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Vamadevan A, Konge L, Bjerrum F. Variable practice is superior to self-directed training for laparoscopic simulator training: a randomized trial. Surg Endosc 2024; 38:1902-1911. [PMID: 38321334 PMCID: PMC10978673 DOI: 10.1007/s00464-024-10688-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Mastering laparoscopy is challenging-it requires specific psychomotor skills which are difficult to obtain in the operating room without potentially compromising patient safety. Proficiency-based training programs using virtual reality simulators allow novices to practice and develop their skills in a patient-safe learning environment. Variable practice leads to stronger retention and skills transfer in a non-surgical setting. The objective of this trial was to investigate if variable practice was superior to self-directed training. METHODS A randomized trial where participants (n = 36) were randomized to proficiency-based laparoscopic simulator training of basic skills using either variable practice or self-directed training, followed by a transfer test with proficiency-based training on a procedural task (a salpingectomy). All participants returned after a period of 3-5 weeks to perform a retention test. RESULTS The mean time to proficiency for the basic skills tasks were 119 min (SD: 93) for the variable practice group versus 182 min (SD: 46) for the self-directed training group (p = 0.015). The time to reach proficiency during the transfer test was 103 min (SD: 57) versus 183 min (SD: 64) for the variable practice group versus the self-directed training group, respectively (p < 0.001). The mean time to proficiency for the retention test was 51 min (SD: 26) and 109 min (SD: 53) for the variable practice group and self-directed training group, respectively (p < 0.001). CONCLUSION Variable practice is superior to self-directed training for proficiency-based laparoscopic training. With variable time to practice proficiency is reduced, there is higher transfer to a procedural task, and retention is improved.
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Affiliation(s)
- Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and Centre for HR and Education, Capital Region, Ryesgade, 53B, 2100, Copenhagen, Denmark.
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and Centre for HR and Education, Capital Region, Ryesgade, 53B, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and Centre for HR and Education, Capital Region, Ryesgade, 53B, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Surgical Section, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
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2
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Tang DHY, Østdal TB, Vamadevan A, Konge L, Houlind K, Stadeager M, Bjerrum F. No difference between using short and long intervals for distributed proficiency-based laparoscopy simulator training: a randomized trial. Surg Endosc 2024; 38:300-305. [PMID: 37993677 PMCID: PMC10776690 DOI: 10.1007/s00464-023-10522-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Simulation-based training is increasingly used to acquire basic laparoscopic skills. Multiple factors can influence training, e.g., distributed practice is superior to massed practice in terms of efficiency. However, the optimal interval between training sessions is unclear. The objective of this trial was to investigate if shorter intervals between sessions are more efficient than longer intervals during proficiency-based laparoscopy simulator training. METHODS A randomized simulation-based trial where medical students (n = 39) were randomized to proficiency-based training with either 1-2 days (intervention group) or 6-8 days (control group) between training sessions. Both groups practiced a series of basic tasks and a procedural module until proficiency level on the LapSim® simulator. Both groups were given instructor feedback upon request. After reaching proficiency, participants were invited back for a retention test 3-5 weeks later and practiced the same tasks to proficiency again. RESULTS The mean time to reach proficiency during training was 291 (SD 89) and 299 (SD 89) min in the intervention and control group, respectively (p = 0.81). During the retention test, the mean time to reach proficiency was 94 (SD 53) and 96 (SD 39) minutes in the intervention and control groups, respectively (p = 0.91). CONCLUSION We found no difference whether practicing with shorter intervals or longer intervals between training sessions when examining time to proficiency or retention.
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Affiliation(s)
- Diana Hai Yen Tang
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark.
- The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Theresa Bruun Østdal
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Houlind
- The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Vascular Surgery, Hospital Lillebaelt, University of Southern Denmark, Odense, Denmark
| | - Morten Stadeager
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Surgery, Hvidovre Hospital, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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3
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Vamadevan A, Konge L, Stadeager M, Bjerrum F. Haptic simulators accelerate laparoscopic simulator training, but skills are not transferable to a non-haptic simulator: a randomized trial. Surg Endosc 2023; 37:200-208. [PMID: 35918547 DOI: 10.1007/s00464-022-09422-4] [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: 03/10/2022] [Accepted: 06/24/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Laparoscopy requires specific psychomotor skills and can be challenging to learn. Most proficiency-based laparoscopic training programs have used non-haptic virtual reality simulators; however, haptic simulators can provide the tactile sensations that the surgeon would experience in the operating room. The objective was to investigate the effect of adding haptic simulators to a proficiency-based laparoscopy training program. METHODS A randomized controlled trial was designed where residents (n = 36) were randomized to proficiency-based laparoscopic simulator training using haptic or non-haptic simulators. Subsequently, participants from the haptic group completed a follow-up test, where they had to reach proficiency again using the non-haptic simulator. Participants from the non-haptic group returned to train until reaching proficiency again using the non-haptic simulator. RESULTS Mean completion times during the intervention were 120 min (SD 38.7 min) and 183 min (SD 66.3 min) for the haptic group and the non-haptic group, respectively (p = 0.001). The mean times to proficiency during the follow-up test were 107 min (SD 41.0 min) and 58 min (SD 23.7 min) for the haptic and the non-haptic group, respectively (p < 0.001). The haptic group was not faster to reach proficiency in the follow-up test than during the intervention (p = 0.22). In contrast, the non-haptic group reached the required proficiency level significantly faster in the follow-up test (p < 0.001). CONCLUSION Haptic virtual reality simulators reduce the time to reach proficiency compared to non-haptic simulators. However, the acquired skills are not transferable to the conventional non-haptic setting.
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Affiliation(s)
- Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Copenhagen, Denmark.
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Stadeager
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Copenhagen, Denmark.,Department of Surgery, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Copenhagen, Denmark.,Department of Surgery, Zealand University Hospital, Køge, Denmark
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4
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Zetner DB, Konge L, Fabrin A, Christensen JB, Thinggaard E. The Challenges of Dyad Practice in Simulation Training of Basic Open Surgical Skills-A Mixed-Method Study. Simul Healthc 2022; 17:e91-e97. [PMID: 34009912 DOI: 10.1097/sih.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulation training at home improves access to training, but motivation can be difficult to maintain. Dyad training could keep trainees motivated. This study aimed to examine the effect of self-regulated training of basic surgical skills in pairs versus individually. METHODS One hundred one medical doctors were included in this prospective, mixed-method, simulation-based study. Participants were randomized to train individually or in pairs during a 6-week course in open surgical skills, consisting of didactic instructions and self-directed training at home. Trainees kept a training log and filled in a questionnaire. Skills were tested before and after the course. Tests were rated by an expert using the Objective Structured Assessment of Technical Skills Global Rating Scale. RESULTS Ninety-seven doctors completed the study. We found no differences in test score between dyad and individual trainees. Dyad trainees compared with individual trainees improved by 7.23 points (intercept estimate) versus 6.94 points, respectively (P = 0.881). Dyad trainees trained less frequently [7.3 times (intercept estimate) vs. 12.1 times, P < 0.001, but for longer intervals compared with individual trainees (68 minutes vs. 38 minutes)]. Dyad trainees reported benefits such as having a sparring partner, receiving feedback, corrections, increased motivation, having fun, and more structured training sessions. However, the coordination of training sessions was difficult. CONCLUSIONS No differences were found between dyad trainees and individual trainees in improvement of surgical skills. Off-site dyad training led to fewer, but longer training sessions, which may have negatively impacted the effectiveness of training. Dyad trainees perceived dyad training beneficial.
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Affiliation(s)
- Diana B Zetner
- From the Copenhagen Academy for Medical Education and Simulation (D.B.Z., L.K., A.F., J.B.C., E.T.), Copenhagen Ø; University of Copenhagen, Faculty of Health and Medical Sciences (L.K.), Copenhagen N; Department of Thoracic, Cardiac and Vascular Surgery (A.F.), Odense University Hospital, Odense; and Department of Obstetrics and Gynaecology, Slagelse Sygehus (E.T.), Slagelse, Denmark
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5
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ROBOT-ASSISTED VITREORETINAL SURGERY IMPROVES SURGICAL ACCURACY COMPARED WITH MANUAL SURGERY: A Randomized Trial in a Simulated Setting. Retina 2021; 40:2091-2098. [PMID: 31842191 PMCID: PMC7575030 DOI: 10.1097/iae.0000000000002720] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Robot-assisted vitreoretinal surgery increases precision and limits tissue damage compared with manual surgery especially for the novice surgeon. The Eyesi Simulator is a feasible platform for investigating robot-assisted vitreoretinal surgery. Purpose: To compare manual and robot-assisted vitreoretinal surgery using a virtual-reality surgical simulator. Methods: Randomized controlled crossover study. Ten experienced vitreoretinal surgeons and 10 novice ophthalmic surgeons were included. The participants were randomized to start with either manual or robot-assisted surgery. Participants completed a test session consisting of three vitreoretinal modules on the Eyesi virtual-reality simulator. The automated metrics of performance supplied by the Eyesi simulator were used as outcome measures. Primary outcome measures were time with instruments inserted (seconds), instrument movement (mm), and tissue treatment (mm2). Results: Robot-assisted surgery was slower than manual surgery for both novices and vitreoretinal surgeons, 0.24 SD units (P = 0.024) and 0.73 SD units (P < 0.001), respectively. Robot-assisted surgery allowed for greater precision in novices and vitreoretinal surgeons, −0.96 SD units (P < 0.001) and −0.47 SD units (P < 0.001), respectively. Finally, novices using robot-assisted surgery inflicted less tissue damage when compared with that using manual surgery, −0.59 SD units (P = 0.009). Conclusion: At the cost of time, robot-assisted vitreoretinal surgery seems to improve precision and limit tissue damage compared with that of manual surgery. In particular, the performance of novice surgeons is enhanced with robot-assisted vitreoretinal surgery.
