1
|
Sachdeva AK, Tekian A, Park YS, Cheung JJH. Surgical skills training for practicing surgeons founded on established educational theories and frameworks. MEDICAL TEACHER 2024; 46:556-563. [PMID: 37813106 DOI: 10.1080/0142159x.2023.2262101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Following completion of structured training in residency or fellowship programs, surgeons need to acquire new skills throughout their careers to address changes in their surgical practices, and to perform new procedures and use new technologies as these are developed. The opportunities available to surgeons to acquire the new skills, safely introduce these skills into surgical practice, and then maintain the skills, vary greatly and may not fully support a surgeon's needs. The article shares background information relating to the vexing problems, and describes established educational theories and frameworks as well as specific frameworks relating to surgical skills training and verification that may be used in designing and implementing comprehensive and impactful surgical skills training programs aimed at practicing surgeons. A number of practical strategies based on these theories and frameworks are highlighted. National professional organizations and academic medical centers need to play a critical role in pursuing such efforts, which will remain pivotal in supporting the professional work of surgeons and in providing optimal surgical care well into the future.
Collapse
Affiliation(s)
- Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, IL, USA
| | - Ara Tekian
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL, USA
| | - Jeffrey J H Cheung
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL, USA
| |
Collapse
|
2
|
Pakkasjärvi N, Anttila H, Pyhältö K. What are the learning objectives in surgical training - a systematic literature review of the surgical competence framework. BMC MEDICAL EDUCATION 2024; 24:119. [PMID: 38321437 PMCID: PMC10848354 DOI: 10.1186/s12909-024-05068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To map the landscape of contemporary surgical education through a competence framework by conducting a systematic literature review on learning outcomes of surgical education and the instructional methods applied to attain the outcomes. BACKGROUND Surgical education has seen a paradigm shift towards competence-based training. However, a gap remains in the literature regarding the specific components of competency taught and the instructional methods employed to achieve these outcomes. This paper aims to bridge this gap by conducting a systematic review on the learning outcomes of surgical education within a competence framework and the instructional methods applied. The primary outcome measure was to elucidate the components of competency emphasized by modern surgical curricula. The secondary outcome measure was to discern the instructional methods proven effective in achieving these competencies. METHODS A search was conducted across PubMed, Medline, ProQuest Eric, and Cochrane databases, adhering to PRISMA guidelines, limited to 2017-2021. Keywords included terms related to surgical education and training. Inclusion criteria mandated original empirical studies that described learning outcomes and methods, and targeted both medical students and surgical residents. RESULTS Out of 42 studies involving 2097 participants, most concentrated on technical skills within competency-based training, with a lesser emphasis on non-technical competencies. The effect on clinical outcomes was infrequently explored. CONCLUSION The shift towards competency in surgical training is evident. However, further studies on its ramifications on clinical outcomes are needed. The transition from technical to clinical competence and the creation of validated assessments are crucial for establishing a foundation for lifelong surgical learning.
Collapse
Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
- Department of Pediatric Surgery, Section of Urology, University Children's Hospital, Uppsala, Sweden.
| | - Henrika Anttila
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Kirsi Pyhältö
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
- Centre for Higher and Adult Education, Faculty of Education, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
3
|
Willemot L, Lee MJ, Mulford J. Introduction to surgical coaching. ANZ J Surg 2023; 93:487-492. [PMID: 36707460 DOI: 10.1111/ans.18287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/22/2022] [Accepted: 01/08/2023] [Indexed: 01/29/2023]
Abstract
Surgical coaching is a new approach to continuous professional development (CPD). Advocates claim that coaching improves surgical and non-technical skills, leading to enhanced performance and reduced stress and burnout. Widespread acceptance of coaching in the surgical community is limited due to a paucity of evidence, surgery-specific obstacles and lack of resources. This narrative review introduces what 'surgical coaching' is and describes its origins. Coaching techniques are based on live or video observation of procedures, followed by collaborative analysis, reflection and goal planning in a non-competitive setting aided by an expert, peer or lay coach. Technical skills improvements have been reported using coaching techniques, yet long-term influence on non-technical competencies, overall performance and surgeon wellbeing are largely hypothetical. There are clear potential benefits in the application of surgical coaching to daily surgical practice. However, significant knowledge gaps remain. Dedicated research into the short-term applicability and the long-term effects of surgical coaching are required.
