1
|
Kuemmerli C, Linke K, Daume D, Germann N, Peterli R, Müller-Stich B, Klasen JM. The PLET (Portable Laparoscopic Endo-Trainer) study: a randomized controlled trial of home- versus hospital-based surgical training. Langenbecks Arch Surg 2024; 409:186. [PMID: 38869683 DOI: 10.1007/s00423-024-03375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE The purpose of this study was to assess the effect of training with a personal, portable laparoscopic endo-trainer (PLET) on residents' laparoscopic skills. METHODS The study took place at a tertiary-care academic university hospital in Switzerland. All participants were randomized to either a home- or hospital-based PLET training group, and surgical skill performance was assessed using five laparoscopic exercises. 24 surgical residents, 13 females and 11 males, were enrolled at any training stage. Nine residents completed the assessments. Endpoints consisted of subjective and objective assessment ratings as well as exercise time and qualitative data up to 12 weeks. The primary outcome was the difference in exercise time and secondary outcomes included performance scores as well as qualitative data. RESULTS The hospital-based training group performed exercises number 1, 3 and 4 faster at 12 weeks than at baseline (p = .003, < 0.001 and 0.024). Surgical skill performance was not statistically significantly different in any of the endpoints between the hospital- and home-based training groups at 12 weeks. Both the subjective and objective assessment ratings significantly improved in the hospital-based training group between baseline and 12 weeks (p = .006 and 0.003, respectively). There was no statistically significant improvement in exercise time as well as subjective and objective assessment ratings over time in the home-based training group. The qualitative data suggested that participants who were randomized to the hospital-based training group wished to have the PLET at home and vice versa. Several participants across groups lacked motivation because of their workload or time constraints, though most believed the COVID-19 pandemic had no influence on their motivation or the time they had for training. CONCLUSION The PLET enhances laparoscopic surgical skills over time in a hospital-based training setting. In order to understand and optimize motivational factors, further research is needed. TRIAL REGISTRATION This trial was retrospectively registered on clinicaltrials.gov (NCT06301230).
Collapse
Affiliation(s)
- Christoph Kuemmerli
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Katja Linke
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Diana Daume
- Department of General Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Ralph Peterli
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Beat Müller-Stich
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Jennifer M Klasen
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland.
| |
Collapse
|
2
|
Levitt EB, Paul KD, Vatsia SK, Scannell B, Patt JC, Templeton K, McGwin G, Ponce BA. Benefits of an Orthopedic Education Research Collaborative: An Innovative Approach. Cureus 2023; 15:e34903. [PMID: 36938282 PMCID: PMC10016735 DOI: 10.7759/cureus.34903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 02/16/2023] Open
Abstract
Background Graduate Medical Education (GME) research in orthopedic surgery is an important but underrepresented subject in the medical literature. It was unknown if orthopedic residency leaders were interested in a surgical education research collaborative (orthopedic collaborative). The objectives of this study were to assess the potential benefit of an orthopedic collaborative from orthopedic residency leaders and investigate the factors associated with the support of a research collaborative within a surgical subspecialty. Methodology An anonymous 19-question survey-based study was distributed through REDCap (Nashville, TN, USA) to orthopedic residency leaders in the United States, from July to October 2020. The main outcome was perceived benefit. Additional aspects included program characteristics, challenges in performing resident education research, and organizational issues such as authorship, frequency of study requests, and governance. Results Almost all orthopedic faculty leadership (99%, 73/74) stated that resident education and faculty development research projects would benefit from an orthopedic education research collaborative. In comparison to unsupportive respondents, younger age (P = 0.006), 15 or fewer years in practice (P = 0.04), and having 0 to 100 peer-reviewed publications (P = 0.047) were associated with support for an orthopedic collaborative. Conclusions Challenges related to survey-based study quality and generalizability at single institutions can benefit from multi-institutional collaboration to develop high-quality studies that capture a representative sample to support orthopedic surgery program development.
Collapse
Affiliation(s)
- Eli B Levitt
- Orthopedic Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
- Internal Medicine, Palmetto General Hospital, Hialeah, USA
| | - Kyle D Paul
- Orthopedic Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, USA
- Orthopedic Surgery, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center, San Antonio, USA
| | | | | | | | - Kim Templeton
- Orthopedic Surgery, University of Kansas School of Medicine, Kansas City, USA
| | - Gerald McGwin
- Epidemiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | | |
Collapse
|
3
|
Schmidt MW, Haney CM, Kowalewski KF, Bintintan VV, Abu Hilal M, Arezzo A, Bahra M, Besselink MG, Biebl M, Boni L, Diana M, Egberts JH, Fischer L, Francis N, Hashimoto DA, Perez D, Schijven M, Schmelzle M, Soltes M, Swanstrom L, Welsch T, Müller-Stich BP, Nickel F. Development and validity evidence of an objective structured assessment of technical skills score for minimally invasive linear-stapled, hand-sewn intestinal anastomoses: the A-OSATS score. Surg Endosc 2022; 36:4529-4541. [PMID: 34755235 PMCID: PMC9085690 DOI: 10.1007/s00464-021-08806-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The aim of this study was to develop a reliable objective structured assessment of technical skills (OSATS) score for linear-stapled, hand-sewn closure of enterotomy intestinal anastomoses (A-OSATS). MATERIALS AND METHODS The Delphi methodology was used to create a traditional and weighted A-OSATS score highlighting the more important steps for patient outcomes according to an international expert consensus. Minimally invasive novices, intermediates, and experts were asked to perform a minimally invasive linear-stapled intestinal anastomosis with hand-sewn closure of the enterotomy in a live animal model either laparoscopically or robot-assisted. Video recordings were scored by two blinded raters assessing intrarater and interrater reliability and discriminative abilities between novices (n = 8), intermediates (n = 24), and experts (n = 8). RESULTS The Delphi process included 18 international experts and was successfully completed after 4 rounds. A total of 4 relevant main steps as well as 15 substeps were identified and a definition of each substep was provided. A maximum of 75 points could be reached in the unweighted A-OSATS score and 170 points in the weighted A-OSATS score respectively. A total of 41 anastomoses were evaluated. Excellent intrarater (r = 0.807-0.988, p < 0.001) and interrater (intraclass correlation coefficient = 0.923-0.924, p < 0.001) reliability was demonstrated. Both versions of the A-OSATS correlated well with the general OSATS and discriminated between novices, intermediates, and experts defined by their OSATS global rating scale. CONCLUSION With the weighted and unweighted A-OSATS score, we propose a new reliable standard to assess the creation of minimally invasive linear-stapled, hand-sewn anastomoses based on an international expert consensus. Validity evidence in live animal models is provided in this study. Future research should focus on assessing whether the weighted A-OSATS exceeds the predictive capabilities of patient outcomes of the unweighted A-OSATS and provide further validity evidence on using the score on different anastomotic techniques in humans.
