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Lund S, Navarro S, D'Angelo JD, Park YS, Rivera M. Expanded Access to Video-Based Laparoscopic Skills Assessments: Ease, Reliability, and Accuracy. JOURNAL OF SURGICAL EDUCATION 2024; 81:850-857. [PMID: 38664172 DOI: 10.1016/j.jsurg.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/29/2024] [Accepted: 03/13/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Video-based performance assessments provide essential feedback to surgical residents, but in-person and remote video-based assessment by trained proctors incurs significant cost. We aimed to determine the reliability, accuracy, and difficulty of untrained attending staff surgeon raters completing video-based assessments of a basic laparoscopic skill. Secondarily, we aimed to compare reliability and accuracy between 2 different types of assessment tools. DESIGN An anonymous survey was distributed electronically to surgical attendings via a national organizational listserv. Survey items included demographics, rating of video-based assessment experience (1 = have never completed video-based assessments, 5 = often complete video-based assessments), and rating of favorability toward video-based and in-person assessments (0 = not favorable, 100 = favorable). Participants watched 2 laparoscopic peg transfer performances, then rated each performance using an Objective Structured Assessment of Technical Skill (OSATS) form and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS). Participants then rated assessment completion ease (1 = Very Easy, 5 = Very Difficult). SETTING National survey of practicing surgeons. PARTICIPANTS Sixty-one surgery attendings with experience in laparoscopic surgery from 10 institutions participated as untrained raters. Six experienced laparoscopic skills proctors participated as expert raters. RESULTS Inter-rater reliability was substantial for both OSATS (k = 0.75) and MISTELS (k = 0.85). MISTELS accuracy was significantly higher than that of OSATS (κ: MISTELS = 0.18, 95%CI = [0.06,0.29]; OSATS = 0.02, 95%CI = [-0.01,0.04]). While participants were inexperienced with completing video-based assessments (median = 1/5), they perceived video-based assessments favorably (mean = 73.4) and felt assessment completion was "Easy" on average. CONCLUSIONS We demonstrate that faculty raters untrained in simulation-based assessments can successfully complete video-based assessments of basic laparoscopic skills with substantial inter-rater reliability without marked difficulty. These findings suggest an opportunity to increase access to feedback for trainees using video-based assessment of fundamental skills in laparoscopic surgery.
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Affiliation(s)
- Sarah Lund
- Mayo Clinic Department of Surgery, 200 1st Street SW, Rochester, Minnesota 55905.
| | - Sergio Navarro
- Mayo Clinic Department of Surgery, 200 1st Street SW, Rochester, Minnesota 55905
| | - Jonathan D D'Angelo
- Mayo Clinic Division of Colon and Rectal Surgery, 200 1st Street SW, Rochester, Minnesota 55905
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois at Chicago College of Medicine, 808 S Wood Street, Chicago Illinois 60612
| | - Mariela Rivera
- Mayo Clinic Division of Trauma, Critical Care, and General Surgery, 200 1st Street SW, Rochester, Minnesota 55905
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López-Baamonde M, Perdomo JM, Ibáñez C, Angelès-Fité G, Magaldi M, Panzeri MF, Bergé R, Gómez-López L, Guirao Montes Á, Gomar-Sancho C. Construction and Evaluation of a Realistic Low-Cost Model for Training in Chest-Tube Insertion. Simul Healthc 2024; 19:188-195. [PMID: 36892559 DOI: 10.1097/sih.0000000000000720] [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: 03/10/2023]
Abstract
INTRODUCTION Emergency thoracostomy is applied in life-threatening situations. Simulation plays a pivotal role in training in invasive techniques used mainly in stressful situations. Currently available commercial simulation models for thoracostomy have various drawbacks. METHODS We designed a thoracostomy phantom from discarded hospital materials and pigskin with underlying flesh. The phantom can be used alone for developing technical skills or mounted on an actor in simulation scenarios. Medical students, intensive care unit (ICU) and emergency department teams, and thoracostomy experts evaluated its technical fidelity and usefulness for achieving learning objectives in workshops. RESULTS The materials used to construct the phantom cost €47. A total of 12 experts in chest-tube placement and 73 workshop participants (12 ICU physicians and nurses, 20 emergency physicians and nurses, and 41 fourth-year medical students) evaluated the model. All groups rated the model's usefulness and the sensation of perforating the pleura highly. Experts rated the air release after pleura perforation lower than other groups. Lung reexpansion was the lowest rated item in all groups. Ratings of the appearance and feel of the model correlated strongly among all groups and experts. The ICU professionals rated the resistance encountered in introducing the chest drain lower than the other groups. CONCLUSIONS This low-cost, reusable, transportable, and highly realistic model is an attractive alternative to commercial models for training in chest-tube insertion skills.
