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Ortiz C, Vela J, Contreras C, Belmar F, Paul I, Zinco A, Ramos JP, Ottolino P, Achurra P, Jarufe N, Alseidi A, Varas J. A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program. Surg Endosc 2022; 36:8441-8450. [PMID: 35237901 PMCID: PMC8890468 DOI: 10.1007/s00464-022-09098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents' exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. METHODS A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 different programs were recruited. Each station was videotaped in high definition and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specific rating scales alongside procedural times. Self-confidence to perform the procedure as the leading surgeon was evaluated before and after training. RESULTS Statistically significant differences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants significantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A significant improvement in self-confidence was shown in all stations. CONCLUSION An OSCE scenario for training surgical skills in trauma was effective in improving proficiency level and self-confidence. Low pre-training scores and level of confidence in the cardiac and lung injury stations represent a deficit in residency programs that should be addressed. The incorporation of simulation-based teaching tools at early stages in residency would be beneficial when future surgeons face extremely severe trauma scenarios.
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Affiliation(s)
- Catalina Ortiz
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Vela
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Caterina Contreras
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Belmar
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ivan Paul
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Analia Zinco
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Juan Pablo Ramos
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Pablo Ottolino
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Jarufe
- Department of Surgery, Clínica Las Condes, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Julian Varas
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Hussein N, Van den Eynde J, Callahan C, Guariento A, Gollmann-Tepeköylü C, Elbatarny M, Loubani M. The use of objective assessments in the evaluation of technical skills in cardiothoracic surgery: a systematic review. Interact Cardiovasc Thorac Surg 2022; 35:6651070. [PMID: 35900153 PMCID: PMC9403301 DOI: 10.1093/icvts/ivac194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES With reductions in training time and intraoperative exposure, there is a need for objective assessments to measure trainee progression. This systematic review focuses on the evaluation of trainee technical skill performance using objective assessments in cardiothoracic surgery and its incorporation into training curricula. METHODS Databases (EBSCOHOST, Scopus and Web of Science) and reference lists of relevant articles for studies that incorporated objective assessment of technical skills of trainees/residents in cardiothoracic surgery were included. Data extraction included task performed; assessment setting and tool used; number/level of assessors; study outcome and whether the assessments were incorporated into training curricula. The methodological rigour of the studies was scored using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS Fifty-four studies were included for quantitative synthesis. Six were randomized-controlled trials. Cardiac surgery was the most common speciality utilizing objective assessment methods with coronary anastomosis the most frequently tested task. Likert-based assessment tools were most commonly used (61%). Eighty-five per cent of studies were simulation-based with the rest being intraoperative. Expert surgeons were primarily used for objective assessments (78%) with 46% using blinding. Thirty (56%) studies explored objective changes in technical performance with 97% demonstrating improvement. The other studies were primarily validating assessment tools. Thirty-nine per cent of studies had established these assessment tools into training curricula. The mean ± standard deviation MERSQI score for all studies was 13.6 ± 1.5 demonstrating high validity. CONCLUSIONS Despite validated technical skill assessment tools being available and demonstrating trainee improvement, their regular adoption into training curricula is lacking. There is a need to incorporate these assessments to increase the efficiency and transparency of training programmes for cardiothoracic surgeons.
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Affiliation(s)
- Nabil Hussein
- Hull-York-Medical-School, University of York, York, UK.,Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | | | - Connor Callahan
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Malak Elbatarny
- Department of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Mahmoud Loubani
- Hull-York-Medical-School, University of York, York, UK.,Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
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Stathakarou N, Sonesson L, Lundberg L, Boffard KD, Kononowicz AA, Karlgren K. Teams managing civilian and military complex trauma: What are the competencies required in austere environments and the potential of simulation technology to address them? Health Informatics J 2021; 27:14604582211052253. [PMID: 34821149 DOI: 10.1177/14604582211052253] [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: 01/04/2023]
Abstract
Surgical training in civilian hospitals may not be sufficient for managing complex trauma in a setting where such care is not commonly practiced. Understanding the challenges that civilian teams face when moving to austere environments can inform the competencies that need to be trained. The aim of this study was to explore the competencies required in austere environments for teams managing complex trauma, and how they can be trained with simulation technologies. Ethnographic field observations were conducted, and field notes were synthesized. The field notes were structured with the elements of Activity Theory to generate the teams' competencies that need to be trained. A literature review was conducted to verify the results and identify examples of relevant simulation modalities. The analysis resulted in a structured list of competencies for civilian teams to manage complex trauma in an austere environment and recommendations which simulation technologies could be used in training of those competencies based on published studies. Our study contributes to understanding the challenges that civilian teams face when operating in an austere environment. A systematized list of competencies with suggested simulation technologies directs future research to improve quality of complex trauma training in civilian and military collaboration.
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Affiliation(s)
- Natalia Stathakarou
- Department of Learning, Infortmatics, Management and Ethics (LIME), 27106Karolinska Institutet, Stockholm, Sweden
| | - Linda Sonesson
- Collaborative Partnerships Office, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Lars Lundberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kenneth D Boffard
- Department of Surgery, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Andrzej A Kononowicz
- Department of Bioinformatics and Telemedicine, 49573Jagiellonian University Medical College, Kraków, Poland
| | - Klas Karlgren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Research, Education and Development and Innovation, Södersjukhuset, Sweden.,Faculty of Health and Social Sciences, Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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