Collapse
Affiliation(s)
- Mona W. Schmidt
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Department of Gynecology and Obstetrics, University Medical Centre Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Caelan M. Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Department of Urology, University Hospital Leipzig, Liebigstraße 20, Haus 4, 04103 Leipzig, Germany
| | - Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Vasile V. Bintintan
- Department of Surgery, 1st Surgical Clinic, University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Mohammed Abu Hilal
- Department of Surgery, Hepatobiliary Pancreatic and Minimally Invasive Unit, Poliambulanza Foundation Hospital, Brescia, Italy ,Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Marcus Bahra
- Department of Surgical Oncology and Robotics, Waldfriede Hospital, Berlin, Germany
| | - Marc G. Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Matthias Biebl
- Department of Surgery, Charité—Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow Klinikum, Berlin, Germany
| | - Luigi Boni
- Fondazione IRCCS-Ca`Granda - Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Michele Diana
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France ,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France ,Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France ,ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France
| | - Jan H. Egberts
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, Kurt Semm Center for Minimally Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Lars Fischer
- Department of Surgery, Hospital Mittelbaden, Baden-Baden, Germany
| | - Nader Francis
- Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, UK
| | | | - Daniel Perez
- Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlies Schijven
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Moritz Schmelzle
- Department of Surgery, Charité—Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow Klinikum, Berlin, Germany
| | - Marek Soltes
- 1St Department of Surgery, University of Pavol Jozef Safarik, Košice, Slovakia
| | - Lee Swanstrom
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Thilo Welsch
- Department of Visceral, Thoracic, and Vascular Surgery, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Beat P. Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| |
Collapse
|
4
|
Taaffe JP, Kabbani LS, Goltz CJ, Bath J, Mattos MA, Caputo FJ, Singh P, Vogel TR. Feasibility and Evaluation of Surgical Simulation with Developed Crisis Scenarios: A Comparison of Performance by Vascular Surgery Training Paradigms. JOURNAL OF SURGICAL EDUCATION 2021; 78:2110-2116. [PMID: 34172409 DOI: 10.1016/j.jsurg.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/03/2021] [Accepted: 05/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Surgical simulation is an integral component of training and has become increasingly vital in the evaluation and assessment of surgical trainees. Simulation proficiency determination has been traditionally based on accuracy and time to completion of various simulated tasks, but we were interested in assessing clinical judgment during a simulated crisis scenario. This study assessed the feasibility of creating a crisis simulator station for vascular surgery and evaluated the performance of vascular surgery integrated residents (0+5) and vascular surgery fellows (5+2) during a technical testing with an integrated crisis scenario. METHODS A Modified Delphi method was used to create vascular surgery crisis simulation stations containing a clinical scenario in conjunction with either an open or endovascular simulator. Senior level vascular surgery trainees from both integrated residencies (0+5) and traditional vascular surgery fellowships (5+2) were then evaluated on two simulation stations: 1) Elective carotid endarterectomy (CEA) where the crisis is a postoperative stroke and 2) Endovascular aneurysm repair (EVAR) for a ruptured abdominal aortic aneurysm (rAAA). Each simulation had a crisis scenario incorporated into the procedure. Assessment was completed using a performance assessment tool containing a Likert scale. Total score was calculated as a percentage. Scores were also sub-divided in the following four categories: Situation Recognition and Decision-making, Procedural Flow, Technical Skills, and Interpretation and Use of Imaging Skills. Student's t-test was used for analysis. RESULTS 40 senior-level trainees were evaluated (27 fellows and 13 integrated residents) completing 80 simulations. The CEA crisis simulation yielded similar results between both groups (0+5 vs. 5+2, p = 1.00). The 0+5 residents in vascular surgery were graded to be more proficient in the EVAR for rAAA crisis simulation and demonstrated significant differences in Total Score (p = 0.04), Procedural Flow (p=0.03), and Interpretation and Use of Imaging Skills (p = 0.02). CONCLUSIONS The creation of crisis-based simulation for trainees in vascular surgery is feasible and actionable. Integrated 0+5 residents performed similarly to 5+2 fellows on an open carotid endarterectomy (CEA) crisis simulation, but 0+5 residents scored significantly higher compared to traditional 5+2 fellows in an endovascular rAAA crisis simulation. Crisis simulation may offer better educational experiences and improved value compared to routine simulation. Further studies using different procedural models and clinical scenarios are needed to assess the validity of crisis simulation in vascular surgery and to better understand the performance disparities found between these training paradigms.
Collapse
Affiliation(s)
- John P Taaffe
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, Missouri
| | - Loay S Kabbani
- Department of Vascular Surgery, Henry Ford Hospital, Edith and Benson Ford Heart and Vascular Institute, Detroit, Michigan
| | - Christopher J Goltz
- Michigan Vascular Center and Michigan State University Department of Surgery, Flint, Michigan
| | - Jonathan Bath
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, Missouri
| | - Mark A Mattos
- Michigan Vascular Center and Michigan State University Department of Surgery, Flint, Michigan
| | - Francis J Caputo
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Priyanka Singh
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, Missouri
| | - Todd R Vogel
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, Missouri.
| |
Collapse
|
5
|
Lovasik BP, Fay KT, Patel A, Stetler J, Papandria D, Santore MT, Davis SS, Lin E, Srinivasan JK. Development of a laparoscopic surgical skills simulation curriculum: Enhancing resident training through directed coaching and closed-loop feedback. Surgery 2021; 171:897-903. [PMID: 34521515 DOI: 10.1016/j.surg.2021.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Performance feedback through peer coaching and rigorous self-assessment is a critical part of technical skills improvement. However, formal collaborative programs using operative video-based skills assessments to generate peer coaching feedback have only been validated among attending surgeons. In this study, we developed a unique longitudinal, simulation video-based laparoscopic skills resident curriculum using video-based peer coaching and evaluated its association with skills acquisition among surgical trainees. METHODS The laparoscopic simulation curriculum consists of a pre-practice laparoscopic skill video recording, followed by receipt of directed coaching and feedback on performance from a faculty coach, a peer coach, and self-coaching. Residents then completed 6 weeks of feedback-directed practice and submitted a second post-practice laparoscopic skill video recording of the same skill, which was evaluated by a minimally invasive surgery expert grader. All general surgery residents in a single institution were enrolled, with 107 residents completing the curriculum in its initial 2 years. RESULTS Overall, more than two-thirds of residents achieved skills proficiency on their expert assessments, with similar rates of residents achieving skills proficiency at all postgraduate year levels. Significant improvements between the pre-practice assessments and post-practice assessments were most frequently seen in the instrument handling, precision, and motion & flow categories (P < .05 each). Faculty provided the highest number and proportion of closed-loop comments; residents' self-coaching feedback had the lowest number of closed-loop comments, with 83% of self-assessments containing none. CONCLUSION In this study, we describe the successful implementation of a longitudinal laparoscopic skills video-based coaching curriculum designed to improve residents' laparoscopic technical abilities through iterative directed practice supplemented by formative closed-loop feedback. This feasible, reproducible, and low-cost simulation curriculum can be adapted to other training programs and skills acquisition endeavors. This program also prepares trainees for ongoing performance feedback after completion of residency through rigorous self-assessment and peer-to-peer coaching.
Collapse
Affiliation(s)
- Brendan P Lovasik
- Department of Surgery, Emory University School of Medicine, Atlanta, GA. https://twitter.com/blovasik
| | - Katherine T Fay
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Ankit Patel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA. https://twitter.com/ankitpatelmd
| | - Jamil Stetler
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Dominic Papandria
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Matthew T Santore
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - S Scott Davis
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Edward Lin
- Department of Surgery, Emory University School of Medicine, Atlanta, GA. https://twitter.com/edlinemory
| | | |
Collapse
|
6
|
Intelligent Tutoring for Surgical Decision Making: a Planning-Based Approach. INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE IN EDUCATION 2021. [DOI: 10.1007/s40593-021-00261-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Samaratunga R, Johnson L, Gatzidis C, Swain I, Wainwright T, Middleton R. A review of participant recruitment transparency for sound validation of hip surgery simulators: a novel umbrella approach. J Med Eng Technol 2021; 45:434-456. [PMID: 34016011 DOI: 10.1080/03091902.2021.1921868] [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: 01/11/2023]
Abstract
Malposition of implants is associated with complications, higher wear and increased revision rates in total hip replacement (THR) along with surgeon inexperience. Training THR residents to reach expert proficiency is affected by the high cost and resource limitations of traditional training techniques. Research in extended reality (XR) technologies can overcome such barriers. These offer a platform for learning, objective skill-monitoring and, potentially, for automated certification. Prior to their incorporation into curricula however, thorough validation must be undertaken. As validity is heavily dependent on the participants recruited, there is a need to review, scrutinise and define recruitment criteria in the absence of pre-defined standards, for sound simulator validation. A systematic review on PubMed and IEEE databases was conducted. Training simulator validation research in fracture, arthroscopy and arthroplasty relating to the hip was included. 46 validation studies were reviewed. It was observed that there was no uniformity in reporting or recruitment criteria, rendering cross-comparison challenging. This work developed Umbrella categories to help prioritise recruitment, and has formulated a detailed template of fields and guidelines for reporting criteria so that, in future, research may come to a consensus as to recruitment criteria for a hip "expert" or "novice".
