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Botelho F, Gerk A, Harley JM, Poenaru D. Improving Pediatric Trauma Education by Teaching Non-technical Skills: A Randomized Controlled Trial. J Pediatr Surg 2024; 59:874-888. [PMID: 38369400 DOI: 10.1016/j.jpedsurg.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pediatric trauma is a significant cause of child mortality, and the absence of non-technical skills (NTS) among health providers is linked with errors in patients' care. In this study, we evaluate the effectiveness of a structured debriefing protocol in enhancing NTS during pediatric trauma simulation. METHODS A total of 45 medical students were successfully recruited from two medical schools, one in Brazil and one in Canada. Medical students were assigned to a control (N = 20) or intervention group (N = 25) in a randomized control trial. Following simulated scenarios, participants in the intervention group underwent NTS debriefing, while the control received standard debriefing based on the Advanced Trauma Life Support (ATLS) protocol. Students' confidence, NTS level, and performance were measured through self-assessment surveys, the Non-Technical Skills for Surgeons (NOTSS) score, and adherence to the trauma protocol, respectively. Baseline characteristics and outcomes were compared using t-tests, Mann-Whitney, Wilcoxon signed-rank Kruskal-Wallis, ANOVA, and a repeated-measures ANCOVA. A significance level was set at p < 0.05. RESULTS The workshop increased students' confidence in leading trauma resuscitation regardless of their assignment to condition. While controlling for covariates, students in the intervention group significantly improved their overall NOTSS compared to those in the control and in all categories: situational awareness, decision-making, communication and teamwork, and leadership. The intervention teams also demonstrated a significant increase in completing trauma protocol steps. CONCLUSION Implementing structured debriefing focusing on NTS enhanced these skills and improved adherence to protocol among medical students managing pediatric trauma-simulated scenarios. These findings support integrating NTS training in pediatric trauma education. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Fabio Botelho
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
| | - Ayla Gerk
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada
| | - Jason M Harley
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Dan Poenaru
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
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Knowlin LT, Laskay NMB, Jules NP, Godzik J, Chang TP, Spurrier RG. Advances in Pediatric Surgery Simulation-Based Training. CHILDREN (BASEL, SWITZERLAND) 2023; 11:34. [PMID: 38255348 PMCID: PMC10813955 DOI: 10.3390/children11010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Pediatric surgery is the diagnostic, operative, and postoperative surgical care of children with congenital and acquired anomalies and diseases. The early history of the specialty followed the classic "see one, do one, teach one" philosophy of training but has since evolved to modern methods including simulation-based training (SBT). Current trainees in pediatric surgery face numerous challenges, such as the decreasing incidence of congenital disease and reduced work hours. SBT consists of several modalities that together assist in the acquisition of technical skills and improve performance in the operating room. SBT has evolved to incorporate simulator models and video gaming technology, in parallel with the development of simulation in other surgical and non-surgical pediatric fields. SBT has advanced to a level of sophistication that means that it can improve the skills of not only pediatric surgery trainees but also practicing attending surgeons. In this review, we will discuss the history of pediatric surgery, simulation in pediatric surgery training, and the potential direction of pediatric surgical simulation training in the future.
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Affiliation(s)
- Laquanda T. Knowlin
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #175, Los Angeles, CA 90027, USA
- Las Madrinas Simulation Research Laboratory, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Nicholas M. B. Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Nehemie P. Jules
- Las Madrinas Simulation Research Laboratory, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Jakub Godzik
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Todd P. Chang
- Las Madrinas Simulation Research Laboratory, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Ryan G. Spurrier
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #175, Los Angeles, CA 90027, USA
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Reppucci M, Prendergast C, Flynn K, Scarbro S, Derderian SC, Diaz-Miron J. Trainee educational curriculum to standardize central venous catheter repair. BMC MEDICAL EDUCATION 2023; 23:978. [PMID: 38115058 PMCID: PMC10731855 DOI: 10.1186/s12909-023-04977-9] [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: 06/22/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Children may require durable central venous catheters (CVCs) for various reasons. CVC-related integrity complications are common and can often be repaired at the bedside to increase lifetime. Variability in repair techniques can lead to complications, including the need for repeat repair and Central Line Associated Blood Stream Infection (CLABSI). METHODS The impact of an educational curriculum to standardize tunneled CVC repairs for trainees on a pediatric surgery service was studied, focusing on comfort level with tunneled CVC repair and to determine the impact on complication rates. Rotating trainees studied a dedicated audiovisual educational curriculum comprised of a video, educational slides, and a practical component from November 2020 through January 2022. Experience and comfort level with tunneled CVC repairs were assessed before and after the rotation. CVCs repaired during the duration of the study were evaluated and compared to the period prior. RESULTS Forty-nine individuals completed the pre- and post-training survey. Respondents (34.7%, n = 17) most commonly reported one year of surgical experience, and (79.6%, n = 39) had never observed or assisted in a repair previously. Following training, respondents felt more comfortable with all aspects of the CVC repair process (p < 0.001). There were no statistically significant differences in re-repair rates or CLABSI rates following the implementation of the curriculum. CONCLUSIONS Tunneled CVC procedural repair variability can be standardized with a dedicated educational curriculum for rotating trainees, which improves knowledge and comfort with such procedures.
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Affiliation(s)
- Marina Reppucci
- Department of General Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Connor Prendergast
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Katherine Flynn
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Sharon Scarbro
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S Christopher Derderian
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Jose Diaz-Miron
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA.
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Shah S, Kapur A, Young A, Boele F, Bekker H, Pompili C. Healthcare professional experiences of making surgical oncology decisions and delivering COVID-19 safe care: a qualitative study. Acta Chir Belg 2023; 123:640-646. [PMID: 36089887 DOI: 10.1080/00015458.2022.2122313] [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: 07/25/2022] [Accepted: 09/04/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic was declared a public health emergency in March 2020. The British National Health Service (NHS) redirected medical attention towards prioritising COVID-19-positive patients in favour of less urgent care affecting cancer service provision. This study aims to explore experiences of healthcare professionals (HCPs) and investigate the impact of COVID-19 on decision-making in surgical oncology. METHODS HCPs with experience in surgical oncology were recruited from January 2021 to June 2021. Qualitative semi-structured telephone interviews were conducted and transcribed verbatim. Interviews were conducted until data saturation. Thematic analysis was used to identify frequently discussed themes. RESULTS A total of 13 participants were interviewed, identifying three main pandemic-related challenges: multi-disciplinary team (MDT) processes - telephone pre-operative assessments impoverished information elicited from in-person examination; service delivery - personal protective equipment (PPE) added complexity to surgical practice and more difficult communication; work routines - increased workload to deliver COVID-safe remote practices and decreased training time. CONCLUSIONS COVID-19 influenced cancer service provision with teams making significant changes to ensure that effective clinical reasoning and surgical standards were maintained. Managing safe COVID-19 surgical care impacted daily-life and work stressors. Post crisis, service delivery is looking to integrate telemedicine within care whilst reducing its impact on workload and in-practice training.