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Affiliation(s)
- Manuel López-Baamonde
- From the Anesthesiology and Intensive Care Department (L.-B.M., P.J.M., I.C., A.-F.G., M.M., P.M.F., R.B., G.-L.L., G.-S.C.), Hospital Clínic de Barcelona, University of Barcelona. Barcelona, Spain; SIMCLÍNIC (L.-B.M., P.J.M., I.C., A.-F.G., M.M., P.M.F., R.B., G.-L.L., G.-M.Á., G.-S.C.), Anesthesiology Clinical Simulation Group, Hospital Clínic, University of Barcelona. Barcelona, Spain; Anesthesiology Department (A.-F.G.), Heidelberg University Hospital. Heidelberg, Germany; Thoracic Surgery Department (G.-M.Á.), Hospital Clínic, University of Barcelona. Barcelona, Spain; GRInDoSSeP (G.-S.C.), University of Vic-Central University of Catalonia. Manresa, Spain
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Misra A, Chapman A, Watson WD, Bach JA, Bonta MJ, Elliott JO, Dominguez EP. Use of Low-Cost Task Trainer for Emergency Department Thoracotomy Training in General Surgery Residency Program. JOURNAL OF SURGICAL EDUCATION 2024; 81:134-144. [PMID: 37926660 DOI: 10.1016/j.jsurg.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Emergency department thoracotomy (EDT) is an uncommon but potentially lifesaving procedure that warrants familiarity with anatomy, instruments, and indications necessary for completion. To address this need, we developed a low-cost EDT trainer. The primary objective of this study was to compare the effectiveness of a low-cost EDT trainer to teach emergency department thoracotomy with a discussion-based teaching session. Secondary objective was to study the face validity of the low-cost EDT trainer. DESIGN A prospective 2-phase randomized control study was conducted. Participants were randomly divided into two groups. In phase one, baseline medical knowledge for both groups was assessed using a multiple-choice question pretest. In Group 1, each participant was taught EDT using a one-on-one discussion with a trauma surgeon, whereas Group 2 used the EDT trainer and debriefing for training. In phase 2 (1 month later), all participants completed a knowledge retention test and performed a videoed EDT using our EDT trainer, the video recordings were later reviewed by content experts blinded to the study participants using a checklist with a maximum score of 22. The participants also completed a reaction survey at the end of phase 2 of the study. SETTING OhioHealth Riverside Methodist Hospital, an urban tertiary care academic hospital in Columbus, Ohio. PARTICIPANTS Nine senior surgery residents from training years 3 to 5. RESULTS The mean score for the performance of the procedure for the simulation-based (Group 2) was significantly higher than that of the discussion-based (Group 1) (Rater 1: 21.2 ± 0.8 vs. 19.0 ± 2.0, p = 0.05, Rater 2: 20.4 ± 1.5 vs. 18.3±1.0, p = 0.04). Group 2 also was quicker than Group 1 in deciding to start the procedure by approximately 56 seconds. When comparing the mean pretest knowledge score to the mean knowledge retention score 30 days after training, the discussion-based group improved from 58.33% to 81.25% (p = 0.01); the simulation-trained group's scores remained at 68.33%. All the participants agreed or strongly agreed that the simulator provided a realistic opportunity to perform EDT and improved their confidence. CONCLUSIONS The results of this pilot study support our hypothesis that using a low-cost EDT trainer effectively improves general surgery residents' confidence and procedural skills scores in a simulated environment. Further training with low-cost simulators may provide surgical residents with deliberate practice opportunities and improve performance when learning low-frequency procedures.