Collapse
Affiliation(s)
| | - Layla Johnson
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - Christos Gatzidis
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - Ian Swain
- Faculty of Science and Technology, Bournemouth University, Poole, UK.,Orthopaedic Research Institute, Bournemouth University, UK
| | - Thomas Wainwright
- Orthopaedic Research Institute, Bournemouth University, UK.,University Hospitals Dorset NHS Foundation Trust, UK
| | - Robert Middleton
- Orthopaedic Research Institute, Bournemouth University, UK.,University Hospitals Dorset NHS Foundation Trust, UK
| |
Collapse
|
8
|
Wong SL, Gill BK, Chan JHM, Cheung APH, Charm CYC, Fung CKM, Lam CY, Tong MYT, Lo CKY, Tsang AYK, Nestel D. School-based research agenda on healthcare simulation for nursing education in Hong Kong. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:435-437. [PMID: 35515737 PMCID: PMC8936752 DOI: 10.1136/bmjstel-2020-000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/05/2020] [Accepted: 02/11/2021] [Indexed: 11/20/2022]
Abstract
Background Healthcare simulation has been used as a pedagogical strategy in nursing education. Evidence has shown one of the positive impacts that simulations replace clinical placement. These wide-ranging initiatives are essential, and they can guide a nursing school’s simulation training. However, researching each innovation in the nursing field is beyond the scope. Methods To focus our research and develop the capacity and capability to incorporate healthcare simulation in nursing education, we used a consensus building process to establish a school’s research agenda. A modified Delphi process was adopted to reach a consensus among 10 nursing faculty members in one university with a visiting professor’s support. Results The three themes were identified as (1) embedding simulation into the baccalaureate in nursing curriculum, (2) designing effective simulation-based education and (3) simulating education in the broader world (adolescents). These themes were further categorised into two areas that used simulation in the educational and community settings. Sixty per cent of the faculty members agreed that the question, ‘How can simulation be incorporated into clinical placements to enhance students’ learning?' should be the highest research priority. Conclusion This study adds understanding to incorporate simulation-based education in the nursing curriculum and community provides insights into future research.
Collapse
Affiliation(s)
- Suet Lai Wong
- School of Nursing & Health Studies, The Open University of Hong Kong, Kowloon, Hong Kong SAR
| | - Baljit Kaur Gill
- School of Nursing & Health Studies, The Open University of Hong Kong, Kowloon, Hong Kong SAR
| | - Jacky Hoi Man Chan
- School of Nursing & Health Studies, The Open University of Hong Kong, Kowloon, Hong Kong SAR
| | - Alison Pui Han Cheung
- School of Nursing & Health Studies, The Open University of Hong Kong, Kowloon, Hong Kong SAR
| | | | - Carmen Ka Man Fung
- School of Nursing & Health Studies, The Open University of Hong Kong, Kowloon, Hong Kong SAR
| | - Ching Yee Lam
- School of Nursing & Health Studies, The Open University of Hong Kong, Kowloon, Hong Kong SAR
| | - Mavis Ying Ting Tong
- School of Nursing & Health Studies, The Open University of Hong Kong, Kowloon, Hong Kong SAR
| | - Cora Ka Yee Lo
- School of Nursing & Health Studies, The Open University of Hong Kong, Kowloon, Hong Kong SAR
| | - Alan Yat Kwan Tsang
- School of Nursing & Health Studies, The Open University of Hong Kong, Kowloon, Hong Kong SAR
| | - Debra Nestel
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
9
|
Hedman LR, Felländer-Tsai L. Simulation-based skills training in non-performing orthopedic surgeons: skills acquisition, motivation, and flow during the COVID-19 pandemic. Acta Orthop 2020; 91:520-522. [PMID: 32573303 PMCID: PMC8023967 DOI: 10.1080/17453674.2020.1781413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Leif Rune Hedman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden, and Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden, and Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm
| |
Collapse
|
10
|
Joseph FJ, Weber S, Raabe A, Bervini D. Neurosurgical simulator for training aneurysm microsurgery-a user suitability study involving neurosurgeons and residents. Acta Neurochir (Wien) 2020; 162:2313-2321. [PMID: 32780255 PMCID: PMC7496061 DOI: 10.1007/s00701-020-04522-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to its complexity and to existing treatment alternatives, exposure to intracranial aneurysm microsurgery at the time of neurosurgical residency is limited. The current state of the art includes training methods like assisting in surgeries, operating under supervision, and video training. These approaches are labor-intensive and difficult to fit into a timetable limited by the new work regulations. Existing virtual reality (VR)-based training modules lack patient-specific exercises and haptic properties and are thus inferior to hands-on training sessions and exposure to real surgical procedures. MATERIALS AND METHODS We developed a physical simulator able to reproduce the experience of clipping an intracranial aneurysm based on a patient-specific 3D-printed model of the skull, brain, and arteries. The simulator is made of materials that not only imitate tissue properties including arterial wall patency, thickness, and elasticity but also able to recreate a pulsatile blood flow. A sample group of 25 neurosurgeons and residents (n = 16: early residency with less than 4 years of neurosurgical exposure; n = 9: late residency and board-certified neurosurgeons, 4-15 years of neurosurgical exposure) took part to the study. Participants evaluated the simulator and were asked to answer questions about surgical simulation anatomy, realism, haptics, tactility, and general usage, scored on a 5-point Likert scale. In order to evaluate the feasibility of a future validation study on the role of the simulator in neurosurgical postgraduate training, an expert neurosurgeon assessed participants' clipping performance and a comparison between groups was done. RESULTS The proposed simulator is reliable and potentially useful for training neurosurgical residents and board-certified neurosurgeons. A large majority of participants (84%) found it a better alternative than conventional neurosurgical training methods. CONCLUSION The integration of a new surgical simulator including blood circulation and pulsatility should be considered as part of the future armamentarium of postgraduate education aimed to ensure high training standards for current and future generations of neurosurgeons involved in intracranial aneurysm surgery.
Collapse
Affiliation(s)
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
| |
Collapse
|
11
|
Vega Vega C, Gostlow HC, Marlow N, Babidge W, Maddern G. Examination of participant preferences in the design and delivery of simulation-based education programmes. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:245-246. [DOI: 10.1136/bmjstel-2019-000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 11/03/2022]
|
12
|
Urdiales AIA, Struck GT, Guetter CR, Yaegashi CH, Temperly KS, Abreu P, Tomasich FS, Campos ACL. Surgical cricothyroidostomy. Analysis and comparison between teaching and validation models of simulator models. ACTA ACUST UNITED AC 2020; 47:e20202522. [PMID: 32520132 DOI: 10.1590/0100-6991e-20202522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE to compare the acquisition and retention of knowledge about surgical cricothyroidostomy by the rapid four-step technique (RFST), when taught by expository lecture, low fidelity and high-fidelity simulation models. METHODS ninety medical students at UFPR in the first years of training were randomized assigned into 3 groups, submitted to different teaching methods: 1) expository lectures, 2) low-fidelity simulator model, developed by the research team or 3) high-fidelity simulator model (commercial). The procedure chosen was surgical cricothyroidostomy using the RFST. Soon after lectures, the groups were submitted to a multiple-choice test with 20 questions (P1). Four months later, they underwent another test (P2) with similar content. Analysis of Variance was used to compare the grades of each group in P1 with their grades in P2, and the grades of the 3 groups 2 by 2 in P1 and P2. A multiple comparisons test (post-hoc) was used to check differences within each factor (test and group). Statistical significance was considered when p<0.05. Statistical analysis was performed in the statistical software R version 3.6.1. RESULTS each group was composed of 30 medical students, without demographic differences between them. The mean scores of the groups of the expositive lecture, of the simulator of low fidelity model and of high-fidelity simulator model in P1 were, respectively, 75.00, 76.09, and 68.79, (p<0.05). In P2 the grades were 69.84, 75.32, 69.46, respectively, (p>0.05). CONCLUSIONS the simulation of low fidelity model was more effective in learning and knowledge retention, being feasible for RFST cricothyroidostomy training in inexperienced students.