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Affiliation(s)
- Salonee Shah
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Alanah Kapur
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Alastair Young
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK
| | - Florien Boele
- Section of Patient Centred Outcomes Research, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Hilary Bekker
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cecilia Pompili
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Zahradniková P, Babala J, Pechanová R, Smrek M, Vitovič P, Laurovičová M, Bernát T, Nedomová B. Inanimate 3D printed model for thoracoscopic repair of esophageal atresia with tracheoesophageal fistula. Front Pediatr 2023; 11:1286946. [PMID: 38034821 PMCID: PMC10682092 DOI: 10.3389/fped.2023.1286946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background Thoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) poses significant technical challenges. This study aimed to develop an inexpensive, reusable, high-fidelity synthetic tissue model for simulating EA/TEF repairs and to assess the validity of the simulator. Methods By using 3D printing and silicone casting, we designed an inexpensive and reusable inanimate model for training in thoracoscopic EA/TEF repair. The objective was to validate the model using a 5-point Likert scale and the Objective Structured Assessment of Technical Skills (OSATS) to evaluate participants' surgical proficiency. Results A total of 18 participants (7 medical students, 4 pediatric surgery trainees, and 7 experienced surgeons), after being instructed and trained, were asked to perform TEF ligation, dissection, as well as esophageal anastomosis using six sliding knots on the EA/TEF simulator. All participants in the expert group completed the task within the 120-minute time limit, however only 4 (57%) participants from the novice/intermediate completed the task within the time limit. There was a statistically significant difference in OSATS scores for the "flow of task" (p = 0.018) and scores for the "overall MIS skills" (p = 0.010) task distinguishing between novice and intermediates and experts. The simulator demonstrated strong suitability as a training tool, indicated by a mean score of 4.66. The mean scores for the model's realism and the working environment were 4.25 and 4.5, respectively. Overall, the face validity was scored significantly lower in the expert group compared to the novice/intermediate groups (p = 0.0002). Conclusions Our study established good face and content validity of the simulator. Due to its reusability, and suitability for individual participants, our model holds promise as a training tool for thoracoscopic procedures among surgeons. However, novices and trainees struggled with advanced minimally invasive surgical procedures. Therefore, a structured and focused training curriculum in pediatric MIS is needed for optimal utilization of the available training hours.
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Affiliation(s)
- Petra Zahradniková
- Department of Pediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Jozef Babala
- Department of Pediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Rebeka Pechanová
- Department of Pediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Martin Smrek
- Department of Pediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Pavol Vitovič
- Faculty of Medicine, Institute of Medical Education and Simulations, Comenius University, Bratislava, Slovakia
| | - Miroslava Laurovičová
- Faculty of Medicine, Institute of Medical Education and Simulations, Comenius University, Bratislava, Slovakia
| | - Tomáš Bernát
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Barbora Nedomová
- Department of Paediatric Anaesthesiology and Intensive Medicine, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
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Jhala T, Rentea RM, Aichner J, Szavay P. Surgical Simulation of Posterior Sagittal Anorectoplasty for Rectovestibular Fistula: Low-Cost High-Fidelity Animal-Tissue Model. J Pediatr Surg 2023; 58:1916-1920. [PMID: 36935227 DOI: 10.1016/j.jpedsurg.2023.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To provide a high-fidelity, animal tissue-based model for the advanced surgical simulation of a Posterior Sagittal Anorectoplasty (PSARP) for rectovestibular fistula in anorectal malformation (ARM). MATERIALS AND METHODS A chicken cadaver was used to assess the feasibility of simulating a PSARP for rectovestibular fistula in ARM. No modification was required to implement the surgical simulation. RESULTS A detailed description of the high-fidelity surgical simulation model is provided. The PSARP can be simulated while providing realistic anatomy (e.g. common wall between rectovestibular fistula and vagina), adequate rectal size, location and placement of the rectovestibular fistula, and proximity to the vagina. Haptic conditions of the tissue resemble human tissue and operative conditions as well. DISCUSSION Concerning the decreased exposure of index cases of pediatric surgical trainees and pediatric surgeons in practice, simulation-based training can provide means to acquire or maintain the necessary skills to perform complex surgical procedures [1-5] Surgical simulation models for ARM are limited. Few low-cost trainers are available with predominant artificial and mostly unrealistic tissue [6-8] Animal models have the advantage of realistic multilayer tissue haptic feedback [6]. CONCLUSION We provide a low-cost, high-fidelity model for correcting a rectovestibular fistula in a child with ARM, a complex operative procedure with low incidence but high-stake outcomes. The described tissue model utilizing the chicken cloaca anatomy provides a high-fidelity model for operative correction of rectovestibular ARM. For simulation purposes in the treatment of ARM, this model appears to be promising in terms of providing realistic pathology and haptic feedback in pediatric dimensions. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Tobias Jhala
- Department of Pediatric Surgery, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland.
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Jonathan Aichner
- Department of Pediatric Surgery, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland
| | - Philipp Szavay
- Department of Pediatric Surgery, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland
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Evans MA, Namburi N, Allison HR, Saleem K, Lee LS. Nontechnical Skills for Surgeons as a Framework to Evaluate Cardiopulmonary Bypass Management Skills of Resident Trainees. JOURNAL OF SURGICAL EDUCATION 2023; 80:965-970. [PMID: 37198079 DOI: 10.1016/j.jsurg.2023.04.011] [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: 02/03/2023] [Accepted: 04/14/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Nontechnical skills are critical in cardiac surgery but currently there is no formal paradigm to teach these in residency training. We investigated the use of the Nontechnical skills for surgeons (NOTSS) system as a framework to assess and teach nontechnical skills related to cardiopulmonary bypass (CPB) management. METHODS Single-center retrospective analysis of Integrated and Independent pathway thoracic surgery residents who participated in dedicated nontechnical skills evaluation and training. Two CPB management simulation scenarios were utilized. All residents received a lecture on CPB fundamentals and then individually participated in the first simulation ("Pre-NOTSS"). Immediately following this, nontechnical skills were rated by self-assessment and by a NOTSS trainer. All residents then underwent group NOTSS training followed by the second individual simulation ("Post-NOTSS"). Nontechnical skills were rated as before. NOTSS categories assessed included Situation Awareness, Decision Making, Communication and Teamwork, and Leadership. RESULTS Nine residents were divided into 2 groups: Junior (n = 4, PGY1-4) and Senior (n = 5, PGY5-8). Pre-NOTSS resident self-ratings were higher for Senior than Junior in the categories of Decision Making, Communication and Teamwork, and Leadership while trainer ratings were similar between the groups. Post-NOTSS, resident self-ratings were higher for Senior than Junior in Situation Awareness and Decision Making while trainer scores were higher for both groups in Communication and Teamwork and Leadership. CONCLUSIONS The NOTSS framework in conjunction with simulation scenarios provides a practical framework to evaluate and teach nontechnical skills related to CPB management. NOTSS training can lead to improvements in both subjective and objective ratings of nontechnical skills for all PGY levels.
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Affiliation(s)
- Megan A Evans
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Niharika Namburi
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Hannah R Allison
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kashif Saleem
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lawrence S Lee
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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Yokoyama S, Kurashima Y, Ieiri S, Yamataka A, Okuyama H, Uchida H, Ishimaru T, Hirano S. Comprehension of fundamental knowledge about pediatric endoscopic surgery: a cross-sectional study in Japan. Surg Endosc 2023:10.1007/s00464-023-09975-y. [PMID: 36947222 DOI: 10.1007/s00464-023-09975-y] [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: 08/10/2022] [Accepted: 02/21/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Pediatric endoscopic surgery has become an alternative to conventional techniques with the development of medical equipment. However, there is no formal, standardized curriculum for pediatric endoscopic surgery, and its requirement remains elusive. The purpose of this study is to determine the baseline knowledge of pediatric surgeons that is considered essential for pediatric laparoscopic and thoracoscopic surgery. METHODS Sixteen web-based multiple-choice questions based on the fundamental cognitive knowledge of pediatric endoscopic surgery were administered. The questions were created based on the fields covered by the Fundamentals of Laparoscopic Surgery ™ (FLS) certification examination blueprints and eight specific diseases of pediatric surgery. Pediatric surgeons and pediatric surgical trainees participated in this study voluntarily. RESULTS A total of 122 surgeons participated through the Japanese Society of Pediatric Surgeons. The response rate was 95% (122/128). The total mean examination score of all participants was 79.4% (77.3-81.4%). There were no significant differences in total scores between the board-certified pediatric surgeons without an endoscopic surgical skill qualification and the non-board-certified pediatric surgeons (80.4% vs. 77.1%, p = 0.12). The endoscopic surgical skill-qualified surgeons had significantly higher percentages of correct responses in specific subjects than board-certified pediatric surgeons and surgeons without pediatric board certification (94.3% vs. 82.9%, p = 0.02; 94.3% vs. 77.5%, p = 0.0002). The FLS original subjects' scores were not significantly different among them. The mean score of surgeons who had experienced more than 200 cases of endoscopic surgery, including adult cases, was 83.2% (80.4-85.9%). CONCLUSIONS A knowledge gap exists between surgeons, board-certified pediatric surgeons, and endoscopic surgical skill-qualified surgeons in Japan. In the field of pediatric surgery, an effective formal curriculum, such as FLS, is required to help address this vast knowledge gap for the safe conduct of endoscopic surgeries.
