01/07/2023]
Abstract
Background Training of basic laparoscopic psychomotor skills improves the acquisition of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial was designed to evaluate whether pre-training of basic skills, as laparoscopic camera navigation (LCN), hand-eye coordination (HEC), and bimanual coordination (BMC), and the combination of the three of them, has any beneficial effect upon the learning curve of LICK. The study was carried out in a private center in Asunción, Paraguay, by 80 medical students without any experience in surgery. Four laparoscopic tasks were performed in the ENCILAP model (LCN, HEC, BMC, and LICK). Participants were allocated to 5 groups (G1-G5). The study was structured in 5 phases. In phase 1, they underwent a base-line test (T1) for all tasks (1 repetition of each task in consecutive order). In phase 2, participants underwent different training programs (30 consecutive repetitions) for basic tasks according to the group they belong to (G1: none; G2: LCN; G3: HEC; G4: BMC; and G5: LCN, HEC, and BMC). In phase 3, they were tested again (T2) in the same manner than at T1. In phase 4, they underwent a standardized training program for LICK (30 consecutive repetitions). In phase 5, they were tested again (T3) in the same manner than at T1 and T2. At each repetition, scoring was based on the time taken for task completion system. Results The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). The LICK group learning curves fitted better to the two-phase exponential decay model. From these curves, the starting points (Y0), the point after HEC training/before LICK training (Y1), the Plateau, and the rate constants (K) were calculated. All groups, except for G4, started from a similar point (Y0). At Y1, G5 scored already better than the others (G1 p = .004; G2 p = .04; G3 p < .0001; G4 NS). Although all groups reached a similar Plateau, G5 has a quicker learning than the others, demonstrated by a higher K (G1 p < 0.0001; G2 p < 0.0001; G3 p < 0.0001; and G4 p < 0.0001). Conclusions Our data confirms that training improves laparoscopic skills and demonstrates that pre-training of all basic skills (i.e., LCN, HEC, and BMC) shortens the LICK learning curve.
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Molinas CR, Binda MM, Campo R. Dominant hand, non-dominant hand, or both? The effect of pre-training in hand-eye coordination upon the learning curve of laparoscopic intra-corporeal knot tying. ACTA ACUST UNITED AC 2017; 14:12. [PMID: 28890675 PMCID: PMC5570794 DOI: 10.1186/s10397-017-1015-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/27/2017] [Indexed: 01/17/2023]
Abstract
Background Training of basic laparoscopic psychomotor skills improves both acquisition and retention of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial (RCT) was performed to evaluate the effect of different pre-training programs in hand-eye coordination (HEC) upon the learning curve of LICK. Results The study was performed in a private center in Asunción, Paraguay, by 60 residents/specialists in gynaecology with no experience in laparoscopic surgery. Participants were allocated in three groups. In phase 1, a baseline test was performed (T1, three repetitions). In phase 2, participants underwent different training programs for HEC (60 repetitions): G1 with both the dominant hand (DH) and the non-dominant hand (NDH), G2 with the DH only, G3 none. In phase 3, a post HEC/pre LICK training test was performed (T2, three repetitions). In phase 4, participants underwent a standardized training program for LICK (60 repetitions). In phase 5, a final test was performed (T3, three repetitions). The score was based on the time taken for task completion system. The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). For both HEC and LICK, the group learning curves fitted better to the two-phase exponential decay model. For HEC with the DH, G1 and G2 started from a similar point, but G1 reached a lower plateau at a higher speed. In G1, the DH curve started from a lower point than the NDH curve, but both curves reached a similar plateau at comparable speeds. For LICK, all groups started from a similar point, but immediately after HEC training and before LICK training, G1 scored better than the others. All groups reached a similar plateau but with a different decay, G1 reaching this plateau faster than the others groups. Conclusions This study demonstrates that pre-training in HEC with both the DH and the NDH shortens the LICK learning curve.