Collapse
Affiliation(s)
- Akihito Inca Atahualpa Urdiales
- - Hospital do Trabalhador/Federal University of Paraná, Department of Integrated Medicine - Curitiba - PR - Brazil.,- Hospital do Trabalhador/Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil.,- Federal University of Paraná, Postgraduate Program in Surgical Clinic - Curitiba - PR - Brazil
| | | | | | - Cecilia Hissai Yaegashi
- - Cajuru University Hospital- Pontifical Catholic University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| | - Kassio Silva Temperly
- - Pontifical Catholic University of Paraná, Course of Medicina - Curitiba - PR - Brazil
| | - Phillipe Abreu
- - Hospital do Trabalhador/Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| | - Flavio Saavedra Tomasich
- - Hospital do Trabalhador/Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil.,- Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| | - Antônio Carlos Ligocki Campos
- - Federal University of Paraná, Postgraduate Program in Surgical Clinic - Curitiba - PR - Brazil.,- Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| |
Collapse
|
13
|
Huffman EM, Martin JR, Stefanidis D. Teaching technical surgery. Surgery 2020; 167:782-786. [DOI: 10.1016/j.surg.2019.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/18/2022]
|
14
|
Abstract
Annually, an estimated 234 million major surgical operations occur worldwide, with concomitant seven million complications and one million deaths. It is now well established that technical competence is necessary, but not sufficient for modern surgical practice and outcomes. Breakdown in non-technical skills has been attributed as a key root cause for near misses and patient harm in the operating room. This article discusses the multi-faceted skills-set that is necessary for the modern surgeon to succeed and for optimal patient outcomes. This includes technical skills, non-technical skills, with a focus on key CanMEDS framework domains, including leadership, communication, evidence-based surgery and mentorship.
Collapse
Affiliation(s)
- Ankur Khajuria
- Department of Surgery and Cancer, Imperial College London, UK.,Kellogg College, University of Oxford, UK
| |
Collapse
|
15
|
Oussi N, Enochsson L, Henningsohn L, Castegren M, Georgiou E, Kjellin A. Trainee Performance After Laparoscopic Simulator Training Using a Blackbox versus LapMentor. J Surg Res 2020; 250:1-11. [PMID: 32014696 DOI: 10.1016/j.jss.2019.12.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/15/2019] [Accepted: 12/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Training using laparoscopic high-fidelity simulators (LHFSs) to proficiency levels improves laparoscopic cholecystectomy skills. However, high-cost simulators and their limited availability could negatively impact residents' laparoscopic training opportunities. We aimed to assess whether motivation and surgical skill performance differ after basic skills training (BST) using a low-cost (Blackbox) versus LHFS (LapMentor) among medical students. MATERIALS AND METHODS Sixty-three medical students from Karolinska Institutet volunteered, completing written informed consent, questionnaire regarding expectations of the simulation training, and a visuospatial ability test. They were randomized into two groups that received BST using Blackbox (n = 32) or LapMentor (n = 31). However, seven students absence resulted in 56 participants, followed by another 9 dropouts. Subsequently, after training, 47 students took up three consecutive tests using the minimally invasive surgical trainer-virtual reality (MIST-VR) simulator, finalizing a questionnaire. RESULTS More Blackbox group participants completed all MIST-VR tests (29/31 versus 18/25). Students anticipated mastering LapMentor would be more difficult than Blackbox (P = 0.04). In those completing the simulation training, a trend toward an increase was noted in how well participants in the Blackbox group liked the simulator training (P = 0.07). Subgroup analysis of motivation and difficulty in liking the training regardless of simulator was found only in women (Blackbox [P = 0.02]; LapMentor [P = 0.06]). In the Blackbox group, the perceived difficulty of training, facilitation, and liking the Blackbox training (significant only in women) were significantly correlated with the students' performance in the MIST-simulator. No such correlations were found in the LapMentor group. CONCLUSIONS Results indicate an important role for low-tech/low-cost Blackbox laparoscopic BST of students in an otherwise high-tech surrounding. Furthermore, experience of Blackbox BST procedures correlate with students' performance in the MIST-VR simulator, with some gender-specific differences.
Collapse
Affiliation(s)
- Ninos Oussi
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden.
| | - Lars Enochsson
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Lars Henningsohn
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden; Division of Urology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Markus Castegren
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Sweden
| | - Evangelos Georgiou
- Medical Physics Laboratory and Simulation Center, Medical School, University of Athens, Athens, Greece
| | - Ann Kjellin
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
Ostapenko A, McPeck S, Liechty S, Kleiner D. Impacts on Surgery Resident Education at a First Wave COVID-19 Epicenter. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520975022. [PMID: 33283051 PMCID: PMC7691890 DOI: 10.1177/2382120520975022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE This study aims to identify the effects of the COVID-19 pandemic on surgical resident training and education at Danbury Hospital. METHODS We conducted an observational study at a Western Connecticut hospital heavily affected by the first wave of the COVID-19 pandemic to assess its effects on surgical residents, focusing on surgical education, clinical experience, and operative skills development. Objective data was available through recorded work hours, case logs, and formal didactics. In addition, we created an anonymous survey to assess resident perception of their residency experience during the pandemic. RESULTS There are 22 surgical residents at our institution; all were included in the study. Resident weekly duty hours decreased by 23.9 hours with the majority of clinical time redirected to caring for COVID-19 patients. Independent studying increased by 1.6 hours (26.2%) while weekly didactics decreased by 2.1 hours (35.6%). The operative volume per resident decreased by 65.7% from 35.0 to 12.0 cases for the period of interest, with a disproportionately high effect on junior residents, who experienced a 76.2% decrease. Unsurprisingly, 70% of residents reported a negative effect of the pandemic on their surgical skills. CONCLUSIONS During the first wave of the COVID-19 pandemic, surgical residents' usual workflows changed dramatically, as much of their time was dedicated to the critical care of patients with COVID-19. However, the consequent opportunity cost was to surgery-specific training; there was a significant decrease in operative cases and time spent in surgical didactics, along with elevated concern about overall preparedness for their intended career.
Collapse
Affiliation(s)
| | - Samantha McPeck
- Department of Internal Medicine,
University of Connecticut, Storrs, CT, USA
| | - Shawn Liechty
- Department of General Surgery, Danbury
Hospital, Danbury, CT, USA
| | - Daniel Kleiner
- Department of General Surgery, Danbury
Hospital, Danbury, CT, USA
| |
Collapse
|
17
|
Anton NE, Gardner AK, Stefanidis D. Priorities in surgical simulation research: What do the experts say? Am J Surg 2019; 220:95-99. [PMID: 31672307 DOI: 10.1016/j.amjsurg.2019.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Progressing the field of surgical simulation research cohesively requires organization. The purpose of this study was to establish contemporary research priorities utilizing Delphi methodology. METHODS Surgical researchers with expertise in simulation-based research were invited to submit important questions for the field according to an organized framework. Thematic analysis was used to collapse questions into unique questions. In a second round, experts rated the importance of questions. In a third round, experts re-rated the importance of questions. A prioritized agenda was then created. RESULTS Eighteen experts submitted 80 questions in round one, which were collapsed into 43. In the final round, experts rated the following question as the most important priority: "Does demonstrated competency in the simulation lab translate to clinical competency (OR etc.)?" CONCLUSIONS Our systematic approach identified multiple important questions to advance the field that may guide researchers and funding agencies alike.
Collapse
Affiliation(s)
- Nicholas E Anton
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| |
Collapse
|
18
|
Reichl K, Baird JM, Chisholm D, Terhorst L. Measuring and Describing Occupational Therapists’ Perceptions of the Impact of High-Fidelity, High-Technology Simulation Experiences on Performance. Am J Occup Ther 2019; 73:7306205090p1-7306205098p8. [DOI: 10.5014/ajot.2019.034694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: As the use of simulation in occupational therapy education continues to increase, so too does the need for continued research on its impact on clinical practice performance and the value of simulation as a pedagogic method.
Objective: To develop a survey to measure the perceived impact of high-fidelity, high-technology simulation experiences during occupational therapy education on occupational therapists’ performance and to describe occupational therapists’ perceptions of the impact of simulation on clinical skills.
Design: Cross-sectional descriptive study.
Setting: Online survey administration.
Participants: Occupational therapists completed an online survey to measure their perceptions of the impact of high-fidelity, high-technology simulation experiences on essential skills in four performance domains: confidence, knowledge, clinical skills, and patient safety skills.