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Affiliation(s)
- Asit Misra
- OhioHealth Learning, Department of Medical Education, Riverside Methodist Hospital, Columbus, Ohio.
| | - Alexander Chapman
- OhioHealth Trauma & Acute Care Surgery, Riverside Methodist Hospital, Columbus, Ohio
| | - William D Watson
- OhioHealth Learning, Department of Medical Education, Riverside Methodist Hospital, Columbus, Ohio
| | - John A Bach
- OhioHealth Trauma & Acute Care Surgery, Riverside Methodist Hospital, Columbus, Ohio
| | - Marco J Bonta
- OhioHealth Trauma & Acute Care Surgery, Riverside Methodist Hospital, Columbus, Ohio
| | | | - Edward P Dominguez
- OhioHealth Trauma & Acute Care Surgery, Riverside Methodist Hospital, Columbus, Ohio
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Ricard C, Plewa D, Vernamonti J, Scott EM, Nepomnayshy D, Benoit E. Needs Assessment for a Resuscitative Thoracotomy Curriculum for General Surgery Residents in the Northeast Region. JOURNAL OF SURGICAL EDUCATION 2023; 80:1843-1849. [PMID: 37770295 DOI: 10.1016/j.jsurg.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Resuscitative thoracotomy (RT) is a high-acuity low occurrence (HALO) procedure with which general surgical resident (GSR) experience and confidence are unknown. We sought to identify and describe this educational gap by conducting a targeted needs assessment for an RT curriculum for GSRs. METHODS An online regional needs assessment survey was conducted for an RT curriculum for GSRs. The survey was developed by a group of trauma stakeholders and revised after being piloted on a small, representative group of GSRs. We surveyed GSRs in the Northeast region regarding their experience and confidence with RT; interest in an RT curriculum; and content, format, and scope for an RT curriculum. RESULTS The survey response rate was 43%, reflecting the viewpoints of GSRs at 8 major training centers across the Northeast. Only 13% of respondents were interested in pursuing a career in Trauma and Critical Care despite 97% of them training at a Level I Trauma Center. Twenty-nine percent and 33% of GSRs had ever assisted with or performed RT, respectively. Twenty-one percent of GSRs reported feeling confident performing RT. Most respondents (98%) agreed or strongly agreed that an RT curriculum would add value to their general surgery education. The most positively rated content topics were resuscitative maneuvers (100% positive responses [PR]), when to cease resuscitative efforts (100% PR), and morbidity and mortality associated with RT (98% PR). The most highly rated learning methods were individual RT simulation time (97% PR) and a tour of the trauma bay equipment (97% PR). CONCLUSIONS This needs assessment demonstrates a lack of experience and confidence with RT, a strong learner interest in an RT curriculum, and a desire for experiential learning methods. Learning objectives are defined herein, and the next steps involve developing educational materials for an RT curriculum for GSRs.
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Affiliation(s)
- Caroline Ricard
- Simulation Department, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Deanna Plewa
- Simulation Department, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Jack Vernamonti
- General Surgery Department, Maine Medical Center, Portland, Maine
| | - Erin M Scott
- General Surgery Department, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Dmitry Nepomnayshy
- Simulation Department, Lahey Hospital and Medical Center, Burlington, Massachusetts; General Surgery Department, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Eric Benoit
- General Surgery Department, Lahey Hospital and Medical Center, Burlington, Massachusetts; Trauma and Acute Care Surgery Department, Lahey Hospital and Medical Center, Burlington Massachusetts
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Clifford E, Stourton F, Willers J, Colucci G. Development of a Low-Cost, High-Fidelity, Reusable Model to Simulate Clamshell Thoracotomy. Surg Innov 2023; 30:739-744. [PMID: 37876028 PMCID: PMC10656785 DOI: 10.1177/15533506231208572] [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] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Clamshell thoracotomy (CST) is an emergency procedure performed during traumatic cardiac arrest. Emergency physicians and surgeons are expected to perform this procedure in the Emergency Department. However, the procedure has a low occurrence rate, therefore physicians are often poorly prepared. Current teaching methods include expensive simulators and anatomically inaccurate animal models. The goal of this study was to design, produce and test, a low-cost, high-fidelity model for the teaching of CST. DESIGN, SETTING AND PARTICIPANTS The model was produced from inexpensive, commercially available materials as well as ADAMgel; a custom, recyclable, inexpensive tissue analogue. The model was tested across 19 physicians, mostly consultants and senior registrars in emergency medicine, anaesthesia and surgery. Participants completed comparative questionnaires before and after testing the model. The questionnaires were adapted from previous anaesthetic-based simulation studies and used a modified Likert scale to assess prior knowledge, anatomical realism and the teaching benefits of the model. RESULTS Participants had varied prior knowledge and experience before testing the model. Results showed that 89.47% (n = 17) of trainees felt the model was a reasonable substitute for practice and 100% (n = 19) agreed that the model was a good training aid for inexperienced trainees and would recommend it to others. CONCLUSIONS The model proved a successful teaching tool, improving physicians' knowledge and confidence with performing CST. This high fidelity, low cost model demonstrated that a high standard simulation teaching tool can be made which improves teaching of CST.