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Affiliation(s)
- Carlos Roger Molinas
- Neolife - Medicina y Cirugia Reproductiva, Avenida Brasilia 760, 1434 Asuncion, Paraguay
| | - Maria Mercedes Binda
- Neolife - Medicina y Cirugia Reproductiva, Avenida Brasilia 760, 1434 Asuncion, Paraguay
| | - Rudi Campo
- European Academy of Gynaecological Surgery, Leuven, Belgium
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Molinas CR, Campo R. Retention of laparoscopic psychomotor skills after a structured training program depends on the quality of the training and on the complexity of the task. ACTA ACUST UNITED AC 2016; 13:395-402. [PMID: 28003800 PMCID: PMC5133276 DOI: 10.1007/s10397-016-0962-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022]
Abstract
This follow-up RCT was conducted to evaluate laparoscopic psychomotor skills retention after finishing a structured training program. In a first study, 80 gynecologists were randomly allocated to four groups to follow different training programs for hand-eye coordination (task 1) with the dominant hand (task 1-a) and the non-dominant hand (task 1-b) and laparoscopic intra-corporeal knot tying (task 2) in the Laparoscopic Skills Testing and Training (LASTT) model. First, baseline skills were tested (T1). Then, participants trained task 1 (G1: 1-a and 1-b, G2: 1-a only, G3 and G4: none) and then task 2 (all groups but G4). After training all groups were tested again to evaluate skills acquisition (T2). For this study, 2 years after a resting period, 73 participants were recruited and tested again to evaluate skills retention (T3). All groups had comparable skills at T1 for all tasks. At T2, G1, G2, and G3 improved their skills, but the level of improvement was different (G1 = G2 > G3 > G4 for task 1; G1 = G2 = G3 > G4 for task 2). At T3, all groups retained their task 1 skills at the same level than at T2. For task 2, however, a skill decay was already noticed for G2 and G3, being G1 the only group that retained their skills at the post-training level. Training improves laparoscopic skills, which can be retained over time depending on the comprehensiveness of the training program and on the complexity of the task. For high complexity tasks, full training is advisable for both skills acquisition and retention.
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Affiliation(s)
- Carlos Roger Molinas
- Neolife Medicina y Cirugía Reproductiva, Avenida Brasilia 760, 1434 Asunción, Paraguay ; European Academy of Gynaecological Surgery, Leuven, Belgium
| | - Rudi Campo
- European Academy of Gynaecological Surgery, Leuven, Belgium
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Campo R, Wattiez A, Tanos V, Di Spiezio Sardo A, Grimbizis G, Wallwiener D, Brucker S, Puga M, Molinas R, O’Donovan P, Deprest J, Van Belle Y, Lissens A, Herrmann A, Tahir M, Benedetto C, Siebert I, Rabischong B, De Wilde RL. Gynaecological endoscopic surgical education and assessment. A diploma programme in gynaecological endoscopic surgery. GYNECOLOGICAL SURGERY 2016; 13:133-137. [PMID: 27478427 PMCID: PMC4949291 DOI: 10.1007/s10397-016-0957-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills, are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA) recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high-stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy, (b) the Minimally Invasive Gynaecological Surgeon (MIGS) and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence, and it counteracts the problem of the traditional surgical apprentice-tutor model. It is seen as a major step toward standardisation of endoscopic surgical training in general.
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Affiliation(s)
- Rudi Campo
- />Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Arnaud Wattiez
- />Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Vasilis Tanos
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | | | - Grigoris Grimbizis
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Diethelm Wallwiener
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Department of Women’s Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Sara Brucker
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Department of Women’s Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Marco Puga
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Roger Molinas
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Peter O’Donovan
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Jan Deprest
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Center for Surgical Technologies, Leuven, Belgium
| | - Yves Van Belle
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Ann Lissens
- />European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Center for Surgical Technologies, Leuven, Belgium
- />University Hospitals Leuven, Leuven, Belgium
| | - Anja Herrmann
- />Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
| | - Mahmood Tahir
- />European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Chiara Benedetto
- />European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Igno Siebert
- />African Endoscopic Training Academy, Cape Town, South Africa
| | - Benoit Rabischong
- />International Centre for Endoscopic Surgery, Clermont-Ferrand, France
| | - Rudy Leon De Wilde
- />European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
- />Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
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Campo R, Wattiez A, Tanos V, Di Spiezio Sardo A, Grimbizis G, Wallwiener D, Brucker S, Puga M, Molinas R, O'Donovan P, Deprest J, Van Belle Y, Lissens A, Herrmann A, Tahir M, Benedetto C, Siebert I, Rabischong B, De Wilde RL. Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery. Eur J Obstet Gynecol Reprod Biol 2016; 199:183-6. [PMID: 26946312 DOI: 10.1016/j.ejogrb.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Abstract
In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general.