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Affiliation(s)
- Shinichiro Yokoyama
- Faculty of Medicine, Department of Gastroenterological Surgery II, Hokkaido University, Kita 15, Nishi 7, Kita-Ku, Sapporo, 060-8638, Japan
- Department of Pediatric Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Yo Kurashima
- Faculty of Medicine, Department of Gastroenterological Surgery II, Hokkaido University, Kita 15, Nishi 7, Kita-Ku, Sapporo, 060-8638, Japan.
- Clinical Simulation Center, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Ishimaru
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Satoshi Hirano
- Faculty of Medicine, Department of Gastroenterological Surgery II, Hokkaido University, Kita 15, Nishi 7, Kita-Ku, Sapporo, 060-8638, Japan
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Correa Restrepo J, Romero Espitía W, Chams Anturi A, Mejía Bueno AM. Development and Validation of a Laparoscopy Simulation Model of Pyeloplasty for Pediatric Patients. J Laparoendosc Adv Surg Tech A 2023; 33:101-109. [PMID: 36318790 DOI: 10.1089/lap.2021.0852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: Given the extensive training required for laparoscopic pyeloplasty and the difficulties achieving this training, there is a need to recreate the activity in a controlled environment, but high-fidelity models are unavailable or expensive. Our objective was to develop a model of pyeloureteral junction stenosis, resembling the anatomical details and consistency of natural tissue, for a replicable, cheaper, and realistic simulation model of laparoscopic pyeloplasty in children. Materials and Methods: A three-dimensional, printed synthetic model was created from magnetic resonance urography. The model comprises a plastic kidney as the reusable structure and a silicone renal pelvis and ureter as the interchangeable structure. We evaluated realism and performance with surgeons and residents at different levels of training, comparing operative time and complications of the procedure. Results: Twenty-four participants were recruited; 41.7% had previous experience in laparoscopic pyeloplasty, with 5.5 years of experience in laparoscopic surgery (interquartile range [IQR] 2-7.75). There were no cases of stenosis, but leaks accounted for 41.7%. The procedure lasted 72 minutes (IQR 55-90), with significant differences according to the level of training (85 minutes for residents, 68 minutes for pediatric surgeons and urologists, and 40 minutes for laparoscopic surgeons; P: .011) and years of previous experience in laparoscopic surgery (P: .003). Conclusions: A high-fidelity, replicable, and low-cost pyeloureteral stenosis model was developed to simulate laparoscopic pyeloplasty in pediatric patients.
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Affiliation(s)
| | - Walter Romero Espitía
- Department of Pediatric Surgery, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Abraham Chams Anturi
- Departments of Pediatric Surgery, University of Antioquia, Medellín, Colombia.,Department of Pediatric Surgery, Hospital Universitario San Vicente Fundación, Medellín, Colombia
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Joosten M, de Blaauw I, Botden SM. Validated simulation models in pediatric surgery: A review. J Pediatr Surg 2022; 57:876-886. [PMID: 35871858 DOI: 10.1016/j.jpedsurg.2022.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This review evaluates the validation and availability of simulation models in the field of pediatric surgery that can be used for training purposes. METHODS MEDLINE and EMBASE were searched for studies describing a simulation models in pediatric surgery. Articles were included if face, content and/or construct validity was described. Additionally, the costs and availability were assessed. Validation scores for each model were depicted as percentage (0-100), based on the reported data, to compare the outcomes. A score of >70% was considered adequate. RESULTS Forty-three studies were identified, describing the validation process of 38 simulation models. Face validity was evaluated in 33 articles, content in 36 and construct in 19. Twenty-two models received adequate validation scores (>70%). The majority (27/38, 70%) was strictly inanimate. Five models were available for purchase and eleven models were replicable based on the article. CONCLUSION The number of validated inanimate simulation models for pediatric surgery procedures is growing, however, few are replicable or available for widespread training purposes. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Maja Joosten
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Geert Grooteplein Zuid 10 Route 618, Nijmegen 6500HB, the Netherlands.
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Geert Grooteplein Zuid 10 Route 618, Nijmegen 6500HB, the Netherlands
| | - Sanne Mbi Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Geert Grooteplein Zuid 10 Route 618, Nijmegen 6500HB, the Netherlands
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Ljuhar D, Nayahangan LJ, Nataraja R, Nestel D. A Bi-national needs assessment to identify and prioritise procedures in paediatric surgery for simulation-based training. J Pediatr Surg 2022:S0022-3468(22)00657-1. [PMID: 36336540 DOI: 10.1016/j.jpedsurg.2022.10.001] [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: 07/10/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Simulation-based education (SBE) has led to significant changes in healthcare education. However, SBE has often been based on available resources and local expertise rather than a systematic approach to curriculum development. The aim of this study was to perform a bi-national needs assessment to identify and prioritise procedures in a paediatric surgery curriculum that can be supported using SBE. METHOD A modified 3-round Delphi technique was used to gather consensus from education leaders and trainees in paediatric surgery in Australia and Aotearoa New Zealand (ANZ). Round 1 identified all procedures a newly specialised paediatric surgeon should be able to perform. In Round 2, each procedure was explored for the need for SBE using the Copenhagen Academy for Medical Education and Simulation (CAMES) Needs-Assessment Formula (NAF). This pre-prioritised list from Round 2 was sent back to participants for final exclusion and ranking in Round 3. Results 88 participants were identified and invited. From 174 procedures identified in Round 1, 71 procedures were grouped and categorised for Round 2 using the CAMES NAF. In Round 3, 17 procedures were eliminated resulting in 54 procedures. Appendicectomy, inguinal herniotomy, and central venous access were the highest rank procedures after prioritisation in Round 3. There was a strong correlation (r = 0.99) between the NAF score and the prioritised ranking, as well as between consultants and trainees (r = 0.92 in Round 2 and 0.98 in Round 3). CONCLUSION The prioritised list represents a consensus document decided upon by education leaders and stakeholders in paediatric surgery. These procedures should be an integral part of the SBE of paediatric surgeons in the region. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Damir Ljuhar
- Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, Copenhagen, Denmark
| | - Ram Nataraja
- Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Debra Nestel
- Department of Surgery (Austin), The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
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12
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Percutaneous peritoneal drain placement: A pilot study of pediatric surgery simulation-based training for general surgery residents. J Pediatr Surg 2022; 57:509-512. [PMID: 33714453 DOI: 10.1016/j.jpedsurg.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION General surgery residents often feel unprepared to perform pediatric surgery procedures since case volume and experience may be low. Previously, we successfully implemented a simulation-based training (SBT) module for placement of a silastic silo for gastroschisis. Therefore, we designed a single institution pilot study to assess whether SBT for placement of a percutaneous peritoneal drain for perforated necrotizing enterocolitis (NEC) was feasible and lead to skill acquisition and increased confidence. METHODS Our newly created NEC module within our pediatric surgery SBT curriculum for general surgery residents was used. Residents completed two simulation sessions three months apart with confidence testing before and after each session. Skill acquisition and performance were assessed using a standardized case scenario and procedure checklist. Changes in residents' confidence and performance were determined using Wilcoxon Signed-Rank Tests. RESULTS Nine post-graduate-year three general surgery residents completed this curriculum. Following completion, residents reported improved confidence completing each step of the procedure initially (p = 0.005) and at 3 months (p = 0.008) with improved technical scores (p = 0.011). The number of residents deemed proficient significantly improved (p = 0.031). CONCLUSION Implementation of SBT module for perforated NEC was feasible and improved residents' confidence and proficiency completing the procedure.
