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Zhou Y, Gao H, Wang Q, Zhi J, Liu Q, Xia W, Duan Q, Yang D. Impact of simulation-based training on bougie-assisted cricothyrotomy technique: a quasi-experimental study. BMC MEDICAL EDUCATION 2024; 24:356. [PMID: 38553688 PMCID: PMC10981348 DOI: 10.1186/s12909-024-05285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Cricothyrotomy is a lifesaving surgical technique in critical airway events. However, a large proportion of anesthesiologists have little experience with cricothyrotomy due to its low incidence. This study aimed to develop a multisensory, readily available training curriculum for learning cricothyrotomy and evaluate its training effectiveness. METHODS Seventy board-certificated anesthesiologists were recruited into the study. Participants first viewed an instructional video and observed an expert performing the bougie-assisted cricothyrotomy on a self-made simulator. They were tested before and after a one-hour practice on their cricothyrotomy skills and evaluated by a checklist and a global rating scale (GRS). Additionally, a questionnaire survey regarding participants' confidence in performing cricothyrotomy was conducted during the training session. RESULTS The duration to complete cricothyrotomy was decreased from the pretest (median = 85.0 s, IQR = 72.5-103.0 s) to the posttest (median = 59.0 s, IQR = 49.0-69.0 s). Furthermore, the median checklist score was increased significantly from the pretest (median = 30.0, IQR = 27.0-33.5) to the posttest (median = 37.0, IQR = 35.5-39.0), as well as the GRS score (pretest median = 22.5, IQR = 18.0-25.0, posttest median = 32.0, IQR = 31.0-33.5). Participants' confidence levels in performing cricothyrotomy also improved after the curriculum. CONCLUSION The simulation-based training with a self-made simulator is effective for teaching anesthesiologists to perform cricothyrotomy.
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Affiliation(s)
- Ying Zhou
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Huibin Gao
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Qianyu Wang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Juan Zhi
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Quanle Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Weipeng Xia
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Qirui Duan
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China.
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Nour MG, Moradi EV, AlJamal YN, Arghami A, Sadrzadeh SM, Assadi R. Evaluation of the Educational Value of Low-Cost Training Model for Emergency Cricothyrotomy. Surg Innov 2023; 30:383-389. [PMID: 37002547 DOI: 10.1177/15533506231162992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND In this study, we aimed to evaluate the educational value and students' satisfaction with the hand-made low-cost cricothyrotomy simulation model. MATERIALS AND METHODS A low-cost and hand-made model and a high-fidelity model were used to assess the students. The students' knowledge and satisfaction were evaluated using a 10-item checklist and a satisfaction questionnaire, respectively. Medical interns in the present study participated in a two-hour briefing and debriefing session held in the Clinical Skills Training Center by an emergency attending doctor. RESULTS Based on the results of data analysis, no significant differences were found between the two groups in terms of gender, age, the month of internship, and last semester's grade (P = .628, .356, .847, and .421, respectively). We also found no significant differences between our groups in terms of the median score of each item in the assessment checklist (P = .838, .736, .805, .172, .439, .823, .243, .950, .812, and .756, respectively). The study groups had no significant difference in the median total scores of the checklist as well (P = .504). Regarding the students' satisfaction, our results showed that interns evaluated their experience of the model as positive (median scores of 4 and 5 out of 5). They also gave the hand-made model a median score of 7 in comparison with the high-fidelity model and 8 out of 10 for its usability. CONCLUSION The study results showed that a low-cost model could be as effective as an expensive high-fidelity model for teaching the necessary knowledge of cricothyrotomy techniques to medical trainees.
