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Haiser A, Aydin A, Kunduzi B, Ahmed K, Dasgupta P. A Systematic Review of Simulation-Based Training in Vascular Surgery. J Surg Res 2022; 279:409-419. [PMID: 35839575 PMCID: PMC9483723 DOI: 10.1016/j.jss.2022.05.009] [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: 01/10/2022] [Revised: 04/20/2022] [Accepted: 05/22/2022] [Indexed: 11/25/2022]
Abstract
Introduction Recent advancements in surgical technology, reduced working hours, and training opportunities exacerbated by the COVID-19 pandemic have led to an increase in simulation-based training. Furthermore, a rise in endovascular procedures has led to a requirement for high-fidelity simulators that offer comprehensive feedback. This review aims to identify vascular surgery simulation models and assess their validity and levels of effectiveness (LoE) for each model in order to successfully implement them into current training curricula. Methods PubMed and EMBASE were searched on January 1, 2021, for full-text English studies on vascular surgery simulators. Eligible articles were given validity ratings based on Messick’s modern concept of validity alongside an LoE score according to McGaghie’s translational outcomes. Results Overall 76 eligible articles validated 34 vascular surgery simulators and training courses for open and endovascular procedures. High validity ratings were achieved across studies for: content (35), response processes (12), the internal structure (5), relations to other variables (57), and consequences (2). Only seven studies achieved an LoE greater than 3/5. Overall, ANGIO Mentor was the most highly validated and effective simulator and was the only simulator to achieve an LoE of 5/5. Conclusions Simulation-based training in vascular surgery is a continuously developing field with exciting future prospects, demonstrated by the vast number of models and training courses. To effectively integrate simulation models into current vascular surgery curricula and assessments, there is a need for studies to look at trainee skill retention over a longer period of time. A more detailed discussion on cost-effectiveness is also needed.
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Affiliation(s)
- Alexander Haiser
- Guy's, King's and St Thomas' School of Medical Education, King's College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.
| | - Basir Kunduzi
- Department of Transplant Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
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Systematic Review of Vascular Surgery Recruitment Strategies for Medical Students and General Surgery Residents. J Vasc Surg 2022; 76:837-843.e4. [PMID: 35470017 DOI: 10.1016/j.jvs.2022.03.875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/14/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Recruitment into the vascular surgery specialty is an imperative as the specialty faces significant demographic changes. Due to the changing dynamics in vascular surgery training pathways, we sought to review current literature on recruitment strategies and their effectiveness with medical students and general surgery residents. METHODS A systematic search, following PRISMA guidelines, was performed by searching MEDLINE, EMBASE, Scopus, CINAHL, and ERIC databases for studies on vascular surgery recruitment methods for medical students and general surgery residents from inception of databases to 12/31/2021. Reports in English discussing recruitment strategies were included. Reports lacking recruitment method data and those with insufficient data were excluded. RESULTS Ten reports met inclusion criteria and studied a total of 688 participants. Seven reports (70%) employed simulation, didactic, or online courses. The remaining 30% of studies included data on mentorship, research, or other interventions. Most of the studies (50%) reported data for medical students (MS1-MS4). Interventions specific to residents or both students and residents comprised the other 50% of studies. Simulation and didactic courses increased interest in vascular surgery by a median of 50% (IQR 38) for both medical students and residents. Importantly, without reinforcement, interest was seen to decrease over time. CONCLUSIONS Recruitment interventions are useful in increasing student interest in vascular surgery. Early exposure to simulated vascular surgery procedures and mentorship are cited as common reasons for entering the field. Further studies on recruitment strategies focused on long-term outcomes are required.
