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Narasimha S, Obuseh M, Anton NE, Chen H, Chakrabarty R, Stefanidis D, Yu D. Eye tracking and audio sensors to evaluate surgeon's non-technical skills: An empirical study. APPLIED ERGONOMICS 2024; 119:104320. [PMID: 38797012 DOI: 10.1016/j.apergo.2024.104320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/06/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
Non-Technical Skills (NTS) of medical teams are currently measured using subjective and resource-intensive ratings given by experts. This study explores if objective NTS assessment approaches with eye-tracking and audio sensors can measure teamwork and communication skills in surgery. Eight surgeons participated in a simulated two-phase surgical scenario developed to assess their NTS. Sensor-based audio, eye tracking and video data were collected and analyzed along with rating from the NOTSS scale. Different levels of communication were detected by the sensor data during the two phases of the simulated surgery. Sensor data detected leadership qualities among surgeons based on speech metrics, and eye tracking offered additional evidence about gaze patterns related to NTS. This objective approach to NTS measurement captured differences in communication in greater detail as opposed to a single collective rating obtained using current assessment tools.
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Affiliation(s)
| | - Marian Obuseh
- School of Industrial Engineering, Purdue University, USA
| | - Nicholas Eric Anton
- School of Industrial Engineering, Purdue University, USA; School of Medicine, Indiana University, USA
| | - Haozhi Chen
- School of Industrial Engineering, Purdue University, USA
| | | | | | - Denny Yu
- School of Industrial Engineering, Purdue University, USA
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Anton NE, Obuseh M, Lim C, Chen H, Yang J, Stefanidis D, Yu D. Nontechnical Skills Assessment in Acute Care Trauma Simulations: A Mixed Methods Approach Using Eye Tracking and Behavioral Marker Systems. Mil Med 2024; 189:719-727. [PMID: 39160814 PMCID: PMC11368209 DOI: 10.1093/milmed/usae240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/12/2024] [Accepted: 05/02/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION The condition of trauma patients and the urgent need for timely resuscitation present unique challenges to trauma teams. These difficulties are exacerbated for military trauma teams in combat environments. Consequently, there is a need for continued improvement of nontechnical skills (NTS) training for trauma teams. However, current approaches to NTS assessment rely on subjective ratings, which can introduce bias. Accordingly, objective methods of NTS evaluation are needed. Eye-tracking (ET) methods have been applied to studying communication, situation awareness, and leadership in many health care settings, and could be applied to studying physicians' NTS during trauma situations. In this study, we aimed to assess the relationship between trauma team leaders' objective gaze patterns and subjective expert NTS ratings during patient care simulations. MATERIALS AND METHODS After Institutional Review Board approval, 9 trauma teams from first-year post-graduate general surgery and emergency medicine residents were recruited to participate in 1 of 2 trauma simulations (a difficult airway case and a multi-patient trauma). Each scenario lasted approximately 15 minutes. All team leaders wore a mobile ET system to evaluate gaze metrics-time to first fixation (TTFF), average fixation duration (AFD), and total percentage of the scenario (TPS) focused on Areas of Interest (AOI), which included patient, care team, diagnostic equipment, and patient care equipment. Trained faculty raters completed the Non-Technical Skills for Surgeons (NOTSS) assessment tool and the Trauma Non-Technical Skills (T-NOTECHS) scale. One-way analysis of variance, Kruskal-Wallis, and appropriate post-hoc pairwise comparison tests were run to assess differences between ET metrics across AOI groups. Spearman's Rho tests were used to assess correlations between ET and subjective NTS ratings. RESULTS Compared to other NTS domains, trauma teams scored relatively poorly on communication across both T-NOTECHS (3.29$ \pm $0.61, maximum = 5) and NOTSS (2.87$ \pm $0.66, maximum = 4). We found significant differences in trauma team leaders' TTFF between teammates and the patient (Team: 1.56 vs Patient: 29.82 seconds, P < .001). TTFF on the diagnostic equipment was negatively correlated (P < .05) to multiple measures of subjective NTS assessments. There were no significant differences in AFD between AOIs, and AFD on teammates was positively correlated (P < .05) to communication and teamwork. There were significant differences in TPS across most AOI pairs (P < .05), and the average TPS fixated was highest on the patient (32%). Finally, there were several significant correlations between additional ET and NTS metrics. CONCLUSIONS This study utilized a mixed methods approach to assess trauma team leaders' NTS in simulated acute care trauma simulations. Our results provide several objective insights into trauma team leaders' NTS behaviors during patient care simulations. Such objective insights provide a more comprehensive understanding of NTS behaviors and can be leveraged to guide NTS training of trauma physicians in the future. More studies are needed to apply these methods to capture NTS from a larger sample of teams in both simulated and real trauma environments.
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Affiliation(s)
- Nicholas E. Anton
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- School of Industrial Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Marian Obuseh
- School of Industrial Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Chiho Lim
- School of Industrial Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Haozhi Chen
- School of Industrial Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Jing Yang
- Department of Industrial and Systems Engineering, University of Buffalo, Buffalo, NY, 14260, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, 47907, USA
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Kennedy-Metz LR, Conboy HM, Liu A, Dias RD, Harari RE, Gikandi A, Shapeton A, Clarke LA, Osterweil LJ, Avrunin GS, Chaspari T, Yule S, Zenati MA. A novel multimodal, intraoperative cognitive workload assessment of cardiac surgery team members. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00670-6. [PMID: 39084333 DOI: 10.1016/j.jtcvs.2024.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/03/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE To characterize cognitive workload (CWL) of cardiac surgery team members in a real-world setting during coronary artery bypass grafting (CABG) surgery using providers' heart rate variability (HRV) data as a surrogate measure of CWL. METHODS HRV was collected from the surgeon, anesthesiologist, perfusionist, and scrub nurse, and audio/video recordings were made during isolated, nonemergency CABG surgeries (n = 27). Eight surgical phases were annotated by trained researchers, and HRV was calculated for each phase. RESULTS Significant differences in CWL were observed within a given role across surgical phases. Results are reported as predicted probability (95% confidence interval [CI]). CWL was significantly higher for anesthesiologists during "preparation and induction" (0.57; 95% CI, 0.42-0.71) and "anastomoses" (0.44; 95% CI, 0.30-0.58) compared to other phases, and the same held for nurses during the "opening" (0.51; 95% CI, 0.37-0.65) and "postoperative" (0.68; 95% CI, 0.42-0.86) phases. Additional significant differences were observed between roles within a given surgical phase. For example, surgeons had significantly higher CWL during "anastomoses" (0.81; 95% CI, 0.69-0.89) compared to all other phases, and the same was true of perfusionists during the "opening" (0.79; 95% CI, 0.66-0.88) and "prebypass preparation" (0.50; 95% CI, 0.36-0.64) phases. CONCLUSIONS Our innovative analysis demonstrates that CWL fluctuates across surgical procedures by role and phase, which may reflect the distribution of primary tasks. This corroborates earlier findings from self-report measures. The data suggest that team-wide, peak CWL during a phase decreases from early phases of surgery through initiation of cardiopumonary bypass (CPB), rises during anastomosis, and decreases after termination of CPB. Knowledge of these trends could encourage the adoption of behaviors to enhance team dynamics and performance.
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Affiliation(s)
- Lauren R Kennedy-Metz
- Department of Psychology, Roanoke College, Salem, Va; Medical Robotics & Computer-Assisted Surgery Laboratory, Harvard Medical School, Boston, Mass; Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Mass.
| | - Heather M Conboy
- Manning College of Information & Computer Sciences, University of Massachusetts Amherst, Amherst, Mass
| | - Anna Liu
- Manning College of Information & Computer Sciences, University of Massachusetts Amherst, Amherst, Mass
| | - Roger D Dias
- Division of Emergency Medicine, STRATUS Center for Medical Simulation, Mass General Brigham, Boston, Mass
| | - Rayan E Harari
- Division of Emergency Medicine, STRATUS Center for Medical Simulation, Mass General Brigham, Boston, Mass
| | - Ajami Gikandi
- Medical Robotics & Computer-Assisted Surgery Laboratory, Harvard Medical School, Boston, Mass
| | - Alexander Shapeton
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Mass
| | - Lori A Clarke
- Manning College of Information & Computer Sciences, University of Massachusetts Amherst, Amherst, Mass
| | - Leon J Osterweil
- Manning College of Information & Computer Sciences, University of Massachusetts Amherst, Amherst, Mass
| | - George S Avrunin
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, Mass
| | - Theodora Chaspari
- Computer Science & Institute of Cognitive Sciences, University of Colorado Boulder, Boulder, Colo
| | - Steven Yule
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Marco A Zenati
- Medical Robotics & Computer-Assisted Surgery Laboratory, Harvard Medical School, Boston, Mass; Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Mass; Division of Cardiac Surgery, Mass General Brigham, Boston, Mass
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Howie EE, Ambler O, Gunn EG, Dias RD, Wigmore SJ, Skipworth RJ, Yule SJ. Surgical Sabermetrics: A Scoping Review of Technology-enhanced Assessment of Nontechnical Skills in the Operating Room. Ann Surg 2024; 279:973-984. [PMID: 38258573 PMCID: PMC11086675 DOI: 10.1097/sla.0000000000006211] [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] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance. BACKGROUND Surgeons need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons. METHODS A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMA-ScR guidelines. MeSH terms and keywords included "Assessment," "Surgeons," and "Technology". Eligible studies included a digital assessment of nontechnical skills for surgeons, residents, and/or medical students within an operative context. RESULTS From 19,229 articles screened, 81 articles met the inclusion criteria. The studies varied in surgical specialties, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least 1 category of surgical nontechnical skill using a single (n=54) or multiple objective measures (n=27). The majority of studies utilized simulation (n=48) over live operative settings (n=32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load (n=57), situation awareness (n=24), communication (n=3), teamwork (n=13), and leadership (n=2). No studies measured intraoperative decision-making. CONCLUSIONS The literature detailing the intersection between surgical data science and operative nontechnical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including the need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide a holistic assessment of surgical performance.
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Affiliation(s)
- Emma E. Howie
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Olivia Ambler
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Eilidh G.M. Gunn
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Roger D. Dias
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
- Human Factors and Cognitive Engineering Lab, STRATUS Centre for Medical Simulation, Brigham & Women’s Hospital, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Stephen J. Wigmore
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Richard J.E. Skipworth
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Steven J. Yule
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
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Varghese C, Harrison EM, O'Grady G, Topol EJ. Artificial intelligence in surgery. Nat Med 2024; 30:1257-1268. [PMID: 38740998 DOI: 10.1038/s41591-024-02970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
Artificial intelligence (AI) is rapidly emerging in healthcare, yet applications in surgery remain relatively nascent. Here we review the integration of AI in the field of surgery, centering our discussion on multifaceted improvements in surgical care in the preoperative, intraoperative and postoperative space. The emergence of foundation model architectures, wearable technologies and improving surgical data infrastructures is enabling rapid advances in AI interventions and utility. We discuss how maturing AI methods hold the potential to improve patient outcomes, facilitate surgical education and optimize surgical care. We review the current applications of deep learning approaches and outline a vision for future advances through multimodal foundation models.
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Affiliation(s)
- Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Eric J Topol
- Scripps Research Translational Institute, La Jolla, CA, USA.