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Affiliation(s)
- Mohammad G Nour
- E-Learning Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elnaz V Moradi
- Emergency Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yazan N AlJamal
- Department of Cardiac Surgery, Mayo Clinic, Rochester, MN, USA
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sayyed M Sadrzadeh
- Emergency Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Assadi
- E-Learning Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Berdida DJE, Elero FSL, Donato MFT, Dungo MKS, Dunque NIO, Dy KJE, Elarmo RAGF, Espineli JMB, Espineli VJG. Filipino nursing students' use of low-cost simulators during the COVID-19 pandemic: A summative content analysis of YouTube videos. TEACHING AND LEARNING IN NURSING : OFFICIAL JOURNAL OF THE NATIONAL ORGANIZATION FOR ASSCIATE DEGREE NURSING 2023; 18:134-143. [PMID: 35999891 PMCID: PMC9388447 DOI: 10.1016/j.teln.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 02/08/2023]
Abstract
This study examined Filipino nursing students' use of household materials as low-cost simulators and how they aid in online return demonstrations. Summative content analysis guided this study. We collected uploaded YouTube videos (n = 14) depicting Filipino nursing students using low-cost simulators in their skills demonstration. We used Bengtsson's approach to content analysis to analyze the data. Four themes of low-cost simulators were identified: home and hardware, health and beauty, creative articles, and entertainment. The categories under home and hardware were tools, containers, furniture, and packaging. Health and beauty low-cost simulators were toiletries and medical supplies. Creative articles included fabrics, clothing accessories, and stationeries. Entertainment low-cost-simulators had toys and computer accessories. During the COVID-19 pandemic, our research uncovered home equipment employed as low-cost simulators to help nursing students' online simulation of skills demonstration. We recommend further investigation of whether students learned using low-cost simulators.
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Tankard KA, Sharifpour M, Chang MG, Bittner EA. Design and Implementation of Airway Response Teams to Improve the Practice of Emergency Airway Management. J Clin Med 2022; 11:6336. [PMID: 36362564 PMCID: PMC9656324 DOI: 10.3390/jcm11216336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 09/11/2023] Open
Abstract
Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms that guide clinical decision-making, the practice of EAM is associated with significant morbidity and mortality. Evidence suggests that a dedicated airway response team (ART) can help mitigate the risks associated with EAM and provide a framework for airway management in acute settings. We review the risks and challenges related to EAM and describe strategies to improve patient care and outcomes via implementation of an ART.
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Affiliation(s)
- Kelly A. Tankard
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Milad Sharifpour
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA 90048, USA
| | - Marvin G. Chang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Edward A. Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
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Traynor MD, Owino J, Rivera M, Parker RK, White RE, Steffes BC, Chikoya L, Matsumoto JM, Moir CR. Surgical Simulation in East, Central, and Southern Africa: A Multinational Survey. JOURNAL OF SURGICAL EDUCATION 2021; 78:1644-1654. [PMID: 33487586 DOI: 10.1016/j.jsurg.2021.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND High-income countries have increased the use of simulation-based training and assessment for surgical education. Learners in low- and middle-income countries may have different educational needs and levels of autonomy but they and their patients could equally benefit from the procedural training simulation provides. We sought to characterize the current state of surgical skills simulation in East, Central, and Southern Africa and determine residents' perception and future interest in such activities. METHODS A survey was created via collaboration and revision between trainees and educators with experiences spanning high-income countries and low- and middle-income countries. The survey was administered on paper to 76 trainees (PGY2-3) who were completing the College of Surgeons of East, Central, and Southern Africa (COSECSA) Membership of the College of Surgeons examination in Kampala, Uganda in December 2019. Data from paper responses were summarized using descriptive statistics and frequencies. RESULTS We received responses from 43 trainees (57%) from 11 countries in sub-Saharan Africa who participated in the examination. Fifty-eight percent of respondents reported having dedicated space for surgical skills simulation training, and most (91%) had participated in some form of simulation activity at some point in their training. However, just 16% used simulation as a regular part of training. The majority of trainees (90%) felt that surgical skills learned in simulation were transferrable to the operating room and agreed it should be a required part of training. Seventy-one percent of trainees felt that simulation could objectively measure technical skills, and 73% percent of respondents agreed that simulation should be integrated into formal assessment. However, residents split on whether proficiency in simulation should be achieved prior to operative experience (54%) and if nontechnical skills could be measured (51%). The most common cited barriers to the integration of surgical simulation into residents' education were lack of suitable tools and models (85%), funding (73%), and maintenance of facilities (49%). CONCLUSIONS Residents from East, Central, and Southern Africa strongly agree that simulation is a valuable educational tool and ought to be required during their surgical residency. Barriers to achieving this goal include availability of affordable tools, adequate funding and confidence in the value of the educational experience. Trainees affirm further efforts are necessary to make simulation more widely available in these contexts.