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Lee HJ, Corbetta L. Training in interventional pulmonology: the European and US perspective. Eur Respir Rev 2021; 30:30/160/200025. [PMID: 34039670 DOI: 10.1183/16000617.0025-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 10/12/2020] [Indexed: 11/05/2022] Open
Abstract
As the breadth of interventional pulmonology continues to expand, training in this discipline gains further importance. Interventional pulmonology training in the USA and Europe has common roots and similar concepts; however, there are variations in its delivery. We discuss the similarities, differences, challenges and goals of interventional pulmonology training in both continents. Collaboration and exchange of experiences between the USA and Europe are fundamental to entering the new era of competency/mastery training to implement a multidimensional approach to procedure-related education.
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Affiliation(s)
- Hans J Lee
- Division Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, Baltimore, MD, USA
| | - Lorenzo Corbetta
- Department of Experimental and Clinical Medicine, Interventional Pulmonology Unit, University of Florence, Careggi Hospital, Florence, Italy
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7
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Decentralized Virtual Reality Training of Mastoidectomy Improves Cadaver Dissection Performance: A Prospective, Controlled Cohort Study. Otol Neurotol 2020; 41:476-481. [DOI: 10.1097/mao.0000000000002541] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Bube S, Dagnaes-Hansen J, Mahmood O, Rohrsted M, Bjerrum F, Salling L, Hansen RB, Konge L. Simulation-based training for flexible cystoscopy – A randomized trial comparing two approaches. Heliyon 2020; 6:e03086. [PMID: 31922043 PMCID: PMC6948262 DOI: 10.1016/j.heliyon.2019.e03086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/29/2019] [Accepted: 12/17/2019] [Indexed: 01/16/2023] Open
Abstract
Background Simulation-based training allows trainees to experiment during training and end-of-training tests could increase motivation and retention. The aim of this trial was to determine if a simulation-based training program including directed self-regulated learning and post-testing improved clinical outcomes compared to a traditional simulation-based training program. Methods A randomized trial was conducted involving 32 participants without prior experience in endoscopic procedures. The intervention group practiced independently in a simulation centre and got a post-test whereas the control group received traditional instructions and demonstrations before being allowed to practice. Three weeks after the intervention the participants performed cystoscopies on two consecutive patients. Clinical performance was assessed using a global rating scale (GRS) with established evidence of validity. Independent samples t-test, Cronbach's α, Pearson's r, and paired samples t-test were used for statistical analysis. Results Twenty-five participants performed two cystoscopies on patients. There was no significant difference between the two study groups with respect to mean GRS of performance (p = 0.63, 95 % CI; -2.4–3.9). The internal consistency of the global rating scale was high, Cronbach's α = 0.91. Participants from both study groups demonstrated significant improvement between the first and second clinical procedures (p = 0.004, 95 % CI, 0.8–3.5). Eight (32%) and 15 (60%) participants demonstrated adequate clinical skills in their first and second procedure, respectively. Conclusions No significant differences were found on the clinical transfer when comparing the two programs. Neither of our training programs was able to ensure consistent, competent performance on patients and this finding could serve as an important argument for simulation-based mastery learning where all training continues until a pre-defined level of proficiency is met. Trial registrations The trial was submitted before enrolment of participants to the Regional Scientific Ethics Committee of the Capital Region which established that ethical approval was not necessary (H-4-2014-122). The trial was registered at Clinicaltrials.gov (NCT02411747).
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Affiliation(s)
- Sarah Bube
- Department of Urology, Roskilde Hospital, Zealand University Hospital, University of Copenhagen, Zealand Region, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Corresponding author.
| | - Julia Dagnaes-Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Urology, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Oria Mahmood
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Anaesthesiology, Holbaek Hospital, Zealand Region, Holbaek, Denmark
| | - Malene Rohrsted
- Department of Urology, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Surgery, Herlev/Gentofte Hospital, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Lisbeth Salling
- Department of Urology, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Rikke B. Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
- Department of Urology, Herlev/Gentofte Hospital, University of Copenhagen, Capital Region, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen, Capital Region, Copenhagen, Denmark
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9
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Gustafsson A, Viberg B, Paltved C, Palm H, Konge L, Nayahangan LJ. Identifying Technical Procedures in Orthopaedic Surgery and Traumatology That Should Be Integrated in a Simulation-Based Curriculum: A National General Needs Assessment in Denmark. J Bone Joint Surg Am 2019; 101:e108. [PMID: 31626016 DOI: 10.2106/jbjs.18.01122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Simulation-based training is emerging within the orthopaedic field to alleviate the challenges that trainees face such as work-hour restrictions, limited exposure to procedures, and increasing pressures to reduce risk to patients. This training modality has grown increasingly popular over the last 2 decades. However, integration into the curriculum often fails to follow a structured educational plan. The development of simulation-based curricula should follow a structured and stepwise approach that starts with a general needs assessment. This study aimed to identify and prioritize procedures within orthopaedic surgery to be included in a simulation-based curriculum on a national basis. METHODS A national needs assessment was conducted using the Delphi method. Ninety-five experts who are involved in the training of orthopaedic surgeons from all orthopaedic departments in Denmark were selected to participate in the assessment. Round 1 was a brainstorming phase to identify technical procedures that are relevant for orthopaedic surgeons in training. Round 2 was performed on a departmental basis; it explored the frequency of procedures, the number of surgeons performing each procedure, the risk and/or discomfort to patients, and the feasibility for simulation-based training to prioritize and eliminate some of the procedures that were determined in round 1. During round 3, the experts eliminated and reprioritized procedures from round 2 to produce a final prioritized list. RESULTS During the first round, 194 procedures were identified. These were reduced to 62 in round 2, and the final list after round 3 consisted of 33 prioritized procedures that are relevant for simulation-based training in orthopaedic surgery. The response rates were 63 of 95 physicians for round 1, 26 of 26 departments for round 2, and 64 of 97 physicians for round 3. The highest prioritized procedures were basic surgical techniques and principles for osteosynthesis, osteosynthesis of proximal femoral fracture, and surgical exposure of the upper and lower extremities. CONCLUSIONS The prioritized list of technical procedures in orthopaedic surgery that are suitable for simulation-based training can aid in the development of a simulation-based curriculum. CLINICAL RELEVANCE This article offers insights into needs assessment and curriculum development of simulation-based training in orthopaedic surgery and traumatology.
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Affiliation(s)
- Amandus Gustafsson
- Copenhagen Academy for Medical Education and Simulation and The Capital Region of Denmark, Copenhagen, Denmark.,Orthopaedic Department, Slagelse Hospital, Slagelse, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital, Hospital Lillebaelt, Kolding, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Denmark
| | | | - Henrik Palm
- Orthopaedic Department, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation and The Capital Region of Denmark, Copenhagen, Denmark.,Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation and The Capital Region of Denmark, Copenhagen, Denmark
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10
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Bube SH, Hansen RB, Dahl C, Konge L, Azawi N. Development and validation of a simulator-based test in transurethral resection of bladder tumours (TURBEST). Scand J Urol 2019; 53:319-324. [DOI: 10.1080/21681805.2019.1663921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Sarah Hjartbro Bube
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Copenhagen, Denmark
| | - Rikke Boelling Hansen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Urology, Herlev/Gentofte Hospital, Herlev, Denmark
| | - Claus Dahl
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Copenhagen, Denmark
| | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
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11
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Gustafsson A, Pedersen P, Rømer TB, Viberg B, Palm H, Konge L. Hip-fracture osteosynthesis training: exploring learning curves and setting proficiency standards. Acta Orthop 2019; 90:348-353. [PMID: 31017542 PMCID: PMC6718183 DOI: 10.1080/17453674.2019.1607111] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Orthopedic surgeons must be able to perform internal fixation of proximal femoral fractures early in their career, but inexperienced trainees prolong surgery and cause increased reoperation rates. Simulation-based virtual reality (VR) training has been proposed to overcome the initial steep part of the learning curve but it is unknown how much simulation training is necessary before trainees can progress to supervised surgery on patients. We determined characteristics of learning curves for novices and experts and a pass/fail mastery-learning standard for junior trainees was established. Methods - 38 first-year residents and 8 consultants specialized in orthopedic trauma surgery performed cannulated screws, Hansson pins, and sliding hip screw on the Swemac TraumaVision VR simulator. A previously validated test was used. The participants repeated the procedures until they reached their learning plateau. Results - The novices and the experts reached their learning plateau after an average of 169 minutes (95% CI 152-87) and 143 minutes (CI 109-177), respectively. Highest achieved scores were 92% (CI 91-93) for novices and 96% (CI 94-97) for experts. Plateau score, defined as the average of the 4 last scores, was 85% (CI 82-87) and 92% (CI 89-96) for the novices and the experts, respectively. Interpretation - Training time to reach plateau varied widely and it is paramount that simulation-based training continues to a predefined standard instead of ending after a fixed number of attempts or amount of time. A score of 92% comparable to the experts' plateau score could be used as a mastery learning pass/fail standard.