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Affiliation(s)
| | - Frederick Stourton
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
| | - Johann Willers
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
| | - Gianluca Colucci
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
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Atkins K, Schneider A, Gallaher J, Cairns B, Charles A. Who benefits from resuscitative thoracotomies following penetrating trauma: The patient or the learner? Injury 2023; 54:111033. [PMID: 37716863 PMCID: PMC10591838 DOI: 10.1016/j.injury.2023.111033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Resuscitative thoracotomy (RT) is a salvage procedure following traumatic cardiac arrest. We aim to evaluate RT trends and outcomes in adults with cardiac arrest following penetrating trauma to determine the effect on mortality in this population. Further, we aim to estimate the effect of hospital teaching status on the performance of resuscitative thoracotomies and mortality. METHODS We reviewed the National Trauma Data Bank (2017-2021) for adults (≥16 years old) with penetrating trauma and prehospital cardiac arrest, stratified by the performance of a RT. We performed multivariable logistic regressions to estimate the effect of RT on mortality and the effect of hospital teaching status on the performance of resuscitative thoracotomies and mortality. RESULTS 13,115 patients met our inclusion criteria. RT occurred in 12.7% (n = 1,664) of patients. Rates of RT trended up over the study period. Crude mortality was similar in RT and Non-RT patients (95.6% vs. 94.5%, p = 0.07). There was no statistically significant difference in the adjusted odds of mortality based on RT status (OR 0.82, 95%CI 0.56-1.21). University-teaching hospitals had an adjusted odds ratio of 1.68 (95% CI 1.31-2.17) for performing a RT than non-teaching hospitals. There was no difference in the adjusted odds of mortality in patients that underwent RT based on hospital teaching status. CONCLUSION Despite up-trending rates, a resuscitative thoracotomy may not improve mortality in adults with penetrating, traumatic cardiac arrest. University teaching hospitals are nearly twice as likely to perform a RT than non-teaching hospitals, with no subsequent improvement in mortality.
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Affiliation(s)
- Kathryn Atkins
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Andrew Schneider
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Bruce Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, USA.
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Whittaker G, Ghita IA, Taylor M, Salmasi MY, Granato F, Athanasiou T. Current Status of Simulation in Thoracic Surgical Training. Ann Thorac Surg 2023; 116:1107-1115. [PMID: 37201622 DOI: 10.1016/j.athoracsur.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/21/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Simulation is playing an increasingly important role in surgical training but is not yet a mandatory part of most surgical curricula. A simulator must undergo rigorous validation to verify it as a reliable tool. The aim of this study was to review the literature to identify simulators that are currently available to augment thoracic surgical training and to analyze any evidence supporting or validating them. METHODS A literature search of the MEDLINE (1946 to November 2022) and Embase (1947 to November 2022) databases was performed to identify simulators for basic skills and procedures in thoracic surgery. A selection of keywords were used to perform the literature search. After identification of appropriate articles, data were extracted and analyzed. RESULTS Thirty-three simulators were found in 31 articles. Simulators for basic skills (n = 13) and thoracic lobectomy (n = 13) were most commonly described, followed by miscellaneous (n = 7). Most models were of a hybrid modality (n = 18). Evidence of validity was established in 48.5% (n = 16) of simulators. In total, 15.2% (n = 5) of simulators had 3 or more elements of validity demonstrated, and only 3.0% (n = 1) accomplished full validation. CONCLUSIONS Numerous simulators of varying modality and fidelity exist for a variety of thoracic surgical skills and procedures, although validation evidence is frequently inadequate. Simulation models may be able to provide training in basic surgical and procedural skills; however, further assessment of validity needs to be undertaken before consideration of their integration into training programs.