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Affiliation(s)
| | - June Owino
- Department of Surgery, Tenwek Hospital, Bomet, Kenya; Pan-African Academy of Christian Surgeons, Palatine, Illinois
| | - Mariela Rivera
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert K Parker
- Department of Surgery, Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island; Pan-African Academy of Christian Surgeons, Palatine, Illinois
| | - Russell E White
- Department of Surgery, Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island; Pan-African Academy of Christian Surgeons, Palatine, Illinois
| | - Bruce C Steffes
- Pan-African Academy of Christian Surgeons, Palatine, Illinois
| | - Laston Chikoya
- Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | | | - Christopher R Moir
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; Pan-African Academy of Christian Surgeons, Palatine, Illinois.
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Bhalla S, Beegun I, Hogan C, Awad Z, Tolley N. Emergency airway training: "Who are you going to FONA?". Clin Otolaryngol 2020; 45:889-895. [PMID: 32741121 DOI: 10.1111/coa.13621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/22/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To demonstrate face and content validity of a home-made simulation model as a training tool for front of neck access (FONA) procedures. DESIGN This was a prospective evaluation study, in which experienced otolaryngologists and trainees were recruited to complete 3 tasks using our FONA model. SETTING The study was completed during regular simulation training days and international conferences. PARTICIPANTS A total of 52 participants completed the questionnaire and were included in the study; 25 were experts and 27 were trainees. MAIN OUTCOME MEASURES All participants completed a validated 15-item questionnaire using a 5-point likert scale to assess the model across 4 domains: face validity (FV), global content (GC), task-specific content (TSC) and curriculum applicability (CTR). RESULTS There were no statistically significant differences between the groups ratings for FV, GC, TSC or CTR (P = .76, .13, .4 and .67, respectively). The model achieved a median FV of 4 (IQR 4-5) with the agreement of experienced and trainee groups (68.9% and 92%, respectively). The median GC validity score was 5 (IQR 4-5) with the agreement of 87.6% and 98.4% in respected groups. The model achieved a median TSC of 4.8 (IQR 4-5) with the agreement of 54.5% and 99% in respected groups. The median CTR score was 5 (IQR 4-5) with the agreement of 54.4% and 100% in respected groups. CONCLUSION Our home-made FONA model achieved face and content validity for training and is safe and affordable for teaching basic front of neck access skills to otolaryngology trainees.
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Affiliation(s)
- Sanjana Bhalla
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Issa Beegun
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Chris Hogan
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Zaid Awad
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Neil Tolley
- Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
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Ozkaya Senuren C, Yaylaci S, Kayayurt K, Aldinc H, Gun C, Şimşek P, Tatli O, Turkmen S. Developing Cricothyroidotomy Skills Using a Biomaterial-Covered Model. Wilderness Environ Med 2020; 31:291-297. [PMID: 32855020 DOI: 10.1016/j.wem.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Cricothyroidotomy is an advanced and life-saving technique, but it is also a rare and a difficult procedure. The purpose of the present study was to produce a low-cost simulation model with realistic anatomic features to investigate its effectiveness in developing cricothyroidotomy skills. METHODS This study was performed at a university simulation center with 57 second-year student paramedics and a cricothyroidotomy simulation model. Total scores were assessed using a checklist. This consisted of 13 steps and was scored as misapplication/omission=0, correct performance and timing with hesitation=1, and correct performance and timing without hesitation=2. One of these steps, local anesthesia of the area if time is available, was not performed owing to time limitations. The highest possible score was 24. Data are presented as mean±SD with range, as appropriate. Normal distribution was evaluated using the Kolmogorov-Smirnov test, Student t test, and Mann-Whitney U test, and correlation analysis was used for statistical analysis. RESULTS Students completed the cricothyroidotomy procedure steps in 116±46 (55-238) s. At performance assessment, the score achieved was 12±5 (2-24). The highest total score of 24 was achieved by 3 students (5%). Total scores exhibited negative and significant correlation with procedure time (r=-0.403, P=0.002). CONCLUSIONS The model developed in this study is an inexpensive and effective method that can be used in cricothyroidotomy training for student paramedics. We think that repeating the cricothyroidotomy procedure on the model will increase success levels.