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Affiliation(s)
- Amandus Gustafsson
- Copenhagen Academy for Medical Education and Simulation
- Orthopedic Department, Slagelse Hospital, Region Zealand
| | | | | | | | - Henrik Palm
- Orthopedic Department, University Hospital Bispebjerg
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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12
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Uzunel A, Petersen RH. Troubleshooting in advanced VATS procedures. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:248. [PMID: 31317018 DOI: 10.21037/atm.2019.05.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ayse Uzunel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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13
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Cognitive load and performance in immersive virtual reality versus conventional virtual reality simulation training of laparoscopic surgery: a randomized trial. Surg Endosc 2019; 34:1244-1252. [PMID: 31172325 DOI: 10.1007/s00464-019-06887-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/31/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Virtual reality simulators combined with head-mounted displays enable highly immersive virtual reality (VR) for surgical skills training, potentially bridging the gap between the simulation environment and real-life operating room conditions. However, the increased complexity of the learning situation in immersive VR could potentially induce high cognitive load thereby inhibiting performance and learning. This study aims to compare cognitive load and performance in immersive VR and conventional VR simulation training. METHODS A randomized controlled trial of residents (n = 31) performing laparoscopic salpingectomies with an ectopic pregnancy in either immersive VR or conventional VR simulation. Cognitive load was estimated by secondary-task reaction time at baseline, and during nonstressor and stressor phases of the procedure. Simulator metrics were used to evaluate performance. RESULTS Cognitive load was increased by 66% and 58% during immersive VR and conventional VR simulation, respectively (p < 0.001), compared to baseline. A light stressor induced a further increase in cognitive load by 15.2% and a severe stressor by 43.1% in the immersive VR group compared to 23% (severe stressor) in the conventional VR group. Immersive VR also caused a significantly worse performance on most simulator metrics. CONCLUSION Immersive VR simulation training induces a higher cognitive load and results in a poorer performance than conventional VR simulation training in laparoscopy. High extraneous load and element interactivity in the immersive VR are suggested as mechanisms explaining this finding. However, immersive VR offers some potential advantages over conventional VR such as more real-life conditions but we only recommend introducing immersive VR in surgical skills training after initial training in conventional VR.
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14
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Østergaard ML, Konge L, Kahr N, Albrecht-Beste E, Nielsen MB, Nielsen KR. Four Virtual-Reality Simulators for Diagnostic Abdominal Ultrasound Training in Radiology. Diagnostics (Basel) 2019; 9:diagnostics9020050. [PMID: 31064080 PMCID: PMC6627565 DOI: 10.3390/diagnostics9020050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 12/04/2022] Open
Abstract
Ultrasound exams need skilled examiners, and simulation-based training could provide standardized and safe skill training. This study aims to give an overview of different types of virtual-reality simulators for use in abdominal diagnostic ultrasound training in radiology. Fifteen specialized radiologists and radiological residents were presented with two similar cases on four different simulators for abdominal ultrasound training. A feedback sheet for each individual simulator and for an overall comparison was filled out by all participants. All means of scores were compared, and simulators were ranked from least to most favorable. One simulator was ranked most favorable in seven out of nine questions, but none of the mean scores had statistically significant differences. All simulators were recommended for training radiologists, and all simulators were perceived to benefit trainees more than experienced ultra-sonographers.
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Affiliation(s)
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, 2100 Copenhagen, Denmark.
| | - Niklas Kahr
- Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Elisabeth Albrecht-Beste
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, 2100 Copenhagen, Denmark.
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Hertz P, Jensen K, Abudaff SN, Strøm M, Subhi Y, Lababidi H, Konge L. Ensuring basic competency in chest tube insertion using a simulated scenario: an international validation study. BMJ Open Respir Res 2019; 5:e000362. [PMID: 30622719 PMCID: PMC6307557 DOI: 10.1136/bmjresp-2018-000362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Chest tube insertion can be associated with serious complications. A structured training programme is needed to minimise complications and enhance patient safety. Novices should pass a reliable test with solid evidence of validity before performing the procedure supervised on patients. The aim of this study was to establish a credible pass/fail standard. Methods We used an established assessment tool the Chest Tube Insertion Competency Test (TUBE-iCOMPT). Validity evidence was explored according to Messick’s five sources of validity. Two methods were used to establish a credible pass/fail standard. Contrasting groups’ method: 34 doctors (23 novices and 11 experienced surgeons) performed the procedure twice and all procedures were video recorded, edited, blinded and rated by two independent, international raters. Modified Angoff method: seven thoracic surgeons individually determined the scores that defined the pass/fail criteria. The data was gathered in Copenhagen, Denmark and Riyadh, Saudi Arabia. Results Internal consistency reliability was calculated as Cronbach’s alpha to 0.94. The generalisability coefficient with two raters and two procedures was 0.91. Mean scores were 50.7 (SD±13.2) and 74.7 (SD±4.8) for novices and experienced surgeons, respectively (p<0.001). The pass/fail score of 62 points resulted in zero false negatives and only three false positives. Discussion We have gathered valuable additional validity evidence for the assessment tool TUBE-iCOMPT including establishment of a credible pass/fail score. The TUBE-iCOMPT can now be integrated in mastery learning programmes to ensure competency before independent practice.
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Affiliation(s)
- Peter Hertz
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Katrine Jensen
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Michael Strøm
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark.,Department of Vascular Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Yousif Subhi
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark
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Østergaard ML, Rue Nielsen K, Albrecht-Beste E, Kjær Ersbøll A, Konge L, Bachmann Nielsen M. Simulator training improves ultrasound scanning performance on patients: a randomized controlled trial. Eur Radiol 2019; 29:3210-3218. [PMID: 30617476 DOI: 10.1007/s00330-018-5923-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/30/2018] [Accepted: 11/28/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Simulation-based mastery training may improve clinical performance. The aim of this study was to determine the effect of simulation-based mastery training on clinical performance in abdominal diagnostic ultrasound for radiology residents. METHOD This study was a multicenter randomized controlled trial registered at clinicaltrials.gov (identifier: NCT02921867) and reported using the Consolidated Standards of Reporting Trials (CONSORT) statement. Twenty radiology residents from 10 different hospitals were included in the study. Participants were randomized into two groups: (1) simulator-based training until passing a validated test scored by a blinded reviewer or (2) no intervention prior to standard clinical ultrasound training on patients. All scans performed during the first 6 weeks of clinical ultrasound training were scored. The primary outcome was performance scores assessed using Objective Structured Assessment of Ultrasound Skills (OSAUS). An exponential learning curve was fitted for the OSAUS score for the two groups using non-linear regression with random variation. Confidence intervals were calculated based on the variation between individual learning curves. RESULTS After randomization, eleven residents completed the simulation intervention and nine received standard clinical training. The simulation group participants attended two to seven training sessions using between 6 and 17 h of simulation-based training. The performance score for the simulation group was significantly higher for the first 29 scans compared to that for the non-simulation group, such that scores reached approximately the same level after 49 and 77 scans, respectively. CONCLUSION We showed improved performance in diagnostic ultrasound scanning on patients after simulation-based mastery learning for radiology residents. TRIAL REGISTRATION NCT02921867 KEY POINTS: • Improvement in scanning performance on patients is seen after simulation-based mastery learning in diagnostic abdominal ultrasound. • Simulation-based mastery learning can prevent patients from bearing the burden of the initial steep part of trainees' learning curve.
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Affiliation(s)
- Mia Louise Østergaard
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Kristina Rue Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Elisabeth Albrecht-Beste
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation CAMES, The Capital Region of Denmark, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Corbetta L, Arru LB, Mereu C, Pasini V, Patelli M. Competence and training in interventional pulmonology. Panminerva Med 2018; 61:203-231. [PMID: 30394710 DOI: 10.23736/s0031-0808.18.03562-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Interventional pulmonology (IP) is experiencing a rapid evolution of new technologies. There is a need to develop structured training programs, organized in high volume expert centers in order to improve trainee education, and including the development of validated metrics for their competency assessment. Concerning teaching methods, a gradual progression from theory to practice, using new teaching techniques, including live sessions and low and high-fidelity simulation, flipped classroom models and problem-based learning (PBL) exercises would provide a training setting more suitable for our current need to improve skills and update professionals. Training programs should be learner-centered and competence-oriented, as well as being based on a spiral-shaped approach in which the same subject is addressed many times, from new and different perspectives of knowledge, ability, behavior and attitude, until the trainee has demonstrated a high degree of skill and professionalism. Furthermore there is a need to standardize the training programs as guide for physicians wishing to undertake a gradual and voluntary improvement of their own competencies, and assist those planning and organizing training programs in IP. The article includes a general part on core curriculum contents, innovative training methods and simulation, and introduces the following articles on the skills that the Interventional Pulmonologist must master in order to perform the different procedures. This monography should be considered a starting point that will evolve over time and results in better training for practitioners and better care for our patients. The task of establishing a trainee's competence to practice independently as an Interventional Pulmonologist remains the responsibility of the IP fellowship program director and faculty, who validate logbooks and assess competence for each procedure. These standards need to be reviewed and approved by national and International Scientific Societies and Healthcare Institutions with the aim to improve, disseminate and incorporate them in healthcare programs.