Results: Sixty-seven occupational therapists perceived participation in simulation experiences during occupational therapy education had more impact on transferring clients and using safe body mechanics than on communicating with clients, assessing vital signs, or applying clinical reasoning. The survey items had evidence of content validity, and scores showed good internal consistency reliability.
Conclusions: Survey results suggested high-fidelity, high-technology simulation during occupational therapy education may affect clinical practice performance. Additional research is needed to determine the effectiveness of simulation education in preparing occupational therapists for clinical practice.
What This Article Adds: The survey developed in this study is a reliable measure of the impact of simulation experiences on clinical practice performance of occupational therapists.
Collapse
Affiliation(s)
- Kenneth Reichl
- Kenneth Reichl, CScD, OTR/L, is Assistant Professor, Department of Biology, Slippery Rock University, Slippery Rock, PA;
| | - Joanne M. Baird
- Joanne M. Baird, PhD, OTR/L, CHSE, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Denise Chisholm
- Denise Chisholm, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Lauren Terhorst
- Lauren Terhorst, PhD, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
19
|
Kelz RR, Sellers MM, Merkow R, Aggarwal R, Ko CY. Defining the Content for a Quality and Safety in Surgery Curriculum Using a Nominal Group Technique. JOURNAL OF SURGICAL EDUCATION 2019; 76:795-801. [PMID: 30466885 DOI: 10.1016/j.jsurg.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE There is growing awareness of the need to provide surgical residents with training in quality and safety. Previous studies have revealed a need for a formal curriculum, but the content and structure of such a curriculum has not been defined. Our objective was to develop a surgery resident curriculum using a consensus, team-building approach. DESIGN This study consisted of moderated, structured focus groups using a nominal group technique to guide discussion. Participants generated rank lists of topics to be included and answered questions regarding structure and design of teaching and assessment modalities. SETTING Two separate focus groups among 9 surgical residents and 10 faculty experts in quality and safety were held in conjunction with the American College of Surgeons Quality and Safety Conference in July 2017. A total of 16 institutions were represented. RESULTS A total of 35 topics were initially proposed by the resident group and a total of 41 topics were proposed by the expert group. After discussion, each group reached consensus on a final list of 9 topics. Most topics in the final lists fell into the broad areas of improvement science and nontechnical skills. Residents indicated that most topics were, on average, poorly covered by their current training program, however, a wide range was noted within each topic. Faculty indicated a preference for didactic instructional methods and assessment using multiple-choice questions. CONCLUSIONS Quality and safety are integral components of surgical training. Learners and experts agreed that topics within the domains of improvement science and nontechnical skills should be included in a formal curriculum. Learners reported wide variation on how well these topics are currently included in graduate medical education training programs.
Collapse
Affiliation(s)
- Rachel R Kelz
- Center for Surgery and Healthcare Economics, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Philadelphia.
| | - Morgan M Sellers
- Center for Surgery and Healthcare Economics, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Philadelphia; Department of General Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Merkow
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rajesh Aggarwal
- Department of Surgery, Thomas Jefferson University, Philadelphia, Philadelphia
| | - Clifford Y Ko
- American College of Surgeons, Chicago, Illinois; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| |
Collapse
|
20
|
McKinley SK, Hashimoto DA, Mansur A, Cassidy D, Petrusa E, Mullen JT, Phitayakorn R, Gee DW. Feasibility and Perceived Usefulness of Using Head-Mounted Cameras for Resident Video Portfolios. J Surg Res 2019; 239:233-241. [PMID: 30856516 DOI: 10.1016/j.jss.2019.01.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is limited guidance on how to longitudinally administer simulation materials or to incorporate video recordings into assessment portfolios of simulated surgical skills. MATERIALS AND METHODS We launched a longitudinal weekly simulation curriculum for PGY1-PGY3 surgical residents based on the ACS/APDS Curriculum. Residents underwent monthly objective structured assessment of technical skills (OSATS) while wearing head-mounted cameras. Videos of OSATS performance accrued into individual online video portfolios. Residents were surveyed about their attitudes toward video recording. RESULTS Twenty-seven general surgical residents participated, completing 161 OSATS encompassing 11 distinct skills and generating 258 videos of simulated skills performance. The overall survey response rate was 88%. Residents viewed the curriculum favorably overall, and 36.4% of residents accessed their videos. Of those who did not watch their videos, 78.6% cited not having enough time, whereas 28.6% did not think the videos would be useful. Over 95% of surveyed residents expressed interest in having a video library of attending-performed procedures, 59.1% were interested in having their own operations recorded, and 45.5% were interested in video-based coaching. CONCLUSIONS Residents viewed longitudinal administration of the ACS/APDS Curriculum positively. Although video recording in simulation is feasible, resident interest may be higher for intraoperative recordings than for simulated skills.
Collapse
Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel A Hashimoto
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arian Mansur
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas Cassidy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
21
|
Veenstra BR, Wojtowicz A, Walsh N, Velasco JM. The emergency surgical airway: Bridging the gap from quality outcome to performance improvement through a novel simulation based curriculum. Am J Surg 2019; 217:562-565. [DOI: 10.1016/j.amjsurg.2018.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
|
22
|
Selzer DJ. Overview of Simulation in Surgery. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
23
|
Characteristics of participants who withdraw from surgical simulation-based educational research. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2019; 5:27-31. [DOI: 10.1136/bmjstel-2017-000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 11/03/2022]
Abstract
IntroductionThe problems associated with recruitment and retention of patients in clinical trials have been widely addressed in literature; however, similar problems associated with healthcare workers are rarely reported. The aim of this paper is to outline the factors that can impede a participant’s successful participation in a research project and to analyse the characteristics of participants that withdrew.MethodsThe Laparoscopic Simulation Skills Program (LSSP) was a prospective randomised cohort study investigating the efficacy of self-directed learning for basic laparoscopic skills acquisition. Two hundred and seven medical students, junior doctors, as well as surgical and gynaecology trainees were enrolled between June 2015 and November 2016.ResultsFifty-six (27%) participants failed to attend the final assessment. Of these, 43 participants (77%) responded to the follow-up survey and/or phone contact regarding non-attendance. Most participants failed to attend due to lack of free time/conflicting clinical duties and university requirements. Participants who did not attend the final assessment and did not provide further responses were less motivated by a career in surgery, surgical simulation and perceived less benefits of laparoscopic simulation. The 43 participants who answered the survey and/or phone contact provided similar responses to the participants who completed the study requirements and had more intrinsic motivators to enrol.ConclusionsClinical duties and other educational commitments are the biggest barriers to participation in simulation based-education research.
Collapse
|
24
|
David JA, Rifkin WJ, Saadeh PB, Sinno S. Assessing the Value of a Multimedia-Based Aesthetic Curriculum in Plastic Surgery Residency: A Single-Center Pilot Study. Aesthet Surg J 2018; 38:NP216-NP224. [PMID: 29733345 DOI: 10.1093/asj/sjy110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although global demand for cosmetic surgery continues to rise, plastic surgery residents feel that current models of aesthetic training are inadequate in preparing them for future practice. Digital learning resources offer promising educational possibilities, yet there are no formal studies investigating the integration of these technologies into the aesthetic curriculum. OBJECTIVES Here, we review the current state of aesthetic training for plastic surgery residents and present a pilot study investigating the value of a dedicated multimedia-based aesthetic curriculum at a single, large academic program. METHODS Twenty plastic surgery residents participated in an 8-week curriculum consisting of weekly multimedia-based modules covering a specific aesthetic topic. Participants completed pre- and post-intervention surveys at 0 and 10 weeks, respectively. Surveys evaluated resident perspectives of the current state of aesthetic training, confidence in performing surgical and non-surgical aesthetic procedures, perceived efficacy of multimedia interventions for learning, and preferences for inclusion of such approaches in future curricula. RESULTS 16.7% of participants planned on entering an aesthetic fellowship following residency. The mean number of months of dedicated cosmetic surgery rotations was 1.65 months. Resident confidence level in performing a particular aesthetic procedure significantly increased in 6/14 modules. More than 90% of residents were interested in incorporating the modules into residency. CONCLUSIONS Technology-based aesthetic training is critical for producing the finest future practitioners and leaders of this specialty. Here, we show that plastic surgery residents can benefit from a multimedia-based aesthetic curriculum, even if they do not plan on pursuing a career devoted to cosmetic surgery.