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13
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Chebib E, Lemarteleur V, Azalé M, Deneufbourg L, Ceccaldi PF, Teissier N. Step-by-step development and evaluation of a 3D printed home-made low-cost pediatric tracheobronchial tree for foreign body aspiration extractions. Int J Pediatr Otorhinolaryngol 2022; 153:111040. [PMID: 35026720 DOI: 10.1016/j.ijporl.2022.111040] [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: 09/08/2021] [Revised: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The management of foreign body aspirations (FBA) is dreaded by pediatric physicians due to the high risk of respiratory distress and a potential fatal outcome, favored by a lack of experience of young specialists. Furthermore, there has been an increasing requirement for low-cost simulation. The aim was to describe the step-by-step manufacturing process and to validate a low-cost, easily home-made training model of pediatric tracheo-bronchial tree (pTBT) for simulation-based training in order to teach young physicians to practice foreign body (FBA) extractions. METHODS A simulator was designed in order to reproduce the physical and esthetic properties of a pTBT. The production cost of a single simulator was estimated. The simulator was then tested by experienced physicians using a rigid bronchoscope. A manufacturing manual of the simulator is hereby presented. A group of 7 experienced pediatric otolaryngologists performed a FBA extraction in the conditions of installation of an operating room. RESULTS The result of the survey showed a high fidelity of the simulator in mimicking the biological esthetics and physical properties of a pTBT during a FBA extraction (mean 4.3 ± 0.8). The total cost of the custom-made simulator is about 20.5 € ($23.4) for the production of the first simulator. CONCLUSIONS A highly realistic and easily reproducible pediatric tracheo-bronchial tree simulator is presented and can therefore be used during simulation-based training.
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Affiliation(s)
- Emilien Chebib
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medecine, University of Paris, Paris, France; Simulation Department of University of Paris, Paris, France.
| | | | - Mehdi Azalé
- Department of Anaesthesia and Intensive Care, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medecine, University of Paris, Paris, France
| | | | | | - Natacha Teissier
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medecine, University of Paris, Paris, France
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14
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Development and validation of a novel 3D-printed simulation model for open oesophageal atresia and tracheo-oesophageal fistula repair. Pediatr Surg Int 2022; 38:133-141. [PMID: 34476537 PMCID: PMC8412403 DOI: 10.1007/s00383-021-05007-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The role of simulation training in paediatric surgery is expanding as more simulation devices are designed and validated. We aimed to conduct a training needs assessment of UK paediatric surgical trainees to prioritise procedures for simulation, and to validate a novel 3D-printed simulation model for oesophageal atresia and tracheo-oesophageal fistula (OA-TOF) repair. METHODS A questionnaire was sent to UK trainee paediatric surgeons surveying the availability and utility of simulation. The operation ranked as most useful to simulate was OA-TOF repair. 3D-printing techniques were used to build an OA-TOF model. Content, face and construct validity was assessed by 40 paediatric surgeons of varying experience. RESULTS Thirty-four paediatric surgeons completed the survey; 79% had access to surgical simulation at least monthly, and 47% had access to paediatric-specific resources. Perceived utility of simulation was 4.1/5. Validation of open OA-TOF repair was conducted by 40 surgeons. Participants rated the model as useful 4.9/5. Anatomical realism was scored 4.2/5 and surgical realism 3.9/5. The model was able to discriminate between experienced and inexperienced surgeons. CONCLUSION UK paediatric surgeons voted OA-TOF repair as the most useful procedure to simulate. In response we have developed and validated an affordable 3D-printed simulation model for open OA-TOF repair.
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Current status of simulation-based training tools in general surgery: A systematic review. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2021.100427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Palmisani F, Sezen P, Haag E, Metzelder ML, Krois W. The "chicken-leg anastomosis": Low-cost tissue-realistic simulation model for esophageal atresia training in pediatric surgery. Front Pediatr 2022; 10:893639. [PMID: 36110113 PMCID: PMC9468334 DOI: 10.3389/fped.2022.893639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Shifting the training from the operating room (OR) to simulation models has been proven effective in enhancing patient safety and reducing the learning time to achieve competency and increase the operative efficiency. Currently the field of pediatric surgery only offers few low-cost trainers for specialized training and these feature predominantly artificial and often unrealistic tissue. The aim of this study was to develop an easy access low-cost tissue-realistic simulation model for open training of esophageal atresia and to evaluate the acceptance in trainees and junior pediatric surgeons. MATERIALS AND METHODS The model is fashioned using reconfigured chicken skin from a chicken leg. To create a model of esophageal atresia, the chicken skin is dissected off the muscle and reconfigured around a foley catheter balloon to recreate the proximal pouch and a feeding tube to recreate the distal pouch. Surrounding structures such as the tracheo-esophageal fistula and the azygos vein can be easily added, obtaining a realistic esophageal atresia (Type C) prototype. Evaluation of model construction, usage and impact on user were performed by both a self-assessment questionnaire with pre- and post-training questions as well as observer-based variables and a revised Objective Structured Assessment of Technical Skills (OSATS) score. RESULTS A total of 10 participants were constructing and using the model at two different timepoints. OSATS score for overall performance was significantly higher (p = 0.005, z = -2.78) during the second observational period [median (MD): 4,95% confidence interval CI: 3.4, 5.1] compared to the first (MD: 3, 95% CI 2.4, 4.1). Self-reported boost in confidence after model usage for performing future esophageal atresia (EA) repair and bowel anastomosis (BA) in general was significantly higher (EA: U = 1, z = -2.3, p = 0.021, BA: U = 1, z = -2.41, p = 0.016) in participants with more years in training/attending status (EA MD:5, BA MD: 5.5) compared to less experienced participants (EA MD: 1.5, BA: 1). CONCLUSION Our easy access low-cost simulation model represents a feasible and tissue realistic training option to increase surgical performance of pediatric surgical trainees outside the OR.
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Affiliation(s)
- Francesca Palmisani
- Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
| | - Patrick Sezen
- Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Haag
- Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin L Metzelder
- Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
| | - Wilfried Krois
- Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
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Wagner M, Werther T, Unger E, Kasprian G, Dovjak G, Dorfer C, Schned H, Steinbauer P, Goeral K, Olischar M, Roessler K, Berger A, Oberoi G. Development of a 3D printed patient-specific neonatal brain simulation model using multimodality imaging for perioperative management. Pediatr Res 2022; 91:64-69. [PMID: 33654283 DOI: 10.1038/s41390-021-01421-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/01/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Medical-imaging-based three-dimensional (3D) printed models enable improvement in skills training, surgical planning, and decision-making. This pilot study aimed to use multimodality imaging and to add and compare 3D ultrasound as a future standard to develop realistic neonatal brain models including the ventricular system. METHODS Retrospective computed tomography (CT), magnetic resonance imaging (MRI), and 3D ultrasound-based brain imaging protocols of five neonatal patients were analyzed and subsequently segmented with the aim of developing a multimodality imaging-based 3D printed model. The ventricular anatomy was analyzed to compare the MRI and 3D ultrasound modalities. RESULTS A realistic anatomical model of the neonatal brain, including the ventricular system, was created using MRI and 3D ultrasound data from one patient. T2-weighted isovoxel 3D MRI sequences were found to have better resolution and accuracy than 2D sequences. The surface area, anatomy, and volume of the lateral ventricles derived from both MRI and 3D ultrasound were comparable. CONCLUSIONS We created an ultrasound- and MRI-based 3D printed patient-specific neonatal brain simulation model that can be used for perioperative management. To introduce 3D ultrasound as a standard for 3D models, additional dimensional correlations between MRI and ultrasound need to be examined. IMPACT We studied the feasibility of implementing 3D ultrasound as a standard for 3D printed models of the neonatal brain. Different imaging modalities were compared and both 3D isotropic MRI and 3D ultrasound imaging are feasible for printing neonatal brain models with good dimensional accuracy and anatomical replication. Further dimensional correlations need to be defined to implement it as a standard to produce 3D printed models.