Collapse
Affiliation(s)
- Laurent Willemot
- Launceston General Hospital, Launceston, Tasmania, Australia
- College of Health & Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Matthew J Lee
- College of Health & Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Jonathan Mulford
- Launceston General Hospital, Launceston, Tasmania, Australia
- College of Health & Medicine, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
4
|
Nagaraj MB, Namazi B, Sankaranarayanan G, Scott DJ. Developing artificial intelligence models for medical student suturing and knot-tying video-based assessment and coaching. Surg Endosc 2023; 37:402-411. [PMID: 35982284 PMCID: PMC9388210 DOI: 10.1007/s00464-022-09509-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/23/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Early introduction and distributed learning have been shown to improve student comfort with basic requisite suturing skills. The need for more frequent and directed feedback, however, remains an enduring concern for both remote and in-person training. A previous in-person curriculum for our second-year medical students transitioning to clerkships was adapted to an at-home video-based assessment model due to the social distancing implications of COVID-19. We aimed to develop an Artificial Intelligence (AI) model to perform video-based assessment. METHODS Second-year medical students were asked to submit a video of a simple interrupted knot on a penrose drain with instrument tying technique after self-training to proficiency. Proficiency was defined as performing the task under two minutes with no critical errors. All the videos were first manually rated with a pass-fail rating and then subsequently underwent task segmentation. We developed and trained two AI models based on convolutional neural networks to identify errors (instrument holding and knot-tying) and provide automated ratings. RESULTS A total of 229 medical student videos were reviewed (150 pass, 79 fail). Of those who failed, the critical error distribution was 15 knot-tying, 47 instrument-holding, and 17 multiple. A total of 216 videos were used to train the models after excluding the low-quality videos. A k-fold cross-validation (k = 10) was used. The accuracy of the instrument holding model was 89% with an F-1 score of 74%. For the knot-tying model, the accuracy was 91% with an F-1 score of 54%. CONCLUSIONS Medical students require assessment and directed feedback to better acquire surgical skill, but this is often time-consuming and inadequately done. AI techniques can instead be employed to perform automated surgical video analysis. Future work will optimize the current model to identify discrete errors in order to supplement video-based rating with specific feedback.
Collapse
Affiliation(s)
- Madhuri B Nagaraj
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9159, USA.
- University of Texas Southwestern Simulation Center, 2001 Inwood Road, Dallas, TX, 75390-9092, USA.
| | - Babak Namazi
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9159, USA
| | - Ganesh Sankaranarayanan
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9159, USA
| | - Daniel J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9159, USA
- University of Texas Southwestern Simulation Center, 2001 Inwood Road, Dallas, TX, 75390-9092, USA
| |
Collapse
|
5
|
Giménez ME, Garcia Vazquez A, Davrieux CF, Verde JM, Serra E, Palermo M, Houghton EJ, Dallemagne B, Perretta S, Acquafresca PA, Diana M, Marescaux J. Image-Guided Surgical Training in Percutaneous Hepatobiliary Procedures: Development of a Realistic and Meaningful Bile Duct Dilatation Porcine Model. J Laparoendosc Adv Surg Tech A 2021; 31:790-795. [DOI: 10.1089/lap.2020.0680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Mariano Eduardo Giménez
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Alain Garcia Vazquez
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Carlos Federico Davrieux
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Juan M. Verde
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Edgardo Serra
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Mariano Palermo
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Eduardo Javier Houghton
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Bernard Dallemagne
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Silvana Perretta
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Pablo Agustín Acquafresca
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| |
Collapse
|
6
|