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Affiliation(s)
- Lorenzo Corbetta
- Unit of Interventional Pulmonology, Department of Experimental and Clinical Medicine, University Hospital of Careggi, University of Florence, Florence, Italy -
| | - Luigi B Arru
- Council of Health of the Region Sardinia, Cagliari, Italy
| | - Carlo Mereu
- Unit of Pneumology, ASL 2 Savonese, Savona, Italy
| | - Valeria Pasini
- Interventional Pulmonary Program, University of Florence, Florence, Italy
| | - Marco Patelli
- Unit of Interventional Pulmonology, University of Florence and Bologna, Florence, Italy
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Jensen K, Hansen HJ, Petersen RH, Neckelmann K, Vad H, Møller LB, Pedersen JH, Konge L. Evaluating competency in video-assisted thoracoscopic surgery (VATS) lobectomy performance using a novel assessment tool and virtual reality simulation. Surg Endosc 2018; 33:1465-1473. [PMID: 30225606 DOI: 10.1007/s00464-018-6428-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Competency-based training has gained ground in surgical training and with it assessment tools to ensure that training objectives are met. Very few assessment tools are available for evaluating performance in thoracoscopic procedures. Video recordings would provide the possibility of blinded assessment and limited rater bias. This study aimed to provide validity evidence for a newly developed and dedicated tool for assessing competency in Video-Assisted Thoracoscopic Surgery (VATS) lobectomy. METHODS Participants with varying experience with VATS lobectomy were included from different countries. Video recordings from participants' performance of a VATS right upper lobe lobectomy on a virtual reality simulator were rated by three raters using a modified version of a newly developed VATS lobectomy assessment tool (the VATSAT) and analyzed in relation to the unitary framework (content, response process, internal structure, relation to other variables, and consequences of testing). RESULTS Fifty-three participants performed two consecutive simulated VATS lobectomies on the virtual reality simulator, leaving a total of 106 videos. Content established in previously published studies. Response process Standardized data collection was ensured by using an instructional element, uniform data collection, a special rating program, and automatic generation of the results to a database. Raters were carefully instructed in using the VATSAT, and tryout ratings were carried out. Internal structure Inter-rater reliability was calculated as intra-class correlation coefficients, to 0.91 for average measures (p < 0.001). Test/re-test reliability was calculated as Pearson's r of 0.70 (p < 0.001). G-coefficient was calculated to be 0.79 with two procedures and three raters. By performing D-theory was found that either three procedures rated by two raters or five procedures rated by one rater were enough to reach an acceptable G-coefficient of ≥ 0.8. Relation to other variables Significant differences between groups were found (p < 0.001). The participants' VATS lobectomy experience correlated significantly to their VATSAT score (p = 0.016). Consequences of testing The pass/fail score was found to be 14.9 points by the contrasting groups' method, leaving five false positive (29%) and six false negatives (43%). CONCLUSION Validity evidence was provided for the VATSAT according to the unitary framework. The VATSAT provides supervisors and assessors with a procedure-specific assessment tool for evaluating VATS lobectomy performance and aids with the decision of when the trainee is ready for unsupervised performance.
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Affiliation(s)
- Katrine Jensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. .,Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region, Copenhagen, Denmark. .,Department 5404, Copenhagen Academy for Medical Education and Simulation (CAMES), Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Neckelmann
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Henrik Vad
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
| | | | - Jesper Holst Pedersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region, Copenhagen, Denmark
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19
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Fjørtoft K, Konge L, Gögenur I, Thinggaard E. The Implementation Gap in Laparoscopic Simulation Training. Scand J Surg 2018; 108:109-116. [PMID: 30207205 DOI: 10.1177/1457496918798201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Simulation-based training in laparoscopy can improve patient safety and efficiency of care, but it depends on how it is used. Research in medical education has moved from demonstrating transferability of simulation training to the operating room to how to best implement it. This study aims to investigate how simulation-based training in laparoscopy has been implemented Scandinavia. MATERIAL AND METHODS An online survey was sent out to medical doctors at surgical, gynecological, and urological departments at 138 hospitals in Denmark, Norway, and Sweden. The questionnaire included questions on respondents' baseline characteristics, opinions, access, and actual use of simulation-based training in laparoscopy. RESULTS In total, 738 respondents completed the survey. Of these, 636 (86.2%) of respondents agreed or strongly agreed that simulation-based training in laparoscopy should be mandatory. A total of 602 (81.6%) had access to simulation-based training in laparoscopy. Of the total 738 respondents, 141 (19.1%) were offered structured training courses, 129 (17.5%) were required to reach a predefined level of competency, and 66 (8.9%) had mandatory courses in laparoscopy. In all, 72 (9.8%) had never used simulation-based training in laparoscopy. CONCLUSION An implementation gap in laparoscopic simulation-based training still exists in Scandinavia. Simulation equipment is generally available, but there is a lack of structured simulation-based training.
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Affiliation(s)
- K Fjørtoft
- 1 Copenhagen Academy for Medical Education and Simulation-CAMES Rigshospitalet, Copenhagen, Denmark
| | - L Konge
- 1 Copenhagen Academy for Medical Education and Simulation-CAMES Rigshospitalet, Copenhagen, Denmark
| | - I Gögenur
- 2 Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - E Thinggaard
- 1 Copenhagen Academy for Medical Education and Simulation-CAMES Rigshospitalet, Copenhagen, Denmark.,2 Center for Surgical Science, Zealand University Hospital, Køge, Denmark
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20
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Russell L, Østergaard ML, Nielsen MB, Konge L, Nielsen KR. Standardised assessment of competence in Focused Assessment with Sonography for Trauma. Acta Anaesthesiol Scand 2018; 62:1154-1160. [PMID: 29708590 DOI: 10.1111/aas.13141] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE The aim of this study was to develop and gather validity evidence for a standardised test of competence in Focused Assessment with Sonography for Trauma (FAST) and to define the appropriate cut-off point in simulation-based learning of the FAST protocol. METHODS A 20-item simulation-based test for assessing competence in FAST was created. The test was administered to thirteen novices and twelve radiologists experienced in abdominal ultrasound diagnostics. The Contrasting Groups' method was used to establish a credible passing score. RESULTS The internal consistency was high (Cronbach's α = 0.90) and the test had good discriminatory ability (P < .001). The mean score was 16.9 (95% CI: 15.5-18.3) in the experienced group and 8.0 (95% CI: 5.8-10.2) in the novice group, corresponding to 85% and 40% of the total score, respectively. A pass/fail standard of 14 points was established using the Contrasting Groups' method. CONCLUSIONS The FAST simulation-based test provided valid assessment of competence in FAST. The FAST test could be used to guide training and ensure basic competence of physicians using FAST.
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Affiliation(s)
- L Russell
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
- Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Emergency Medical Services Copenhagen, The Capital Region of Denmark, Ballerup, Denmark
| | - M L Østergaard
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M B Nielsen
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - L Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
| | - K R Nielsen
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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21
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Thomsen ASS, la Cour M, Paltved C, Lindorff-Larsen KG, Nielsen BU, Konge L, Nayahangan LJ. Consensus on procedures to include in a simulation-based curriculum in ophthalmology: a national Delphi study. Acta Ophthalmol 2018; 96:519-527. [PMID: 29575657 DOI: 10.1111/aos.13700] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 12/09/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The number of available simulation-based models for technical skills training in ophthalmology is rapidly increasing, and development of training programmes around these procedures should follow a structured approach. The aim of this study was to identify all technical procedures that should be integrated in a simulation-based curriculum in ophthalmology. METHODS Key opinion leaders involved in the education of ophthalmologists in Denmark including heads of departments, heads of clinical education, professors and board members of the society were invited to participate in a three-round Delphi process. Round 1 aimed at identifying technical procedures that physicians should be able to perform competently when completing specialty training; round 2 involved characterization of each procedure including frequency, number of operators, risk and/or discomfort for patients associated with an inexperienced physician, and feasibility of simulation-based training; round 3 included a priority ranking of procedures. RESULTS The response rate for each round was 71%, 64% and 64%, respectively. Sixty-five procedures were reduced to 25 prioritized procedures during the three rounds. Two-thirds of the procedures that were identified and highly prioritized were therapeutic procedures such as intravitreal injection therapy, yttrium-aluminium-garnet laser iridotomy/capsulotomy, minor ocular surface procedures and retinal argon laser therapy. The diagnostic procedures that were prioritized were ocular ultrasound, superficial keratectomy and optical coherence tomography (OCT). CONCLUSION The Delphi process identified and prioritized 25 procedures that should be practised in a simulation-based environment to achieve competency before working with patients. The list may be used to guide the development of future training programmes for ophthalmologists.