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Affiliation(s)
- Michael Wagner
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Tobias Werther
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gregor Dovjak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Hannah Schned
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Steinbauer
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katharina Goeral
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care Medicine and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Gunpreet Oberoi
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Nair D, Wells JM, Cook N, Yi M, Scott V, Beasley SW. Construct validation of a 3D printed neonatal thoracoscopic simulator: Can it measure expertise? J Pediatr Surg 2021; 56:1962-1965. [PMID: 33962761 DOI: 10.1016/j.jpedsurg.2021.03.054] [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: 10/14/2020] [Revised: 03/21/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND acquiring technical expertise for neonatal thoracoscopy is challenging. To address this, we designed a fully synthetic thoracoscopic simulator for which we established its construct validity. METHODS three thoracoscopic tasks were assessed: ring transfer, needle pass and incision of a blind upper esophageal pouch (EA cut). Participants watched instructional videos with accompanying written instructions for each task before having their attempt video recorded. All tasks were marked by three blinded pediatric surgeons using a modified Objective Structured Assessment of Technical Skills (OSATS). Scores were assessed using appropriate statistical analysis and inter-rater reliability was analyzed by interclass correlation coefficient (ICC). RESULTS 23 participants completed the ring transfer and needle pass and 21 the EA cut: 5 experts (consultant surgeons), 5 intermediate (registrars on a training program) and 13 novices (medical students, house surgeons or non-training registrars). All three tasks distinguished between novice and intermediate/expert (ring transfer p = 0.00001, needle pass p = 0.0004 and EA cut p = 0.0014, respectively). Interrater reliability was good for ring transfer and needle pass but poor for EA cut. CONCLUSION the tasks distinguished between novice and intermediate/expert but not between expert and intermediate. In needle pass and EA cut, there was a trend for the experts to score higher than intermediate participants. Ring transfer and needle pass tasks achieved construct validity, had good interrater reliability and were found to be useful in assessing a novice surgeon's progression towards the intermediate level. Distinguishing between intermediate and expert may require assessment of more complex tasks such as intracorporeal suturing and tying. LEVEL OF EVIDENCE II.
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Affiliation(s)
- David Nair
- Canterbury District Health Board, New Zealand.
| | - Jonathan M Wells
- Canterbury District Health Board, New Zealand; University of Otago, 2 Riccarton Ave, Christchurch Central, Christchurch 8011, New Zealand
| | - Nick Cook
- Canterbury District Health Board, New Zealand
| | - Ma Yi
- Canterbury District Health Board, New Zealand
| | | | - Spencer W Beasley
- Canterbury District Health Board, New Zealand; University of Otago, 2 Riccarton Ave, Christchurch Central, Christchurch 8011, New Zealand
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Silo placement in gastroschisis: A pilot study of simulation-based training for general surgery residents. J Pediatr Surg 2021; 56:1728-1731. [PMID: 33139027 DOI: 10.1016/j.jpedsurg.2020.09.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION General surgery residents often feel unprepared for rotations on pediatric surgical services as case volume and experience performing pediatric procedures may be inadequate for high acuity, low volume procedures. We designed a single institution pilot study to assess whether simulation-based training (SBT) for placement of a silastic silo for gastroschisis was feasible and lead to skill acquisition, retention and increased resident confidence. METHODS We used our newly created gastroschisis module within our pediatric surgery SBT curriculum for general surgery residents. Residents completed two simulation sessions three months apart, completed confidence testing before and after each session, and were assessed using a standardized case scenario and procedure checklist. Wilcoxon Signed-Rank Tests evaluated changes in residents' confidence and performance. RESULTS Ten post-graduate-year three general surgery residents completed this curriculum. Residents reported improved confidence completing each step of the procedure initially (p=0.008) and at 3 months (p=0.005). They had improved technical scores across all steps of the procedure (p=0.005). The number of residents deemed proficient significantly improved (p=0.008). CONCLUSION We demonstrated the feasibility of assessing the technical skills of general surgery residents performing a simulated placement of a silastic silo for gastroschisis. Residents' confidence and proficiency improved over the three-month period. STUDY TYPE Prospective LEVEL OF EVIDENCE: Level II.
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Parente G, De Marziani L, Cordola C, Gargano T, Libri M, Lima M. Training minimally invasive surgery's basic skills: is expensive always better? Pediatr Surg Int 2021; 37:1287-1293. [PMID: 34110478 DOI: 10.1007/s00383-021-04937-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Not all hospitals have a MIS training facility because often training is not a main corporate objective and could require lots of money. We tried to build a laparoscopic simulator that was effective and that would allow to carry out an adequate laparoscopic training similar to that obtained with the models normally used in MIS training programs. To construct a box trainer that would achieve the equivalent results than those usually used. A validation study was carried out by evaluating the content validity and construct validity of our simulator in addition a comparison study of our homemade trainer vs Karl Storz box trainer was performed. MATERIAL AND METHODS The HM laparoscopic trainer was assembled using a wood frame. Two LED lights were positioned on the inside roof of the trainer and a webcam was positioned through a special support as operative optic. The webcam was then connected to a PC and the latter was used as a monitor for the operator. Participants were 20 students and a group of 6 surgeons. Students were prospectively randomized to perform 4 of the 5 tasks of the fundamental laparoscopic surgery (FLS) program on both the HM trainer and the KS trainer (pegboard transfer, pattern cut, placement of ligating loop and intracorporeal knot suture). Simple paired t test was performed to compare times between the trainers. Then students performed two more sets of exercises on the HM. The group of surgeons performed three sets of the same exercises performed by the students on the HM. The time taken by surgeons and students to complete the exercises was compared using t test. At the end, all the participants carried out a questionnaire to evaluate their experience with the HM box trainer. For the questionnaire it was chosen to use a Linkert 1-5 scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree). RESULTS HM vs KS BT: Comparing time to complete the 4 tasks performed by students on both the BT, for the first task the p value was 0.30, for the second task 0.48, for the third task 0.80, for the fourth task 0.93, and for the total time 0.86. The comparison between the mean time of the first set of tasks of the participants who started with the HM BT and one of the participants who started on the KS p value was 1 p = 0.09; task 2 p = 0.32; task 3 p = 0.62; task 4 p = 0.32; total time p = 0.81. The comparison between the meantime of the second set of tasks of the participants who switched to the HM BT with the one of those who switched to the KS BT showed a p value of: p = 0.20 tasks 1 p = 0.53 task 2; p = 0.39 task 3; p = 0.30 task 4; p = 0.56 total time. Construct validity: The mean experts and students time of every single task and the total one showed a p value of: p < 0.01 for task 1; p < 0.01 task 2; p < 0.01 task 3; p < 0.01 task 4; p < 0.01 total time. Content validity: Both experts and students indicated the HM BT as a useful training tool and appreciated its easy use. Both groups would use it at home if it were available. CONCLUSION Valid MIS trainer can be easily built at home with few low-cost materials. Our study shows how training programs can be structured even with few resources in a creative and innovative way.
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Affiliation(s)
- Giovanni Parente
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy. .,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy.