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Affiliation(s)
- George Whittaker
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
| | - Ioana-Alexandra Ghita
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - M Yousuf Salmasi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Technology-enhanced trauma training in low-resource settings: A scoping review and feasibility analysis of educational technologies. J Pediatr Surg 2023; 58:955-963. [PMID: 36828675 DOI: 10.1016/j.jpedsurg.2023.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lack of training contributes to the burden of trauma-related mortality and morbidity in low- and lower-middle-income countries (LMICs). Educational technologies present a unique opportunity to enhance the quality of trauma training. Therefore, this study reviews current technologies used in trauma courses and evaluates their feasibility for LMICs. METHODS We conducted a scoping review evaluating the learning outcomes of technology-enhanced training in general trauma assessment, team skills or any procedures covered in the 2020 Advanced Trauma Life Support® program. Based on the Technology-Enhanced Learning criteria, we created and applied a feasibility analysis tool to evaluate the technologies for use in LMICs. RESULTS We screened 6471 articles and included 64. Thirty-four (45%) articles explored training in general trauma assessment, 28 (37%) in team skills, and 24 (32%) in procedures. The most common technologies were high-fidelity mannequins (60%), video-assisted debriefing (19%), and low-fidelity mannequins (13%). Despite their effectiveness, high-fidelity mannequins ranked poorly in production, maintenance, cost, and reusability categories, therefore being poorly suited for LMICs. Virtual simulation and digital courses had the best feasibility scores, but still represented a minority of articles in our review. CONCLUSION To our knowledge, this is the first study to perform a feasibility analysis of trauma training technologies in the LMIC context. We identified that the majority of trauma courses in the literature use technologies which are less suitable for LMICs. Given the urgent need for pediatric trauma training, educators must use technologies that optimize learning outcomes and remain feasible for low-resource settings. LEVEL OF EVIDENCE IV.
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Hussein N, Van den Eynde J, Callahan C, Guariento A, Gollmann-Tepeköylü C, Elbatarny M, Loubani M. The use of objective assessments in the evaluation of technical skills in cardiothoracic surgery: a systematic review. Interact Cardiovasc Thorac Surg 2022; 35:6651070. [PMID: 35900153 PMCID: PMC9403301 DOI: 10.1093/icvts/ivac194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES With reductions in training time and intraoperative exposure, there is a need for objective assessments to measure trainee progression. This systematic review focuses on the evaluation of trainee technical skill performance using objective assessments in cardiothoracic surgery and its incorporation into training curricula. METHODS Databases (EBSCOHOST, Scopus and Web of Science) and reference lists of relevant articles for studies that incorporated objective assessment of technical skills of trainees/residents in cardiothoracic surgery were included. Data extraction included task performed; assessment setting and tool used; number/level of assessors; study outcome and whether the assessments were incorporated into training curricula. The methodological rigour of the studies was scored using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS Fifty-four studies were included for quantitative synthesis. Six were randomized-controlled trials. Cardiac surgery was the most common speciality utilizing objective assessment methods with coronary anastomosis the most frequently tested task. Likert-based assessment tools were most commonly used (61%). Eighty-five per cent of studies were simulation-based with the rest being intraoperative. Expert surgeons were primarily used for objective assessments (78%) with 46% using blinding. Thirty (56%) studies explored objective changes in technical performance with 97% demonstrating improvement. The other studies were primarily validating assessment tools. Thirty-nine per cent of studies had established these assessment tools into training curricula. The mean ± standard deviation MERSQI score for all studies was 13.6 ± 1.5 demonstrating high validity. CONCLUSIONS Despite validated technical skill assessment tools being available and demonstrating trainee improvement, their regular adoption into training curricula is lacking. There is a need to incorporate these assessments to increase the efficiency and transparency of training programmes for cardiothoracic surgeons.
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Affiliation(s)
- Nabil Hussein
- Hull-York-Medical-School, University of York, York, UK.,Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | | | - Connor Callahan
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Malak Elbatarny
- Department of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Mahmoud Loubani
- Hull-York-Medical-School, University of York, York, UK.,Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
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Simulation training for embryo transfer: findings from the American Society for Reproductive Medicine Embryo Transfer Certificate Course. Fertil Steril 2020; 115:852-859. [PMID: 33358251 DOI: 10.1016/j.fertnstert.2020.10.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the value of the American Society for Reproductive Medicine Embryo Transfer Certificate Course in confidence and skill building for performing a live embryo transfer (ET). DESIGN Prospective cohort study. SETTING Two-day simulation workshops of reproductive endocrine and infertility (REI) fellows from American Board of Obstetrics and Gynecology-approved training programs, using four different uterine models (A-D). PATIENT(S) None. INTERVENTION(S) Didactic and hands-on simulation training program. MAIN OUTCOME MEASURE(S) Primary outcomes included ET simulation scores of all exercises analyzed at various points of the training and self-assessed confidence before and after the completion of the Embryo Transfer Certificate Course based on a 6-point Likert scale and association of both with extent of prior live ET experience and year of fellowship. RESULT(S) Data were collected for 78 REI fellows who completed the Embryo Transfer Certificate Course and demonstrated significant improvements in both skill and confidence. The data for a subset of 58 fellows who performed five direct transfers on both Embryo Transfer Certificate Course uterine models A and B demonstrated significant overall improvement in ET simulation scores between the first and fifth direct transfers. A separate data subset of 57 fellows who performed five afterload transfers for each exercise on all four uterine models demonstrated differences in difficulty among them. Embryo transfer simulation using the uterine A model was consistently the easiest. The ET simulation scores for fellows using the uterine B and C models showed a progressive and significant increase across the five afterload ETs. When using the uterine D model, ET simulation scores increased significantly between the first and second transfers but remained at the same level for the remaining three transfers. Except for uterus A, a significant increase in ET simulation scores between the first and last transfers was observed for fellows overall in all afterload transfers and for those fellows with <50 prior live transfers. Data for all 78 fellows demonstrate a significant gain of self-confidence for all parameters, with the highest overall increase (78%) observed for first-year fellows as well as for fellows of any year with no prior live transfer experience (109%). Fellows with the largest number of prior live ET experience started with higher confidence, which also increased significantly, although they had a lower gain in confidence compared with fellows with less experience. CONCLUSION(S) The American Society for Reproductive Medicine Embryo Transfer Certificate Course data analysis demonstrates the effectiveness of simulator-based ET training for REI fellows across the 3 years of training, regardless of prior experience with live ET.