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Affiliation(s)
- Cigdem Ozkaya Senuren
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - Serpil Yaylaci
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Kamil Kayayurt
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Hasan Aldinc
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cem Gun
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Perihan Şimşek
- Department of Nursing, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Ozgur Tatli
- Department of Emergency Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Suha Turkmen
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Hamad Medical Corporation, Emergency Department, Doha, Qatar
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Gottlieb M, Landry A, Egan DJ, Shappell E, Bailitz J, Horowitz R, Fix M. Rethinking Residency Conferences in the Era of COVID-19. AEM EDUCATION AND TRAINING 2020; 4:313-317. [PMID: 32704605 PMCID: PMC7369491 DOI: 10.1002/aet2.10449] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 05/06/2023]
Abstract
The COVID-19 pandemic requires a substantial change to the traditional approach to conference didactics. Switching to a virtual medium for conference sessions presents several challenges, particularly with regard to aspects that rely heavily on in-person components (e.g., simulation, ultrasound). This paper will discuss the challenges and strategies to address them for conference planning in the era of COVID-19.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoIL
| | - Adaira Landry
- Department of Emergency MedicineBrigham and Women's HospitalBostonMA
| | - Daniel J. Egan
- Department of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew York CityNY
| | - Eric Shappell
- Department of Emergency MedicineMassachusetts General HospitalBostonMA
| | - John Bailitz
- Department of Emergency MedicineNorthwestern Memorial HospitalChicagoIL
| | - Russ Horowitz
- Department of Emergency MedicineLurie Children's HospitalChicagoIL
| | - Megan Fix
- Department of Emergency MedicineUniversity of Utah School of MedicineSalt Lake CityUT
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Urdiales AIA, Struck GT, Guetter CR, Yaegashi CH, Temperly KS, Abreu P, Tomasich FS, Campos ACL. Surgical cricothyroidostomy. Analysis and comparison between teaching and validation models of simulator models. ACTA ACUST UNITED AC 2020; 47:e20202522. [PMID: 32520132 DOI: 10.1590/0100-6991e-20202522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE to compare the acquisition and retention of knowledge about surgical cricothyroidostomy by the rapid four-step technique (RFST), when taught by expository lecture, low fidelity and high-fidelity simulation models. METHODS ninety medical students at UFPR in the first years of training were randomized assigned into 3 groups, submitted to different teaching methods: 1) expository lectures, 2) low-fidelity simulator model, developed by the research team or 3) high-fidelity simulator model (commercial). The procedure chosen was surgical cricothyroidostomy using the RFST. Soon after lectures, the groups were submitted to a multiple-choice test with 20 questions (P1). Four months later, they underwent another test (P2) with similar content. Analysis of Variance was used to compare the grades of each group in P1 with their grades in P2, and the grades of the 3 groups 2 by 2 in P1 and P2. A multiple comparisons test (post-hoc) was used to check differences within each factor (test and group). Statistical significance was considered when p<0.05. Statistical analysis was performed in the statistical software R version 3.6.1. RESULTS each group was composed of 30 medical students, without demographic differences between them. The mean scores of the groups of the expositive lecture, of the simulator of low fidelity model and of high-fidelity simulator model in P1 were, respectively, 75.00, 76.09, and 68.79, (p<0.05). In P2 the grades were 69.84, 75.32, 69.46, respectively, (p>0.05). CONCLUSIONS the simulation of low fidelity model was more effective in learning and knowledge retention, being feasible for RFST cricothyroidostomy training in inexperienced students.
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Affiliation(s)
- Akihito Inca Atahualpa Urdiales
- - Hospital do Trabalhador/Federal University of Paraná, Department of Integrated Medicine - Curitiba - PR - Brazil.,- Hospital do Trabalhador/Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil.,- Federal University of Paraná, Postgraduate Program in Surgical Clinic - Curitiba - PR - Brazil
| | | | | | - Cecilia Hissai Yaegashi
- - Cajuru University Hospital- Pontifical Catholic University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| | - Kassio Silva Temperly
- - Pontifical Catholic University of Paraná, Course of Medicina - Curitiba - PR - Brazil
| | - Phillipe Abreu
- - Hospital do Trabalhador/Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| | - Flavio Saavedra Tomasich
- - Hospital do Trabalhador/Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil.,- Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil
| | - Antônio Carlos Ligocki Campos
- - Federal University of Paraná, Postgraduate Program in Surgical Clinic - Curitiba - PR - Brazil.,- Federal University of Paraná, Department of Surgery - Curitiba - PR - Brazil
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Bhalla S, Tolley N, Awad Z. Creating a Validated Simulation Training Curriculum in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose of Review
Simulation-based training is an integral component of surgical training. It allows practice of technical skills within a safe environment without compromising patient safety. This article seeks to review current virtual and non-virtual reality simulation models within the literature and review their validation status.