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Transformation of neurosurgical training from “see one, do one, teach one” to AR/VR & simulation – A survey by the EANS Young Neurosurgeons. BRAIN AND SPINE 2022; 2:100929. [PMID: 36248173 PMCID: PMC9560525 DOI: 10.1016/j.bas.2022.100929] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022]
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Mandal I, Ojha U. Training in Interventional Radiology: A Simulation-Based Approach. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520912744. [PMID: 32313840 PMCID: PMC7155237 DOI: 10.1177/2382120520912744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 06/11/2023]
Abstract
Innovations in medical technology have revolutionised both medical and surgical practice. Indeed, with such innovations, training for specific specialties has become more advanced and streamlined. However, despite these novel approaches to train students and specialist trainees, training for interventional radiology (IR) is lagging. While the reason for this lag remains contentious, one of the primary reasons for this issue may be the lack of standardisation for IR training due to a scarcity of specific guidelines for the delivery of IR procedural training. Interventional radiologists manage a vast array of conditions and perform various procedures. However, training for each procedure is largely dependent on the centre and access to a range of cases. Recently, the use of simulation technology has allowed this issue to be addressed. Simulation technology allows trainees to participate in a range of procedures regardless of their centre and availability of cases. Specialties such as cardiology and vascular surgery have already adopted simulation-based technology for trainees and have commented positively on this approach. However, simulation-based training is still lacking in the IR training pathway. Here, we evaluate why IR training can benefit from a more simulation-based approach. We further consider the cost-effectiveness of implementing simulation-based training nationally. Finally, we outline the potential pitfalls that may arise of introducing simulation-based training for IR trainees. We conclude that despite its disadvantages, simulation training will prove to be more cost-efficient and allow standardisation of IR training.
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Affiliation(s)
- Indrajeet Mandal
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Utkarsh Ojha
- Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
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Irfan W, Sheahan C, Mitchell EL, Sheahan MG. The pathway to a national vascular skills examination and the role of simulation-based training in an increasingly complex specialty. Semin Vasc Surg 2019; 32:48-67. [DOI: 10.1053/j.semvascsurg.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Simulation in Vascular Surgery. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Systematic review of the implementation of simulation training in surgical residency curriculum. Surg Today 2016; 47:777-782. [DOI: 10.1007/s00595-016-1455-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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8
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Image-guidance technology and the surgical resection of spinal column tumors. J Neurooncol 2016; 131:425-435. [DOI: 10.1007/s11060-016-2325-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Evidence for Endovascular Simulation Training: A Systematic Review. Eur J Vasc Endovasc Surg 2015; 51:441-51. [PMID: 26684597 DOI: 10.1016/j.ejvs.2015.10.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/18/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Simulation training in endovascular surgery provides opportunities for trainees to practice and learn from non-patient based experience. Several types of endovascular simulators are available commercially. Previous studies on endovascular simulation training can be categorized into trials in which only a simulator was used when measuring performance metrics or "trials within simulation"; patient specific procedure rehearsals; and randomized, controlled trials (RCTs) or translational studies. OBJECTIVES To examine whether endovascular simulation training can improve surgeon techniques and patient outcomes in real clinical settings. METHODS A literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All searches were done via PubMed and Embase. Review articles, and papers that were not related to endovascular surgery and not within the scope of interest were excluded. References of review articles were further screened according to the exclusion criteria. RESULTS In total, 909 records were identified and 290 duplicates were removed. Thirty-one were included in the qualitative analysis. Twenty-three were trials within simulation and most of them found statistically significant improvements in procedure time, fluoroscopy time, and contrast volume. Five were patient specific procedure rehearsals and showed that simulation significantly affected the fluoroscopy angle and improved performance metrics. Three were RCTs and revealed mainly positive results on a Global Rating Scale and procedure specific rating scale. CONCLUSIONS Contemporary evidence shows that performance metrics within endovascular simulations improve with simulation training. Successful translation to in vivo situations is observed in patient specific procedure rehearsals and RCTs on real procedures. However, there is no level I evidence to show that predictive validity of simulation can definitively improve patient outcomes. Current literature supports the idea that there is a beneficial role of simulation in endovascular training. Future studies are needed to confirm the efficacy of simulation in endovascular surgical training and to see if simulation is superior to traditional training in the operating theatre.
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Eslahpazir BA, Goldstone J, Allemang MT, Wang JC, Kashyap VS. Principal considerations for the contemporary high-fidelity endovascular simulator design used in training and evaluation. J Vasc Surg 2014; 59:1154-62. [DOI: 10.1016/j.jvs.2013.11.074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/18/2013] [Accepted: 11/20/2013] [Indexed: 01/22/2023]
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Trehan K, Kemp CD, Yang SC. Simulation in cardiothoracic surgical training: where do we stand? J Thorac Cardiovasc Surg 2014; 147:18-24.e2. [PMID: 24331908 DOI: 10.1016/j.jtcvs.2013.09.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/22/2013] [Accepted: 09/24/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Simulation may reduce the risks associated with the complex operations of cardiothoracic surgery and help create a more efficient, thorough, and uniform curriculum for cardiothoracic surgery fellowship. Here, we review the current status of simulation in cardiothoracic surgical training and provide an overview of all simulation models applicable to cardiothoracic surgery that have been published to date. METHODS We completed a comprehensive search of all publications pertaining to simulation of cardiothoracic surgical procedures by using PubMed. RESULTS Numerous cardiothoracic surgical simulators at various stages of development, assessment, and commercial manufacturing have been published to date. There is currently a predominance of models simulating coronary artery bypass grafting and bronchoscopy and a relative paucity of simulators of open pulmonary and esophageal procedures. Despite the wide range of simulators available, few models have been formally assessed for validity and educational value. CONCLUSIONS Surgical simulation is becoming an increasingly important educational tool in training cardiothoracic surgeons. Our next steps forward will be to develop an objective, standardized way to assess surgical simulation training compared with the current apprenticeship model.