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Bartier S, Fieux M, Carsuzaa F, Coste A, Legré M, Alexandru M, Favier V, Fath L. Perception of endoscopic endonasal surgery training by French otolaryngology residents: A STROBE analysis of expectations. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:61-67. [PMID: 38081760 DOI: 10.1016/j.anorl.2023.11.014] [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] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To analyze the perception of endoscopic endonasal surgery training by French otolaryngology residents. MATERIAL AND METHODS A multicenter retrospective observational study was conducted from March to April 2023. Otolaryngology residents from 7 French regions filled out a 27-item questionnaire on their training in endoscopic endonasal surgery. RESULTS Out of 283 residents contacted, 126 (45%) filled out the questionnaire. Seventy-four (59%) had already partially or completely performed the surgeries specified in their diploma course. The level of mastery of the main steps of endonasal surgery and the level of autonomy were higher in the consolidation stage group than in the basic and advanced stages. Seventy residents (56%) felt they had gaps in their level of training. To improve training, 94 (75%) wished for more dissection sessions, surgical skills assessments each semester and simulation sessions. Eighty-nine (71%) felt they needed to find their own teaching aids and other methods to complete their training. One hundred and thirteen (90%) felt that the lack of funding available for congresses and training courses was detrimental. CONCLUSION This study highlighted the overall satisfaction of residents with their training in endoscopic endonasal surgery. They expressed a desire for more dissection, simulation and evaluation.
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Affiliation(s)
- S Bartier
- Service d'ORL, de chirurgie cervico-faciale, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France, université Paris Est Créteil, Inserm, IMRB, CNRS EMR 7000, 94010 Créteil, France.
| | - M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite cedex, France; Université de Lyon, université Lyon 1, 69003 Lyon, France
| | - F Carsuzaa
- Service ORL, chirurgie cervico-maxillo-faciale et audiophonologie, centre hospitalier universitaire de Poitiers, laboratoire inflammation tissus épithéliaux et cytokines (LITEC), UR15560, université de Poitiers, 86000 Poitiers, France
| | - A Coste
- Service d'ORL, de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, université Paris Est Créteil, Inserm, IMRB, CNRS EMR 7000, 94010 Créteil, France
| | - M Legré
- Service ORL et chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - M Alexandru
- Service d'Orl et chirurgie cervico-faciale, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Institut national de la santé et de la recherche médicale, France Sorbonne université,UMR_S933, hôpital Armand-Trousseau, 75012 Paris, France
| | - V Favier
- Département d'ORL, chirurgie cervico-faciale et maxillo-faciale, centre hospitalier universitaire de Montpellier, hôpital Gui-de-Chauliac, ICAR Research Team, Laboratory of Computer Science, Robotics, Microelectronics of Montpellier (LIRMM), University of Montpellier, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - L Fath
- Service d'ORL, de chirurgie cervico-faciale, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France; Unité Inserm 1121, biomatériaux et bioingénierie, 1, rue Eugène-Boeckel, Strasbourg, France
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Nagy T, Fritúz G, Gál J, Székely A, Kovács E. Teaching nontechnical skills in the undergraduate education of health care professionals: a nationwide cross-sectional study in Hungary. BMC MEDICAL EDUCATION 2024; 24:174. [PMID: 38388925 PMCID: PMC10885394 DOI: 10.1186/s12909-024-05164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The aim of our cross-sectional study was to evaluate the current situation and curriculum of nontechnical skills (NTS) training in the undergraduate education of health care professionals in Hungary. METHODS All institutes with relevant NTS training in Hungarian faculties of medicine and faculties of health sciences were asked to fill out a 19-item questionnaire. Descriptive statistics were performed, and the characteristics of NTS teaching and non-NTS teaching institutes were compared. The independent predictors of teaching NTS in a particular institute were identified with multiple logistic regression. RESULTS Seventy-seven institutes responded (52% response rate), of which 66% trained NTS. The most frequent method of NTS training is talking about them during a practice or lecture, and less than half of NTS respondents use simulation. The most frequent cause of not teaching NTS is a lack of human or technical resources. The type of faculty (p = 0.025), academic year (p = 0.001), field of medicine (p = 0.025), and importance of teamwork (p = 0.021) differed between NTS and noNTS institutes. Teaching students in academic year two represented the only independent predictor of NTS education (p = 0.012). CONCLUSIONS Our findings show that the undergraduate curriculum of Hungarian universities includes some type of NTS education; however, this education requires further development.
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Affiliation(s)
- Tamás Nagy
- Subdepartment of Clinical Simulation, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
- Faculty of Health Sciences, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
| | - Gábor Fritúz
- Subdepartment of Clinical Simulation, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, P.O.B. 2, Budapest, 1428, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, P.O.B. 2, Budapest, 1428, Hungary
| | - Andrea Székely
- Faculty of Health Sciences, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, P.O.B. 2, Budapest, 1428, Hungary
- Heart and Vascular Center, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary
| | - Enikő Kovács
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, P.O.B. 2, Budapest, 1428, Hungary.
- Heart and Vascular Center, Semmelweis University, P.O.B. 2, Budapest, H-1428, Hungary.
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Schwalbe D, Timmermann C, Gregersen TA, Steffensen SV, Ammentorp J. Communication, Cognition and Competency Development in Healthcare: A Model for Integrating Cognitive Ethnography and Communication Skills Training in Clinical Interventions. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231223319. [PMID: 38204973 PMCID: PMC10777782 DOI: 10.1177/23821205231223319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The aim of this study was to conduct and evaluate the Blended Learning communication skills training program. The key objective was to investigate (i) how clinical intervention studies can be designed to include cognitive, organizational, and interactive processes, and (ii) how researchers and practitioners could work with integrated methods to support the desired change. METHODS The method combined design and implementation of a 12-week Blended Learning communication skills training program based on the Calgary-Cambridge Guide. The training was implemented in a patient clinic at a Danish university hospital and targeted all healthcare professionals at the clinic. Cognitive ethnography was used to document and evaluate healthcare professionals' implementation and individual competency development, and support the design of in-situ simulation training scenarios. RESULTS Thirteen participants completed the program. The synergy within the teams, as well as the opportunities for participants to coordinate, share, discuss, and reflect on the received knowledge with a colleague or on-site researcher, affected learning positively. The knowledge transfer process was affected by negative feedback loops, such as time shortages, issues with concept development and transfer, disjuncture between the expectations of participants and instructors of the overall course structure, as well as participant insecurity and a gradual loss of motivation and compliance. CONCLUSION We propose a novel 3-step model for clinical interventions based on our findings and literature review. This model will effectively support the implementation of educational interventions in health care by narrowing the theory-practice gap. It will also stimulate desired change in individual behavior and organizational culture over time. Furthermore, it will work for the benefit of the clinic and may be more suitable for the implementation of communication projects than, for example, randomized setups.
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Affiliation(s)
- Daria Schwalbe
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
- Centre for Human Interactivity, Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
- Centre for Culture and the Mind, Department of English, Germanic and Romance Studies, University of Copenhagen, Copenhagen, Denmark
| | - Connie Timmermann
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
| | - Trine A Gregersen
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
| | - Sune Vork Steffensen
- Centre for Human Interactivity, Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
- Center for Ecolinguistics, South China Agricultural University, Guangzhou, China
- College of International Studies, Southwest University, Chongqing, China
| | - Jette Ammentorp
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
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Sendek G, Blum JD, Reghunathan M, Chen S, Luong TT, Gosman AA, Butler PD. Deconstructing the Excellent Plastic Surgeon: A Survey of Key Attributes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5460. [PMID: 38098952 PMCID: PMC10721122 DOI: 10.1097/gox.0000000000005460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/17/2023] [Indexed: 12/17/2023]
Abstract
Background Most plastic surgeons practice in nonacademic settings, leaving a small subset of academic plastic surgeons with the responsibility of selecting the future generation of plastic surgeons without representation from a majority of our field. This raises questions as to whether the academic attributes valued during residency selection are valid predictive markers of who will become an excellent plastic surgeon. A survey was conducted of both academic and nonacademic plastic surgeons, as well as trainees, to determine what traits are considered most essential to being an excellent plastic surgeon. Methods An electronic survey was distributed before the American Council of Academic Plastic Surgeons 10th Annual Winter Meeting. Demographics and information regarding the respondents' training and academic status were collected. Respondents were asked to select five traits that they considered most important to be an excellent plastic surgeon from a list of 20 preselected traits. Chi-square and Fisher exact tests were used to perform subgroup analyses. Results A total of 187 responses were received from meeting attendees, representing an 89.0% response rate. Overall, the five values endorsed as most important for a plastic surgeon were being technically sound (53%), collaborative (48%), ethical (44%), compassionate (37%), and emotionally intelligent (33%). However, the emphasis placed on these different attributes differed significantly amongst different demographic groups. Conclusion It is important that we use methods such as holistic review when evaluating plastic surgery applicants to ensure our selection process is congruent with the traits we value.
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Affiliation(s)
- Gabriela Sendek
- From the Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, Calif
| | - Jessica D Blum
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin, Madison, Wis
| | - Meera Reghunathan
- From the Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, Calif
| | - Shirley Chen
- Department of Plastic Surgery, Vanderbilt University, Nashville, Tenn
| | - Thanh T Luong
- From the Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, Calif
| | - Amanda A Gosman
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin, Madison, Wis
| | - Paris D Butler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
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Won P, Premaratne ID, Stoneburner J, Naidu P, Collier ZJ, Yenikomshian HA, Carey JN. Gaps in plastic surgery training: A comparative literature review of assessment tools in plastic surgery and general surgery. J Plast Reconstr Aesthet Surg 2023; 87:238-250. [PMID: 37922663 DOI: 10.1016/j.bjps.2023.10.055] [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: 06/03/2023] [Revised: 09/23/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
Assessment tools for grading technical and nontechnical skills, such as operative technique and professionalism, are well established in general surgery. Less is known regarding the application of these tools in plastic surgery training. This study is a comparative review of the most prevalent assessment tools and rubrics utilized in general and plastic surgery. Two parallel systematic reviews of the literature utilizing PubMed and Cochrane were conducted for articles published between 1990 and 2022. Searches used Boolean operators specific to assessment tools in general and plastic surgery. Fourteen studies met the inclusion criteria for general surgery assessment tools, and 21 studies were included for plastic surgery assessment tools. Seven studies (50%) evaluated technical skills in general surgery, whereas 15 studies (71%) assessed technical skills in plastic surgery with commonality found in the evaluation of principles, such as tissue and instrument handling and operative flow. Task-specific evaluation tools were described for both general and plastic surgeries. Five studies evaluated nontechnical skills, such as communication and leadership in general surgery, whereas no plastic surgery studies solely examined nontechnical assessment tools. Our literature review demonstrates that standardized skill assessments in plastic surgery are lacking compared with those available in general surgery. Plastic surgery programs should consider implementing competency-based assessment tools in surgical coaching and training for technical and nontechnical skills. More research is necessary in plastic surgery to optimize the evaluation of nontechnical skills.
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Affiliation(s)
- Paul Won
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Ishani D Premaratne
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Jacqueline Stoneburner
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Priyanka Naidu
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Zachary J Collier
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Joseph N Carey
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA.
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11
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Neerhut T, Ninan J, Grills R, McLeod K. Defining the good surgical resident: a resident and registrar perspective. ANZ J Surg 2023; 93:2574-2579. [PMID: 37668282 DOI: 10.1111/ans.18689] [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: 05/15/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Surgical residency provides insight into the essential skills required to become a successful surgical registrar. However, the role of the surgical resident remains largely undefined. While the Royal Australasian College of Surgeon (RACS) JDocs framework provides a useful guide, no published research explores what defines a highly performing surgical resident. We investigate what constitutes a 'good' surgical resident from the surgical resident and accredited surgical registrar perspectives. We hope this knowledge will improve patient care and assist surgical residents towards becoming valuable team members and successful accredited surgical training candidates. METHODS A qualitative research approach was utilized employing reflexive thematic analysis. Using semi-structured interviews, 10 surgical residents and 10 accredited surgical registrars across eight surgical specialties were interviewed. RESULTS Amongst surgical residents five themes were identified: efficiency: mastering the mundane, 'stepping up' to more responsibility, enthusiasm to learn, first do no harm: a safe practitioner, and lastly no resident is an island: a team player. Four themes described by accredited registrars included: somebody you can trust, finding a safe 'balance', a perfect fit: teamwork and communication and finally eagerness to improve. CONCLUSION Themes correlated well with eight of 10 RACS competencies and the JDocs Framework. Our results reaffirmed the importance of developing early career non-technical skills. Explicit knowledge and understanding of these attributes used in conjunction with the core competency and JDocs frameworks may help those contemplating a career in surgery throughout their early surgical years.