Recent Findings
Many simulation models exist within otolaryngology and are currently being used for education. New models are also continuously being developed; however, validity should be proven for the models before incorporating their use for educational purposes. Validity should be determined by experts and trainees themselves.
Summary
A validated simulation curriculum should be incorporated within the otolaryngology training programme. A curriculum based on the current training programme at our institution serves as an exemplar for local adoption.
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Rajesh A, Asaad M, Chandra A, Rivera M, Stulak JM, Heller SF, Farley DR. What Do Former Residents Say About Their Nondesignated Preliminary Year? A Survey of Prelims' Experiences in a General Surgery Residency Program. JOURNAL OF SURGICAL EDUCATION 2020; 77:281-290. [PMID: 31677981 DOI: 10.1016/j.jsurg.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The nondesignated preliminary (NDP) position in general surgery (GS) offers a 1-year surgical training opportunity for medical school graduates prior to obtaining categorical residency positions. Given that there is little long-term follow-up on the experiences of NDP residents, we sought to determine how NDPs felt about their intern year in GS. DESIGN A cross-sectional survey of all NDP GS interns from 1993 to 2018. SETTING Academic, tertiary care center with a large GS residency program (Mayo Clinic, Rochester, MN). PARTICIPANTS NDP GS interns (n = 151). RESULTS Two-hundred and four surveys were emailed and 151 (62%) former NDP residents responded. Exposure to diverse pathology (85%), opportunity to work with experts (85%) and operative experience (72%) were the top 3 positive experiences from the NDP year. The uncertainty of being an NDP resident (78%) and experience compared to categorical counterparts (32%) were cited as the top 2 negative experiences. While 73% (n = 110) considered their NDP year to have laid a "strong" foundation for their future career, most respondents felt that the year was stressful and suggested improving mentoring and support for preliminary residents. Eighty-two percent (n = 124) of respondents stated that, they would be willing to redo their preliminary year. Fifty-four percent (n = 82) of respondents stated that they might have preferred a categorical position at a smaller institution versus a preliminary year. Forty percent of respondents (n = 60) reported fewer interviews and 24% (n = 36) reported a similar number of interviews offered when applying to the Match as a PGY1 prelim resident. CONCLUSIONS Pursuing the NDP year is difficult, given the uncertainty that looms and the immense pressure to perform well. While the vast majority of our NDPs obtained categorical residency spots following their 1 year of training, feedback from this survey using 25 years of experience suggests that we can and should do more to mentor, support, and assist these residents.
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Affiliation(s)
- Aashish Rajesh
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Malke Asaad
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mariela Rivera
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - John M Stulak
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - David R Farley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Katayama A, Watanabe K, Tokumine J, Lefor AK, Nakazawa H, Jimbo I, Yorozu T. Cricothyroidotomy needle length is associated with posterior tracheal wall injury: A randomized crossover simulation study (CONSORT). Medicine (Baltimore) 2020; 99:e19331. [PMID: 32118765 PMCID: PMC7478458 DOI: 10.1097/md.0000000000019331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cricothyroidotomy is the final strategy in the "cannot intubate, cannot oxygenate" scenario, but half of needle cricothyroidotomy attempts result in failure. The most frequent complication in needle cricothyroidotomy is posterior tracheal wall injury. We hypothesized that needle length is related to posterior wall injury and compared needle cricothyroidotomy with a commercial kit to a modified shorter needle to evaluate success and posterior wall injury rates. METHODS The commercial kit has a needle stopper to prevent posterior wall injury, with a penetrating length of 25 mm. We made long stopper to shorten the length by 5 mm (net 20 mm penetrating length). Residents were recruited, received a lecture about cricothyroidotomy and practiced needle cricothyroidotomy using the commercial kit on a simulator. They then performed cricothyroidotomy using the commercial kit or the shorter needle on an ex-vivo porcine larynx covered with artificial skin. An intra-tracheal endoscope recorded the procedure. The video was evaluated for success/failure or posterior wall injury by independent evaluators. Larynxes with a distance from the outer surface to the inner lumen exceeding 13 mm were excluded. The distance in each larynx was measured by dissection after the study. Success and posterior wall injury rates were analyzed using Fisher exact test (P < .05 was statistically significant). RESULTS Forty-seven residents participated in the study. Data for two residents were excluded. There was no statistically significant difference in success rate between the commercial kit (100%, 45/45) and the shorter needle (91%, 41/45, P = .12). Failure was defined if the needle tip did not reach the lumen in four trials. Cannulated but complicated by posterior wall injury occurred in 33% (15/45) with the commercial kit and 5% (2/43) with the shorter needle (P < .01). CONCLUSION During needle cricothyroidotomy, force is needed for the needle to penetrate the cricothyroid ligament. The advancing needle sometimes cannot be stopped after penetrating the cricothyroid ligament. These data suggest that needle length is associated with posterior wall injury.