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Affiliation(s)
- Kanika Trehan
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Clinton D Kemp
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Stephen C Yang
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
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Kesser BW, Hallman M, Murphy L, Tillar M, Keeley M, Peirce S. Interval vs Massed Training. Otolaryngol Head Neck Surg 2013; 150:61-7. [DOI: 10.1177/0194599813513712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare 2 different training paradigms, massed vs interval training, when novice students learn a surgical procedure, myringotomy with ventilation tube insertion, on a validated surgical simulator. Study Design Medical students were randomized into 2 training groups: the interval group (n = 19) was trained to perform the procedure in 5 trials/d over 3 days, and the massed group (n = 21) was trained to perform the procedure in 15 trials all in 1 session. One week later, all students were tested in 5 additional final trials. Pre- and posttest surveys were administered. Setting Academic medical center. Subjects and Methods Forty medical students: 19 students in the interval group were compared with 21 students in the massed group. Time to complete the procedure and number and type of error made were recorded and compared between groups. Pre- and poststudy surveys examined confidence levels working under a microscope and with the procedure. Results Students in both groups had a significant decrease in time between practice and final trials. In the final 5 trials, there was no difference in average time to complete the procedure between the massed and interval training groups. No difference was observed in the number of errors committed per trial between initial and final trials (both groups) or between massed and interval training groups. The students’ confidence levels significantly increased across the trials, regardless of group. Conclusion Surgical training improves proficiency, but method of training had little impact on proficiency in performing a simulated surgical procedure in this setting.
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Affiliation(s)
- Bradley W. Kesser
- Departments of Otolaryngology–Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Matthew Hallman
- Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Loren Murphy
- Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Maggie Tillar
- Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Meg Keeley
- Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Shayn Peirce
- Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Wehbe-Janek H, Colbert CY, Govednik-Horny C, White BAA, Thomas S, Shabahang M. Residents' perspectives of the value of a simulation curriculum in a general surgery residency program: a multimethod study of stakeholder feedback. Surgery 2012; 151:815-21. [PMID: 22652123 DOI: 10.1016/j.surg.2012.03.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/15/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Simulation has altered surgical curricula throughout residency programs. The purpose of this multimethod study was to explore residents' perceptions of simulation within surgical residency as relevant stakeholder feedback and program evaluation of the surgery simulation curriculum. METHODS Focus groups were held with a sample of surgery residents (n = 25) at a university-affiliated program. Residents participated in focus groups based on level of training and completed questionnaires regarding simulation curricula. Groups were facilitated by nonsurgeon faculty. Residents were asked: "What is the role of simulation in surgical education?" An interdisciplinary team recorded narrative data and performed content analyses. Quantitative data from questionnaires were summarized using descriptive statistics and frequencies. RESULTS Major themes from the qualitative data included: concerns regarding simulation in surgical education (28%), exposure to situations and technical skills in a low-stress learning environment (24%), pressure by external agencies (19%), an educational tool (17%), and quality assurance for patient care (12%). Laparoscopy and cadaver lab were the most prevalent simulation training during residency, in addition to trauma simulations, central lines/chest tubes/IV access, and stapling lab. In response to the statement: "ACGME should require a simulation curriculum in surgery residency," 52.1% responded favorably and 47.8% responded nonfavorably. CONCLUSION Residents acknowledge the value of simulation in patient safety, quality, and exposure to procedures before clinical experience, but remain divided on efficacy and requirement of simulation within curricula. The greater challenge to residency programs may be strategic implementation of simulation curricula within the right training context.
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Affiliation(s)
- Hania Wehbe-Janek
- Department of Internal Medicine, Texas A&M Health Science Center, College of Medicine, Temple, TX, USA.