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Affiliation(s)
- Thomas Neerhut
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - John Ninan
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Richard Grills
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
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12
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Sirevåg I, Tjoflåt I, Hansen BS. Expanding the non-technical skills vocabulary of operating room nurses: a qualitative study. BMC Nurs 2023; 22:323. [PMID: 37723549 PMCID: PMC10507908 DOI: 10.1186/s12912-023-01500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Operating room nurses have specialised technical and non-technical skills and are essential members of the surgical team. The profession's dependency of tacit knowledge has made their non-technical skills difficult to access for researchers, thus, creating limitations in the identification of the non-technical skills of operating room nurses. Non-technical skills are categorised in the crew resource management framework, and previously, non-technical skills of operating room nurses have been identified within the scope of the framework. The purpose of this study is to explore operating room nurses' descriptions of their practices in search for non-technical skills not included in the crew resource management framework. METHODS This study has a qualitative design. An expert panel of experienced operating room nurses (N = 96) in Norway provided qualitative descriptions of their practice in a Delphi survey. The data were analysed in an inductive thematic analysis. This study was conducted and reported in line with Standards for Reporting Qualitative Research (SRQR). RESULTS The inductive thematic analysis developed two themes, 'Ethical competence' and 'Professional accountability', that encompass operating room nurses' novel descriptions of their non-technical skills. The participants take pride in having the patients' best interest as their main objective even if this may threaten their position in the team. CONCLUSIONS This study has identified novel non-technical skills that are not described in the crew resource management framework. These findings will contribute to the development of a new behavioural marker system for the non-technical skills of operating room nurses. This system will facilitate verbalisation of tacit knowledge and contribute to an increased knowledge about the operating room nursing profession.
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Affiliation(s)
- Irene Sirevåg
- Faculty of Health Sciences, Department of Caring and Ethics, University of Stavanger, Postboks 8600, Stavanger, 4036, Norway.
| | - Ingrid Tjoflåt
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Britt Sætre Hansen
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
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13
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Robinson D, Beaumont G. Making Surgery as Safe as It Should Be: A Qualitative Study. Am J Med Qual 2023; 38:238-244. [PMID: 37503856 PMCID: PMC10484182 DOI: 10.1097/jmq.0000000000000139] [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] [Indexed: 07/29/2023]
Abstract
Existing literature supports the view that adverse outcomes from surgical interventions are more likely to be the result of degraded nontechnical skills (NTS) rather than the technical skills of surgeons. In the present context, NTS comprise the behaviors and cognitions deployed by surgeons to make decisions, maintain awareness of the operating environment, communicate with and lead supporting personnel. A contemporary safety thesis suggests that focusing on what makes things go right (eg, NTS) is far more productive than retrospective analysis (learning from mistakes). The present qualitative research explored how surgeons deploy NTS to facilitate safe and effective outcomes from surgical interventions. The thematic analysis revealed that this surgical cohort engaged specific self-regulated NTS along an intervention construct consisting of planning, implementation, monitoring progress, and deliberate learning through reflection during the preoperative, operative, and postoperative phases of care. Behaviors supporting these contentions were identified in the data and used to amplify use of the construct.
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Affiliation(s)
| | - Graham Beaumont
- Australia and New Zealand Audit of Surgical Mortality (ANZASM), Melbourne, VIC, Australia
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14
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Taggart SM, Girard O, Landers GJ, Ecker UKH, Wallman KE. Impact of living and working in the heat on cognitive and psycho-physiological responses in outdoor fly-in fly-out tradesmen: a mining industry study. Front Physiol 2023; 14:1210692. [PMID: 37501924 PMCID: PMC10368878 DOI: 10.3389/fphys.2023.1210692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023] Open
Abstract
Objective: This study aimed to evaluate complex cognitive function, manual dexterity and psycho-physiological parameters in tradesmen working outdoors in the mining industry during summer and winter. Methods: Twenty-six males working in a mining village in the north-west of Australia were assessed pre- and post-an 11-h shift at the start, middle, and end of a 14-day swing in summer (average daily temperature: 33.9°C, 38% RH; n = 12) and winter (24.3°C, 36% RH; n = 14). Results: Working memory performance did not differ between seasons, over the swing or shift (p ≥ 0.053). Processing efficiency and manual dexterity performance did not differ between seasons (p ≥ 0.243), yet improved over the course of the swing (p ≤ 0.001) and shift (p ≤ 0.001). Core temperature, heart rate, thermal comfort, rating of perceived exertion and thermal sensation were not significantly different between seasons (p ≥ 0.076); however, average shift dehydration was greater in winter compared to summer (1.021 ± 0.005 vs. 1.018 ± 0.006; p = 0.014). Conclusion: The ability to self-regulate the intensity of activity likely helped outdoor workers to thermoregulate effectively, minimising thermal strain during their swings and shifts, in turn explaining unaltered cognitive function and manual dexterity performance between seasons. Regardless of season, workers should receive education on dehydration and workplace risks to protect their health.
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Affiliation(s)
- Sarah M. Taggart
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Olivier Girard
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Grant J. Landers
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Ullrich K. H. Ecker
- School of Psychological Science, The University of Western Australia, Crawley, WA, Australia
| | - Karen E. Wallman
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
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15
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Obuseh M, Cavuoto L, Stefanidis D, Yu D. A sensor-based framework for layout and workflow assessment in operating rooms. APPLIED ERGONOMICS 2023; 112:104059. [PMID: 37311305 DOI: 10.1016/j.apergo.2023.104059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/19/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023]
Abstract
Due to their large sizes and impediments to personnel workflows, integrating robotic technologies into the existing operating rooms (OR) is a challenge. In this study, we developed an ultra-wideband sensor-based human-machine-environment framework for layout and workflow assessments within the OR. In addition to providing best practices for use of the framework, we also demonstrated its effectiveness in understanding layout and workflow inefficiencies in 12 robotic-assisted surgeries (RAS) across 4 different surgical specialties. We found avoidable movements as the circulating nurse covers at least twice the distance of any other OR personnel before the patient cart (robot) is docked. OR areas of congestion and undesirable personnel-pair proximities across RAS phases that impose extra non-technical skill challenges were determined. Our findings highlight several implications for the added complexity of integrating robotic technologies into the OR, which can serve as drivers for objective evidence-based recommendations to combat RAS OR layout and workflow inefficiencies.
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Affiliation(s)
- Marian Obuseh
- School of Industrial Engineering, Purdue University, West Lafayette, IN, 47907, USA.
| | - Lora Cavuoto
- Department of Industrial and Systems Engineering, University of Buffalo, Buffalo, NY, 14260, USA.
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN, 47907, USA.
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16
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Wong EY, Chu TN, Ma R, Dalieh IS, Yang CH, Ramaswamy A, Medina LG, Kocielnik R, Ladi-Seyedian SS, Shtulman A, Cen SY, Goldenberg MG, Hung AJ. Development of a Classification System for Live Surgical Feedback. JAMA Netw Open 2023; 6:e2320702. [PMID: 37378981 DOI: 10.1001/jamanetworkopen.2023.20702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Importance Live feedback in the operating room is essential in surgical training. Despite the role this feedback plays in developing surgical skills, an accepted methodology to characterize the salient features of feedback has not been defined. Objective To quantify the intraoperative feedback provided to trainees during live surgical cases and propose a standardized deconstruction for feedback. Design, Setting, and Participants In this qualitative study using a mixed methods analysis, surgeons at a single academic tertiary care hospital were audio and video recorded in the operating room from April to October 2022. Urological residents, fellows, and faculty attending surgeons involved in robotic teaching cases during which trainees had active control of the robotic console for at least some portion of a surgery were eligible to voluntarily participate. Feedback was time stamped and transcribed verbatim. An iterative coding process was performed using recordings and transcript data until recurring themes emerged. Exposure Feedback in audiovisual recorded surgery. Main Outcomes and Measures The primary outcomes were the reliability and generalizability of a feedback classification system in characterizing surgical feedback. Secondary outcomes included assessing the utility of our system. Results In 29 surgical procedures that were recorded and analyzed, 4 attending surgeons, 6 minimally invasive surgery fellows, and 5 residents (postgraduate years, 3-5) were involved. For the reliability of the system, 3 trained raters achieved moderate to substantial interrater reliability in coding cases using 5 types of triggers, 6 types of feedback, and 9 types of responses (prevalence-adjusted and bias-adjusted κ range: a 0.56 [95% CI, 0.45-0.68] minimum for triggers to a 0.99 [95% CI, 0.97-1.00] maximum for feedback and responses). For the generalizability of the system, 6 types of surgical procedures and 3711 instances of feedback were analyzed and coded with types of triggers, feedback, and responses. Significant differences in triggers, feedback, and responses reflected surgeon experience level and surgical task being performed. For example, as a response, attending surgeons took over for safety concerns more often for fellows than residents (prevalence rate ratio [RR], 3.97 [95% CI, 3.12-4.82]; P = .002), and suturing involved more errors that triggered feedback than dissection (RR, 1.65 [95% CI, 1.03-3.33]; P = .007). For the utility of the system, different combinations of trainer feedback had associations with rates of different trainee responses. For example, technical feedback with a visual component was associated with an increased rate of trainee behavioral change or verbal acknowledgment responses (RR, 1.11 [95% CI, 1.03-1.20]; P = .02). Conclusions and Relevance These findings suggest that identifying different types of triggers, feedback, and responses may be a feasible and reliable method for classifying surgical feedback across several robotic procedures. Outcomes suggest that a system that can be generalized across surgical specialties and for trainees of different experience levels may help galvanize novel surgical education strategies.
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Affiliation(s)
- Elyssa Y Wong
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles
| | - Timothy N Chu
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles
| | - Runzhuo Ma
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles
| | - Istabraq S Dalieh
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles
| | - Cherine H Yang
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles
| | - Ashwin Ramaswamy
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Luis G Medina
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles
| | - Rafal Kocielnik
- Department of Computing and Mathematical Sciences, California Institute of Technology, Pasadena
| | - Seyedeh-Sanam Ladi-Seyedian
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles
| | - Andrew Shtulman
- Thinking Lab, Department of Psychology, Occidental College, Los Angeles, California
| | - Steven Y Cen
- Department of Radiology, University of Southern California, Los Angeles
| | - Mitchell G Goldenberg
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles
| | - Andrew J Hung
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles
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17
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Alzahrani KH, Abutalib RA, Elsheikh AM, Alzahrani LK, Khoshhal KI. The need for non-technical skills education in orthopedic surgery. BMC MEDICAL EDUCATION 2023; 23:262. [PMID: 37076848 PMCID: PMC10113970 DOI: 10.1186/s12909-023-04196-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 03/24/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The issue of surgical safety has increased significantly over the last few decades. Several studies have established that it is linked to non-technical performance, rather than clinical competencies. Non-technical skills can be blended with technical training in the surgical profession to improve surgeons' abilities and enhance patient care and procedural skills. The main goal of this study was to determine orthopedic surgeons' requirements of non-technical skills, and to identify the most pressing issues. METHODS We conducted a self-administered online questionnaire survey in this cross-sectional study. The questionnaire was piloted, validated, pretested, and clearly stated the study's purpose. After the pilot, minor wording and questions were clarified before starting the data collection. Orthopedic surgeons from the Middle East and Northern Africa were invited. The questionnaire was based on a five-point Likert scale, the data were analyzed categorically, and variables were summarized as descriptive statistics. RESULTS Of the 1713 orthopedic surgeons invited, 60% completed the survey (1033 out of 1713). The majority demonstrated a high likelihood of participating in such activities in the future (80.5%). More than half (53%) of them preferred non-technical skills courses to be part of major orthopedic conferences, rather than independent courses. Most (65%) chose them to be face-to-face. Although 97.2% agreed on the importance of these courses, only 27% had attended similar courses in the last three years. Patient safety, infection prevention and control, and communication skills were ranked at the top as topics to be addressed. Moreover, participants indicated they would most likely attend courses on infection prevention and control, patient safety and teamwork, and team management. CONCLUSION The results highlight the need for non-technical skills training in the region and the general preferences regarding modality and setting. These findings support the high demand from orthopedic surgeons' perspective to develop an educational program on non-technical skills.