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Affiliation(s)
- Ann Sofia Skou Thomsen
- Department of Ophthalmology; Rigshospitalet - Glostrup; Copenhagen Denmark
- Copenhagen Academy for Medical Education and Simulation; University of Copenhagen and The Capital Region of Denmark; Copenhagen Denmark
| | - Morten la Cour
- Department of Ophthalmology; Rigshospitalet - Glostrup; Copenhagen Denmark
| | - Charlotte Paltved
- MidtSim - Centre for Human Resources; Central Region of Denmark and Aarhus University; Aarhus Denmark
| | | | - Bjørn Ulrik Nielsen
- Sim-C - Simulation Centre of Odense; Odense University Hospital; Odense Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation; University of Copenhagen and The Capital Region of Denmark; Copenhagen Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation; University of Copenhagen and The Capital Region of Denmark; Copenhagen Denmark
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Bjerrum F, Thomsen ASS, Nayahangan LJ, Konge L. Surgical simulation: Current practices and future perspectives for technical skills training. MEDICAL TEACHER 2018; 40:668-675. [PMID: 29911477 DOI: 10.1080/0142159x.2018.1472754] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Simulation-based training (SBT) has become a standard component of modern surgical education, yet successful implementation of evidence-based training programs remains challenging. In this narrative review, we use Kern's framework for curriculum development to describe where we are now and what lies ahead for SBT within surgery with a focus on technical skills in operative procedures. Despite principles for optimal SBT (proficiency-based, distributed, and deliberate practice) having been identified, massed training with fixed time intervals or a fixed number of repetitions is still being extensively used, and simulators are generally underutilized. SBT should be part of surgical training curricula, including theoretical, technical, and non-technical skills, and be based on relevant needs assessments. Furthermore, training should follow evidence-based theoretical principles for optimal training, and the effect of training needs to be evaluated using relevant outcomes. There is a larger, still unrealized potential of surgical SBT, which may be realized in the near future as simulator technologies evolve, more evidence-based training programs are implemented, and cost-effectiveness and impact on patient safety is clearly demonstrated.
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Affiliation(s)
- Flemming Bjerrum
- a Department of Surgery , Herlev Gentofte Hospital , Herlev , Denmark
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
| | - Ann Sofia Skou Thomsen
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
- c Department of Ophthalmology , Rigshospitalet-Glostrup , Copenhagen , Denmark
| | - Leizl Joy Nayahangan
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
| | - Lars Konge
- b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark
- d Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
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23
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Nayahangan LJ, Stefanidis D, Kern DE, Konge L. How to identify and prioritize procedures suitable for simulation-based training: Experiences from general needs assessments using a modified Delphi method and a needs assessment formula. MEDICAL TEACHER 2018; 40:676-683. [PMID: 29938547 DOI: 10.1080/0142159x.2018.1472756] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Simulation-based training (SBT) is a revolutionary addition to the education of residents in different specialties. However, the selection of training programs is often reliant on commercially available equipment or on experiential notions, local interests or coincidence. The first step to developing training programs should be problem identification and general needs assessment to ensure that these are aligned with current trainee needs. We describe a stepwise approach to performing a needs assessment following the Delphi process and using a needs assessment formula (NAF) to prioritize technical procedures for simulation training. This technique relies on a panel of experts to gather information and achieve a convergence of opinion. We used three rounds of survey iterations. Round 1: A brainstorming phase to gather all procedures that a newly qualified resident should be able to perform. Round 2: Rating and preliminary prioritization with a NAF including frequency of the procedure, number of doctors, impact, and feasibility. Round 3: Elimination and final prioritization of procedures. The needs assessment identifies and prioritizes procedures for simulation training. It can guide medical educators in the planning of SBT programs to address current trainee needs with the aim of improving the education and training of future doctors.
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Affiliation(s)
- Leizl Joy Nayahangan
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , University of Copenhagen and The Capital Region of Denmark , Copenhagen , Denmark
| | | | - David E Kern
- c School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Lars Konge
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , University of Copenhagen and The Capital Region of Denmark , Copenhagen , Denmark
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24
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Andersen SAW, Konge L, Sørensen MS. The effect of distributed virtual reality simulation training on cognitive load during subsequent dissection training. MEDICAL TEACHER 2018; 40:684-689. [PMID: 29730952 DOI: 10.1080/0142159x.2018.1465182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Complex tasks such as surgical procedures can induce excessive cognitive load (CL), which can have a negative effect on learning, especially for novices. AIM To investigate if repeated and distributed virtual reality (VR) simulation practice induces a lower CL and higher performance in subsequent cadaveric dissection training. METHODS In a prospective, controlled cohort study, 37 residents in otorhinolaryngology received VR simulation training either as additional distributed practice prior to course participation (intervention) (9 participants) or as standard practice during the course (control) (28 participants). Cognitive load was estimated as the relative change in secondary-task reaction time during VR simulation and cadaveric procedures. RESULTS Structured distributed VR simulation practice resulted in lower mean reaction times (32% vs. 47% for the intervention and control group, respectively, p < 0.01) as well as a superior final-product performance during subsequent cadaveric dissection training. CONCLUSIONS Repeated and distributed VR simulation causes a lower CL to be induced when the learning situation is increased in complexity. A suggested mechanism is the formation of mental schemas and reduction of the intrinsic CL. This has potential implications for surgical skills training and suggests that structured, distributed training be systematically implemented in surgical training curricula.
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Affiliation(s)
- Steven Arild Wuyts Andersen
- a Department of Otorhinolaryngology-Head and Neck Surgery , Rigshospitalet , Copenhagen , Denmark
- b Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR , Copenhagen , Denmark
| | - Lars Konge
- b Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR , Copenhagen , Denmark
| | - Mads Sølvsten Sørensen
- a Department of Otorhinolaryngology-Head and Neck Surgery , Rigshospitalet , Copenhagen , Denmark
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25
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Konge L, Petersen RH, Ringsted C. Developing competency in video-assisted thoracic surgery (VATS) lobectomy. J Thorac Dis 2018; 10:S2025-S2028. [PMID: 30023109 DOI: 10.21037/jtd.2018.05.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Horsleben Petersen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Ringsted
- Centre for Health Science Education, Faculty of Health, Aarhus University, Aarhus, Denmark
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26
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Mahmood O, Dagnæs J, Bube S, Rohrsted M, Konge L. Nonspecialist Raters Can Provide Reliable Assessments of Procedural Skills. JOURNAL OF SURGICAL EDUCATION 2018; 75:370-376. [PMID: 28716383 DOI: 10.1016/j.jsurg.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/26/2017] [Accepted: 07/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Competency-based learning has become a crucial component in medical education. Despite the advantages of competency-based learning, there are still challenges that need to be addressed. Currently, the common perception is that specialist assessment is needed for evaluating procedural skills which is difficult owing to the limited availability of faculty time. The aim of this study was to explore the validity of assessments of video recorded procedures performed by nonspecialist raters. METHODS This study was a blinded observational trial. Twenty-three novices (senior medical students) and 9 experienced doctors were video recorded while each performing 2 flexible cystoscopies on patients. The recordings were anonymized and placed in random order and then rated by 2 experienced cystoscopists (specialist raters) and 2 medical students (nonspecialist raters). Flexible cystoscopy was chosen as it is a simple procedural skill that is crucial to master in a resident urology program. RESULTS The internal consistency of assessments was high, Cronbach's α = 0.93 and 0.95 for nonspecialist and specialist raters, respectively (p < 0.001 for both correlations). The interrater reliability was significant (p < 0.001) with a Pearson's correlation of 0.77 for the nonspecialists and 0.75 for the specialists. The test-retest reliability showed the biggest difference between the 2 groups, 0.59 and 0.38 for the nonspecialist raters and the specialist raters, respectively (p < 0.001). CONCLUSION Our study suggests that nonspecialist raters can provide reliable and valid assessments of video recorded cystoscopies. This could make mastery learning and competency-based education more feasible.
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Affiliation(s)
- Oria Mahmood
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; University of Copenhagen, Copenhagen, Denmark.
| | - Julia Dagnæs
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; University of Copenhagen, Copenhagen, Denmark; Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | - Sarah Bube
- University of Copenhagen, Copenhagen, Denmark; Department of Urology, University Hospital Zealand, Roskilde, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Capital Region, Denmark; University of Copenhagen, Copenhagen, Denmark
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Nayahangan LJ, Nielsen KR, Albrecht-Beste E, Bachmann Nielsen M, Paltved C, Lindorff-Larsen KG, Nielsen BU, Konge L. Determining procedures for simulation-based training in radiology: a nationwide needs assessment. Eur Radiol 2018; 28:2319-2327. [PMID: 29318426 DOI: 10.1007/s00330-017-5244-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/03/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES New training modalities such as simulation are widely accepted in radiology; however, development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The study objective was to perform a nationwide needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum. METHODS A needs assessment using the Delphi method was completed among 91 key leaders in radiology. Round 1 identified technical procedures that radiologists should learn. Round 2 explored frequency of procedure, number of radiologists performing the procedure, risk and/or discomfort for patients, and feasibility for simulation. Round 3 was elimination and prioritization of procedures. RESULTS Response rates were 67 %, 70 % and 66 %, respectively. In Round 1, 22 technical procedures were included. Round 2 resulted in pre-prioritization of procedures. In round 3, 13 procedures were included in the final prioritized list. The three highly prioritized procedures were ultrasound-guided (US) histological biopsy and fine-needle aspiration, US-guided needle puncture and catheter drainage, and basic abdominal ultrasound. CONCLUSION A needs assessment identified and prioritized 13 technical procedures to include in a simulation-based curriculum. The list may be used as guide for development of training programs. KEY POINTS • Simulation-based training can supplement training on patients in radiology. • Development of simulation-based training should follow a structured approach. • The CAMES Needs Assessment Formula explores needs for simulation training. • A national Delphi study identified and prioritized procedures suitable for simulation training. • The prioritized list serves as guide for development of courses in radiology.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.