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Våpenstad C, Buzink SN. Procedural virtual reality simulation in minimally invasive surgery. Surg Endosc 2012; 27:364-77. [DOI: 10.1007/s00464-012-2503-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/19/2012] [Indexed: 12/16/2022]
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Markovic J, Peyser C, Cavoores T, Fletcher E, Peterson D, Shortell C. Impact of endovascular simulator training on vascular surgery as a career choice in medical students. J Vasc Surg 2012; 55:1515-21. [PMID: 22464708 DOI: 10.1016/j.jvs.2011.11.060] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 11/07/2011] [Accepted: 11/09/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The primary goal of this study was to determine whether exposure to endovascular simulator training increases interest in vascular surgery among medical students. Secondary goals were to determine whether interest in vascular surgery is inversely related to the time after exposure, to identify factors associated with interest, and to identify students' characteristics that positively influence performance metrics. METHODS This was a prospective, randomized, crossover study comprising 80 medical students who were randomized into group A (n = 40) and group B (n = 40). Participants completed a survey of their interest in vascular surgery and attitudinal factors using Vascular Surgery Interest Form (VSIF) before exposure to the simulator (pretest). At 1 month after exposure of group A to the simulator, both groups were tested using VSIF (test). Upon completion of testing, group B was exposed to simulator training, whereas group A received no further training. At 2 months after exposure of group B to the simulator, both groups were posttested using VSIF, which asked the students' level of interest in vascular surgery using a 1 to 10 scale. Performance metrics were recorded during each exposure. Differences among cohort demographics were determined using Pearson χ(2) analysis. Differences in interest were determined with paired sample correlations. Linear regression and analysis of variance were used to correlate VSIF responses with interest and the performance metrics. RESULTS Both student cohorts had significant increases in interest after exposure to simulation. In group A, test interest (mean ± standard deviation) was significantly higher than pretest and posttest interests (5.51 ± 1.73 vs 4.00 ± 1.88 vs 4.18 ± 1.82; P < .05). In group B, posttest interest was significantly higher than pretest and test interests (5.62 ± 2.03 vs 3.96 ± 1.61 vs 4.08 ± 1.64; P < .05). The increase in interest was reciprocally related to the time passed since the initial exposure. Resident and attending lifestyle, length of training, radiation concerns, gender identification of a mentor, and personality fit with occupation were not correlated with interest. Sex, medical school year, comfort with endovascular procedures, willingness to work long hours, interest in performing percutaneous procedures, and commitment to surgical career did not affect impact performance metrics. CONCLUSIONS One exposure of students to endovascular simulator training is associated with an increase in vascular surgery interest. Acquired interest is reciprocally related to the time demonstrating the temporal importance of the exposure.
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Affiliation(s)
- Jovan Markovic
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Aparajita R, Zayed MA, Casey K, Dayal R, Lee JT. Development and Implementation of an Introductory Endovascular Training Course for Medical Students. Ann Vasc Surg 2011; 25:1104-12. [DOI: 10.1016/j.avsg.2011.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 07/12/2011] [Accepted: 07/13/2011] [Indexed: 01/30/2023]
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Tesche LJ, Feins RH, Dedmon MM, Newton KN, Egan TM, Haithcock BE, Veeramachaneni NK, Bowdish ME. Simulation Experience Enhances Medical Students' Interest in Cardiothoracic Surgery. Ann Thorac Surg 2010; 90:1967-73; discussion 1973-4. [DOI: 10.1016/j.athoracsur.2010.06.117] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 06/23/2010] [Accepted: 06/29/2010] [Indexed: 10/18/2022]
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Seixas-Mikelus SA, Adal A, Kesavadas T, Baheti A, Srimathveeravalli G, Hussain A, Chandrasekhar R, Wilding GE, Guru KA. Can image-based virtual reality help teach anatomy? J Endourol 2010; 24:629-34. [PMID: 20192818 DOI: 10.1089/end.2009.0556] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the utilization of a novel virtual reality robotic surgical simulator (RoSS) in surgical anatomy training and pattern recognition. STUDY DESIGN Ten surgical trainees (medical students and residents) were recruited to participate in a study that evaluated the efficacy of a robotic simulator in anatomy training. The subjects were divided into two groups of five individuals each. Each participant received a syllabus consisting of line diagrams and color pictures of the human anatomy. All participants were later tested on identifying the same five anatomical landmarks from photographs from actual laparoscopic procedures. Group I studied the syllabus and took the test. Group II similarly studied the syllabus, but were trained on the RoSS system using cognitive skill sets and then took the same test. Group II were asked to complete a posttest survey. RESULTS Mean time to complete the test was 142.8 seconds for group I and 118.4 seconds for group II. Mean number of errors committed by the group trained on RoSS was 0.4 out of 5, whereas the group that did not undergo training on RoSS committed 1.7 out of 5. The mean number of correct answers given by group I was 2.9 out of 5, whereas group II answered 4.2 out 5 correctly. All results were statistically significant. The subjects rated the anatomy module helpful, with a mean rating of 3.6 out of 5. CONCLUSIONS RoSS is an effective tool in anatomy training. Further testing is underway to illustrate its important role in medical education and robotic surgical training.