Collapse
Affiliation(s)
- Joshua A David
- Chief of Plastic Surgery Service, Bellevue Hospital Center New York University Langone Health, New York, NY
- Director of the Plastic Surgery Residency Program, New York University Langone Health, New York, NY Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Health, New York, NY
| | - William J Rifkin
- Chief of Plastic Surgery Service, Bellevue Hospital Center New York University Langone Health, New York, NY
- Director of the Plastic Surgery Residency Program, New York University Langone Health, New York, NY Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Health, New York, NY
| | - Pierre B Saadeh
- Chief of Plastic Surgery Service, Bellevue Hospital Center New York University Langone Health, New York, NY
- Director of the Plastic Surgery Residency Program, New York University Langone Health, New York, NY Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Health, New York, NY
| | - Sammy Sinno
- Plastic surgeon in private practice in Chicago, IL
| |
Collapse
|
25
|
Abstract
STATEMENT Improving healthcare safety is a worthwhile and important endeavor. Simulation-based activities can help with such a goal through research and training. In this manner, it can focus on education and training, assessment and metrics, process improvement, and culture change to help move forward both patient safety and quality of care.This article will address the following three main topics: (1) designing simulation-based activities to promote high reliability in healthcare, (2) developing simulation-based activities to foster resilience in healthcare systems, and (3) evaluating the impact of adverse events in healthcare and how simulation-based activities can be used to determine and potentially to prevent their cause. These topics will be treated sequentially, providing synopses of concepts and giving examples of research currently being undertaken. It will then highlight current priorities for simulation-based research in this domain by drawing from insights obtained and a targeted literature review.
Collapse
|
26
|
|
27
|
Gibby JT, Swenson SA, Cvetko S, Rao R, Javan R. Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography. Int J Comput Assist Radiol Surg 2018; 14:525-535. [PMID: 29934792 DOI: 10.1007/s11548-018-1814-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/13/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Augmented reality has potential to enhance surgical navigation and visualization. We determined whether head-mounted display augmented reality (HMD-AR) with superimposed computed tomography (CT) data could allow the wearer to percutaneously guide pedicle screw placement in an opaque lumbar model with no real-time fluoroscopic guidance. METHODS CT imaging was obtained of a phantom composed of L1-L3 Sawbones vertebrae in opaque silicone. Preprocedural planning was performed by creating virtual trajectories of appropriate angle and depth for ideal approach into the pedicle, and these data were integrated into the Microsoft HoloLens using the Novarad OpenSight application allowing the user to view the virtual trajectory guides and CT images superimposed on the phantom in two and three dimensions. Spinal needles were inserted following the virtual trajectories to the point of contact with bone. Repeat CT revealed actual needle trajectory, allowing comparison with the ideal preprocedural paths. RESULTS Registration of AR to phantom showed a roughly circular deviation with maximum average radius of 2.5 mm. Users took an average of 200 s to place a needle. Extrapolation of needle trajectory into the pedicle showed that of 36 needles placed, 35 (97%) would have remained within the pedicles. Needles placed approximated a mean distance of 4.69 mm in the mediolateral direction and 4.48 mm in the craniocaudal direction from pedicle bone edge. CONCLUSION To our knowledge, this is the first peer-reviewed report and evaluation of HMD-AR with superimposed 3D guidance utilizing CT for spinal pedicle guide placement for the purpose of cannulation without the use of fluoroscopy.
Collapse
Affiliation(s)
- Jacob T Gibby
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA
| | - Samuel A Swenson
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA
| | - Steve Cvetko
- Novarad Corporation, 752 East 1180 South, Suite 200, American Fork, UT, 84003, USA
| | - Raj Rao
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA.,Department of Orthopedic Surgery, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA
| | - Ramin Javan
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA. .,Department of Neuroradiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.
| |
Collapse
|
28
|
Buescher JF, Mehdorn AS, Neumann PA, Becker F, Eichelmann AK, Pankratius U, Bahde R, Foell D, Senninger N, Rijcken E. Effect of Continuous Motion Parameter Feedback on Laparoscopic Simulation Training: A Prospective Randomized Controlled Trial on Skill Acquisition and Retention. JOURNAL OF SURGICAL EDUCATION 2018; 75:516-526. [PMID: 28864265 DOI: 10.1016/j.jsurg.2017.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/06/2017] [Accepted: 08/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the effect of motion parameter feedback on laparoscopic basic skill acquisition and retention during a standardized box training curriculum. DESIGN A Lap-X Hybrid laparoscopic simulator was designed to provide individual and continuous motion parameter feedback in a dry box trainer setting. In a prospective controlled trial, surgical novices were randomized into 2 groups (regular box group, n = 18, and Hybrid group, n = 18) to undergo an identical 5-day training program. In each group, 7 standardized tasks on laparoscopic basic skills were completed twice a day on 4 consecutive days in fixed pairs. Additionally, each participant performed a simulated standard laparoscopic cholecystectomy before (day 1) and after training (day 5) on a LAP Mentor II virtual reality (VR) trainer, allowing an independent control of skill progress in both groups. A follow-up assessment of skill retention was performed after 6 weeks with repetition of both the box tasks and VR cholecystectomy. SETTING Muenster University Hospital Training Center, Muenster, Germany. PARTICIPANTS Medical students without previous surgical experience. RESULTS Laparoscopic skills in both groups improved significantly during the training period, measured by the overall task performance time. The 6 week follow-up showed comparable skill retention in both groups. Evaluation of the VR cholecystectomies demonstrated significant decrease of operation time (p < 0.01), path length of the left and right instrument, and the number of movements of the left and right instruments for the Hybrid group (all p < 0.001), compared to the box group. Similar results were found at the assessment of skill retention. CONCLUSION Simulation training on both trainers enables reliable acquisition of laparoscopic basic skills. Furthermore, individual and continuous motion feedback improves laparoscopic skill enhancement significantly in several aspects. Thus, training systems with feedback of motion parameters should be considered to achieve long-term improvement of motion economy among surgical trainees.
Collapse
Affiliation(s)
| | - Anne-Sophie Mehdorn
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | | | - Felix Becker
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ann-Kathrin Eichelmann
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ulrich Pankratius
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ralf Bahde
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Daniel Foell
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Norbert Senninger
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Emile Rijcken
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
| |
Collapse
|
29
|
Aldekhyl S, Cavalcanti RB, Naismith LM. Cognitive load predicts point-of-care ultrasound simulator performance. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:23-32. [PMID: 29305817 PMCID: PMC5807260 DOI: 10.1007/s40037-017-0392-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The ability to maintain good performance with low cognitive load is an important marker of expertise. Incorporating cognitive load measurements in the context of simulation training may help to inform judgements of competence. This exploratory study investigated relationships between demographic markers of expertise, cognitive load measures, and simulator performance in the context of point-of-care ultrasonography. METHODS Twenty-nine medical trainees and clinicians at the University of Toronto with a range of clinical ultrasound experience were recruited. Participants answered a demographic questionnaire then used an ultrasound simulator to perform targeted scanning tasks based on clinical vignettes. Participants were scored on their ability to both acquire and interpret ultrasound images. Cognitive load measures included participant self-report, eye-based physiological indices, and behavioural measures. Data were analyzed using a multilevel linear modelling approach, wherein observations were clustered by participants. RESULTS Experienced participants outperformed novice participants on ultrasound image acquisition. Ultrasound image interpretation was comparable between the two groups. Ultrasound image acquisition performance was predicted by level of training, prior ultrasound training, and cognitive load. There was significant convergence between cognitive load measurement techniques. A marginal model of ultrasound image acquisition performance including prior ultrasound training and cognitive load as fixed effects provided the best overall fit for the observed data. DISCUSSION In this proof-of-principle study, the combination of demographic and cognitive load measures provided more sensitive metrics to predict ultrasound simulator performance. Performance assessments which include cognitive load can help differentiate between levels of expertise in simulation environments, and may serve as better predictors of skill transfer to clinical practice.