| | - Luca De Marziani
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Chiara Cordola
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Michele Libri
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
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Etlinger P, Barroso C, Miranda A, Moreira Pinto J, Lamas-Pinheiro R, Ferreira H, Leão P, Kovács T, Juhász L, Sasi Szabó L, Farkas A, Vajda P, Kálmán A, Géczi T, Simonka Z, Cserni T, Nógrády M, Fodor GH, Szabó A, Correia-Pinto J. Characterization of technical skill progress in a standardized rabbit model for training in laparoscopic duodenal atresia repair. Surg Endosc 2021; 36:2456-2465. [PMID: 33999254 PMCID: PMC8921057 DOI: 10.1007/s00464-021-08530-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laboratory skills training is an essential step before conducting minimally invasive surgery in clinical practice. Our main aim was to develop an animal model for training in clinically highly challenging laparoscopic duodenal atresia repair that could be useful in establishing a minimum number of repetitions to indicate safe performance of similar interventions on humans. MATERIALS AND METHODS A rabbit model of laparoscopic duodenum atresia surgery involving a diamond-shaped duodeno-duodenostomy was designed. This approach was tested in two groups of surgeons: in a beginner group without any previous clinical laparoscopic experience (but having undergone previous standardized dry-lab training, n = 8) and in an advanced group comprising pediatric surgery fellows with previous clinical experience of laparoscopy (n = 7). Each participant performed eight interventions. Surgical time, expert assessment using the Global Operative Assessment of Laparoscopic Skills (GOALS) score, anastomosis quality (leakage) and results from participant feedback questionnaires were analyzed. RESULTS Participants in both groups successfully completed all eight surgeries. The surgical time gradually improved in both groups, but it was typically shorter in the advanced group than in the beginner group. The leakage rate was significantly lower in the advanced group in the first two interventions, and it reached its optimal level after five operations in both groups. The GOALS and participant feedback scores showed gradual increases, evident even after the fifth surgery. CONCLUSIONS Our data confirm the feasibility of this advanced pediatric laparoscopic model. Surgical time, anastomosis quality, GOALS score and self-assessment parameters adequately quantify technical improvement among the participants. Anastomosis quality reaches its optimal value after the fifth operation even in novice, but uniformly trained surgeons. A minimum number of wet-lab operations can be determined before surgery can be safely conducted in a clinical setting, where the development of further non-technical skills is also required.
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Affiliation(s)
- Péter Etlinger
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. .,Division of Pediatric Surgery, Department of Pediatrics, University of Szeged, Korányi fasor 14-15, 6720, Szeged, Hungary. .,Institute of Surgical Research, University of Szeged, Szeged, Hungary.
| | - Catarina Barroso
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
| | - Alice Miranda
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - João Moreira Pinto
- Pediatric Surgery, Hospital-Escola da Universidade Fernando Pessoa, Gondomar, Portugal.,EpiUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Ruben Lamas-Pinheiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
| | - Hélder Ferreira
- Minimally Invasive Gynecology Department, Centro Hospitalar Universitario do Porto EPE-Centro Materno Infantil do Norte, Porto, Portugal
| | - Pedro Leão
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tamás Kovács
- Division of Pediatric Surgery, Department of Pediatrics, University of Szeged, Korányi fasor 14-15, 6720, Szeged, Hungary
| | - László Juhász
- Division of Pediatric Surgery, Department of Pediatrics, University of Szeged, Korányi fasor 14-15, 6720, Szeged, Hungary
| | - László Sasi Szabó
- Division of Pediatric Surgery, Department of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - András Farkas
- Division of Pediatric Surgery, Department of Pediatrics, University of Pécs, Pécs, Hungary
| | - Péter Vajda
- Division of Pediatric Surgery, Department of Pediatrics, University of Pécs, Pécs, Hungary
| | - Attila Kálmán
- Division of Pediatric Surgery, Department of Pediatrics No. I, Semmelweis University, Budapest, Hungary
| | - Tibor Géczi
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Zsolt Simonka
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Tamás Cserni
- Institute of Surgical Research, University of Szeged, Szeged, Hungary.,Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - Miklós Nógrády
- Institute of Surgical Research, University of Szeged, Szeged, Hungary.,Department of Gynecology, Kiskunhalas Teaching Hospital, University of Szeged, Szeged, Hungary
| | - Gergely H Fodor
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Andrea Szabó
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
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22
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The challenge of understanding, evaluating and providing feedback on regulation during group learning. SCIENTIA MEDICA 2021. [DOI: 10.15448/1980-6108.2021.1.39294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Learning in groups is commonly used in academic and clinical health professions education (HPE). There is growing recognition that regulation during learning is essential for both the individual learner and group learning. The authors in this article propose a practical approach for understanding, evaluating and providing feedback on regulation during group learning. The approach is informed by previous studies conducted in other areas of education. Three varieties of regulation during group learning are discussed: individual, co-regulation and shared regulation. Each variety of regulation has a focus on three essential activities during group learning: task, social and motivation. Illustrative scenarios are presented to describe how the approach can be practically used in HPE. The specific and additional focus on regulation can enhance current approaches for providing feedback on group learning and the authors discuss recommendations for practical implementation and future research.
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23
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Kim JS, Hernandez RA, Smink DS, Yule S, Jackson NJ, Shemin RJ, Kwon MH. Nontechnical skills training in cardiothoracic surgery: A pilot study. J Thorac Cardiovasc Surg 2021; 163:2155-2162.e4. [PMID: 33676757 DOI: 10.1016/j.jtcvs.2021.01.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The importance of nontechnical skills in surgery is widely recognized. We demonstrate the feasibility of administering and assessing the results of a formal Non-Technical Skills in Surgery (NOTSS) curriculum to cardiothoracic surgery residents. METHODS Eight cardiothoracic surgery residents participated in the NOTSS curriculum. They were assessed on their cognitive (situation awareness, decision-making) and social (communication and teamwork, leadership) skills based on simulated vignettes. The residents underwent pretraining NOTSS assessments followed by self-administered confidence ratings regarding the 4 skills. Subsequently, a formal NOTSS lecture was delivered and additional readings from the NOTSS textbook was assigned. A month later, the residents returned for post-training NOTSS assessments and self-administered confidence ratings. Changes across days (or within-day before vs after curriculum) were assessed using Wilcoxon signed rank test. RESULTS There was a significant improvement in the overall NOTSS assessment score (P = .01) as well as in the individual categories (situation awareness, P = .02; decision-making, P = .02; communication and teamwork, P = .01; leadership, P = .02). There was also an increase in resident self-perception of improvement on the post-training day (P = .01). CONCLUSIONS We have developed a simulation-based NOTSS curriculum in cardiothoracic surgery that can be formally integrated into the current residency education. This pilot study indicates the feasibility of reproducible assessments by course educators and self-assessments by participating residents in nontechnical skills competencies.
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Affiliation(s)
- Juka S Kim
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, Calif
| | | | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Steven Yule
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Mass
| | - Nicholas J Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, Calif
| | - Richard J Shemin
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, Calif
| | - Murray H Kwon
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, Calif.
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24
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Torres A, Inzunza M, Jarry C, Serrano F, Varas J, Zavala A. DEVELOPMENT AND VALIDATION OF A NEW LAPAROSCOPIC ENDOTRAINER FOR NEONATAL SURGERY AND REDUCED SPACES. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2021; 33:e1559. [PMID: 33503119 PMCID: PMC7836074 DOI: 10.1590/0102-672020200004e1559] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric laparoscopy box with sliding tray. Pediatric procedures have the difficulty of being performed in reduced spaces. Training in reduced spaces has proven to be different in complexity compared to adult laparoscopic endotrainers. AIM To develop and validate a new neonatal/reduced-space endotrainer. METHODS The simulator was tested and assessed by users with different skill levels and experience in laparoscopic pediatric surgery through an 8-item questionnaire. Construct validity was determined by evaluating the performance of each subject on nine exercises. RESULTS A 10.5 x 10 x 18 cm acrylic simulator was created, with an internal working surface of 9 x 9 cm. An HD camera was incorporated, with a 0-180° range of movement. All exercises of a Basic Laparoscopic Training Program were adapted on a scale of 1:0.5 to fit in. From 49 participants, 42 (85.71%) answered the survey; 80.5% considered that the simulator reproduces similar conditions to procedures performed in children under one year of age; 61.1% thought that the simulator represents a difficulty identical to procedures performed in newborns; 73.7% considered that the neonatal simulator is more complicated than the adult simulator. Experts showed significantly better performance in all proposed exercises. CONCLUSION The simulator has a high-quality image and design that allows training with basic tasks. The endotrainer permitted to discriminate between these different skill levels and was well evaluated by users with diverse surgical experience.