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Affiliation(s)
- Rudi Campo
- Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium; European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; European Board and College of Obstetrics and Gynaecology, Brussels, Belgium.
| | - Arnaud Wattiez
- Life Expert Centre, Schipvaartstraat 2 Bus 4, 3000 Leuven, Belgium; European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Vasilis Tanos
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | | | - Grigoris Grimbizis
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Diethelm Wallwiener
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; Department of Women's Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Sara Brucker
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; Department of Women's Health, University Hospital Tuebingen, Calwerstraat 7, 72077 Tuebingen, Germany
| | - Marco Puga
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Roger Molinas
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Peter O'Donovan
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Jan Deprest
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; Center for Surgical Technologies, Leuven, Belgium, University Hospitals Leuven, Leuven, Belgium.
| | - Yves Van Belle
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Ann Lissens
- European Academy for Gynaecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium; Center for Surgical Technologies, Leuven, Belgium, University Hospitals Leuven, Leuven, Belgium
| | - Anja Herrmann
- Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
| | - Mahmood Tahir
- European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Chiara Benedetto
- European Board and College of Obstetrics and Gynaecology, Brussels, Belgium
| | - Igno Siebert
- African Endoscopic Training Academy, Cape Town, South Africa
| | - Benoit Rabischong
- International Centre for Endoscopic Surgery, Clermont-Ferrand, France
| | - Rudy Leon De Wilde
- European Society for Gynaecological Endoscopy, Diestsevest 43/0001, 3000 Leuven, Belgium; Pius-Hospital Oldenburg, Department of Gynecology, Obstetrics and Gynaecological Oncology, Carlvon Ossietzky University, Georgstraße 12, 26121 Oldenburg, Germany
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Cook DA, Brydges R, Zendejas B, Hamstra SJ, Hatala R. Mastery learning for health professionals using technology-enhanced simulation: a systematic review and meta-analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:1178-86. [PMID: 23807104 DOI: 10.1097/acm.0b013e31829a365d] [Citation(s) in RCA: 225] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Competency-based education requires individualization of instruction. Mastery learning, an instructional approach requiring learners to achieve a defined proficiency before proceeding to the next instructional objective, offers one approach to individualization. The authors sought to summarize the quantitative outcomes of mastery learning simulation-based medical education (SBME) in comparison with no intervention and nonmastery instruction, and to determine what features of mastery SBME make it effective. METHOD The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous review bibliographies through May 2011. They included original research in any language evaluating mastery SBME, in comparison with any intervention or no intervention, for practicing and student physicians, nurses, and other health professionals. Working in duplicate, they abstracted information on trainees, instructional design (interactivity, feedback, repetitions, and learning time), study design, and outcomes. RESULTS They identified 82 studies evaluating mastery SBME. In comparison with no intervention, mastery SBME was associated with large effects on skills (41 studies; effect size [ES] 1.29 [95% confidence interval, 1.08-1.50]) and moderate effects on patient outcomes (11 studies; ES 0.73 [95% CI, 0.36-1.10]). In comparison with nonmastery SBME instruction, mastery learning was associated with large benefit in skills (3 studies; effect size 1.17 [95% CI, 0.29-2.05]) but required more time. Pretraining and additional practice improved outcomes but, again, took longer. Studies exploring enhanced feedback and self-regulated learning in the mastery model showed mixed results. CONCLUSIONS Limited evidence suggests that mastery learning SBME is superior to nonmastery instruction but takes more time.
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Affiliation(s)
- David A Cook
- Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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State of the evidence on simulation-based training for laparoscopic surgery: a systematic review. Ann Surg 2013; 257:586-93. [PMID: 23407298 DOI: 10.1097/sla.0b013e318288c40b] [Citation(s) in RCA: 223] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Summarize the outcomes and best practices of simulation training for laparoscopic surgery. BACKGROUND Simulation-based training for laparoscopic surgery has become a mainstay of surgical training. Much new evidence has accrued since previous reviews were published. METHODS We systematically searched the literature through May 2011 for studies evaluating simulation, in comparison with no intervention or an alternate training activity, for training health professionals in laparoscopic surgery. Outcomes were classified as satisfaction, skills (in a test setting) of time (to perform the task), process (eg, performance rating), product (eg, knot strength), and behaviors when caring for patients. We used random effects to pool effect sizes. RESULTS From 10,903 articles screened, we identified 219 eligible studies enrolling 7138 trainees, including 91 (42%) randomized trials. For comparisons with no intervention (n = 151 studies), pooled effect size (ES) favored simulation for outcomes of knowledge (1.18; N = 9 studies), skills time (1.13; N = 89), skills process (1.23; N = 114), skills product (1.09; N = 7), behavior time (1.15; N = 7), behavior process (1.22; N = 15), and patient effects (1.28; N = 1), all P < 0.05. When compared with nonsimulation instruction (n = 3 studies), results significantly favored simulation for outcomes of skills time (ES, 0.75) and skills process (ES, 0.54). Comparisons between different simulation interventions (n = 79 studies) clarified best practices. For example, in comparison with virtual reality, box trainers have similar effects for process skills outcomes and seem to be superior for outcomes of satisfaction and skills time. CONCLUSIONS Simulation-based laparoscopic surgery training of health professionals has large benefits when compared with no intervention and is moderately more effective than nonsimulation instruction.
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