Variation in Hospital Utilization of Minimally Invasive Distal Pancreatectomy for Localized Pancreatic Neoplasms. J Gastrointest Surg 2020; 24:2780-2788. [PMID: 31768832 PMCID: PMC7747057 DOI: 10.1007/s11605-019-04414-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/12/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Minimally invasive distal pancreatectomy (MIDP) for localized neoplasms has been demonstrated to be feasible and safe. However, national adoption of the technique is poorly understood. Objectives of this study were to identify factors associated with use of minimally invasive distal pancreatectomy for localized neoplasms and assess hospital variation in MIDP utilization. METHODS Retrospective cohort study of patients with pancreatic cysts, stage I pancreatic ductal adenocarcinoma, and stage I pancreatic neuroendocrine tumors undergoing distal pancreatectomy from the ACS NSQIP Pancreas Targeted Dataset. Factors associated with use of MIDP were identified using multivariable logistic regression and hospital-level variation was assessed. RESULTS Analysis included 3,059 patients at 139 hospitals. Overall, 64.5% of patients underwent minimally invasive distal pancreatectomy. Patients were more likely to undergo MIDP if they had lower ASA classification (P = 0.004) or BMI ≥ 30 (P < 0.001) and less likely if they had pancreatic adenocarcinoma (P < 0.001). There was notable hospital variability in utilization (range 0 to 100% of cases). Hospital-level utilization of minimally invasive distal pancreatectomy did not appear to be driven by patient selection, as hierarchical analysis demonstrated that only 1.8% of observed hospital variation was attributable to measured patient selection factors. CONCLUSION Utilization of MIDP for localized pancreatic neoplasms is highly variable. While some patient-level factors are associated with MIDP use, hospital adoption of MIDP appears to be the primary driver of utilization. Monitoring hospital-level use of MIDP may be a useful quality measure to monitor uptake of emerging techniques in pancreatic surgery.
Collapse
|
7
|
Pradarelli JC, Yule S, Lipsitz SR, Panda N, Craig M, Lowery KW, Ashley SW, Gee DW, Waters PM, Knight J, Smink DS. Surgical Coaching for Operative Performance Enhancement (SCOPE): skill ratings and impact on surgeons’ practice. Surg Endosc 2020; 35:3829-3839. [DOI: 10.1007/s00464-020-07776-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/01/2020] [Indexed: 01/03/2023]
|
8
|
Affiliation(s)
| | - Yue-Yung Hu
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 63, 225 East Chicago Avenue, Chicago, IL 60611, USA. https://twitter.com/YueyungHu
| | - Justin B Dimick
- Department of Surgery, Michigan Medicine, Michigan Medicine General Surgery Clinic, Taubman Center, Floor 2, Reception C, 1500 East Medical Center Drive, SPC 5331, Ann Arbor, MI 48109-5331, USA. https://twitter.com/jdimick1
| | - Caprice C Greenberg
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, MC 1690, Madison, WI 53792-3284, USA. https://twitter.com/CapriceGreenber
| |
Collapse
|
9
|
Corsini EM, Antonoff MB. Wise Dogs Will Always Learn More Tricks. Ann Thorac Surg 2020; 110:753. [PMID: 32315646 DOI: 10.1016/j.athoracsur.2019.12.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/13/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Erin M Corsini
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.
| |
Collapse
|
10
|
Tannyhill RJ, Jensen OT. Computer Simulation Training for Mandibular All-on-Four/All-on-Three Surgery. Oral Maxillofac Surg Clin North Am 2019; 31:505-511. [PMID: 31104949 DOI: 10.1016/j.coms.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mandibular all-on-4 implant reconstruction techniques are less complex than maxillary but more complex than routine dental implant surgery, requiring advanced technical skills, deeper understanding of prosthodontic principles, and more complex surgical planning. Surgical simulation may assist experienced surgeons seeking to acquire new skills through increased planning ability, improved intraspecialty communication, and enhanced technical competence. Achieving competence is different for the trainee devoted to the learning process and the practicing surgeon with limited time and balancing other roles and responsibilities. Well-constructed continuing education incorporating simulation, 3-dimensional printed models, and computer-assisted planning may offer the most efficient path to competence.
Collapse
Affiliation(s)
- R John Tannyhill
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Warren 1201, Boston, MA 02114, USA.
| | - Ole T Jensen
- Department of Oral Maxillofacial Surgery, University of Utah, School of Dentistry, 530 Wakara Way, Salt Lake City, Utah 84108, USA
| |
Collapse
|
11
|
|