| | - Kristina Rue Nielsen
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth Albrecht-Beste
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Paltved
- MidtSim - Centre for Human Resources, Central Region of Denmark and Aarhus University, Aarhus, Denmark
| | | | - Bjørn Ulrik Nielsen
- Sim-C - the Simulation Centre of Odense University Hospital, Odense, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Muharemovic O, Troelsen A, Thomsen MG, Kallemose T, Gosvig KK. Design and evaluation of learning strategies for a group of radiographers in radiostereometric analysis (RSA). Radiography (Lond) 2017; 23:e80-e86. [PMID: 28965908 DOI: 10.1016/j.radi.2017.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/13/2017] [Accepted: 05/27/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this study was to design and evaluate a radiostereometric analysis (RSA) program aimed at radiographers in order to increase their cognitive and practical skills, thereby increasing image quality and minimizing exposure repetition. METHODS AND MATERIALS Twenty radiographers were randomized into two identically sized study groups. Training consisted of a theoretical and practical workshop using a phantom. Tests were performed to compare the effect of training to nontraining, and the effect of time duration on the maintenance of RSA skills. The effect of training was measured by a written test and three defined parameters influencing image quality. RESULTS Group A reduced significantly (p < 0.001) by 31.3 mm (21-31%) the distance between the centrum of the prosthesis (CP) and the centrum of the calibration field (CCF) and increased the number of beads (NB) visible by 3.6 (out of 18). A further significant reduction of 5.1 mm (p = 0.023), 1.0 bead more (p < 0.001) and a 2.1 (p = 0.022) point better rotation of the prosthesis (RP) was registered two months later. Group B was tested twice without training and no significant improvement was registered. One month after training group B had experienced overall significant improvement on a par with group A. CONCLUSION It is realistic to implement an RSA X-ray training program where radiographers significantly improve their theoretical and practical skills in centering the CP closer to the CCF, NB and RP. A duration of up to two months after training does not influence the quality of participants' performance.
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Affiliation(s)
- O Muharemovic
- Functional and Diagnostic Imaging Department, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - A Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - M G Thomsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - T Kallemose
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Clinical Research Center, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, Hvidovre, 2650, Copenhagen, Denmark.
| | - K K Gosvig
- Functional and Diagnostic Imaging Department, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
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Nayahangan LJ, Bølling Hansen R, Gilboe Lindorff-Larsen K, Paltved C, Nielsen BU, Konge L. Identifying content for simulation-based curricula in urology: a national needs assessment. Scand J Urol 2017; 51:484-490. [DOI: 10.1080/21681805.2017.1352618] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
| | - Rikke Bølling Hansen
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Urology, Gentofte/Herlev Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Charlotte Paltved
- MidtSim – Centre for Human Resources, Central Region of Denmark and Aarhus University, Aarhus, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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3D vision accelerates laparoscopic proficiency and skills are transferable to 2D conditions: A randomized trial. Am J Surg 2017; 214:63-68. [DOI: 10.1016/j.amjsurg.2017.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 02/24/2017] [Accepted: 03/08/2017] [Indexed: 01/15/2023]
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Naur TMH, Konge L, Nayahangan LJ, Clementsen PF. Training and certification in endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Dis 2017; 9:2118-2123. [PMID: 28840013 DOI: 10.21037/jtd.2017.06.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays a key role in the staging of lung cancer, which is crucial for allocation to surgical treatment. EBUS-TBNA is a complicated procedure and simulation-based training is helpful in the first part of the long learning curve prior to performing the procedure on actual patients. New trainees should follow a structured training programme consisting of training on simulators to proficiency as assessed with a validated test followed by supervised practice on patients. The simulation-based training is superior to the traditional apprenticeship model and is recommended in the newest guidelines. EBUS-TBNA and oesophageal ultrasound-guided fine needle aspiration (EUS-FNA or EUS-B-FNA) are complementary to each other and the combined techniques are superior to either technique alone. It is logical to learn and to perform the two techniques in combination, however, for lung cancer staging solely EBUS-TBNA simulators exist, but hopefully in the future simulation-based training in EUS will be possible.
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Affiliation(s)
- Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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Konge L, Svendsen MBS, Preisler L, Svendsen LB, Park YS. Combining different methods improves assessment of competence in colonoscopy. Scand J Gastroenterol 2017; 52:601-605. [PMID: 28270044 DOI: 10.1080/00365521.2017.1289415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To develop a reliable method of assessing competence in colonoscopy based on multiple sources. MATERIALS AND METHODS Physicians with varying degrees of experience in colonoscopy performed two colonoscopies each in a standardized simulated environment. Their performances were assessed under direct observation by an expert rater and by automatic computerized analysis of operator movements and scope movements, respectively. Reliability (Cronbach's alpha) for subjective assessment, time to cecum, analysis of operator movement and analysis of scope movements were calculated. Composite score calculations were used to explore different combinations of the measures. RESULTS Twenty physicians were included in the study. The reliability (Cronbach's alpha) were 0.92, 0.57, 0.87 and 0.55 for the subjective score assessed under direct observation, time to cecum, distance between operator's hands and colonoscopy progression score, respectively. Equal weight (=25%) to all four methods resulted in a reliability of 0.91 and optimal weighting of the methods (55%, 10%, 25% and 10%, respectively) resulted in a maximum reliability of 0.95. CONCLUSION Combining subjective expert ratings with automated objective assessments results in a less biased and more reliable assessment of competence in colonoscopy.
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Affiliation(s)
- Lars Konge
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , The Capital Region of Denmark , Copenhagen , Denmark
| | | | - Louise Preisler
- c Department of Surgery, C-Tx , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lars Bo Svendsen
- c Department of Surgery, C-Tx , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Yoon Soo Park
- d Department of Medical Education , University of Illinois Chicago , Chicago , IL , USA
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Nayahangan L, Konge L, Schroeder T, Paltved C, Lindorff-Larsen K, Nielsen B, Eiberg J. A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training. Eur J Vasc Endovasc Surg 2017; 53:591-599. [DOI: 10.1016/j.ejvs.2017.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/18/2017] [Indexed: 12/20/2022]
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Sørensen JL, Østergaard D, LeBlanc V, Ottesen B, Konge L, Dieckmann P, Van der Vleuten C. Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation. BMC MEDICAL EDUCATION 2017; 17:20. [PMID: 28109296 PMCID: PMC5251301 DOI: 10.1186/s12909-016-0838-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 12/05/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities are called in-house training. In-house training facilities can be part of hospital departments and resemble to some extent simulation centres but often have less technical equipment. In situ simulation, introduced over the past decade, mainly comprises of team-based activities and occurs in patient care units with healthcare professionals in their own working environment. Thus, this intentional blend of simulation and real working environments means that in situ simulation brings simulation to the real working environment and provides training where people work. In situ simulation can be either announced or unannounced, the latter also known as a drill. This article presents and discusses the design of SBME and the advantage and disadvantage of the different simulation settings, such as training in simulation-centres, in-house simulations in hospital departments, announced or unannounced in situ simulations. DISCUSSION Non-randomised studies argue that in situ simulation is more effective for educational purposes than other types of simulation settings. Conversely, the few comparison studies that exist, either randomised or retrospective, show that choice of setting does not seem to influence individual or team learning. However, hospital department-based simulations, such as in-house simulation and in situ simulation, lead to a gain in organisational learning. To our knowledge no studies have compared announced and unannounced in situ simulation. The literature suggests some improved organisational learning from unannounced in situ simulation; however, unannounced in situ simulation was also found to be challenging to plan and conduct, and more stressful among participants. The importance of setting, context and fidelity are discussed. Based on the current limited research we suggest that choice of setting for simulations does not seem to influence individual and team learning. Department-based local simulation, such as simulation in-house and especially in situ simulation, leads to gains in organisational learning. The overall objectives of simulation-based education and factors such as feasibility can help determine choice of simulation setting.