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Affiliation(s)
- Khalid H Alzahrani
- Department of Orthopedic Surgery, Security Forces Hospital, PO Box 14799, 21955, Makkah, KSA, Saudi Arabia.
| | - Raid A Abutalib
- Division of Orthopedics, Department of Surgery, Prince Mohammed bin Abdul-Aziz National Guard Hospital, Almadinah Almunawwarah, Medina, PO Box 3684, Saudi Arabia
| | - Ahmed M Elsheikh
- Department of Quality and Patient Safety, Security Forces Hospital, PO Box 14799, 21955, Makkah, KSA, Saudi Arabia
| | - Laura K Alzahrani
- College of Medicine, Fakeeh College of Medical Sciences, Jeddah, 23323, KSA, Saudi Arabia
| | - Khalid I Khoshhal
- Division of Orthopedics, Department of Surgery, Prince Mohammed bin Abdul-Aziz National Guard Hospital, Almadinah Almunawwarah, Medina, PO Box 3684, Saudi Arabia
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18
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Dias RD, Riley W, Shann K, Likosky DS, Fitzgerald D, Yule S. A tool to assess nontechnical skills of perfusionists in the cardiac operating room. J Thorac Cardiovasc Surg 2023; 165:1462-1469. [PMID: 34261581 PMCID: PMC8720321 DOI: 10.1016/j.jtcvs.2021.06.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/22/2021] [Accepted: 06/21/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This study aimed to develop the Perfusionists' Intraoperative Non-Technical Skills tool, specifically to the perfusionists' context, and test its inter-rater reliability. METHODS An expert panel was convened to review existing surgical nontechnical skills taxonomies and develop the Perfusionists' Intraoperative Non-Technical Skills tool. During a workshop held at a national meeting, perfusionists completed the Perfusionists' Intraoperative Non-Technical Skills ratings after watching 4 videos displaying simulated cardiac operations. Two videos showed "good performance," and 2 videos showed "poor performance." Inter-rater reliability analysis was performed and intraclass correlation coefficient was reported. RESULTS The final version of the Perfusionists' Intraoperative Non-Technical Skills taxonomy contains 4 behavioral categories (decision making, situation awareness, task management and leadership, teamwork and communication) with 4 behavioral elements each. Categories and elements are rated using an 8-point Likert scale ranging from 0.5 to 4.0. A total of 60 perfusionist raters were included and the comparison between rating distribution on "poor performance" and "good performance" videos yielded a statistically significant difference between groups, with a P value less than .001. A similar difference was found in all behavioral categories and elements. Reliability analysis showed moderate inter-rater reliability across overall ratings (intraclass correlation coefficient, 0.735; 95% confidence interval, 0.674-0.796; P < .001). Similar inter-rater reliability was found when raters were stratified by experience level. CONCLUSIONS The Perfusionists' Intraoperative Non-Technical Skills tool presented moderate inter-rater reliability among perfusionists with varied levels of experience. This tool can be used to train and assess perfusionists in relevant nontechnical skills, with the potential to enhance safety and improve surgical outcomes.
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Affiliation(s)
- Roger D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Mass; Department of Emergency Medicine, Harvard Medical School, Boston, Mass.
| | - William Riley
- Cardiovascular Center, Tufts Medical Center, Boston, Mass
| | - Kenneth Shann
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich
| | - David Fitzgerald
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Steven Yule
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland
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19
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Quan SF, Landrigan CP, Barger LK, Buie JD, Dominguez C, Iyer JM, Majekodunmi A, Papautsky EL, Robbins R, Shen BH, Stephens JT, Weaver MD, Czeisler CA. Impact of sleep deficiency on surgical performance: a prospective assessment. J Clin Sleep Med 2023; 19:673-683. [PMID: 36661100 PMCID: PMC10071370 DOI: 10.5664/jcsm.10406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVES Sleep deficiency can adversely affect the performance of resident physicians, resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons, is less clear. METHODS Sixty attending surgeons from academic and community departments of surgery or obstetrics and gynecology were studied prospectively using direct observation and self-report to explore the effect of sleep deprivation on patient safety, operating room communication, medical errors, and adverse events while operating under 2 conditions, post-call (defined as > 2 hours of nighttime clinical duties) and non-post-call. RESULTS Each surgeon contributed up to 5 surgical procedures post-call and non-post-call, yielding 362 cases total (150 post-call and 210 non-post-call). Most common were caesarian section and herniorrhaphy. Hours of sleep on the night before the operative procedure were significantly less post-call (4.98 ± 1.41) vs non-post-call (6.68 ± 0.88, P < .01). Errors were infrequent and not related to hours of sleep or post-call status. However, Non-Technical Skills for Surgeons ratings demonstrated poorer performance while post-call for situational awareness, decision-making, and communication/teamwork. Fewer hours of sleep also were related to lower ratings for situational awareness and decision-making. Decreased self-reported alertness was observed to be associated with increased procedure time. CONCLUSIONS Sleep deficiency in attending surgeons was not associated with greater errors during procedures performed during the next day. However, procedure time was increased, suggesting that surgeons were able to compensate for sleep loss by working more slowly. Ratings on nontechnical surgical skills were adversely affected by sleep deficiency. CITATION Quan SF, Landrigan CP, Barger LK, et al. Impact of sleep deficiency on surgical performance: a prospective assessment. J Clin Sleep Med. 2023;19(4):673-683.
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Affiliation(s)
- Stuart F. Quan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher P. Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Justin D. Buie
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jay M. Iyer
- Departments of Molecular and Cellular Biology and Statistics, Harvard University, Cambridge, Massachusetts
| | - Akindele Majekodunmi
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Lerner Papautsky
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
- Division of Pulmonary, Allergy, Sleep and Critical Care, Boston Medical Center, Boston University, Boston, Massachusetts
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Burton H. Shen
- Division of Pulmonary, Allergy, Sleep and Critical Care, Boston Medical Center, Boston University, Boston, Massachusetts
| | - Joshua T. Stephens
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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20
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Gauly J, Court R, Seers K, Currie G, Grove A. In which context and for whom can interventions improve leadership of surgical trainees, surgeons and surgical teams and why: a realist review protocol. NIHR OPEN RESEARCH 2023; 3:16. [PMID: 37881463 PMCID: PMC10593322 DOI: 10.3310/nihropenres.13364.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 10/27/2023]
Abstract
Background Improving effective leadership of individuals, groups, and healthcare organisations is essential for improving surgical performance and indirectly improving health outcomes for patients. Numerous systematic reviews have been conducted which seek to determine the effectiveness of specific leadership interventions across a range of disciplines and healthcare outcomes. The purpose of this realist review is to systematically synthesise the literature which examines in which context and for whom leadership interventions improve leadership of surgeons, surgical teams, and trainees. Methods Several approaches will be used to iteratively search the scientific and grey literature to identify relevant evidence. Selected articles will inform the development of a programme theory that seeks to explain in which context and for whom interventions can improve leadership of surgical trainees, surgeons, and surgical teams. Next, empirical studies will be searched systematically in order to test and, where necessary, refine the theory. Once theoretical saturation has been achieved, recommendations for advancing leadership in surgery will be developed. Stakeholder and patient and public consultations will contribute to the development of the programme theory. The review will be written up according to the Realist And Meta-narrative Evidence Synthesis: Evolving Standards publication standards. No ethical review will be required for the conduct of this realist review. Discussion The knowledge gained from this review will provide evidence-based guidance for those planning or designing leadership interventions in surgery. The recommendations will help policymakers, educationalists, healthcare providers, and those delivering or planning leadership development programmes across the surgical disciplines to design interventions that are acceptable to the surgical community and successful in improving surgical leadership.PROSPERO registration: CRD42021230709.
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Affiliation(s)
- Julia Gauly
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Kate Seers
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, CV4 7AL, UK
| | - Amy Grove
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Grant-Freemantle M, Moore J, McBrien D, Condon F, Harmon D. The role of perceived patient injustice on pain related and functional outcomes in orthopaedic patients; a systematic review. J Orthop 2023; 36:19-23. [PMID: 36582546 PMCID: PMC9793222 DOI: 10.1016/j.jor.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/15/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Higher levels of perceived patient injustice has been associated with higher levels of pain and poor functional outcomes in patients with chronic musculoskeletal pain. We wanted to investigate if there was any evidence of this association in patients who underwent orthopaedic surgery. Materials and methods A systematic search of the literature was performed independently by two researchers on the electronic databases of MEDLINE, EMBASE, Google Scholar, Web of Science, and the Cochrane Database of Systematic Reviews and data extracted in accordance with PRISMA guidelines for systematic reviews. Outcomes of interest were pain, pain intensity, pain interference, opiate use, disability, physical function, return to work, quality of life, depression, anxiety, post-traumatic stress, social functioning and quality of life. Results Five studies were identified for qualitative analysis involving elective and trauma orthopaedic patients. All studies identified a positive correlation between higher levels of perceived injustice and depression, pain intensity and interference as well as reduced function and higher levels of disability. Conclusions Higher levels of perceived patient injustice is associated with worse pain and functional outcomes in patients who undergo orthopaedic surgery in the traumatic and elective setting. Further research is warranted to further elucidate this association and identify potential therapeutic interventions.
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Affiliation(s)
- M.C. Grant-Freemantle
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - J. Moore
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - D. McBrien
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - F. Condon
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
- University of Limerick, Limerick, Ireland
| | - D.C. Harmon
- Department of Anaesthesia and Pain Medicine, University Hospital Limerick, Limerick, Ireland
- University of Limerick, Limerick, Ireland
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Wevling A, Olsen BF, Nygaard AM, Heiberg T. Knowledge and Awareness of Non-Technical Skills Over the Course of an Educational Program in Nursing - A Repeated Cross-Sectional Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:31-41. [PMID: 36647513 PMCID: PMC9840371 DOI: 10.2147/amep.s379341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
Background Non-technical skills (NTS) play an important role in preventing adverse events during hospitalization. Knowledge, awareness and mastery of NTS becomes important key factors in preventing errors. Current status of students and supervisor's knowledge and awareness of NTS are needed in order to construct an educational plan for improvement. Purpose To examine knowledge and awareness of NTS over the course of continuing education of nurse anaesthetists, emergency care nurses, critical care nurses, and operating room nurses. Methods A descriptive, repetitive cross-sectional design with a questionnaire was used to evaluate knowledge and awareness in students and their supervisors about NTS at two different time points during the educational program. Cross tabulations were used in comparisons across specialties and between students and supervisors, frequencies to identify the levels of self-reported knowledge/importance/focus in clinical practice/ impact on adverse events. Results The results showed that there was a numeric difference between the reported knowledge/focus in clinical practice on the one hand and importance/ impact on adverse events on the other, and that this gap was reduced after 12 months of education with special focus on NTS. There was no difference across specialties. Supervisors had higher focus on NTS in clinical practice and on the impact on adverse events, than students at both measurements. Conclusion These data suggest that NTS may have important potential for improvement if included into learning programs both in education and clinical practice. Integration of NTS in various learning activities seems to strengthen students' competence about NTS.
