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Tica VI, Tica AA, De Wilde RL. The Future in Standards of Care for Gynecologic Laparoscopic Surgery to Improve Training and Education. J Clin Med 2022; 11:jcm11082192. [PMID: 35456285 PMCID: PMC9028106 DOI: 10.3390/jcm11082192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy is, now, a standard procedure in operative gynecology, standards are embedded in many laparoscopic procedures, standardization of the skills/competency assessment has been progressively developed, and the proof of competency in laparoscopy may become a standard of care. A continuous development of surgical education includes standard equipment (that may bring value for future advance), standardized training, testing (and performance) assessment, educational process and outcome monitoring/evaluation, patients’ care, and protection, etc. Standards of care and training have a reciprocally sustaining relationship, as training is an essential component of standards of care while care is provided at higher standards after a structured training and as credentialing/certification reunites the two. It is envisaged that through development and implementation, the European wide standards of care in laparoscopic surgery (in close harmonization with personalized medicine) would lead to effective delivery of better clinical services and provide excellent training and education.
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Affiliation(s)
- Vlad I. Tica
- Department of Obstetrics and Gynecology, Doctoral School, University “Ovidius”—Constanta, University Emergency County Hospital of Constanta—Bul. Tomis, 140, Academy of Romanian Scientists, 900591 Constanta, Romania;
| | - Andrei A. Tica
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital of Craiova, Str. Tabaci, nb. 1, 200534 Craiova, Romania
- Correspondence:
| | - Rudy L. De Wilde
- Pius Hospital, Carl von Ossietzky University, 26121 Oldenburg, Germany;
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IJgosse WM, van Goor H, Rosman C, Luursema JM. The Fun Factor: Does Serious Gaming Affect the Volume of Voluntary Laparoscopic Skills Training? World J Surg 2020; 45:66-71. [PMID: 32989581 PMCID: PMC7752875 DOI: 10.1007/s00268-020-05800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 01/22/2023]
Abstract
Background The availability of validated laparoscopic simulators has not resulted in sustainable high-volume training. We investigated whether the validated laparoscopic serious game Underground would increase voluntary training by residents. We hypothesized that by removing intrinsic barriers and extrinsic barriers, residents would spend more time on voluntary training with Underground compared to voluntary training with traditional simulators. Methods After 1 year, we compared amount of voluntary time spent on playing Underground to time spent on all other laparoscopic training modalities and to time spent on performing laparoscopic procedures in the OR for all surgical residents. These data were compared to resident’ time spent on laparoscopic activities over the prior year before the introduction of Underground. Results From March 2016 until March 2017, 63 residents spent on average 20 min on voluntary serious gaming, 17 min on voluntary simulator training, 2 h and 44 min on mandatory laparoscopic training courses, and 14 h and 49 min on laparoscopic procedures in the OR. Voluntary activities represented 3% of laparoscopic training activities which was similar in the prior year wherein fifty residents spent on average 33 min on voluntary simulator training, 3 h and 28 min on mandatory laparoscopic training courses, and 11 h and 19 min on laparoscopic procedures. Conclusion Serious gaming has not increased total voluntary training volume. Underground did not mitigate intrinsic and extrinsic barriers to voluntary training. Mandatory, scheduled training courses remain needed. Serious gaming is flexible and affordable and could be an important part of such training courses.
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Affiliation(s)
- Wouter Martijn IJgosse
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Radboud University Medical Center, PO Box 9101 (960), 6500 HB, Nijmegen, The Netherlands.