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Affiliation(s)
- Atsuko Katayama
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Kunitaro Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | | | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Ippei Jimbo
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
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Bittner EA, Schmidt U. Examining the Learning Practice of Emergency Airway Management Within an Academic Medical Center: Implications for Training and Improving Outcomes. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520965257. [PMID: 33134549 PMCID: PMC7576904 DOI: 10.1177/2382120520965257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
Emergency airway management (EAM) is a "high stakes" clinical practice, associated with a significant risk of procedure-related complications and patient mortality. Learning within the EAM team practice is complex and challenging for trainees. Increasing concern for patient safety and changes in the structure of medical education have resulted in educational challenges and opportunities for improvement within the EAM team practice. This paper is divided into 3 sections that describe the past, present, and future of the EAM team learning practice within a large academic institution. Section 1 provides a brief overview of the evolution of the existing practice of EAM. Key features, goals, and challenges of the practice are outlined and a recently performed needs analysis to identify areas for improvement is described. Section 2 examines the underlying assumptions regarding learning within the existing practice and explores how these assumptions fit into major theories of learning. Section 3 proposes an idealized learning practice for the EAM team which includes the assumptions regarding learners, design of the learning environment, use of technology to enhance learning, and the means of assessment and measuring success. It is hoped that through this systematic exploration of the EAM team practice, learning efficacy and efficiency will be improved and remain adaptable for challenges in the future.
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Affiliation(s)
- Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, MA
| | - Ulrich Schmidt
- Department of Anesthesiology, University of California San Diego Medical Center, San Diego, CA, USA
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Chandra A, Rajesh A, Backstrom C, Farley DR. Training, testing and remediating: the importance of simulation for surgical trainees. ANZ J Surg 2019; 89:1364-1365. [DOI: 10.1111/ans.15274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Aashish Rajesh
- Department of SurgeryMayo Clinic Rochester Minnesota USA
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AlJamal Y, Prabhakar N, Saleem H, Baloul M, Farley DR. Surgical interns in 2018: Objective assessment suggests they are better but still lack critical knowledge and skill. Surgery 2019; 165:1093-1099. [DOI: 10.1016/j.surg.2019.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/28/2022]
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Katayama A, Nakazawa H, Tokumine J, Lefor AK, Watanabe K, Asao T, Yorozu T. A high-fidelity simulator for needle cricothyroidotomy training is not associated with increased proficiency compared with conventional simulators: A randomized controlled study. Medicine (Baltimore) 2019; 98:e14665. [PMID: 30813212 PMCID: PMC6408010 DOI: 10.1097/md.0000000000014665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A high-fidelity task simulator for cricothyroidotomy was created using data from a 3-dimensional (3D) computed tomography scan using a 3D printer. We hypothesized that this high-fidelity cricothyroidotomy simulator results in increased proficiency for needle cricothyroidotomy compared with conventional simulators. METHODS Cricothyroidotomy-naive residents were recruited and randomly assigned to 2 groups, including simulation training with a conventional simulator (Group C) and with a high-fidelity simulator (Group 3D). After simulation training, participants performed cricothyroidotomy using an ex vivo porcine larynx fitted with an endoscope to record the procedure. The primary outcomes were success rate and procedure time. The secondary outcome was a subjective measure of the similarity of the simulator to the porcine larynx. RESULTS Fifty-two residents participated in the study (Group C: n = 27, Group 3D: n = 25). There was no significant difference in the success rate or procedure time between the 2 groups (success rate: P = .24, procedure time: P = .34). There was no significant difference in the similarity of the simulators to the porcine larynx (P = .81). CONCLUSION We developed a high-fidelity simulator for cricothyroidotomy from 3D computed tomography data using a 3D printer. This anatomically high-fidelity simulator did not have any advantages compared with conventional dry simulators.