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Affiliation(s)
- Alberto Torres
- Pediatric Surgery Section, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martín Inzunza
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristián Jarry
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Serrano
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Zavala
- Pediatric Surgery Section, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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25
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MacArthur-Beadle I, Nair DVK, Cook NJ, Yi M, Jones R, Beasley SW, Wells JM. Master and Apprentice or a Slave to Technology? A Randomized Controlled Trial of Minimal Access Surgery Simulation-Based Training Techniques. J Laparoendosc Adv Surg Tech A 2020; 30:1263-1271. [PMID: 33156725 DOI: 10.1089/lap.2020.0637] [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: 11/12/2022] Open
Abstract
Introduction: This study set out to assess the efficacy of three different approaches to simulation-based minimal access surgery (MAS) training using a three-dimensional printed neonatal thoracoscopic simulator and a virtual simulator. Materials and Methods: Randomized controlled trial of medical students (N = 32), as novices to MAS. The participants performed two construct validated tasks on a thoracoscopic simulator and were then randomly allocated into four intervention groups: (1) three consultant-led sessions on a thoracoscopic simulator; (2) three self-directed learning sessions on the same simulator; (3) self-directed "virtual training" on the "SimuSurg" application; and (4) control. Postintervention participants repeated both tasks. Videos of all task attempts were de-identified and marked by a blinded consultant pediatric surgeon. Results: There were no statistically significant differences in baseline objective structured assessment of technical skills (OSATS) scores or demographics in any group. For the "ring transfer" task, Groups 1 and 2 showed significant improvement after intervention, with no significant change in Groups 3 or 4. There was no significant difference between Groups 1 or 2 in postintervention scores. For the "needle pass" task, no group demonstrated a statistically significant improvement after intervention. Conclusion: Practice on a physical simulator either consultant-led or self-directed led to improved scores for MAS novices compared with a virtual simulator or no intervention for a simple "ring transfer" task. This suggests that time on the physical simulator was the most important factor and implies that trainees could usefully practice simple tasks at their convenience rather than require consultant supervision. This improvement is not seen in more challenging tasks such as the "needle pass."
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Affiliation(s)
- Isabella MacArthur-Beadle
- Counties Manukau District Health Board, Auckland, New Zealand
- University of Otago, Christchurch, New Zealand
| | - David V K Nair
- University of Otago, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
- Symulus.net
| | - Nicholas J Cook
- Symulus.net
- Canterbury District Health Board, Department of Medical Physics and Bioengineering, Christchurch, New Zealand
| | - Ma Yi
- Biostatistics, University of Otago, Christchurch, New Zealand
| | | | - Spencer W Beasley
- University of Otago, Christchurch, New Zealand
- Symulus.net
- Canterbury District Health Board, Department of Paediatric Surgery, Christchurch, New Zealand
| | - Jonathan M Wells
- University of Otago, Christchurch, New Zealand
- Symulus.net
- Canterbury District Health Board, Department of Paediatric Surgery, Christchurch, New Zealand
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26
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Skertich NJ, Schimpke SW, Lee T, Wiegmann AL, Pillai S, Rossini C, Madonna MB, Shah AN. Pediatric Surgery Simulation-Based Training for the General Surgery Resident. J Surg Res 2020; 258:339-344. [PMID: 32561030 DOI: 10.1016/j.jss.2020.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Surgical simulation-based training (SBT) can increase resident confidence and improve performance. SBT in pediatric surgery is in its infancy and often geared toward training pediatric surgery fellows. Since case volume for various pediatric surgery-specific procedures can be low based on the rarity of the pathology involved and the level of care provided by the institution, our aim was to create a pediatric surgery simulation-based curriculum for general surgery residents to address this need. MATERIALS AND METHODS We performed an institutional needs assessment consisting of 4 pediatric surgeons' and 28 general surgery residents' confidence in resident ability to independently perform pediatric surgery-specific tasks and procedures using a Likert-scaled survey. These included the placement of a silastic silo for gastroschisis, a percutaneous drain for perforated necrotizing enterocolitis, and completion of a laparoscopic pyloromyotomy for pyloric stenosis. Models simulating these pathologies and curriculum for performing each procedure were generated. RESULTS We successfully created a model and SBT curriculum to teach general surgery residents how to place a silastic silo for patients with gastroschisis, a percutaneous drain for patients with perforated necrotizing enterocolitis, and how to complete a laparoscopic pyloromyotomy for patients with pyloric stenosis. These were deemed high fidelity models based on a survey of our pediatric surgeons. CONCLUSIONS We created a pediatric surgery SBT curriculum for general surgery residents, which can be used to supplement learning of various high-acuity, low-occurrence procedures. Assessment of residents and validation of scores is underway.
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Affiliation(s)
- Nicholas J Skertich
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois; Rush Center For Clinical Skills and Simulation, Rush University Medical Center, Chicago, Illinois.
| | - Scott W Schimpke
- Rush Center For Clinical Skills and Simulation, Rush University Medical Center, Chicago, Illinois; Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Timothy Lee
- Rush Center For Clinical Skills and Simulation, Rush University Medical Center, Chicago, Illinois; Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Aaron L Wiegmann
- Rush Center For Clinical Skills and Simulation, Rush University Medical Center, Chicago, Illinois; Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Srikumar Pillai
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois; Rush Center For Clinical Skills and Simulation, Rush University Medical Center, Chicago, Illinois
| | - Connie Rossini
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois; Rush Center For Clinical Skills and Simulation, Rush University Medical Center, Chicago, Illinois
| | - Mary Beth Madonna
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois; Rush Center For Clinical Skills and Simulation, Rush University Medical Center, Chicago, Illinois
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois; Rush Center For Clinical Skills and Simulation, Rush University Medical Center, Chicago, Illinois
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Aydin A, Ahmed K, Van Hemelrijck M, Ahmed HU, Khan MS, Dasgupta P. Simulation in Urological Training and Education (SIMULATE): Protocol and curriculum development of the first multicentre international randomized controlled trial assessing the transferability of simulation-based surgical training. BJU Int 2020; 126:202-211. [PMID: 32189446 DOI: 10.1111/bju.15056] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To report the study protocol for the first international multicentre randomized controlled trial investigating the effectiveness of simulation-based surgical training and the development process for an evidence-based training curriculum, to be delivered as an educational intervention. PARTICIPANTS AND METHODS This prospective, international, multicentre randomized controlled clinical and educational trial will recruit urology surgical trainees who must not have performed ≥10 of the selected index procedure, ureterorenoscopy (URS). Participants will be randomized to simulation-based training (SBT) or non-simulation-based training (NSBT), the latter of which is the current sole standard of training globally. The primary outcome is the number of procedures required to achieve proficiency, where proficiency is defined as achieving a learning curve plateau of 28 or more on an Objective Structured Assessment of Technical Skills (OSATS) assessment scale, for three consecutive operations, without any complications. All participants will be followed up either until they complete 25 procedures or for 18 months. Development of the URS SBT curriculum took place through a two-round Delphi process. RESULTS A total of 47 respondents, consisting of trainees (n = 24) with URS experience and urolithiasis specialists (n = 23), participated in round 1 of the Delphi process. Specialists (n = 10) finalized the content of the curriculum in round 2. The developed interventional curriculum consists of initial theoretic knowledge through didactic lectures followed by select tasks and cases on the URO-Mentor (Simbionix, Lod, Israel) VR Simulator, Uro-Scopic Trainer (Limbs & Things, Bristol, UK) and Scope Trainer (Mediskills, Manchester, UK) models for both semi-rigid and flexible URS. Respondents also selected relevant non-technical skills scenarios and cadaveric simulation tasks as additional components, with delivery subject to local availability. CONCLUSIONS SIMULATE is the first multicentre trial investigating the effect and transferability of supplementary SBT on operating performance and patient outcomes. An evidence-based training curriculum is presented, developed with expert and trainee input. Participants will be followed and the primary outcome, number of procedures required to proficiency, will be reported alongside key clinical secondary outcomes, (ISCRTN 12260261).