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Affiliation(s)
- Astrid Wevling
- Faculty of Health, Welfare and Organization, University College of Østfold, Halden, Norway
| | - Brita Fosser Olsen
- Faculty of Health, Welfare Organization, University College of Østfold, Halden, and Østfold Hospital Trust, Intensive and Post Operative Unit, Sarpsborg, Norway
| | - Anne Mette Nygaard
- Faculty of Health, Welfare and Organization, University College of Østfold, Halden, Norway
| | - Turid Heiberg
- Department of Clinical Research Support, Oslo University Hospital, Oslo and Faculty of Health, Welfare and Organization, University College of Østfold, Halden, Norway
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23
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Sá-Couto C, Rodrigues D, Gouveia M. Debriefing or Feedback: Exploring the Impact of Two Post-Scenario Discussion Methods in the Acquisition and Retention of Non-Technical Skills. ACTA MEDICA PORT 2023; 36:34-41. [PMID: 35758257 DOI: 10.20344/amp.16898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 04/01/2022] [Accepted: 05/19/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION There is a paucity of quantitative studies objectively comparing debriefing and feedback as methods for post-scenario discussion and its impact on healthcare teams' acquisition and retention of non-technical skills. The main purpose of this study is to provide some insight on this research question, using a sample of medical students. A secondary objective explores students' opinion and preference on the post-scenario discussion. MATERIAL AND METHODS Forty-five medical students were distributed among 15 teams, and randomly allocated to two groups. Each team participated in three different simulated scenarios, with similar levels of difficulty and opportunities to apply specific non-technical skills: leadership, communication, and task management. To assess the acquisition and retention of skills, scenarios occurred on days one (baseline), two (acquisition) and 20 (retention). Team performance was objectively evaluated by an observer, using scenario recordings. Students individually assessed different aspects of debriefing and feedback. RESULTS Both debriefing and feedback groups showed similar overall increase in objective scores, with significant increase between days one and two (acquisition), and a smaller increase between days two and 20 (retention). Students indicated debriefing as the preferred discussion method. CONCLUSION Debriefing and feedback are effective post-scenario discussion methods, promoting acquisition and retention of non-technical skills, by undergraduate students. Allying debriefing reflexive practice with feedback directive style, and shifting appropriately between facilitation and instruction, can be a good compromise to achieve a timely and educationally meaningful discussion.
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Affiliation(s)
- Carla Sá-Couto
- Biomedical Simulation Center. Faculty of Medicine. University of Porto; CINTESIS@RISE. Community Medicine, Information and Decision Sciences Department. Faculty of Medicine. University of Porto. Portugal
| | - Diana Rodrigues
- Biomedical Simulation Center. Faculty of Medicine. University of Porto. Serviço de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Marcos Gouveia
- Biomedical Simulation Center. Faculty of Medicine. University of Porto. Department of Surgery and Physiology. Faculty of Medicine. University of Porto. CUF Porto Hospital. Porto. Portugal
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Walji HD, Ellis SA, Martin-Ucar AE, Hernandez L. Simulation in thoracic surgery-A mini review of a vital educational tool to maximize peri-operative care and minimize complications. Front Surg 2023; 10:1146716. [PMID: 37206340 PMCID: PMC10189136 DOI: 10.3389/fsurg.2023.1146716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
Thoracic surgery is an increasingly expanding field, and the addition of national screening programs has resulted in increasing operative numbers and complexity. Thoracic surgery overall has an approximately 2% mortality and 20% morbidity with common specific complications including persistent air leak, pneumothorax, and fistulas. The nature of the surgery results in complications being unique to thoracic surgery and often very junior members of the surgical team feel underprepared to deal with these complications after very little exposure during their medical school and general surgical rotations. Throughout medicine, simulation is being increasingly used as a method to teach the management of complicated, rare, or significant risk occurrences and has shown significant benefits in learner confidence and outcomes. In this mini review we explain the learning theory and benefits of simulation learning. We also discuss the current state of simulation in thoracic surgery and its potential future in aiding complication management and patient safety.
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Affiliation(s)
- Hasanali David Walji
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Department of Medical Education, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Steven Aaron Ellis
- Department of Medical Education, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Antonio Eduardo Martin-Ucar
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Luis Hernandez
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Correspondence: Luis Hernandez
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Gómez Rivas J, Somani B, Rodriguez Socarrás M, Marra G, Pearce I, Henningsohn L, Zondervan P, Van Poppel H, N'Dow J, Liatsikos E, Palou J. Shaping the Undergraduate Curriculum in Europe: Consensus Statement from the European School of Urology. Eur Urol 2022; 82:581-583. [PMID: 36163308 DOI: 10.1016/j.eururo.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/16/2022] [Accepted: 09/02/2022] [Indexed: 11/04/2022]
Abstract
The European School of Urology has created a taskforce to develop a comprehensive, structured urology curriculum with clinical exposure, practical skills, and hands-on training. The curriculum proposal includes cognitive teaching by symptoms and practical aspects to guarantee uniform access to undergraduate medical education in urology among all European countries, regardless of location, local urology exposure, or bias in national curricula.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain.
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ian Pearce
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Henningsohn
- Department of Urology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Patricia Zondervan
- Amsterdam University Medical Centers, Department of Urology, Amsterdam, The Netherlands
| | | | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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26
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Ting YY, Reid JL, Treloar E, Lee WSB, Tee JY, Cong WJP, Peng D, Edwards S, Ey J, Edwardes N, Granchi N, Maddern GJ. Improving Surgical Excellence: Can Coaching Surgeons Improve Patient Engagement? World J Surg 2022; 47:1144-1150. [PMID: 36401089 DOI: 10.1007/s00268-022-06827-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Non-technical skills complement technical skills in surgeons to provide best possible care for patients. The former is essential to promote patient engagement. Coaching has been introduced to surgeons as a method to improve non-technical skills. We aimed to investigate the impact of coaching for surgeons on patient engagement in the outpatient consultation setting. METHODS This was a single-centre cohort study conducted in South Australia. Consultant surgeons, suitable coaches, and patients were recruited. Coaches underwent further training by a human factors psychologist on being an effective coach. Outpatient consultations were recorded in an audio-visual format and analysed by investigators. Patient talking time, mutual eye gaze between surgeon and patient, and number of questions asked by the patient were measured as outcomes for patient engagement. RESULTS 182 patients, 12 surgeons, and 4 coaches participated in the study. Each surgeon underwent 3 coaching sessions, 5 to 6 weeks apart. There were 62 pre-coaching patient consultations, 63 patient consultations after one coaching session, and 57 patient consultations after two coaching sessions. The mean talking time of the patient increased significantly after a single coaching session (P < 0.05) without making significant difference to the total consultation time (p = 0.76). Coaching sessions did not have a significant effect on mutual eye gaze or mean number of questions asked by the patient. CONCLUSION Coaching of non-technical skills for surgeons appears to objectively improve patient engagement during the outpatient consultation. This would suggest that tailored coaching programs should be developed and delivered to surgeons to improve care delivery.
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Affiliation(s)
- Ying Yang Ting
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia
| | - Jessica L Reid
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia
| | - Ellie Treloar
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia
| | - Wei Shan Bobby Lee
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia
| | - Jeeng Yeeng Tee
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia
| | - Wen Jing Phoebe Cong
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia
| | - Dangyi Peng
- Monash School of Medicine, Monash University, Melbourne, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, The University of Adelaide, Adelaide, Australia
| | - Jesse Ey
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia
| | - Nicholas Edwardes
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia
| | - Nelson Granchi
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia
| | - Guy J Maddern
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, AdelaideWoodville, SA, 5011, Australia.
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Saleem MM, Zubair MS, Asgher AA, Ahmed U. How video games can help medical students become better surgeons in the future – Correspondence. Int J Surg 2022; 104:106805. [DOI: 10.1016/j.ijsu.2022.106805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
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28
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James HK, Fawdington RA. Freestyle Deliberate Practice Cadaveric Hand Surgery Simulation Training for Orthopedic Residents: Cohort Study. JMIR MEDICAL EDUCATION 2022; 8:e34791. [PMID: 35767315 PMCID: PMC9280454 DOI: 10.2196/34791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cadaveric simulation training may be part of the solution to reduced quantity and quality of operative surgical training in the modern climate. Cadaveric simulation allows the early part of the surgical learning curve to be moved away from patients into the laboratory, and there is a growing body of evidence that it may be an effective adjunct to traditional methods for training surgical residents. It is typically resource constrained as cadaveric material and facilities are expensive. Therefore, there is a need to be sure that any given cadaveric training intervention is maximally impactful. Deliberate practice (DP) theory as applied to cadaveric simulation training might enhance the educational impact. OBJECTIVE The objectives of this study were (1) to assess the impact of a freestyle DP cadaveric hand surgery simulation training intervention on self-reported operative confidence for 3 different procedures and (2) to assess the subjective transfer validity, perceived educational value, and simulation fidelity of the training. METHODS This study used validated questionnaires to assess the training impact on a cohort of orthopedic residents. The freestyle course structure allowed the residents to prospectively define personalized learning objectives, which were then addressed through DP. The study was conducted at Keele Anatomy and Surgical Training Centre, a medical school with an integrated cadaveric training laboratory in England, United Kingdom. A total of 22 orthopedic surgery residents of postgraduate year (PGY) 5-10 from 3 regional surgical training programs participated in this study. RESULTS The most junior (PGY 5-6) residents had the greatest self-reported confidence gains after training for the 3 procedures (distal radius open reduction internal fixation, flexor tendon repair, ulnar shortening osteotomy), and these gains diminished with resident seniority. The confidence gains were proportional to the perceived procedural complexity, with the most complex procedure having the lowest pretraining confidence score across all experience levels, and the greatest confidence increase in posttraining. Midstage (PGY 7-8) residents reported receiving the highest level of educational benefit from the training but perceived the simulation to be less realistic, compared to either the junior or senior residents. The most senior residents (PGY 9-10) reported the greatest satisfaction with the self-directed, freestyle nature of the training. All groups reported that they were extremely likely to transfer their technical skill gains to their workplace, that they would change their current practice based on these skills, and that their patients would benefit as a result of their having undertaken the training. CONCLUSIONS Freestyle, resident-directed cadaveric simulation provides optimum DP conditions whereby residents can target their individualized learning needs. By receiving intensive, directed feedback from faculty, they can make rapid skill gains in a short amount of time. Subjective transfer validity potential from the training was very high, and objective, quantitative evidence of this is required from future work.
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Affiliation(s)
- Hannah K James
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ross A Fawdington
- Department of Trauma and Orthopaedics, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Thwin M, Lim R, Glover A. Applying the 'three buckets' theory of situational awareness to surgical training: an updated framework. ANZ J Surg 2022; 92:1498-1501. [PMID: 35488464 DOI: 10.1111/ans.17741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/23/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022]
Affiliation(s)
- May Thwin
- Clinical & Professional Development Unit, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Renee Lim
- Clinical & Professional Development Unit, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Glover
- Clinical & Professional Development Unit, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Endocrine Surgery & Surgical Education Research and Training (SERT) Institute, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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Kalantari R, Zamanian Z, Hasanshahi M, Faghihi SAA, Niakan MH, Jamali J, Gheysari S. An interview study to identify circulating nurses’ nontechnical skills. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Reza Kalantari
- Department of Ergonomics, Faculty of Public Health Shiraz University of Medical Sciences Shiraz Fars Iran
| | - Zahra Zamanian
- Department of Ergonomics, Faculty of Public Health Shiraz University of Medical Sciences Shiraz Fars Iran
| | - Mehdi Hasanshahi
- Department of Operating Room, Faculty of Nursing Shiraz University of Medical Sciences Shiraz Fars Iran
| | | | - Mohammad Hadi Niakan
- Department of Surgery, Faculty of Medicine Shiraz University of Medical Sciences Shiraz Fars Iran
| | - Jamshid Jamali
- Department of Biostatistics, Faculty of Public Health Mashhad University of Medical Sciences Mashhad Khorasane razavi Iran
| | - Somayeh Gheysari
- Department of Operating Room, Faculty of Nursing Shiraz University of Medical Sciences Shiraz Fars Iran
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Zetner DB, Konge L, Fabrin A, Christensen JB, Thinggaard E. The Challenges of Dyad Practice in Simulation Training of Basic Open Surgical Skills-A Mixed-Method Study. Simul Healthc 2022; 17:e91-e97. [PMID: 34009912 DOI: 10.1097/sih.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulation training at home improves access to training, but motivation can be difficult to maintain. Dyad training could keep trainees motivated. This study aimed to examine the effect of self-regulated training of basic surgical skills in pairs versus individually. METHODS One hundred one medical doctors were included in this prospective, mixed-method, simulation-based study. Participants were randomized to train individually or in pairs during a 6-week course in open surgical skills, consisting of didactic instructions and self-directed training at home. Trainees kept a training log and filled in a questionnaire. Skills were tested before and after the course. Tests were rated by an expert using the Objective Structured Assessment of Technical Skills Global Rating Scale. RESULTS Ninety-seven doctors completed the study. We found no differences in test score between dyad and individual trainees. Dyad trainees compared with individual trainees improved by 7.23 points (intercept estimate) versus 6.94 points, respectively (P = 0.881). Dyad trainees trained less frequently [7.3 times (intercept estimate) vs. 12.1 times, P < 0.001, but for longer intervals compared with individual trainees (68 minutes vs. 38 minutes)]. Dyad trainees reported benefits such as having a sparring partner, receiving feedback, corrections, increased motivation, having fun, and more structured training sessions. However, the coordination of training sessions was difficult. CONCLUSIONS No differences were found between dyad trainees and individual trainees in improvement of surgical skills. Off-site dyad training led to fewer, but longer training sessions, which may have negatively impacted the effectiveness of training. Dyad trainees perceived dyad training beneficial.