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Affiliation(s)
- Atsuko Katayama
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi
| | - Kunitaro Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Takayuki Asao
- Big Data Center for Integrative Analysis, Gunma University Initiative for Advance Research, Maebashi, Gunnma, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
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Soliman AMS, Ianacone DC, Isaacson GC. Ex vivo ovine model for teaching open laryngotracheal surgery. World J Otorhinolaryngol Head Neck Surg 2018; 4:140-144. [PMID: 30101225 PMCID: PMC6074011 DOI: 10.1016/j.wjorl.2018.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To develop an animal model for teaching open laryngotracheal surgical procedures. Methods The heads and necks from 5 pre-pubescent sheep were harvested after humane anesthesia. After 2–5 days to allow for rigor mortis to resolve, a specimen was supported with sandbags on an operating table. Operative procedures including tracheotomy, medialization laryngoplasty, anterior cartilage grafting, tracheal resection with primary anastomosis, and laryngectomy with closure of the pharynx were attempted. Results The ovine head and neck provided an accurate model for simulation of all attempted procedures. Ovine tissue resembled that of humans in mechanical properties and handling. Postsurgical endoscopy confirmed graft alignment. Conclusions The sheep head and neck provides an inexpensive, realistic, and safe model for surgical training for a variety of open laryngotracheal procedures. This is particularly relevant given the recent emphasis on surgical simulation and the relative rarity of some of these procedures in residency training.
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Affiliation(s)
- Ahmed M S Soliman
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, 19140, USA
| | - David C Ianacone
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, 19140, USA
| | - Glenn C Isaacson
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, 19140, USA.,Department of Pediatrics, Lewis Katz School of Medicine Temple University, Philadelphia, PA, 19140, USA
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Cardenas Lara F, Naik ND, Pandian TK, Gas BL, Strubel S, Cadeliña R, Heller SF, Farley DR. A Comparison of Objective Assessment Data for the United States and International Medical Graduates in a General Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2017; 74:e1-e7. [PMID: 28869159 DOI: 10.1016/j.jsurg.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/30/2017] [Accepted: 08/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare objective assessment scores between international medical graduates (IMGs) and United States Medical Graduates. Scores of residents who completed a preliminary year, who later matched into a categorical position, were compared to those who matched directly into a categorical position at the Mayo Clinic, Rochester. DESIGN Postgraduate year (PGY) 1 to 5 residents participate in a biannual multistation, OSCE-style assessment event as part of our surgical training program. Assessment data were, retrospectively, reviewed and analyzed from 2008 to 2016 for PGY-1 and from 2013 to 2016 for PGY 2 to 5 categorical residents. SETTING Academic medical center. PARTICIPANTS Categorical PGY 1 to 5 General Surgery (GS) residents at Mayo Clinic Rochester, MN. RESULTS A total of 86 GS residents were identified. Twenty-one residents (1 United States Medical Graduates [USMG] and 20 IMGs) completed a preliminary GS year, before matching into a categorical position and 68 (58 USMGs and 10 IMGs) residents, who matched directly into a categorical position, were compared. Mean scores (%) for the summer and winter multistation assessments were higher for PGY-1 trainees with a preliminary year than those without (summer: 59 vs. 37, p < 0.001; winter: 69 vs. 61, p = 0.05). Summer and winter PGY-2 scores followed the same pattern (74 vs. 64, p < 0.01; 85 vs. 71, p < 0.01). For the PGY 3 to 5 assessments, differences in scores between these groups were not observed. IMGs and USMGs scored equivalently on all assessments. Overall, junior residents showed greater score improvement between tests than their senior colleagues (mean score increase: PGY 1-2 = 18 vs. PGY 3-5 = 3, p < 0.001). CONCLUSIONS Residents with a previous preliminary GS year at our institution scored higher on initial assessments compared to trainees with no prior GS training at our institution. The scoring advantage of an added preliminary year decreased as trainees progressed through residency.