Collapse
Affiliation(s)
- Sara Aldekhyl
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rodrigo B Cavalcanti
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ho Ping Kong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada
| | - Laura M Naismith
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| |
Collapse
|
30
|
Pfandler M, Lazarovici M, Stefan P, Wucherer P, Weigl M. Virtual reality-based simulators for spine surgery: a systematic review. Spine J 2017; 17:1352-1363. [PMID: 28571789 DOI: 10.1016/j.spinee.2017.05.016] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/06/2017] [Accepted: 05/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Virtual reality (VR)-based simulators offer numerous benefits and are very useful in assessing and training surgical skills. Virtual reality-based simulators are standard in some surgical subspecialties, but their actual use in spinal surgery remains unclear. Currently, only technical reviews of VR-based simulators are available for spinal surgery. PURPOSE Thus, we performed a systematic review that examined the existing research on VR-based simulators in spinal procedures. We also assessed the quality of current studies evaluating VR-based training in spinal surgery. Moreover, we wanted to provide a guide for future studies evaluating VR-based simulators in this field. STUDY DESIGN AND SETTING This is a systematic review of the current scientific literature regarding VR-based simulation in spinal surgery. METHODS Five data sources were systematically searched to identify relevant peer-reviewed articles regarding virtual, mixed, or augmented reality-based simulators in spinal surgery. A qualitative data synthesis was performed with particular attention to evaluation approaches and outcomes. Additionally, all included studies were appraised for their quality using the Medical Education Research Study Quality Instrument (MERSQI) tool. RESULTS The initial review identified 476 abstracts and 63 full texts were then assessed by two reviewers. Finally, 19 studies that examined simulators for the following procedures were selected: pedicle screw placement, vertebroplasty, posterior cervical laminectomy and foraminotomy, lumbar puncture, facet joint injection, and spinal needle insertion and placement. These studies had a low-to-medium methodological quality with a MERSQI mean score of 11.47 out of 18 (standard deviation=1.81). CONCLUSIONS This review described the current state and applications of VR-based simulator training and assessment approaches in spinal procedures. Limitations, strengths, and future advancements of VR-based simulators for training and assessment in spinal surgery were explored. Higher-quality studies with patient-related outcome measures are needed. To establish further adaptation of VR-based simulators in spinal surgery, future evaluations need to improve the study quality, apply long-term study designs, and examine non-technical skills, as well as multidisciplinary team training.
Collapse
Affiliation(s)
- Michael Pfandler
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, Munich D-80336, Germany.
| | - Marc Lazarovici
- Institute for Emergency Medicine and Management in Medicine (INM), Ludwig-Maximilians-University Munich, Schillerstraße 53, Munich D-80336, Germany
| | - Philipp Stefan
- Computer Aided Medical Procedures, (CAMP), Computer Science Department (I-16), Technical University of Munich, Boltzmannstraße 3, Garching bei München D-85748, Germany
| | - Patrick Wucherer
- Computer Aided Medical Procedures, (CAMP), Computer Science Department (I-16), Technical University of Munich, Boltzmannstraße 3, Garching bei München D-85748, Germany
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, Munich D-80336, Germany
| |
Collapse
|
31
|
Hosny SG, Johnston MJ, Pucher PH, Erridge S, Darzi A. Barriers to the implementation and uptake of simulation-based training programs in general surgery: a multinational qualitative study. J Surg Res 2017; 220:419-426.e2. [PMID: 28844460 DOI: 10.1016/j.jss.2017.07.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/22/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite evidence demonstrating the advantages of simulation training in general surgery, it is not widely integrated into surgical training programs worldwide. The aim of this study was to identify barriers and facilitators to the implementation and uptake of surgical simulation training programs. METHODS A multinational qualitative study was conducted using semi-structured interviews of general surgical residents and experts. Each interview was audio recorded, transcribed verbatim, and underwent emergent theme analysis. All data were anonymized and results pooled. RESULTS A total of 37 individuals participated in the study. Seventeen experts (Program Directors and Surgical Attendings with an interest in surgical education) and 20 residents drawn from the United States, Canada, United Kingdom, France, and Japan were interviewed. Barriers to simulation-based training were identified based on key themes including financial cost, access, and translational benefit. Participants described cost (89%) and access (76%) as principal barriers to uptake. Common facilitators included a mandatory requirement to complete simulation training (78%) and on-going assessment of skills (78%). Participants felt that simulation training could improve patient outcomes (76%) but identified a lack of evidence to demonstrate benefit (38%). There was a consensus that simulation training has not been widely implemented (70%). CONCLUSIONS There are multiple barriers to the implementation of surgical simulation training programs, however, there is agreement that these programs could potentially improve patient outcomes. Identifying these barriers enable the targeted use of facilitators to deliver simulation training programs.
Collapse
Affiliation(s)
- Shady G Hosny
- Department of Academic Surgery, Imperial College London, London, UK.
| | | | - Philip H Pucher
- Department of Academic Surgery, Imperial College London, London, UK
| | - Simon Erridge
- Department of Academic Surgery, Imperial College London, London, UK
| | - Ara Darzi
- Department of Academic Surgery, Imperial College London, London, UK
| |
Collapse
|
32
|
Brinkmann C, Fritz M, Pankratius U, Bahde R, Neumann P, Schlueter S, Senninger N, Rijcken E. Box- or Virtual-Reality Trainer: Which Tool Results in Better Transfer of Laparoscopic Basic Skills?-A Prospective Randomized Trial. JOURNAL OF SURGICAL EDUCATION 2017; 74:724-735. [PMID: 28089473 DOI: 10.1016/j.jsurg.2016.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Simulation training improves laparoscopic performance. Laparoscopic basic skills can be learned in simulators as box- or virtual-reality (VR) trainers. However, there is no clear recommendation for either box or VR trainers as the most appropriate tool for the transfer of acquired laparoscopic basic skills into a surgical procedure. DESIGN Both training tools were compared, using validated and well-established curricula in the acquirement of basic skills, in a prospective randomized trial in a 5-day structured laparoscopic training course. Participants completed either a box- or VR-trainer curriculum and then applied the learned skills performing an ex situ laparoscopic cholecystectomy on a pig liver. The performance was recorded on video and evaluated offline by 4 blinded observers using the Global Operative Assessment of Laparoscopic Skills (GOALS) score. Learning curves of the various exercises included in the training course were compared and the improvement in each exercise was analyzed. SETTING Surgical Skills Lab of the Department of General and Visceral Surgery, University Hospital Muenster. PARTICIPANTS Surgical novices without prior surgical experience (medical students, n = 36). RESULTS Posttraining evaluation showed significant improvement compared with baseline in both groups, indicating acquisition of laparoscopic basic skills. Learning curves showed almost the same progression with no significant differences. In simulated laparoscopic cholecystectomy, total GOALS score was significantly higher for the box-trained group than the VR-trained group (box: 15.31 ± 3.61 vs. VR: 12.92 ± 3.06; p = 0.039; Hedge׳s g* = 0.699), indicating higher technical skill levels. CONCLUSIONS Despite both systems having advantages and disadvantages, they can both be used for simulation training for laparoscopic skills. In the setting with 2 structured, validated and almost identical curricula, the box-trained group appears to be superior in the better transfer of basic skills into an experimental but structured surgical procedure.