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Ingraham JM, Weber RA, Weber RA. Utilizing a simulated tendon to teach tendon repair technique. Hand (N Y) 2009; 4:150-5. [PMID: 19319610 PMCID: PMC2686799 DOI: 10.1007/s11552-009-9184-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 03/05/2009] [Indexed: 10/21/2022]
Abstract
To evaluate the effectiveness of teaching core tendon repairs using a simulation model, ten surgical residents with no prior experience repairing flexor tendons were taught a four-strand cruciate repair. The residents then performed ten repairs each on a simulated tendon (a round synthetic bait worm 10 mm in diameter) while being timed and graded by a hand surgeon using a global rating scale (1 to 5). Six residents also performed a zone IV flexor tendon repair on a fresh frozen cadaver--three residents who had practiced and three other residents who had no practice on the simulated tendon. The mean initial quality score was 2.4/5.0 which improved to 4.8/5.0 by the tenth trial. There was a significant incremental improvement in mean performance from trial 1 to 10 (p < 0.0001). The mean times to complete the first and last repairs were 5.4 and 3.0 min, respectively. In the cadaver trial, there was statistically significant evidence (p = 0.05, one-sided Wilcoxon exact test) that the three residents previously trained with the simulated tendon had a higher median performance (4.4, min = 4.3, max = 4.8) than the three who had not been trained (1.8, min = 1.7, max = 2.1). The mean times to complete the repairs were 4.0 and 5.8 min, respectively. In conclusion, this inexpensive model mimics an in vivo tendon repair experience with sufficient fidelity to justify its use in training residents to perform a tendon repair.
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Affiliation(s)
- J. M. Ingraham
- Scott & White Memorial Hospital/Texas A&M Health Science Center College of Medicine, Temple, TX USA ,Division of Plastic Surgery, Scott & White Memorial Hospital, 2401 S. 31st Street, Temple, TX 76508 USA
| | | | - R. A. Weber
- Scott & White Memorial Hospital/Texas A&M Health Science Center College of Medicine, Temple, TX USA
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Carter YM, Marshall MB. Open Lobectomy Simulator Is an Effective Tool for Teaching Thoracic Surgical Skills. Ann Thorac Surg 2009; 87:1546-50; discussion 1551. [DOI: 10.1016/j.athoracsur.2009.02.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 02/03/2009] [Accepted: 02/09/2008] [Indexed: 10/20/2022]
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Barrios L, Tsuda S, Derevianko A, Barnett S, Moorman D, Cao CL, Karavas AN, Jones DB. Framing family conversation after early diagnosis of iatrogenic injury and incidental findings. Surg Endosc 2009; 23:2535-42. [PMID: 19343426 DOI: 10.1007/s00464-009-0450-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 02/17/2009] [Accepted: 02/27/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgeons are rarely formally trained in giving bad news to patients. The aim of our study was to examine and compare techniques of disclosure of iatrogenic and incidental operative findings among surgical residents. METHODS General surgery residents performed a laparoscopic cholecystectomy on the SurgicalSIM device in a mock operating room. Half (n = 8) were presented with a common bile duct injury, and half (n = 7) encountered metastatic gallbladder cancer during the operation. Both groups disclosed this information to a patient's scripted family member and completed a questionnaire. All encounters were videotaped and independently rated using a modified SPIKES protocol, a validated tool for delivering bad news. We compared disclosure of iatrogenic versus unexpected findings by year of training. Analysis was performed using the Mann-Whitney test. RESULTS Regardless of the year of training, more residents were comfortable with disclosure of an incidental finding than disclosure of an iatrogenic injury (47 vs. 33%). Senior residents (PGY4-PGY5) had better ratings by SPIKES (p < 0.05), most notably for tailoring disclosure to what patient and family understand, exploring patient and family expectations, and offering to answer any questions (p < 0.05). Even though all residents felt more comfortable with disclosure of an incidental finding, the quality of the disclosure by SPIKES score was the same for iatrogenic and incidental operative findings (p = NS). CONCLUSION In general, trainees are ill prepared for delivering bad news. Disclosure of iatrogenic injuries was more challenging compared to that of incidental findings. Senior residents do better than junior residents at delivering bad news.