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Miller DT, Zaidi HQ, Sista P, Dhake SS, Pirotte MJ, Fant AL, Salzman DH. Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy. West J Emerg Med 2020; 21:1258-1265. [PMID: 32970583 PMCID: PMC7514402 DOI: 10.5811/westjem.2020.5.46207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Emergency department thoracotomy (EDT) is a lifesaving procedure within the scope of practice of emergency physicians. Because EDT is infrequently performed, emergency medicine (EM) residents lack opportunities to develop procedural competency. There is no current mastery learning curriculum for residents to learn EDT. The purpose of this study was to develop and implement a simulation-based mastery learning curriculum to teach and assess EM residents’ performance of the EDT. Methods We developed an EDT curriculum using a mastery learning framework. The minimum passing standard (MPS) for a previously developed 22-item checklist was determined using the Mastery Angoff approach. EM residents at a four-year academic EM residency program underwent baseline testing in performing an EDT on a simulation trainer. Performance was scored by two raters using the checklist. Learners then participated in a novel mastery learning EDT curriculum that included an educational video, hands-on instruction, and deliberate practice. After a three-month period, residents then completed initial post testing. Residents who did not meet the minimum passing standard after post testing participated in additional deliberate practice until mastery was obtained. Baseline and post-test scores, and time to completion of the procedure were compared with paired t-tests. Results Of 56 eligible EM residents, 54 completed baseline testing. Fifty-two residents completed post-testing until mastery was reached. The minimum passing standard was 91.1%, (21/22 items correct on the checklist). No participants met the MPS at the baseline assessment. After completion of the curriculum, all residents subsequently reached the MPS, with deliberate practice sessions not exceeding 40 minutes. Scores from baseline testing to post-testing significantly improved across all postgraduate years from a mean score of 10.2/22 to 21.4/22 (p <0.001). Mean time to complete the procedure improved from baseline testing (6 minutes [min] and 21 seconds [sec], interquartile range [IQR] = 4 min 54 sec - 7 min 51 sec) to post-testing (5 min 19 seconds, interquartile range 4 min 17sec - 6 min 15 sec; p = 0.001). Conclusion This simulation-based mastery learning curriculum resulted in all residents performing an EDT at a level that met or exceeded the MPS with an overall decrease in time needed to perform the procedure.
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Affiliation(s)
- Danielle T Miller
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
| | - Hashim Q Zaidi
- University of Chicago School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Priyanka Sista
- Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, Tennessee
| | - Sarah S Dhake
- NorthShore University Health System, Department of Emergency Medicine, Chicago, Illinois
| | - Matthew J Pirotte
- Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, Tennessee
| | - Abra L Fant
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - David H Salzman
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
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Aslam W, Lee HJ, Lamb CR. Standardizing education in interventional pulmonology in the midst of technological change. J Thorac Dis 2020; 12:3331-3340. [PMID: 32642256 PMCID: PMC7330781 DOI: 10.21037/jtd.2020.03.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Interventional pulmonology (IP) is a maturing subspecialty of pulmonary medicine. The robust innovation in technology demands standardization in IP training with both disease and technology driven training. Simulation based training should be considered a part of IP training as seen in other procedural and surgical subspecialties. Procedure volume is a component of training; however, this does not guarantee or translate into competency for learners. Basic competency skills can be assessed using standardized well validated assessment tools designed for various IP procedures including flexible bronchoscopy, endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA), rigid bronchoscopy and chest tube placement; however, further work is needed to validate tools in all procedures as new technologies are introduced beyond fellowship training. Currently there are at least 39 IP fellowship programs in the United States (US) and Canada which has led to improved training by accreditation of programs who meet rigorous requirements of standardized curriculum and procedural volume. The challenge is to be innovative in how we teach globally with intention and how to best integrate new evolving technology training for those not only during fellowship training but also beyond fellowship training.