Collapse
Affiliation(s)
- Christian Brinkmann
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Mathias Fritz
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ulrich Pankratius
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Ralf Bahde
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Philipp Neumann
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Steffen Schlueter
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Norbert Senninger
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany
| | - Emile Rijcken
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
| |
Collapse
|
33
|
Lee GI, Lee MR. Can a virtual reality surgical simulation training provide a self-driven and mentor-free skills learning? Investigation of the practical influence of the performance metrics from the virtual reality robotic surgery simulator on the skill learning and associated cognitive workloads. Surg Endosc 2017. [DOI: 10.1007/s00464-017-5634-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Can a Novel, Low-Cost Simulation Model be Used to Teach Anterior Cruciate Ligament Graft Preparation? J Pediatr Orthop 2017; 37:e277-e281. [PMID: 28244929 DOI: 10.1097/bpo.0000000000000958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study evaluated an anterior cruciate ligament (ACL) graft preparation simulation learning model for use by orthopaedic surgery trainees. METHODS A simulation model for ACL graft preparation was constructed using shoelace as graft material and a wooden graft preparation board that matched the dimensions of existing products. A 12-minute instructional video targeted at novice learners was created to accompany the simulation model. A prospective randomized controlled trial was conducted on orthopaedic surgery residents divided into 2 groups with equal distributions of postgraduate year (PGY) status. The intervention group learned ACL graft preparation via the Shoelace ACL Simulation Guide, whereas a control group viewed a standard instructional video. All participants then prepared an 8-strand ACL graft using allograft materials and were evaluated via a checklist of critical steps and a global assessment rating as provided by an expert blinded to group allocation. Participants' preintervention and postintervention self-assessment scores were also collected. RESULTS Ten orthopaedic surgery residents from a single institution participated in the study, with even distributions across study groups of PGY-1, PGY-3, and PGY-4 residents. Preintervention self-assessments of knowledge and technical ability were similar between participant groups. The mean overall performance score was significantly greater in the shoelace simulation intervention group (22.6±1.5) than in the instructional video only control group (16.0±5.1) (P=0.043). Participants in the intervention group showed greater improvement in self-confidence in their technical ability than those in the control group (P=0.012). Groups demonstrated similar postintervention improvements in self-reported knowledge of ACL graft preparation (P=0.128). All participants who learned via the Shoelace ACL Simulation Guide strongly agreed that they would use the learning tool to prepare for ACL reconstruction surgery. CONCLUSIONS A self-directed low-cost simulation model for soft tissue ACL graft preparation utilizing shoelaces resulted in improved performance metrics compared with standard video instruction. The teaching model may be incorporated easily and inexpensively into simulation curricula at other training programs. LEVEL OF EVIDENCE Level II-therapeutic study.
Collapse
|
35
|
Rodier S, Saint-Lorant G, Guilloit JM, Palix A, Divanon F, Sichel F, Delépée R. Is hyperthermic intraperitoneal chemotherapy (HIPEC) safe for healthcare workers? Surg Oncol 2017; 26:242-251. [PMID: 28807243 DOI: 10.1016/j.suronc.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND During hyperthermic intraperitoneal chemotherapy (HIPEC), caregivers are exposed by different routes to cytotoxic drugs. This review proposes an overview of the safety of HIPEC by assessing existing data on protection procedures, biological and non-biological samples. Based on these data, relevant good practices, eventual irrelevant overprotection procedures and missing data to implement adapted protections are highlighted. MATERIALS AND METHODS Data were extracted from a systematic review of literature from 1980 till 2016: number and type of surgical procedure, healthcare professionals present, protective equipment, samples, pre-analytical method and analytical method. RESULTS AND DISCUSSION Only 55 HIPEC procedures have been evaluated. The majority of antineoplastic drugs used have all required characteristics to penetrate the organism and are recognized as very dangerous. Moreover, a great heterogeneity in protective equipment used, either individual or collective is observed. Environmental contamination occurs during HIPEC, especially for all surfaces in the operating room. Compounds penetration into caregivers lungs cannot be excluded. Priority remains to prove professionals contamination by focusing on biological samples. Biological material is rarely sampled or samples are not necessarily adapted. CONCLUSION Repeated blood tests should be preferred using appropriate sampling schedules and validated sensitive analytical methods. Furthermore, there is a great need of new biological indicators to monitor caregivers exposure. During hyperthermic intraperitoneal chemotherapy (HIPEC), healthcare workers are exposed by different routes to cytotoxic drugs. There are currently few available occupational exposure data and environmental monitoring and biomonitoring must be improved in order to ensure optimal protection against antineoplastic drugs.
Collapse
Affiliation(s)
- Simon Rodier
- Normandie Univ, UNICAEN, ABTE, Caen 14000, France
| | - Guillaume Saint-Lorant
- Normandie Univ, UNICAEN, ABTE, Caen 14000, France; CHU de Caen, Department of Pharmacy, Caen F-14000, France.
| | - Jean-Marc Guilloit
- Comprehensive Cancer Center F. Baclesse, Department of Surgery, Caen F-14000, France
| | - Agnès Palix
- Comprehensive Cancer Center F. Baclesse, Department of Occupational Health, Caen F-14000, France
| | - Fabienne Divanon
- Comprehensive Cancer Center F. Baclesse, Department of Pharmacy, Caen F-14000, France
| | - François Sichel
- Normandie Univ, UNICAEN, ABTE, Caen 14000, France; Comprehensive Cancer Center F. Baclesse, Caen F-14000, France
| | - Raphaël Delépée
- Normandie Univ, UNICAEN, ABTE, Caen 14000, France; Comprehensive Cancer Center F. Baclesse, Caen F-14000, France
| |
Collapse
|
36
|
Surgical Simulator Training for Plastic Surgery Residents around the World. Plast Reconstr Surg 2017; 139:1032e-1033e. [DOI: 10.1097/prs.0000000000002222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
37
|
Acquisition, retention and transfer of simulated laparoscopic tasks using fNIR and a contextual interference paradigm. Am J Surg 2017; 213:336-345. [DOI: 10.1016/j.amjsurg.2016.11.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 12/14/2022]
|
38
|
A pilot study examining experiential learning vs didactic education of abdominal compartment syndrome. Am J Surg 2016; 214:358-364. [PMID: 27771036 DOI: 10.1016/j.amjsurg.2016.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Current surgical education relies on simulated educational experiences or didactic sessions to teach low-frequency clinical events such as abdominal compartment syndrome (ACS). The purpose of this pilot study was to evaluate if simulation would improve performance and knowledge retention of ACS better than a didactic lecture. METHODS Nineteen general surgery residents were block randomized by postgraduate year level to a didactic or a simulation session. After 3 months, all residents completed a knowledge assessment before participating in an additional simulation. Two independent reviewers assessed resident performance via audio-video recordings. RESULTS No baseline differences in ACS experience were noted between groups. The observational evaluation demonstrated a significant difference in performance between the didactic and simulation groups: 9.9 vs 12.5, P = .037 (effect size = 1.15). Knowledge retention was equivalent between groups. CONCLUSIONS This pilot study suggests that simulation-based education may be more effective for teaching the basic concepts of ACS.
Collapse
|
39
|
Abstract
BACKGROUND Patient safety during operations hinges on the surgeon's skills and abilities. However, surgical training has come under a variety of restrictions. To acquire dexterity with decreasingly "simple" cases, within the legislative time constraints and increasing expectations for surgical results is the future challenge. OBJECTIVES Are there alternatives to traditional master-apprentice learning? MATERIALS AND METHODS A literature review and analysis of the development, implementation, and evaluation of surgical simulation are presented. RESULTS Simulation, using a variety of methods, most important physical and virtual (computer-generated) models, provides a safe environment to practice basic and advanced skills without endangering patients. These environments have specific strengths and weaknesses. CONCLUSIONS Simulations can only serve to decrease the slope of learning curves, but cannot be a substitute for the real situation. Thus, they have to be an integral part of a comprehensive training curriculum. Our surgical societies have to take up that challenge to ensure the training of future generations.
Collapse
Affiliation(s)
- A Nabavi
- Klink für Neurochirurgie, International Neuroscience Institute (INI) Hannover GmbH, Rudolf-Pichlmayr-Straße 4, 30625, Hannover, Deutschland.
| | - J Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Zentrum für Operative Medizin II, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| |
Collapse
|
40
|
Baker P, Feinleib J, O’Sullivan E. Is it time for airway management education to be mandatory? Br J Anaesth 2016; 117 Suppl 1:i13-i16. [DOI: 10.1093/bja/aew129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
41
|
Luc JG, Antonoff MB. Active Learning in Medical Education: Application to the Training of Surgeons. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2016; 3:10.4137_JMECD.S18929. [PMID: 29349326 PMCID: PMC5736298 DOI: 10.4137/jmecd.s18929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 05/03/2023]
Abstract
Our article defines active learning in the context of surgical education and reviews the growing body of research on new approaches to teaching. We then discuss future perspectives and the challenges faced by the trainee and surgeon in applying active learning to surgical training. As modern surgical education faces numerous challenges, we hope our article will help surgical educators in the evaluation of curriculum development, methods of instruction, and assessment.
Collapse
Affiliation(s)
- Jessica G.Y. Luc
- Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|