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Affiliation(s)
- Abdullatif Aydin
- MRC Centre for Transplantation, King's College London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, London, UK.,Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Hashim U Ahmed
- Department of Surgery and Cancer, Imperial College London, UK.,Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, King's College London, London, UK.,Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, UK.,Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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28
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Robinson DA, Piekut DT, Hasman L, Knight PA. Cadaveric Simulation Training in Cardiothoracic Surgery: A Systematic Review. ANATOMICAL SCIENCES EDUCATION 2020; 13:413-425. [PMID: 31232510 DOI: 10.1002/ase.1908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 06/09/2023]
Abstract
Simulation training has become increasingly relevant in the educational curriculum of surgical trainees. The types of simulation models used, goals of simulation training, and an objective assessment of its utility and effectiveness are highly variable. The role and effectiveness of cadaveric simulation in cardiothoracic surgical training has not been well established. The objective of this study was to evaluate the current medical literature available on the utility and the effectiveness of cadaveric simulation in cardiothoracic surgical residency training. A literature search was performed using PubMed, Cochrane Library, Embase, Scopus, and CINAHL from inception to February 2019. Of the 362 citations obtained, 23 articles were identified and retrieved for full review, yielding ten eligible articles that were included for analysis. One additional study was identified and included in the analysis. Extraction of data from the selected articles was performed using predetermined data fields, including study design, study participants, simulation task, performance metrics, and costs. Most of these studies were only descriptive of a cadaveric or perfused cadaveric simulation model that could be used to augment clinical operative training in cardiothoracic surgery. There is a paucity of evidence in the literature that specifically evaluates the utility and the efficacy of cadavers in cardiothoracic surgery training. Of the few studies that have been published in the literature, cadaveric simulation does seem to have a role in cardiothoracic surgery training beyond simply learning basic skills. Additional research in this area is needed.
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Affiliation(s)
- Davida A Robinson
- Division of Cardiac Surgery, Department of Surgery, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Diane T Piekut
- Department of Neuroscience, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Linda Hasman
- Division of Research and Clinical Information Services, University of Rochester, Rochester, New York
| | - Peter A Knight
- Division of Cardiac Surgery, Department of Surgery, School of Medicine and Dentistry, University of Rochester, Rochester, New York
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29
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Pacilli M, Clarke SA. Simulation-based education for paediatric surgeons: Does it really improve technical skills? Semin Pediatr Surg 2020; 29:150905. [PMID: 32423599 DOI: 10.1016/j.sempedsurg.2020.150905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In recent years, there has been an increasing interest in employing simulation methodology for teaching surgical skills. Supposedly, skills achieved in the simulation arena, should lead to an improvement of surgical performance in the operating room. In this article we aim to summarise those areas of simulation-based research that relate to paediatric surgery; we present the current evidence behind low-fidelity simulation and computer-based simulation in improving the acquisition of surgical skills.
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Affiliation(s)
- Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, School of Clinical Sciences at Monash Health, Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Simon A Clarke
- Department of Paediatric Surgery, Chelsea Children's Hospital, 369 Fulham Road, London SW10 9AH, United Kingdom; Imperial College, London, United Kingdom.
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30
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Abstract
Traditional surgical training has focused on the acquisition of technical skills and knowledge with minimal focus on teaching nontechnical skills. Patient safety depends on both technical and nontechnical skills, with a higher rate of non-technical skills failure leading to patient harm. Many surgical training and regulatory bodies have incorporated nontechnical skills in the required competencies of a surgeon, but few have introduced formal training in nontechnical skills. Emerging research shows simulation-based education to be a powerful tool to teach nontechnical skills to individual surgeons and surgeons in training, and to interprofessional surgical teams with subsequent improvement of patient safety outcomes.
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Affiliation(s)
- A Lynch
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, 246 Clayton Road Clayton, Melbourne, Australia.
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31
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Patel EA, Aydin A, Cearns M, Dasgupta P, Ahmed K. A Systematic Review of Simulation-Based Training in Neurosurgery, Part 2: Spinal and Pediatric Surgery, Neurointerventional Radiology, and Nontechnical Skills. World Neurosurg 2020; 133:e874-e892. [DOI: 10.1016/j.wneu.2019.08.263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
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Yokoyama S, Mizunuma K, Kurashima Y, Watanabe Y, Mizota T, Poudel S, Kikuchi T, Kawai F, Shichinohe T, Hirano S. Evaluation methods and impact of simulation-based training in pediatric surgery: a systematic review. Pediatr Surg Int 2019; 35:1085-1094. [PMID: 31396735 DOI: 10.1007/s00383-019-04539-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to identify (1) the type of skill evaluation methods and (2) how the effect of training was evaluated in simulation-based training (SBT) in pediatric surgery. METHODS Databases of PubMed, Cochrane Library, and Web of Science were searched for articles published from January 2000 to January 2017. Search concepts of Medical Subject Heading terms were "surgery," "pediatrics," "simulation," and "training, evaluation." RESULTS Of 5858 publications identified, 43 were included. Twenty papers described simulators as assessment tools used to evaluate technical skills. Reviewers differentiated between experts and trainees using a scoring system (45%) and/or a checklist (25%). Simulators as training tools were described in 23 papers. While the training's effectiveness was measured using performance assessment scales (52%) and/or surveys (43%), no study investigated the improvement of the clinical outcomes after SBT. CONCLUSION Scoring, time, and motion analysis methods were used for the evaluation of basic techniques of laparoscopic skills. Only a few SBT in pediatric surgery have definite goals with clinical effect. Future research needs to demonstrate the educational effect of simulators as assessment or training tools on SBT in pediatric surgery.
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Affiliation(s)
- Shinichiro Yokoyama
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenichi Mizunuma
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yo Kurashima
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan. .,Clinical Simulation Center, Hokkaido University, Sapporo, Japan. .,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Yusuke Watanabe
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tomoko Mizota
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Saseem Poudel
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of General Surgery, Steel Memorial Muroran Hospital, Muroran, Japan
| | | | - Fujimi Kawai
- St. Luke's International University Library, Tokyo, Japan
| | - Toshiaki Shichinohe
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Santos DRD, Calvo FC, Feijó DH, Araújo NPD, Teixeira RKC, Yasojima EY. New training model using chickens intestine for pediatric intestinal anastomosis. Acta Cir Bras 2019; 34:e201900709. [PMID: 31531529 PMCID: PMC6756215 DOI: 10.1590/s0102-865020190070000009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/20/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose: To develop a new low-cost, easy-to-make and available training model using chickens’ intestine for infant intestinal anastomosis. Methods: Segments of chicken intestine were used to create an intestinal anastomosis simulator. We tried to perform an end-to-end, end-to-side and side-to-side anastomosis. Handsewn sutured anastomosis were performed in single layered with interrupted prolene 5-0 suture. The parameters analyzed were cost, intestine's diameter and length, anastomosis patency and flow-through and leakage amount. Results: In all cases it was possible to make the anastomosis in double layered without difficulties, different from the usual ones. There was a positive patency at all anastomoses after the end of the procedure, with no need for reinterventions. Conclusion: The new training model using chickens’ intestine for infant intestinal anastomosis is low-cost, easy-to-make and easy available.
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Affiliation(s)
- Deivid Ramos Dos Santos
- Fellow Master degree, Postgraduate Program in Surgery and Experimental Research, Universidade do Estado do Pará (UEPA), Belem-PA, Brazil. Acquisition and interpretation of data; conception, design, intellectual and scientific content of the study; interpretation of data; manuscript writing
| | - Faustino Chaves Calvo
- Graduate student, School of Medicine, UEPA, Belem-PA, Brazil. Acquisition and interpretation of data, manuscript writing
| | - Daniel Haber Feijó
- Fellow Master degree, Postgraduate Program in Surgery and Experimental Research, UEPA, Belem-PA, Brazil. Acquisition and interpretation of data
| | - Nayara Pontes de Araújo
- Graduate student, School of Medicine, UEPA, Belem-PA, Brazil. Acquisition and interpretation of data, manuscript writing
| | - Renan Kleber Costa Teixeira
- MS, Department of Experimental Surgery, School of Medicine, UEPA, Belem-PA, Brazil. Interpretation of data, statistics analysis, critical revision
| | - Edson Yuzur Yasojima
- PhD, Associate Professor, Department of Experimental Surgery, School of Medicine, UEPA, Belem-PA, Brazil. Conception, design, intellectual and scientific content of the study, final revision
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