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Affiliation(s)
- Diana B Zetner
- From the Copenhagen Academy for Medical Education and Simulation (D.B.Z., L.K., A.F., J.B.C., E.T.), Copenhagen Ø; University of Copenhagen, Faculty of Health and Medical Sciences (L.K.), Copenhagen N; Department of Thoracic, Cardiac and Vascular Surgery (A.F.), Odense University Hospital, Odense; and Department of Obstetrics and Gynaecology, Slagelse Sygehus (E.T.), Slagelse, Denmark
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Cha JS, Yu D. Objective Measures of Surgeon Non-Technical Skills in Surgery: A Scoping Review. HUMAN FACTORS 2022; 64:42-73. [PMID: 33682476 DOI: 10.1177/0018720821995319] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this study was to identify, synthesize, and discuss objective behavioral or physiological metrics of surgeons' nontechnical skills (NTS) in the literature. BACKGROUND NTS, or interpersonal or cognitive skills, have been identified to contribute to safe and efficient surgical performance; however, current assessments are subjective, checklist-based tools. Intraoperative skill evaluation, such as technical skills, has been previously utilized as an objective measure to address such limitations. METHODS Five databases in engineering, behavioral science, and medicine were searched following PRISMA reporting guidelines. Eligibility criteria included studies with NTS objective measurements, surgeons, and took place within simulated or live operations. RESULTS Twenty-three articles were included in this review. Objective metrics included communication metrics and measures from physiological responses such as changes in brain activation and motion of the eye. Frequencies of content-coded communication in surgery were utilized in 16 studies and were associated with not only the communication construct but also cognitive constructs of situation awareness and decision making. This indicates the underlying importance of communication in evaluating the NTS constructs. To synthesize the scoped literature, a framework based on the one-way communication model was used to map the objective measures to NTS constructs. CONCLUSION Objective NTS measurement of surgeons is still preliminary, and future work on leveraging objective metrics in parallel with current assessment tools is needed. APPLICATION Findings from this work identify objective NTS metrics for measurement applications in a surgical environment.
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Affiliation(s)
| | - Denny Yu
- 311308 Purdue University, Indiana, USA
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Guzmán-García C, Sánchez-González P, Margallo JAS, Snoriguzzi N, Rabazo JC, Margallo FMS, Gómez EJ, Oropesa I. Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics. SENSORS 2022; 22:s22030837. [PMID: 35161582 PMCID: PMC8838092 DOI: 10.3390/s22030837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
Modern surgical education is focused on making use of the available technologies in order to train and assess surgical skill acquisition. Innovative technologies for the automatic, objective assessment of nontechnical skills are currently under research. The main aim of this study is to determine whether personal resourcefulness can be assessed by monitoring parameters that are related to stress and visual attention and whether there is a relation between these and psychomotor skills in surgical education. For this purpose, we implemented an application in order to monitor the electrocardiogram (ECG), galvanic skin response (GSR), gaze and performance of surgeons-in-training while performing a laparoscopic box-trainer task so as to obtain technical and personal resourcefulness' metrics. Eight surgeons (6 nonexperts and 2 experts) completed the experiment. A total of 22 metrics were calculated (7 technical and 15 related to personal resourcefulness) per subject. The average values of these metrics in the presence of stressors were compared with those in their absence and depending on the participants' expertise. The results show that both the mean normalized GSR signal and average surgical instrument's acceleration change significantly when stressors are present. Additionally, the GSR and acceleration were found to be correlated, which indicates that there is a relation between psychomotor skills and personal resourcefulness.
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Affiliation(s)
- Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Juan A. Sánchez Margallo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | - Nicola Snoriguzzi
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - José Castillo Rabazo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | | | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Correspondence: ; Tel.: +34-910-672-458
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Improving Interprofessional Teamwork in Plastic Surgery: A Novel Approach to Microsurgical Skills Training. Plast Surg Nurs 2021; 41:203-207. [PMID: 34871287 DOI: 10.1097/psn.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Shared mental models between surgeons and nurses allow them to effectively communicate and react to intraoperative complications. Microsurgery poses unique challenges that include the use of an operating microscope, fine instruments, and a restricted view of the operative field. We designed and delivered a microsurgical skills session for surgical nurses consisting of an introduction to the operating microscope and 3 practical stations involving increasingly complex motor tasks designed to highlight the importance of instrument handling and improve awareness of microsurgical challenges. Consultant plastic surgeons acted as scrub persons to add an element of role-reversal. All participants enjoyed the training session and felt that it improved their understanding of microsurgery and was relevant and helpful to their day-to-day role. All attendees reported that they would partake in similar sessions in the future. Our work suggests that role-reversal and skills-based education and training are valuable tools in improving multidisciplinary collaboration during microsurgery. Increasing shared knowledge of complex procedures encourages effective teamwork and communication, which leads to improved efficiency and better patient care. Our study is a first step toward development of a standardized microsurgical skills course for plastic surgical nurses and has broader implications for interprofessional education across all surgical specialties.
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Gómez Rivas J, Somani B, Rodriguez Socarrás M, Marra G, Pearce I, Henningsohn L, Zondervan P, van der Poel H, Van Poppel H, N'Dow J, Liatsikos E, Palou J. Essentials for Standardising the Undergraduate Urology Curriculum in Europe: Outcomes of a Delphi Consensus from the European School of Urology. EUR UROL SUPPL 2021; 33:72-80. [PMID: 34738091 PMCID: PMC8551509 DOI: 10.1016/j.euros.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 01/15/2023] Open
Abstract
Background The burden of urological diseases is rising as the worldwide population ages. Although specialist urological provision is needed, a large proportion of these conditions will be managed in primary care. The importance of including urology in medical education currently remains unclear. Objective To provide recommendations on undergraduate medical education for urology in Europe. Design, setting, and participants A three-round Delphi process to reach consensus on standardising the undergraduate urology curriculum in Europe was endorsed by the European School of Urology. Outcome measurements and statistical analysis The levels of agreement were set using a nine-point scale according to the GRADE grid: 1–3, disagree; 4–6, uncertain; and 7–9, agree. Consensus was defined as at least 70% of the participants scoring within the same 3-point grouping. Results and limitations Overall, consensus was reached for 20 of 34 statements (70.5%) across the three Delphi rounds, with agreement for 75% (n = 15) and disagreement for 25% (n = 5). The following main points were agreed. Urological teaching should be introduced before year 5 of medical school, with at least 20 h of theoretical activities and at least 30 h of practical activities. Urology should be taught as a stand-alone subject rather than combined with another surgical specialty or a nephrology programme. The participants agreed that urology should be taught according to symptoms. A urology programme should include the anatomy and physiology of the urinary tract, and students should know how to clinically assess a urological patient. Conclusions Our recommended urology pathway will allow European medical schools to provide a more comprehensive undergraduate urology curriculum. It will also help to improve and maintain standards of urology undergraduate teaching across Europe. Patient summary Our survey showed that urology in universities should have, at minimum, time for theoretical and practical activities and should be taught as a stand-alone subject on the basis of symptoms. Students should give feedback to facilitate constant improvement and evolution of the teaching programme.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ian Pearce
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Henningsohn
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Patricia Zondervan
- Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Henk van der Poel
- Department of Urology, The Netherlands Cancer Institute, Netherlands Prostate Cancer Network, Amsterdam, The Netherlands
| | | | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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Stucky CH, De Jong MJ. Surgical Team Familiarity: An Integrative Review. AORN J 2021; 113:64-75. [PMID: 33377513 DOI: 10.1002/aorn.13281] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/02/2020] [Accepted: 05/26/2020] [Indexed: 11/05/2022]
Abstract
The dynamic nature of perioperative care often brings unfamiliar clinicians together yet requires them to collectively provide complex health care in a challenging environment. In this review, we comprehensively evaluated evidence regarding surgical team familiarity and its relationship to surgical team performance. Using a comprehensive and iterative search strategy, we searched PubMed, Web of Science, PsycInfo, and EMBASE for surgical team familiarity manuscripts. We identified 598 manuscripts, 16 of which met our inclusion criteria. We found that surgical team familiarity is associated with improved performance for many metrics, including shorter total operative time, team member safety, decreased surgical errors and disruptions, reduced miscommunication, and fewer patient readmissions. Although additional research would be helpful, surgical managers should consider team familiarity and consistency in team membership when assigning staff members to surgical teams to optimize surgical care, decrease inefficiencies, and promote safe patient outcomes.
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Stucke R, Rosenkranz KM. Teaching and Evaluating Nontechnical Skills for General Surgery. Surg Clin North Am 2021; 101:577-586. [PMID: 34242601 DOI: 10.1016/j.suc.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Surgical training programs have long used quantitative measures of knowledge, as well as subjective evaluation of technical skills, to define the competence of trainees. However, a growing body of literature has shown the importance of nontechnical surgical skills as vital components of quality surgical care. Institutions must train nontechnical surgical skills, including leadership, communication, teamwork, situational awareness, and decision making, and incorporate these attributes into their evaluative processes to maximally enhance surgical performance at every career stage.
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Affiliation(s)
- Ryland Stucke
- Fellow in Advanced GI and Minimally Invasive Surgery, Department of Surgery, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, Oregon 97239, USA
| | - Kari M Rosenkranz
- Associate Professor of Surgery, Department of Surgery, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756, USA.
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James HK, Chapman AW, Pattison GTR, Fisher JD, Griffin DR. Analysis of Tools Used in Assessing Technical Skills and Operative Competence in Trauma and Orthopaedic Surgical Training: A Systematic Review. JBJS Rev 2021; 8:e1900167. [PMID: 33006464 PMCID: PMC7360100 DOI: 10.2106/jbjs.rvw.19.00167] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Robust assessment of skills acquisition and surgical performance during training is vital to ensuring operative competence among orthopaedic surgeons. A move to competency-based surgical training requires the use of tools that can assess surgical skills objectively and systematically. The aim of this systematic review was to describe the evidence for the utility of assessment tools used in evaluating operative performance in trauma and orthopaedic surgical training. METHODS We performed a comprehensive literature search of MEDLINE, Embase, and Google Scholar databases to June 2019. From eligible studies we abstracted data on study aim, assessment format (live theater or simulated setting), skills assessed, and tools or metrics used to assess surgical performance. The strengths, limitations, and psychometric properties of the assessment tools are reported on the basis of previously defined utility criteria. RESULTS One hundred and five studies published between 1990 and 2019 were included. Forty-two studies involved open orthopaedic surgical procedures, and 63 involved arthroscopy. The majority (85%) were used in the simulated environment. There was wide variation in the type of assessment tools in used, the strengths and weaknesses of which are assessor and setting-dependent. CONCLUSIONS Current technical skills-assessment tools in trauma and orthopaedic surgery are largely procedure-specific and limited to research use in the simulated environment. An objective technical skills-assessment tool that is suitable for use in the live operative theater requires development and validation, to ensure proper competency-based assessment of surgical performance and readiness for unsupervised clinical practice. CLINICAL RELEVANCE Trainers and trainees can gain further insight into the technical skills assessment tools that they use in practice through the utility evidence provided.