| | - Harry van Goor
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jan-Maarten Luursema
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Jokinen E, Mikkola TS, Härkki P. Effect of structural training on surgical outcomes of residents' first operative laparoscopy: a randomized controlled trial. Surg Endosc 2019; 33:3688-3695. [PMID: 30656454 PMCID: PMC6795620 DOI: 10.1007/s00464-018-06657-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/24/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gynecological surgery and resident education have changed during recent decades, thus impacting surgical training. Training on simulators must begin before operating on patients. The objective of this study was to evaluate the effect of a simple curriculum on the surgical outcome of the participants' first operative laparoscopy. METHODS This randomized prospective interventional study was carried out in Helsinki University Hospital and Hyvinkää Hospital. We recruited twenty junior residents in Obstetrics and Gynecology, of which half formed a control group and the rest completed the intervention with a theoretical and a practical part. The participants' first laparoscopic salpingectomy was assessed from video recordings by using Objective Structured Assessment of Technical Skills (OSATS) forms and the Numeric Rating Scale (NRS). The surgical outcome and assessed scores were compared between the groups. RESULTS We found no differences in operative time, blood loss, or complications, nor in OSATS or NRS scores. In the intervention group, participants with the weakest performances in the simulator, seemed to benefit from the training program more than the participants with the best performances (skill level elevation 29.2-31.6% vs. 21.1-23.3%, respectively). The participants with the best performances in the simulator were scored among the best in the recorded operations as well. CONCLUSION In this study, we found no difference in the surgical outcome between the groups. However, the participants with low starting levels in the simulator could elevate their skill levels more, though they did not reach the skill level of those with a high starting level. Consequently, we found elevation in skills levels in the simulator tasks, but not in the surgical outcome. Likely, our simple training program with a fixed number of repetitions was insufficient to reach a plateau in the learning curve, and thus the training program in such a curriculum should be proficiency based.
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Affiliation(s)
- Ewa Jokinen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, P.O. Box 100, 00029 HUS, Helsinki, Finland.
- Helsinki University Hospital, P.O. Box 100, 00029 HUS, Helsinki, Finland.
| | - Tomi S Mikkola
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, P.O. Box 100, 00029 HUS, Helsinki, Finland
| | - Päivi Härkki
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, P.O. Box 100, 00029 HUS, Helsinki, Finland
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Training and qualification in gynecological minimal access surgery: A systematic review. Best Pract Res Clin Obstet Gynaecol 2019; 59:2-11. [PMID: 30857979 DOI: 10.1016/j.bpobgyn.2019.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 01/08/2023]
Abstract
Minimally invasive surgery demands specific endoscopic psychomotor skills that are usually acquired outside the operating theatre. We present the results of a systematic analysis to identify how simulation is used during training and qualification in minimal access surgery to improve gynecologist's surgical skills. We found that despite the availability of simulation tools along with methods for training and testing specific endoscopic psychomotor and technical skills, there is no clear evidence of the superiority of one tool or method over the others in skill acquisition. However, prospective studies show that well-guided training courses combined with different trainers and methods improve significantly surgeon's laparoscopic skills and suturing ability, which are unforgettable over time. However, this proficiency could deteriorate over time when it is solely learned and executed on simulation trainers. Structured curricula including theory, simulation, and live-surgery seem to be the best option for trainees. More research in this field is needed.
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Peers versus Pros: Feedback using standards in simulation training. Am J Surg 2018; 216:1223-1229. [PMID: 30082027 DOI: 10.1016/j.amjsurg.2018.07.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Creating and updating expert performance-based standards for simulators is labor intensive and requires the regular availability of expert surgeons. We investigated how peer performance based standards compare to expert performance based standards. METHODS One hundred medical students took part in a four-session laparoscopic basic skills simulator training course. Performance for the FLS videotrainer tasks were compared between students who received feedback based on either peer standards, expert standards or no feedback at all (control group). RESULTS No difference in performance between our feedback groups was found. Compared to the control group, they were 18-36% faster but made 52% more errors for tasks on the FLS video trainer (U range [93.5-957], average p < .01). CONCLUSIONS We demonstrated that feedback based on peer standards is equally effective as feedback based on expert standards. The found trade-off between speed and error is not desirable and warrants further investigation.