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Affiliation(s)
| | - Nimesh D Naik
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - T K Pandian
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Becca L Gas
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Suzanne Strubel
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rachel Cadeliña
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Stephanie F Heller
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David R Farley
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
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Burns JA, Adkins LK, Dailey S, Klein AM. Simulators for Laryngeal and Airway Surgery. Otolaryngol Clin North Am 2017; 50:903-922. [DOI: 10.1016/j.otc.2017.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Eardley I, Reisman Y, Goldstein S, Kramer A, Dean J, Coleman E. Existing and Future Educational Needs in Graduate and Postgraduate Education. J Sex Med 2017; 14:475-485. [PMID: 28364975 DOI: 10.1016/j.jsxm.2017.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This review was designed to make recommendations on future educational needs, principles of curricular development, and how the International Society for Sexual Medicine (ISSM) should address the need to enhance and promote human sexuality education around the world. AIM To explore the ways in which graduate and postgraduate medical education in human sexuality has evolved and is currently delivered. METHODS We reviewed existing literature concerning sexuality education, curriculum development, learning strategies, educational formats, evaluation of programs, evaluation of students, and faculty development. We reviewed literature relating to four main areas: (i) the current status of the international regulation of training in sexual medicine; (ii) the current delivery of education and training in sexual medicine; (iii) resident and postgraduate education in sexual medicine surgery; and (iv) education and training for allied health professionals. RESULTS The main findings in these four areas are as follows. Sexual medicine has grown considerably as a specialty during the past 20 years, with many drivers being identified. However, the regulatory aspects of training, assessment, and certification are currently in the early stages of development and are in many ways lagging behind the scientific and clinical knowledge in the field. However, there are examples of the development of curricula with accompanying assessments that have attempted to set standards of education and training that might underlie the delivery of high-quality care to patients in sexual medicine. The development of competence assessment has been applied to surgical training in sexual medicine, and there is increasing interest in simulation as a means of enhancing technical skills training. Although the focus of curriculum development has largely been the medical profession, there is early interest in the development of standards for training and education of allied health professionals. CONCLUSION Organizations of professionals in sexual health, such as the ISSM, have an opportunity, and indeed a responsibility, to provide and disseminate learning opportunities, curricula, and standards of training for doctors and allied health professionals in sexual medicine. Eardley I, Reisman Y, Goldstein S, et al. Existing and Future Educational Needs in Graduate and Postgraduate Education. J Sex Med 2017;14:475-485.
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Affiliation(s)
- Ian Eardley
- Department of Urology, St James University Hospital, Leeds, West Yorkshire, UK.
| | - Yacov Reisman
- Department of Urology, Amstelland Hospital, Amstelveen, The Netherlands
| | | | - Andrew Kramer
- Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - John Dean
- The Salisbury Clinic, South Brent, UK
| | - Eli Coleman
- University of Minnesota, Minneapolis, MN, USA
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Musbahi O, Aydin A, Al Omran Y, Skilbeck CJ, Ahmed K. Current Status of Simulation in Otolaryngology: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:203-215. [PMID: 27839694 DOI: 10.1016/j.jsurg.2016.09.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/06/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Otolaryngology is a highly technical and demanding specialty and the requirements for surgical trainees to acquire proficiency remains challenging. Simulation has been purported to be an effective tool in assisting with this. The aim of this systematic review is to identify the available otolaryngology simulators, their status of validation, and evaluation the level of evidence behind each training model and thereby establish a level of recommendation. DESIGN PubMed, ERIC, and Google Scholar databases were searched for articles that described otolaryngology simulators or training models between 1980 and April 2016. Any validation studies for simulators were also retrieved. Titles and abstracts were screened for relevance using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Level of evidence (LoE) and Level of recommendation (LoR) was awarded to each study and model, respectively. RESULTS A total of 70 studies were identified describing 64 simulators. Out of these, at least 54 simulators had 1 validation study. Simulators for the ear and temporal bone surgery were the most common (n = 32), followed by laryngeal and throat (n = 20) and endoscopic sinus surgery (n = 12). Face validity was evaluated by 29 studies, 20 attempted to show construct, 20 assessed content, 20 transfer, and only 2 assessed concurrent validity. Of the validation assessments, 2 were classified as Level 1b, 10 Level 2a, and 48 Level 2b. No simulators received the highest LoR, but 8 simulators received a LoR of 2. CONCLUSIONS Despite the lack of evidence in outcome studies and limited number of high-validity otolaryngology simulators, the role of simulation continues to grow across surgical specialties Hence, it is imperative that the simulators are of high validity and construct for trainees to practice and rehearse surgical skills to develop confidence.
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Affiliation(s)
- Omar Musbahi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Center for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Yasser Al Omran
- Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Christopher James Skilbeck
- Department of ENT and Head and Neck Surgery, Guy's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Center for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
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A low-cost transcervical laryngeal injection trainer. Laryngoscope 2015; 126:901-5. [DOI: 10.1002/lary.25561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 01/22/2023]
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