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Affiliation(s)
- Hannah K James
- 1Clinical Trials Unit, Warwick Medical School, Coventry, United Kingdom 2Department of Trauma & Orthopedic Surgery, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
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Han H, Knight S, Feimster J, Boehler M, Schwind C, Mellinger J. Attendings' Perceptions of Authentic Evaluation Criteria for Effective Surgical Consults. JOURNAL OF SURGICAL EDUCATION 2021; 78:1319-1327. [PMID: 33386284 DOI: 10.1016/j.jsurg.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The authors aimed to investigate faculty evaluation criteria for an effective oral surgical presentation in actual patient care contexts. DESIGN We conducted a 2-step observation-based qualitative study. Residents audiotaped oral presentations of a surgical consult to an attending. Evaluation panels listened to the recordings and discussed to develop joint feedback for the resident. The panel discussions were recorded and served as the data source for this study. We analyzed the data following the grounded theory approach using open coding and axial coding. SETTING The study setting was at Southern Illinois University School of Medicine, a 5-year general surgery residency program in Springfield, Illinois. PARTICIPANTS Thirteen residents out of 19 in the program participated by virtue of having submitted recordings of a patient care consult presentation via phone. Evaluation panels consisted of general surgery academic and community faculty, as well as senior residents. RESULTS Several criteria for effective oral presentations emerged that have rarely been discussed in prior literature. Themes included: (1) The strategic opening is critical as it "sets the stage" and frames how the attending will listen. Situational factors, such as consideration of time of the day and urgency, should be accounted for in the opening. (2) A deductive structure defines the relevance of the presented information. Clinical judgement should precede supporting evidence. Attending physicians perceive important information as unnecessary if provided outside of this framework. (3) Established trust between a resident and a surgeon determines the level of detail expected of the presenting resident. With increasing trust, surgeons expect residents to present fewer details; if too much detail is included, the presentation may be assessed as ineffective. (4) Surgical descriptions are appreciated for their value in promoting the attending's visualization or mental picture of the patient condition. (5) Oral emphasis using voice tone and pace can be helpful for capturing attending attention. CONCLUSIONS These findings can be utilized to improve the current training program and assessment rubrics toward contextualized work-based assessment practices in surgery. Oral patient presentation skills are neither static nor universal, but fluid and reflexive, based on trust, and situational factors.
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Affiliation(s)
- Heeyoung Han
- Department of Medical Education, Southern Illinois University School of Medicine, Springfield Illinois.
| | - Samantha Knight
- Department of Surgery, Division of General Surgery, Southern Illinois University School of Medicine, Springfield Illinois
| | - James Feimster
- Department of Surgery, Division of General Surgery, Southern Illinois University School of Medicine, Springfield Illinois
| | - Margaret Boehler
- Department of Surgery, Division of General Surgery, Southern Illinois University School of Medicine, Springfield Illinois
| | - Cathy Schwind
- Department of Surgery, Division of General Surgery, Southern Illinois University School of Medicine, Springfield Illinois
| | - John Mellinger
- Department of Surgery, Division of General Surgery, Southern Illinois University School of Medicine, Springfield Illinois
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Dellefield ME, Verkaaik CA. Using the Observational Teamwork Assessment in Surgery Instrument to Measure RN Teamwork During Cardiac Surgery: Lessons Learned. J Nurs Care Qual 2021; 36:162-168. [PMID: 32568965 DOI: 10.1097/ncq.0000000000000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical teams aspire to be safe and avoid preventable deaths. A lack of teamwork has been associated with safety failures, including adverse events and errors. PURPOSE The purpose of the pilot study was to: (1) modify the Observational Teamwork Assessment in Surgery (OTAS) and the original data collection method to measure registered nurse (RN) teamwork during the intraoperative phase of 5 open heart surgical procedures and (2) recommend strategies to further test the reliability and validity of the modified OTAS. METHODS This was a pilot study of the OTAS using direct observation. RESULTS Although characterized as psychometrically rigorous in prior systematic reviews, using the OTAS to measure RN teamwork in the intraoperative phase of cardiac surgery revealed deficits in its content validity and reliability. The OTAS and its original data collection method were modified. CONCLUSION Recommendations for further use of the modified OTAS to increase its reliability and validity are given.
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Augmented Reality, Mixed Reality, and Hybrid Approach in Healthcare Simulation: A Systematic Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Simulation-based medical training is considered an effective tool to acquire/refine technical skills, mitigating the ethical issues of Halsted’s model. This review aims at evaluating the literature on medical simulation techniques based on augmented reality (AR), mixed reality (MR), and hybrid approaches. The research identified 23 articles that meet the inclusion criteria: 43% combine two approaches (MR and hybrid), 22% combine all three, 26% employ only the hybrid approach, and 9% apply only the MR approach. Among the studies reviewed, 22% use commercial simulators, whereas 78% describe custom-made simulators. Each simulator is classified according to its target clinical application: training of surgical tasks (e.g., specific tasks for training in neurosurgery, abdominal surgery, orthopedic surgery, dental surgery, otorhinolaryngological surgery, or also generic tasks such as palpation) and education in medicine (e.g., anatomy learning). Additionally, the review assesses the complexity, reusability, and realism of the physical replicas, as well as the portability of the simulators. Finally, we describe whether and how the simulators have been validated. The review highlights that most of the studies do not have a significant sample size and that they include only a feasibility assessment and preliminary validation; thus, further research is needed to validate existing simulators and to verify whether improvements in performance on a simulated scenario translate into improved performance on real patients.
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Kennedy-Metz LR, Dias RD, Stevens RH, Yule SJ, Zenati MA. Analysis of Mirrored Psychophysiological Change of Cardiac Surgery Team Members During Open Surgery. JOURNAL OF SURGICAL EDUCATION 2021; 78:622-629. [PMID: 32863172 PMCID: PMC7904574 DOI: 10.1016/j.jsurg.2020.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/20/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Mirrored psychophysiological change in cognitive workload indices may reflect shared mental models and effective healthcare team dynamics. In this exploratory analysis, we investigated the frequency of mirrored changes, defined as concurrent peaks in heart rate variability (HRV) across team members, during cardiac surgery. DESIGN Objective cognitive workload was evaluated via HRV collected from the primary surgical team during cardiac surgery cases (N = 15). Root mean square of the successive differences (RMSSD) was calculated as the primary HRV measure. Procedures were divided into consecutive nonoverlapping 5-minute segments, and RMSSD along with deviations from RMSSD were calculated for each segment. Segments with positive deflections represent above-average cognitive workload. Positive deflections and peaks across dyads within the same segment were counted. SETTING Data collection for this study took place in the cardiovascular operating room during live surgeries. PARTICIPANTS Physiological data were collected and analyzed from the attending surgeon, attending anesthesiologist, and primary perfusionist involved with the recorded cases. RESULTS Of the 641 five-minute segments analyzed, 325 (50.7%) were positive deflections above average, concurrently across at least 2 team members. Within the 325 positive deflections, 26 (8%) represented concurrent peaks in HRV across at least 2 active team members. Mirrored peaks across team members were observed most commonly during the coronary anastomoses or valve replacement phase (N = 12). CONCLUSIONS In this pilot study, mirrored physiological responses representing peaks in cognitive workload were observed uncommonly across dyads of cardiac surgery team members (1.73 peaks/case on average). Almost half of these occurred during the most technically demanding phases of cardiac surgery, which may underpin teamwork quality. Future work should investigate interactions between technical and nontechnical performance surrounding times of mirrored peaks and expand the sample size.
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Affiliation(s)
- Lauren R Kennedy-Metz
- Medical Robotics and Computer-Assisted Surgery Laboratory, Boston, Massachusetts; VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Roger D Dias
- Harvard Medical School, Boston, Massachusetts; STRATUS Center for Medical Simulation, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Steven J Yule
- Harvard Medical School, Boston, Massachusetts; Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland; Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Marco A Zenati
- Medical Robotics and Computer-Assisted Surgery Laboratory, Boston, Massachusetts; VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Hanrahan JG, Sideris M, Pasha T, Dedeilia A, Papalois A, Papalois V. Postgraduate Assessment Approaches Across Surgical Specialties: A Systematic Review of the Published Evidence. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:285-295. [PMID: 32889945 DOI: 10.1097/acm.0000000000003712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Ensuring competence for surgical trainees requires holistic assessment of the qualities and competencies necessary to practice safely and effectively. To determine the next steps toward achieving this aim, the authors conducted a systematic review to summarize and appraise the available evidence related to any assessment approach to postgraduate surgical training and to identify the dominant themes for assessment approaches across different specialties or countries. METHOD Medline and Embase were searched on January 10, 2019, without language or time restrictions. Any peer-reviewed study that described an assessment framework (in practice or novel) throughout postgraduate surgical training globally was included. An iterative review and thematic analysis were performed on full-text articles to determine assessment themes. Studies were then grouped by assessment themes. A tailored quality assessment of the studies included in the final analysis was conducted. Assessment themes and validity were compared across surgical specialties and countries. RESULTS From an initial 7,059 articles, 91 studies (evaluating 6,563 surgical trainees) were included in the final analysis. Ten defined assessment themes were extracted. Ten studies (11.0%) were deemed low risk of bias based on the quality assessment tool used and thus were determined to be high quality. Minor differences in assessment themes were observed between specialties and countries. Assessment themes neglected by individual surgical specialties and assessment themes that need validated assessment tools were identified. CONCLUSIONS This review highlights the low quality of evidence and fragmented efforts to develop and optimize surgical assessments. The minor differences observed demonstrate a common approach, globally and across specialties, related to surgical assessments. A paradigm shift in assessment approaches, which will require national and international collaboration, is required to optimize design and validation so that a comprehensive assessment of surgical competence can be implemented.
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Affiliation(s)
- John Gerrard Hanrahan
- J.G. Hanrahan is academic foundation doctor, Department of General Surgery, Lister Hospital, Stevenage, United Kingdom
| | - Michail Sideris
- M. Sideris is a specialty trainee in obstetrics and gynaecology, Women's Health Research Unit, Queen Mary University of London, London, United Kingdom
| | - Terouz Pasha
- T. Pasha is a final-year medical student, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Aikaterini Dedeilia
- A. Dedeilia is a final-year medical student, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos Papalois
- A. Papalois is director, ELPEN Research & Experimental Centre, Athens, Greece
| | - Vassilios Papalois
- V. Papalois is professor of transplant surgery, Department of Surgery and Cancer, Renal Transplant Directorate, Imperial College Healthcare NHS Trust, London, United Kingdom
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Tuma F. The use of educational technology for interactive teaching in lectures. Ann Med Surg (Lond) 2021; 62:231-235. [PMID: 33537136 PMCID: PMC7840803 DOI: 10.1016/j.amsu.2021.01.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
Students often feel overwhelmed by the volume and complexity of knowledge and skills required to learn. Along with this challange, educational technology has been gradually introduced in medical education to facilitate learning and improve outcomes. It became an essential part of communication, storing and transferring information, audio-visual media use and production, and knowledge sharing. Technology's role has been expanding from a mere tool of study and inquiry to an approach and integrated use in education. Its use in medical education is continuously evolving. However, the impact and optimal use of various technology applications are not clearly defined. There are multiple challenges facing educators to choose the right application for the specific educational purpose. Hence, studies and evaluation reviews are needed to inform the better-defined use of educational technology. This review aims to discuss and evaluate various educational technology applications in medical education, focusing on interactive learning during lectures. Lectures and other group learning sessions are common activities used by medical schools. Promoting interactive learning in large groups is known to be challenging. The advances in technology to facilitate communication and promote interaction is a promising adjunct for lectures interactivity.