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Affiliation(s)
- Waqas Aslam
- Department of Interventional Pulmonary, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Hans J Lee
- Department of Interventional Pulmonary, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carla R Lamb
- Department of Interventional Pulmonary, Lahey Hospital & Medical Center, Burlington, MA, USA
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13
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Life-saving interventions in pediatric trauma: A National Trauma Data Bank experience. J Trauma Acute Care Surg 2020; 87:1321-1327. [PMID: 31464866 DOI: 10.1097/ta.0000000000002478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergent procedures are infrequent in pediatric trauma. We sought to determine the frequency and efficacy of life-saving interventions (LSI) performed for pediatric trauma patients within the first hour of care at a trauma center. METHODS The National Trauma Data Bank (2010-2014) was queried for patients 19 years or younger who underwent LSIs within 1 hour of arrival to the emergency department. Life-saving interventions included emergency department thoracotomy (EDT) and emergent airway procedures (EAP). Multivariable logistic regression was used to evaluate the influence of patient and hospital characteristics on mortality. RESULTS Of 725,284 recorded traumatic encounters, only 1,488 (0.2%) pediatric patients underwent at least one of the defined LSI during the 5-year study period (EDT, 1,323; EAP, 187). Most patients (85.6%) were 15 years or older. Mortality was high but varied by procedure type (EDT, 64.3%; EAP, 28.3%). Mortality for patients younger than 1 year undergoing EDT was 100%, decreasing to 62.6% in patients aged 15 years to 19 years. For EAP, mortality ranged from 66.7% for infants to 27.2% in 15-year-old to 19-year-old patients. Lower Glasgow Coma Scale score, higher Injury Severity Score, presence of shock, and a blunt mechanism of injury were independently associated with mortality in the EDT cohort. On average, trauma centers in this study performed approximately one LSI per year, with only 13.8% of cases occurring at a verified pediatric trauma center. CONCLUSION Life-saving interventions in the pediatric trauma population are uncommon and outcomes variable. Novel solutions to keep proficient at such interventions should be sought, especially for younger children. Guidelines to improve identification of appropriate candidates for LSI are critical given their rare occurrence. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Vaidya A, Aydin A, Ridgley J, Raison N, Dasgupta P, Ahmed K. Current Status of Technical Skills Assessment Tools in Surgery: A Systematic Review. J Surg Res 2020; 246:342-378. [DOI: 10.1016/j.jss.2019.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/29/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022]
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Bengiamin DI, Toomasian C, Smith DD, Young TP. Emergency Department Thoracotomy: A Cost-Effective Model for Simulation Training. J Emerg Med 2019; 57:375-379. [PMID: 31378446 DOI: 10.1016/j.jemermed.2019.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/05/2019] [Accepted: 06/15/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Simulation provides a safe learning environment where high-stakes, low-frequency procedures can be practiced without the fear of being unsuccessful or causing harm. Emergency department thoracotomy (EDT) is one such procedure. Realistic thoracotomy models are expensive and not readily available. OBJECTIVE Our objective is to describe a cost-effective, realistic, reproducible, and reusable thoracotomy model for simulation training. METHODS We modified a commercially available clothes mannequin torso to expose the chest and abdominal cavity. A plastic skeleton composed of a spinal cord and ribs was placed inside the torso. Tubing was used to simulate the aorta and esophagus; both tubes were secured to the distal spine with zip ties. Commercially available lungs and heart were placed inside the chest cavity. A small rubber ball simulated the left lung to be able to maneuver the lung. The heart was covered with plastic wrap to simulate the pericardium. Thick tape was used to simulate the pleural cavity. Yoga mats were used to simulate the intercostal muscles, subcutaneous tissue, and skin. RESULTS This model was tested with Emergency Medicine (EM) residents during a simulation session. A voluntary survey was available for residents to provide feedback. Survey results confirmed that the model provided valuable education, with overall positive feedback. CONCLUSION This EDT model provides a valuable teaching opportunity to EM residents who otherwise might not have the opportunity to perform this procedure. Residents agreed that the model improved their confidence and is an effective method in providing the opportunity to practice this low-frequency, high-stakes procedure.