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Affiliation(s)
- Jette Led Sørensen
- Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, 2730 Herlev, Denmark
| | - Vicki LeBlanc
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada
- University of Ottawa Skills and Simulation Centre, The Ottawa Hospital, & University of Ottawa, K1Y 4E9 Ottawa, Canada
| | - Bent Ottesen
- Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Capital Region of Denmark and University of Copenhagen, 2100 Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, 2730 Herlev, Denmark
| | - Cees Van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, Netherlands
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The introduction of emergency cricothyroidotomy simulation training in Zimbabwe contributed to the saving of two lives. The Journal of Laryngology & Otology 2016; 130:923-927. [PMID: 27608941 DOI: 10.1017/s0022215116008719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In developing countries with limited access to ENT services, performing emergency cricothyroidotomy in patients with upper airway obstruction may be a life-saving last resort. An established Danish-Zimbabwean collaboration of otorhinolaryngologists enrolled Zimbabwean doctors into a video-guided simulation training programme on emergency cricothyroidotomy. This paper presents the positive effect of this training, illustrated by two case reports. CASE REPORTS A 56-year-old female presented with upper airway obstruction due to a rapidly progressing infectious swelling of the head and neck progressing to cardiac arrest. Cardiopulmonary resuscitation was initiated and a secure surgical airway was established via an emergency cricothyroidotomy, saving the patient. A 70-year-old male presented with upper airway obstruction secondary to intubation for an elective procedure. When extubated, the patient exhibited severe stridor followed by respiratory arrest. Re-intubation attempts were unsuccessful and emergency cricothyroidotomy was performed to secure the airway, preserving the life of the patient. CONCLUSION Emergency cricothyroidotomy training should be considered for all surgeons, anaesthetists and, eventually, emergency and recovery room personnel in developing countries. A video-guided simulation training programme on emergency cricothyroidotomy in Zimbabwe proved its value in this regard.
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Simulation-based camera navigation training in laparoscopy-a randomized trial. Surg Endosc 2016; 31:2131-2139. [PMID: 27770252 PMCID: PMC5411407 DOI: 10.1007/s00464-016-5210-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/23/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Inexperienced operating assistants are often tasked with the important role of handling camera navigation during laparoscopic surgery. Incorrect handling can lead to poor visualization, increased operating time, and frustration for the operating surgeon-all of which can compromise patient safety. The objectives of this trial were to examine how to train laparoscopic camera navigation and to explore the transfer of skills to the operating room. MATERIALS AND METHODS A randomized, single-center superiority trial with three groups: The first group practiced simulation-based camera navigation tasks (camera group), the second group practiced performing a simulation-based cholecystectomy (procedure group), and the third group received no training (control group). Participants were surgical novices without prior laparoscopic experience. The primary outcome was assessment of camera navigation skills during a laparoscopic cholecystectomy. The secondary outcome was technical skills after training, using a previously developed model for testing camera navigational skills. The exploratory outcome measured participants' motivation toward the task as an operating assistant. RESULTS Thirty-six participants were randomized. No significant difference was found in the primary outcome between the three groups (p = 0.279). The secondary outcome showed no significant difference between the interventions groups, total time 167 s (95% CI, 118-217) and 194 s (95% CI, 152-236) for the camera group and the procedure group, respectively (p = 0.369). Both interventions groups were significantly faster than the control group, 307 s (95% CI, 202-412), p = 0.018 and p = 0.045, respectively. On the exploratory outcome, the control group for two dimensions, interest/enjoyment (p = 0.030) and perceived choice (p = 0.033), had a higher score. CONCLUSIONS Simulation-based training improves the technical skills required for camera navigation, regardless of practicing camera navigation or the procedure itself. Transfer to the clinical setting could, however, not be demonstrated. The control group demonstrated higher interest/enjoyment and perceived choice than the camera group.
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Jensen K, Bjerrum F, Hansen HJ, Petersen RH, Pedersen JH, Konge L. Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy. Surg Endosc 2016; 31:2520-2528. [PMID: 27655381 DOI: 10.1007/s00464-016-5254-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The societies of thoracic surgery are working to incorporate simulation and competency-based assessment into specialty training. One challenge is the development of a simulation-based test, which can be used as an assessment tool. The study objective was to establish validity evidence for a virtual reality simulator test of a video-assisted thoracoscopic surgery (VATS) lobectomy of a right upper lobe. METHODS Participants with varying experience in VATS lobectomy were included. They were familiarized with a virtual reality simulator (LapSim®) and introduced to the steps of the procedure for a VATS right upper lobe lobectomy. The participants performed two VATS lobectomies on the simulator with a 5-min break between attempts. Nineteen pre-defined simulator metrics were recorded. RESULTS Fifty-three participants from nine different countries were included. High internal consistency was found for the metrics with Cronbach's alpha coefficient for standardized items of 0.91. Significant test-retest reliability was found for 15 of the metrics (p-values <0.05). Significant correlations between the metrics and the participants VATS lobectomy experience were identified for seven metrics (p-values <0.001), and 10 metrics showed significant differences between novices (0 VATS lobectomies performed) and experienced surgeons (>50 VATS lobectomies performed). A pass/fail level defined as approximately one standard deviation from the mean metric scores for experienced surgeons passed none of the novices (0 % false positives) and failed four of the experienced surgeons (29 % false negatives). CONCLUSION This study is the first to establish validity evidence for a VATS right upper lobe lobectomy virtual reality simulator test. Several simulator metrics demonstrated significant differences between novices and experienced surgeons and pass/fail criteria for the test were set with acceptable consequences. This test can be used as a first step in assessing thoracic surgery trainees' VATS lobectomy competency.
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Affiliation(s)
- Katrine Jensen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. .,Copenhagen Academy for Medical Education and Simulation (CAMES), Section 5404, University of Copenhagen and Capital Region, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark.
| | - Flemming Bjerrum
- JMC Simulation Unit, The Juliane Marie Centre, Section 4704, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Holst Pedersen
- Department of Cardiothoracic Surgery, Sect. 2152, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Section 5404, University of Copenhagen and Capital Region, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
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Thinggaard E, Konge L, Bjerrum F, Strandbygaard J, Gögenur I, Spanager L. Take-home training in a simulation-based laparoscopy course. Surg Endosc 2016; 31:1738-1745. [PMID: 27515838 DOI: 10.1007/s00464-016-5166-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/30/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Simulation training can prepare trainees for clinical practice in laparoscopic surgery. Training on box trainers allows for simulation training at home, which studies have shown to be a feasible method of training. However, little research has been conducted into how to make it a more efficient method of training. Our aim was to investigate how box trainers are used in take-home training to help guide the design of take-home training courses. METHODS This study was designed using a mixed methods approach. Junior doctors participating in a laparoscopy curriculum, which included practising at home on box trainers, were invited. Quantitative data on training patterns was collected from logbooks. Qualitative data on the use of box trainers was retrieved from focus groups and individual interviews. RESULTS From logbooks, we found that 14 out of 18 junior doctors mixed their training modalities, and four practised first on box trainers then on virtual reality simulators. Twelve practised only at home, while five practised at both places and one practised solely at the simulation centre. After a delayed start, most practised for some time, then had a period without training and then started training again towards the end of the course. We found that the themes of the interviews were: training method, training pattern, feedback and self-regulation. Participants identified the lack of feedback as challenging but described how self-rating provided direction during unsupervised training. Mandatory training elements affected when and how much participants practised. CONCLUSIONS When participants practised at home, they took an individualised approach to training. They mixed their training at home with training at the simulation centre. Participants practised at the beginning and towards the end of the course. Self-rating helped to guide unsupervised training where feedback was not accessible. Curricular requirements and testing determined when and how much participants practised.
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Affiliation(s)
- Ebbe Thinggaard
- Copenhagen Academy for Medical Education and Simulation, Capital Region Denmark, Copenhagen, Denmark.
- Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark.
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region Denmark, Copenhagen, Denmark
| | - Flemming Bjerrum
- Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark
| | | | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark
| | - Lene Spanager
- Department of Surgery, Nordsjaellands Hospital, Hilleroed, Denmark
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Sørensen SMD, Mahmood O, Konge L, Thinggaard E, Bjerrum F. Laser visual guidance versus two-dimensional vision in laparoscopy: a randomized trial. Surg Endosc 2016; 31:112-118. [PMID: 27317036 PMCID: PMC5216078 DOI: 10.1007/s00464-016-4937-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/09/2016] [Indexed: 12/04/2022]
Abstract
Background During laparoscopy, the surgeon’s loss of depth perception and spatial orientation is problematic. Laser visual guidance (LVG) is an innovative technology that improves depth perception to enhance the visual field. In this trial, we examined the effect of LVG on surgical novices’ motor skills, quality of task performance, and cognitive workload. Methods We designed a randomized controlled trial following the CONSORT statement. Thirty-two surgical novices completed the Training and Assessment of Basic Laparoscopic Techniques (TABLT) test. The first attempt allowed participants to familiarize themselves with the exercises. We then randomized the participants, and they completed a test session using either LVG or conventional two-dimensional vision. Results We found no significant difference between using the LVG tool and conventional 2D vision; however, both the mean completion time and movements used were less in the LVG group: Mean time used in the LVG group was 1288 s (95 % CI 1188–1388) versus 1354 s (95 % CI 1190–1518) (p = 0.45); mean angular path length used in the LVG group was 24,049° (95 % CI 20,761–27,336) versus 26,014° (95 % CI 22,059–29,970) (p = 0.42); mean path length in the LVG group was 4560 cm (95 % CI 3971–5,149 cm) versus 5062 cm (95 % CI 4328–5797), (p = 0.26). Moreover, the mean TABLT performance score was higher in the LVG group compared with the 2D group, although not significant: 379 (95 % CI 352–405) versus 338 (95 % CI 288–387) (p = 0.14). No significant difference was found between the groups’ cognitive workloads. Conclusion We found no significant improvement of laparoscopic motor skills when using LVG, although a tendency toward improved performance was seen. LVG could have the potential to help novice surgeons acquire basic laparoscopic; however, further development of the concept and validation is needed to confirm this.