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Affiliation(s)
- Faiz Tuma
- Department of General Surgery, Central Michigan University College of Medicine, 912 S. Washington Avenue, Suite #1 Saginaw, MI, 48601-2578, USA
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Tuma F, Kamel MK, Shebrain S, Ghanem M, Blebea J. Alternatives surgical training approaches during COVID-19 pandemic. Ann Med Surg (Lond) 2021; 62:253-257. [PMID: 33520221 PMCID: PMC7825981 DOI: 10.1016/j.amsu.2021.01.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
Importance Coping with the COIVD-19 global-pandemic major changes in healthcare and educational operational policies, mandates the implementation of alternative surgical curriculum objects (components) to replace some of the traditional face-to-face activities. Objective The objective of the study is to review and discuss various alternative curriculum objects (components) that can be used to restructure conventional surgical training curricula during the Declared Healthcare Emergency surgery rotations. The goal is to identify and recommend effective alternative educational activities that are compliant with the new social physical distancing regulations. Evidence review Various curricular components and objects were examined. The educational value of the curriculum objects is studied and analyzed in terms of feasibility, knowledge gain/learning effectiveness, the need for facilitation or feedback, and the evaluation. Several curriculum objects were proposed with description of their value and applications. Findings The selected and proposed activities include scenario-based MCQ writing exercises, video-based surgical skills interactive training, online learning modules, virtual rounding, reflection assignments, surgical skills simulation training, research education, and medical education learning. Their educational value is described and scaled. Conclusion There is urgent and challenging need for surgical training using additional alternative curriculum objects (components). Working with the available resources and experiences is crucial to maximize the learning outcomes. Distance (online) education and educational technology tools and concepts provide a spectrum of valuable educational activities. Further work and studies are needed to optimize their utility. The COIVD-19 pandemic has imposed major changes in healthcare and educational operational policies. This review discusses alternative curriculum objects that can be used to restructure traditional surgical training curricula. Effective alternative educational activities that are compliant with the social distancing regulations were discussed.
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Affiliation(s)
- Faiz Tuma
- General Surgery Department, Central Michigan University College of Medicine, USA
| | - Mohamed K Kamel
- General Surgery Department, Central Michigan University College of Medicine, USA
| | - Saad Shebrain
- Genera Surgery Department, Western Michigan University Homer Stryker MD School of Medicine, USA
| | - Maher Ghanem
- General Surgery Department, Central Michigan University College of Medicine, USA
| | - John Blebea
- General Surgery Department, Central Michigan University College of Medicine, USA
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Stueckle CA, Hackert B, Talarczyk S, Wawro M, Haage P, Weger U. The physician as a success determining factor in CT-guided pain therapy. BMC Med Imaging 2021; 21:11. [PMID: 33435895 PMCID: PMC7805076 DOI: 10.1186/s12880-020-00544-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 12/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Back pain is a common problem and a burden for the patient. MR-morphologically proven pain-causing changes of the spine is often successfully treated utilizing CT-guided pain therapy. The CT-guided execution enables a controlled and reproducible therapy. Nevertheless, treatment results can differ even with the same patient; the physician is a possible influencing factor of the outcome. Accordingly, the present study analyzes the different behaviors and forms of communication of the treating physicians during the course of the intervention as factors influencing the outcome of treatment. METHODS 67 patients suffering from specific back pain were included in this study. 5 treating physicians (2 female, 3 male) of different age (29-63 years), and experience and a total of 244 CT-guided treatments were included in this study. In every case a psychologist observed the treatment based on a standardized observation protocol. Observed were both the verbal and non-verbal interactions as well as the reaction of patient and physician. The success of the therapy was measured in the course of the treatment using the visual analogue pain scale. The technical comparability of the performed CT-guided periradicular therapy was ensured by the distribution of the drug mixture. RESULTS The outcome is significantly better if the patient considers the treating physician to be competent (correlation coefficient: 0.24, p < 0.006) and feels understood (correlation coefficient: 0.29, p < 0.001). In addition, the outcome is better when the physician believes that the treatment brings a positive reduction of pain, underlining his belief with positive statements of affirmation before the intervention thus creating a positive atmosphere [correlation coefficient: 0.24 (p < 0.009)]. In contrast, the outcome is worse if the patient complains about pain during the intervention [average pain reduction M = 0.9 (pain group) vs. M = 2.0 (no-pain group)]. CONCLUSION Our study shows that with comparable implementation of CT-guided periradicular therapy, the outcome of the patient with specific back pain can be significantly improved by certain behavioral patterns of the performing physician and this without side effects and without significant additional time expenditure. Our findings indicate that there is a non-negligible psychological factor linking confidence in therapy to actual therapy success. TRIAL REGISTRATION The study was designed as an observational study, therefore a trial registration was not necessary.
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Affiliation(s)
- Christoph A Stueckle
- Faculty of Health, Witten/Herdecke University, Witten, Germany.
- Department of Diagnostic and Interventional Radiology, HELIOS University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany.
- MVZ Professor Uhlenbrock Und Partner GmbH, Dortmund, Germany.
| | - Benedikt Hackert
- Department of Psychology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Sarah Talarczyk
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- MVZ Professor Uhlenbrock Und Partner GmbH, Dortmund, Germany
| | - Martin Wawro
- Department of Psychology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Patrick Haage
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of Diagnostic and Interventional Radiology, HELIOS University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
| | - Ulrich Weger
- Department of Psychology, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Abstract
INTRODUCTION Health systems often emphasize technical skills to reduce iatrogenic injuries. Nontechnical skills such as clinical and communication skills are mostly overlooked or not readily retrievable from medical records. Our aim was to estimate the association of technical and nontechnical skills of endoscopists with indemnity payments to patients after endoscopic perforations. METHODS This is an observational registry-based study of closed claims against gastroenterologists involved in endoscopic perforations. RESULTS We analyzed 175 closed claims related to perforations, all of which involved allegations of improper performance of the endoscopic procedure. Inadequate communication (n = 71, 41%) and clinical judgment (n = 60, 34%) on the part of the endoscopists were observed. Inadequate communication and clinical judgment were associated with over 3-fold odds of indemnity payment (odds ratio [OR] 3.31; 95% confidence interval [CI], 1.46-7.48, and OR 3.18; 95% CI, 1.44-7.01, respectively). However, if there were no communication breakdown or clinical judgment issues and the only allegation was poor technical skill, the odds of indemnity payments were less than half of those cases (OR 0.43; 95% CI 0.15-0.80). There was no evidence of a statistically significant interaction among age, procedure type, trainee involvement, clinical severity, need for surgery, and procedure-related death. DISCUSSION We observed that inadequate communication and clinical judgment were associated with indemnity payment, independent of the severity of clinical outcomes. On the other hand, cases wherein there was an allegation of poor technical skills alone, without communication breakdown or clinical judgment issues, were associated with favorable legal outcomes for the defendant. (See the Visual Abstract at http://links.lww.com/AJG/B568.).
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Chang YT, Lu PY, Lai CS. Disparity of perspectives between teachers and learners on perioperative teaching and learning. BMC MEDICAL EDUCATION 2020; 20:244. [PMID: 32736559 PMCID: PMC7393732 DOI: 10.1186/s12909-020-02172-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND To build a consensus about learning objectives in the operating room, the aim of the study was to evaluate both surgical teacher and learner perspectives on perioperative teaching and learning in Taiwan. METHODS Twelve main technical and non-technical learning objectives in the operating room were evaluated by learners and surgical teachers in Kaohsiung Medical University Hospital. The learners included postgraduate year (PGY) 1-3 residents (junior learner, JL) and PGY 4-7 residents (senior learner, SL). The definition of learning preferences were recommended learning objectives, and learning load was defined as demands of learning preferences. During the survey, surgical teachers evaluated the learning preferences for the learner, and learners evaluated their learning preferences. The learners also evaluated the learning preferences that the surgical teachers should teach. RESULTS Response rate of the questionnaire was 65.4%. A total of 31 learners and 39 surgical teachers completed the survey. The consensus was that the need to increase the learning loads and ethical issues were the learning preferences for SL, and indications, details of procedure, and teamwork were important to both JL and SL. The teachers intended to set specific learning objectives for different learner levels, including (i) indications, details of procedure, teamwork, and postoperative care for both JL and SL; (ii) preoperative preparation, surgical anatomy, and instrument handling for JL (P = 0.022, 0.021 and 0.006); and (iii) surgical technique, independent practice, clinical reasoning, complications, and ethical issues for SL (P = 0.010, < 0.001, < 0.001, 0.001, 0.011). Resident perspective on learning objectives differed between JL and SL, and there was discrepancy between resident's learning as perceived by teachers, particularly in the JL. CONCLUSIONS Our study revealed significant disparity of perspectives between teachers and learners on perioperative teaching and learning. Surgical teachers should set specific learning objectives for different learner levels, since junior and senior residents have different learning preferences even though both scrub in the same case. Effective communication between teachers and learners has the potential to improve learning experience and create a positive environment in the operating room.
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Affiliation(s)
- Yu-Tang Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peih-Ying Lu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Humanities and Social Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Sheng Lai
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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James HK, Gregory RJH, Tennent D, Pattison GTR, Fisher JD, Griffin DR. Current provision of simulation in the UK and Republic of Ireland trauma and orthopaedic specialist training: a national survey. Bone Jt Open 2020; 1:103-114. [PMID: 33225283 PMCID: PMC7677730 DOI: 10.1302/2633-1462.15.bjo-2020-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aims The primary aim of the survey was to map the current provision of simulation training within UK and Republic of Ireland (RoI) trauma and orthopaedic (T&O) specialist training programmes to inform future design of a simulation based-curriculum. The secondary aims were to characterize; the types of simulation offered to trainees by stage of training, the sources of funding for simulation, the barriers to providing simulation in training, and to measure current research activity assessing the educational impact of simulation. Methods The development of the survey was a collaborative effort between the authors and the British Orthopaedic Association Simulation Group. The survey items were embedded in the Performance and Opportunity Dashboard, which annually audits quality in training across several domains on behalf of the Speciality Advisory Committee (SAC). The survey was sent via email to the 30 training programme directors in March 2019. Data were retrieved and analyzed at the Warwick Clinical Trials Unit, UK. Results Overall, 28 of 30 programme directors completed the survey (93%). 82% of programmes had access to high-fidelity simulation facilities such as cadaveric laboratories. More than half (54%) had access to a non-technical skills simulation training. Less than half (43%) received centralized funding for simulation, a third relied on local funding such as the departmental budget, and there was a heavy reliance on industry sponsorship to partly or wholly fund simulation training (64%). Provision was higher in the mid-stages (ST3-5) compared to late-stages (ST6-8) of training, and was formally timetabled in 68% of prostgrammes. There was no assessment of the impact of simulation training using objective behavioural measures or real-world clinical outcomes. Conclusion There is currently widespread, but variable, provision of simulation in T&O training in the UK and RoI, which is likely to expand further with the new curriculum. It is important that research activity into the impact of simulation training continues, to develop an evidence base to support investment in facilities and provision.
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Affiliation(s)
- Hannah K James
- Clinical Trials Unit, Warwick Medical School, Coventry, UK.,Department of Trauma & Orthopedic Surgery, University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Robert J H Gregory
- Department of Trauma & Orthopaedic Surgery, University Hospital of North Durham, Durham, UK
| | - Duncan Tennent
- Department of Orthopaedics, St. George's NHS Trust, London, UK
| | - Giles T R Pattison
- Department of Trauma & Orthopedic Surgery, University Hospitals Coventry & Warwickshire, Coventry, UK
| | | | - Damian R Griffin
- Clinical Trials Unit, Warwick Medical School, Coventry, UK.,Department of Trauma & Orthopedic Surgery, University Hospitals Coventry & Warwickshire, Coventry, UK
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