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Affiliation(s)
- Limaris Barrios
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Endoscopic endonasal surgery simulator as a training tool for ophthalmology residents. Ophthalmic Plast Reconstr Surg 2009; 24:460-4. [PMID: 19033842 DOI: 10.1097/iop.0b013e31818aaf80] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgical training on the endoscopic endonasal surgery simulator had proven efficacy for otorhinolaryngology residents in preparation for endoscopic endonasal and sinus surgery. Its use for ophthalmology residents in preparation for endoscopic endonasal dacryocystorhinostomy has not been previously studied. METHODS Eight of 15 ophthalmology residents recruited for this experimental study underwent training on the endoscopic endonasal surgery simulator, completing the novice and intermediate modules. All 15 residents then participated in cadaver surgical training, performing defined surgical tasks including endoscopic navigation, identification of nasal anatomy, endonasal injection, and middle turbinate medialization. Performance on these tasks was videotaped and graded by 2 masked observers. Total mean scores and variance by task category were compared between subjects and controls and interobserver variance was compared between observers. RESULTS Correlation between the 2 masked observers' scores was strong (R = 0.677), with total mean scores of 2.34 and 2.38, respectively. Total mean scores were 2.79 for subjects, and 1.86 for controls (F value 0.735, p = 0.01). Residents who trained on the simulator performed significantly better during endonasal navigation (mean scores 2.58 for subjects versus 1.74 for controls, p = 0.04) and endonasal injection (mean scores 2.73 for subjects versus 1.72 for controls, p = 0.03) and minimally better at identification of nasal anatomy (mean scores 2.93 for subjects versus 1.88 for controls, p = 0.18) and middle turbinate medialization (mean scores 3.13 for subjects versus 2.78 for controls, p = 0.36). CONCLUSIONS Ophthalmology residents who trained on the surgical simulator had significantly enhanced endoscopic endonasal surgical skills for endonasal navigation and injection.
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Contag SP, Klein AM, Blount AC, Johns MM. Validation of a laryngeal dissection module for phonomicrosurgical training. Laryngoscope 2009; 119:211-5. [DOI: 10.1002/lary.20018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Rush R, Ginsberg HJ, Jenkinson R, Whyne CM. Beyond the Operating Room: A Simulator for Sacroiliac Screw Insertion. Surg Innov 2008; 15:321-3. [DOI: 10.1177/1553350608327170] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current teaching techniques for orthopedic screw insertions involve “learning by doing” in the operating room. Minimally invasive insertion of sacroilliac (SI) screws is a relatively uncommon operation, providing scant opportunity for training outside of a few major centers. As such, SI screw insertion is a prime candidate for simulator-based training. This work describes the development and implementation of a simulator for minimally invasive SI screw insertion using accurate 3-dimensional (3D) computed tomography (CT)—based visualization of the pelvic and upper sacral anatomy. The simulator was designed in Tool Command Language atop the Amira 3D visualization package. CT images of pelvic regions were automatically segmented to generate 3D surfaces. Using inlet and outlet 3D views, guidewire insertion can be performed followed by an appropriately sized SI screw. The simulator was found to provide a realistic representation of the pelvis, and test users reported increased understanding of the procedure of SI screw insertion following use. The 3D reconstructions of the pelvis allowed for visual correlations between CT slices and inlet and outlet x-ray views. Pilot work with surgical trainees suggests the tool's value in increasing the familiarity of surgical trainees to visualize the pelvis in 3D and perform SI screw insertion.
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Affiliation(s)
- Raphael Rush
- Orthopaedic Biomechanics Laboratory, Sunnybrook Health Sciences
| | - Howard J. Ginsberg
- Department of Surgery, University of Toronto, Division of Neurosurgery, St. Michaels Hospital (HJG), Toronto, Ontario, Canada
| | | | - Cari M. Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Health Sciences, , Department of Surgery, University of Toronto
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