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Affiliation(s)
- Stine Maya Dreier Sørensen
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark. .,University of Copenhagen, Copenhagen, Denmark.
| | - Oria Mahmood
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Ebbe Thinggaard
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Capital Region of Denmark, Denmark.,University of Copenhagen, Copenhagen, Denmark.,Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - Flemming Bjerrum
- University of Copenhagen, Copenhagen, Denmark.,Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
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Nayahangan LJ, Clementsen PF, Paltved C, Lindorff-Larsen KG, Nielsen BU, Konge L. Identifying Technical Procedures in Pulmonary Medicine That Should Be Integrated in a Simulation-Based Curriculum: A National General Needs Assessment. Respiration 2016; 91:517-22. [PMID: 27287472 DOI: 10.1159/000446926] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Simulation training is a revolutionary addition to health care education. However, developing simulation-based training programs is often dictated by those simulators that are commercially available. Curriculum development requires deliberate planning and a standardized approach, including a 'general needs assessment'. OBJECTIVES The aim of this study was to perform a national general needs assessment to identify technical procedures in pulmonary medicine that should be integrated in a simulation-based curriculum. METHODS A three-round Delphi process was initiated among 62 key opinion leaders. Round 1 was an open-ended question to identify technical procedures pulmonologists should learn. Round 2 was a survey using a newly developed needs assessment formula to explore the frequency of procedures, number of operators, risk or discomfort when performed by an inexperienced doctor, and feasibility of simulation-based training. In round 3, results were reviewed and ranked according to priority. RESULTS The response rates for the three rounds were 74, 63, and 60%, respectively. The Delphi process reduced the 30 procedures identified in round 1 to 11 prioritized technical procedures in round 3. These were: flexible bronchoscopy, pleurocentesis, endobronchial ultrasound, endoscopic ultrasound-guided fine-needle aspiration, noninvasive ventilation treatment, transthoracic biopsy of pleural or lung tumor, focused ultrasound scanning of the lungs, chest tube insertion, needle biopsy of visible lymph node/tumor of the skin, focused ultrasound scanning of the heart, and thoracoscopy. CONCLUSION We performed a Delphi study using a needs assessment formula, which identified 11 technical procedures that are highly suitable for simulation-based training. Medical educators can use this list as a resource in planning simulation-based training programs for trainees in pulmonary medicine.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
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Andersen SAW, Mikkelsen PT, Konge L, Cayé-Thomasen P, Sørensen MS. The effect of implementing cognitive load theory-based design principles in virtual reality simulation training of surgical skills: a randomized controlled trial. Adv Simul (Lond) 2016; 1:20. [PMID: 29449989 PMCID: PMC5806310 DOI: 10.1186/s41077-016-0022-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/01/2016] [Indexed: 01/07/2023] Open
Abstract
Background Cognitive overload can inhibit learning, and cognitive load theory-based instructional design principles can be used to optimize learning situations. This study aims to investigate the effect of implementing cognitive load theory-based design principles in virtual reality simulation training of mastoidectomy. Methods Eighteen novice medical students received 1 h of self-directed virtual reality simulation training of the mastoidectomy procedure randomized for standard instructions (control) or cognitive load theory-based instructions with a worked example followed by a problem completion exercise (intervention). Participants then completed two post-training virtual procedures for assessment and comparison. Cognitive load during the post-training procedures was estimated by reaction time testing on an integrated secondary task. Final-product analysis by two blinded expert raters was used to assess the virtual mastoidectomy performances. Results Participants in the intervention group had a significantly increased cognitive load during the post-training procedures compared with the control group (52 vs. 41 %, p = 0.02). This was also reflected in the final-product performance: the intervention group had a significantly lower final-product score than the control group (13.0 vs. 15.4, p < 0.005). Conclusions Initial instruction using worked examples followed by a problem completion exercise did not reduce the cognitive load or improve the performance of the following procedures in novices. Increased cognitive load when part tasks needed to be integrated in the post-training procedures could be a possible explanation for this. Other instructional designs and methods are needed to lower the cognitive load and improve the performance in virtual reality surgical simulation training of novices.
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Affiliation(s)
- Steven Arild Wuyts Andersen
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Blegdamsvej 9, 2100 Copenhagen, The Capital Region of Denmark Denmark
| | - Per Cayé-Thomasen
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mads Sølvsten Sørensen
- 1Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Bjerrum F, Sorensen JL, Thinggaard J, Strandbygaard J, Konge L. Implementation of a Cross-specialty Training Program in Basic Laparoscopy. JSLS 2016; 19:JSLS.2015.00059. [PMID: 26527858 PMCID: PMC4622477 DOI: 10.4293/jsls.2015.00059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background and Objectives: Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the implementation of a regional cross-specialty training program for basic laparoscopy, to increase the flexibility of educational courses, and to provide a more efficient use of simulation equipment. Methods: Using a regional training program in basic laparoscopy for gynecology as a model, we developed a cross-specialty training program for residents in surgery, gynecology, urology, and thoracic surgery. We reviewed data on training for the first year of the program and evaluated the program by using a scoring system for quality criteria for laparoscopic curricula and skills. Results: We held 6 full-day theoretical courses involving 67 residents between September 1, 2013, and August 31, 2014. In the weeks following each course, residents practiced in a self-directed, distributed, and proficiency-based manner at a simulation center and in local hospital departments. A total of 57 residents completed the self-practice and a subsequent practical animal laboratory–based course. The structure of the training program was evaluated according to identified quality criteria for a skills laboratory, and the program scored 38 of a maximum 62 points. Discussion: Implementation of a regional cross-specialty training program in basic laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up.
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Affiliation(s)
- Flemming Bjerrum
- Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - Jette Led Sorensen
- Department of Obstetrics and Gynecology, The Juliane Marie Centre for Children, Women, and Reproduction, Rigshospitalet
| | - Jette Thinggaard
- Department of Surgery, Roskilde and Koege Hospital, Koege, Denmark
| | - Jeanett Strandbygaard
- Department of Obstetrics and Gynecology, The Juliane Marie Centre for Children, Women, and Reproduction, Rigshospitalet
| | - Lars Konge
- Centre for Clinical Education, Capital Region, University of Copenhagen, Copenhagen, Denmark
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Konge L, Lonn L. Simulation-based training of surgical skills. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:3-4. [PMID: 26797929 PMCID: PMC4754214 DOI: 10.1007/s40037-016-0251-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- L Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Rigshospitalet, and University of Copenhagen, Copenhagen, Denmark.
| | - L Lonn
- Departments of Radiology and Vascular Surgery, Rigshospitalet, and University of Copenhagen, Copenhagen, Denmark
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Bjerrum F, Sorensen JL, Konge L, Rosthøj S, Lindschou J, Ottesen B, Strandbygaard J. Randomized trial to examine procedure-to-procedure transfer in laparoscopic simulator training. Br J Surg 2015; 103:44-50. [DOI: 10.1002/bjs.9966] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/18/2015] [Accepted: 09/04/2015] [Indexed: 01/22/2023]
Abstract
Abstract
Background
Laparoscopic simulation has become a standard component of surgical training, but there is limited knowledge regarding skills transfer between procedural tasks. The objective was to investigate the specificity of procedural simulator training.
Methods
This was randomized single-centre educational superiority trial. Surgical novices practised basic skills on a laparoscopic virtual reality simulator. On reaching proficiency, participants were randomized to proficiency-based training. The intervention group practised two procedures on the simulator (appendicectomy followed by salpingectomy), whereas the control group trained on only one procedure (salpingectomy). The main outcomes were number of repetitions and time to proficiency for the second procedure.
Results
Ninety-six participants were randomized, of whom 74 per cent were women, with a median age of 26 years. The intervention group needed significantly fewer attempts than the control group to reach proficiency in the second procedure: median (i.q.r.) 22 (17–34) versus 32 (26–41) attempts, which corresponded to 24·1 per cent fewer attempts as assessed by multivariable analysis (P = 0·004). The intervention group required significantly less time than the control group to reach proficiency: median (i.q.r.) 88 (63–127) versus 131 (101–153) min respectively, corresponding to a difference of 31·1 min as assessed by multivariable analysis (P = 0·001).
Conclusion
Practising two procedures, compared with only one, reduced the number of attempts and time to reach proficiency in the second procedure. Skills transfer is seen between two tasks in laparoscopic simulator training; however, task specificity is still present when practising procedures. Registration number: NCT02069951 (http://www.clinicaltrials.gov).
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Affiliation(s)
- F Bjerrum
- Department of Obstetrics and Gynaecology, The Juliane Marie Centre for Children, Women and Reproduction, Copenhagen, Denmark
| | - J L Sorensen
- Department of Obstetrics and Gynaecology, The Juliane Marie Centre for Children, Women and Reproduction, Copenhagen, Denmark
| | - L Konge
- Centre for Clinical Education, Simulationscenter Rigshospitalet, Capital Region, Copenhagen, Denmark
| | - S Rosthøj
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Ottesen
- Department of Obstetrics and Gynaecology, The Juliane Marie Centre for Children, Women and Reproduction, Copenhagen, Denmark
| | - J Strandbygaard
- Department of Obstetrics and Gynaecology, The Juliane Marie Centre for Children, Women and Reproduction, Copenhagen, Denmark
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