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Saving robots improves laparoscopic performance: transfer of skills from a serious game to a virtual reality simulator. Surg Endosc 2018; 32:3192-3199. [PMID: 29349543 DOI: 10.1007/s00464-018-6036-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Residents find it hard to commit to structural laparoscopic skills training. Serious gaming has been proposed as a solution on the premise that it is effective and more motivating than traditional simulation. We establish construct validity for the laparoscopic serious game Underground by comparing laparoscopic simulator performance for a control group and an Underground training group. METHODS A four-session laparoscopic basic skills course is part of the medical master students surgical internship at the Radboud University Medical Centre. Four cohorts, representing 107 participants, were assigned to either the Underground group or the control group. The control group trained on the FLS video trainer and the LapSim virtual reality simulator for four sessions. The Underground group played Underground for three sessions followed by a transfer session on the FLS video trainer and the LapSim. To assess the effect of engaging in serious gameplay on performance on two validated laparoscopic simulators, initial performance on the FLS video trainer and the LapSim was compared between the control group (first session) and the Underground group (fourth session). RESULTS We chose task duration as a proxy for laparoscopic performance. The Underground group outperformed the control group on all three LapSim tasks: Camera navigation F(1) = 12.71, p < .01; Instrument navigation F(1) = 8.04, p < .01; and Coordination F(1) = 6.36, p = .01. There was no significant effect of playing Underground for performance on the FLS video trainer Peg Transfer task, F(1) = 0.28, p = .60. CONCLUSIONS We demonstrated skills transfer between a serious game and validated laparoscopic simulator technology. Serious gaming may become a valuable, cost-effective addition to the skillslab, if transfer to the operating room can be established. Additionally, we discuss sources of transferable skills to help explain our and previous findings.
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Bjerrum F, Strandbygaard J, Rosthøj S, Grantcharov T, Ottesen B, Sorensen JL. Evaluation of Procedural Simulation as a Training and Assessment Tool in General Surgery-Simulating a Laparoscopic Appendectomy. JOURNAL OF SURGICAL EDUCATION 2017; 74:243-250. [PMID: 27717707 DOI: 10.1016/j.jsurg.2016.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Laparoscopic appendectomy is a commonly performed surgical procedure, but few training models have been described for it. We examined a virtual reality module for practising a laparoscopic appendectomy. METHODS A prospective cohort study with the following 3 groups of surgeons (n = 45): novices (0 procedures), intermediates (10-50 procedures), and experienced (>100 procedures). After being introduced to the simulator and 1 familiarization attempt on the procedural module, the participants practiced the module 20 times. Movements, task time, and procedure-specific parameters were compared over time. RESULTS The time and movement parameters were significantly different during the first attempt, and more experienced surgeons used fewer movements and less time than novices (p < 0.01), although only 2 parameters were significantly different between novices and intermediates. All 3 groups improved significantly over 20 attempts (p < 0.0001). The intraclass correlation coefficient varied between 0.55 and 0.68 and did not differ significantly between the 3 groups (p > 0.05). When comparing novices with experienced surgeons, novices had a higher risk of burn damage to cecum (odds ratio [OR] = 3.0 [95% CI: 1.3; 7.0] p = 0.03), pressure damage to appendix (OR = 3.1 [95% CI: 2.0; 4.9] p < 0.0001), and grasping of the appendix (OR = 2.9 [95% CI: 1.8; 4.7] p < 0.0001). The risk of causing a perforation was not significantly different among the different experience levels (OR = 1.9 [95% CI: 0.9; 3.8] p = 0.14). Only 3 out of 5 error parameters differed significantly when comparing novices and experienced surgeons. Similarly, when comparing intermediates and novices, it was only 2 of the parameters that differed. DISCUSSION The simulator module for practising laparoscopic appendectomy may be useful as a training tool, but further development is required before it can be used for assessment purposes. Procedural simulation may demonstrate more variation for movement parameters, and future research should focus on developing better procedure-specific parameters.
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Affiliation(s)
- Flemming Bjerrum
- Department of Obstetrics and Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Jeanett Strandbygaard
- Department of Obstetrics and Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Rosthøj
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Teodor Grantcharov
- Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Bent Ottesen
- Department of Obstetrics and Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jette Led Sorensen
- Department of Obstetrics and Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Fransson BA. Advances in Laparoscopic Skills Training and Management. Vet Clin North Am Small Anim Pract 2016; 46:1-12. [DOI: 10.1016/j.cvsm.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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