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Affiliation(s)
- Deena I Bengiamin
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
| | - Cory Toomasian
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
| | - Dustin D Smith
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
| | - Timothy P Young
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
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Weersink K, Hall AK, Rich J, Szulewski A, Dagnone JD. Simulation versus real-world performance: a direct comparison of emergency medicine resident resuscitation entrustment scoring. Adv Simul (Lond) 2019; 4:9. [PMID: 31061721 PMCID: PMC6492388 DOI: 10.1186/s41077-019-0099-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Simulation is increasingly being used in postgraduate medical education as an opportunity for competency assessment. However, there is limited direct evidence that supports performance in the simulation lab as a surrogate of workplace-based clinical performance for non-procedural tasks such as resuscitation in the emergency department (ED). We sought to directly compare entrustment scoring of resident performance in the simulation environment to clinical performance in the ED. Methods The resuscitation assessment tool (RAT) was derived from the previously implemented and studied Queen's simulation assessment tool (QSAT) via a modified expert review process. The RAT uses an anchored global assessment scale to generate an entrustment score and narrative comments. Emergency medicine (EM) residents were assessed using the RAT on cases in simulation-based examinations and in the ED during resuscitation cases from July 2016 to June 2017. Resident mean entrustment scores were compared using Pearson's correlation coefficient to determine the relationship between entrustment in simulation cases and in the ED. Inductive thematic analysis of written commentary was conducted to compare workplace-based with simulation-based feedback. Results There was a moderate, positive correlation found between mean entrustment scores in the simulated and workplace-based settings, which was statistically significant (r = 0.630, n = 17, p < 0.01). Further, qualitative analysis demonstrated overall management and leadership themes were more common narratives in the workplace, while more specific task-based feedback predominated in the simulation-based assessment. Both workplace-based and simulation-based narratives frequently commented on communication skills. Conclusions In this single-center study with a limited sample size, assessment of residents using entrustment scoring in simulation settings was demonstrated to have a moderate positive correlation with assessment of resuscitation competence in the workplace. This study suggests that resuscitation performance in simulation settings may be an indicator of competence in the clinical setting. However, multiple factors contribute to this complicated and imperfect relationship. It is imperative to consider narrative comments in supporting the rationale for numerical entrustment scores in both settings and to include both simulation and workplace-based assessment in high-stakes decisions of progression.
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Affiliation(s)
- Kristen Weersink
- 1Department of Emergency Medicine, Queen's University, Kingston Health Sciences Center c/o 76 Stuart St, Kingston, ON K7L2V7 Canada
| | - Andrew K Hall
- 1Department of Emergency Medicine, Queen's University, Kingston Health Sciences Center c/o 76 Stuart St, Kingston, ON K7L2V7 Canada
| | - Jessica Rich
- 2Faculty of Education, Queen's University, Kingston, ON Canada
| | - Adam Szulewski
- 1Department of Emergency Medicine, Queen's University, Kingston Health Sciences Center c/o 76 Stuart St, Kingston, ON K7L2V7 Canada
| | - J Damon Dagnone
- 1Department of Emergency Medicine, Queen's University, Kingston Health Sciences Center c/o 76 Stuart St, Kingston, ON K7L2V7 Canada
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Development and Utilization of 3D Printed Material for Thoracotomy Simulation. Emerg Med Int 2018; 2018:9712647. [PMID: 30581626 PMCID: PMC6276476 DOI: 10.1155/2018/9712647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/18/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022] Open
Abstract
Medical simulation is a widely used training modality that is particularly useful for procedures that are technically difficult or rare. The use of simulations for educational purposes has increased dramatically over the years, with most emergency medicine (EM) programs primarily using mannequin-based simulations to teach medical students and residents. As an alternative to using mannequin, we built a 3D printed models for practicing invasive procedures. Repeated simulations may help further increase comfort levels in performing an emergency department (ED) thoracotomy in particular, and perhaps this can be extrapolated to all invasive procedures. Using this model, a simulation training conducted with EM residents at an inner city teaching hospital showed improved confidence. A total of 21 residents participated in each of the three surveys [(1) initially, (2) after watching the educational video, and (3) after participating in the simulation]. Their comfort levels increased from baseline after watching the educational video (9.5%). The comfort level further improved from baseline after performing the hands on simulation (71.4%).
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