The Role of Manual Dexterity and Cognitive Functioning in Enhancing Resident Operative Autonomy

Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students

BACKGROUND

Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills.

METHODS

A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire.

RESULTS

Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05).

CONCLUSION

Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.

Robot-assisted ex vivo neobladder reconstruction: preliminary results of surgical skill evaluation

PURPOSE

Advanced developments in the medical field have gradually increased the public demand for surgical skill evaluation. However, this assessment always depends on the direct observation of experienced surgeons, which is time-consuming and variable. The introduction of robot-assisted surgery provides a new possibility for this evaluation paradigm. This paper aims at evaluating surgeon performance automatically with novel evaluation metrics based on different surgical data.

METHODS

Urologists ([Formula: see text]) from a hospital were requested to perform a simplified neobladder reconstruction on an ex vivo setup twice with different camera modalities ([Formula: see text]) randomly. They were divided into novices and experts ([Formula: see text], respectively) according to their experience in robot-assisted surgeries. Different performance metrics ([Formula: see text]) are proposed to achieve the surgical skill evaluation, considering both instruments and endoscope. Also, nonparametric tests are adopted to check if there are significant differences when evaluating surgeons performance.

RESULTS

When grouping according to four stages of neobladder reconstruction, statistically significant differences can be appreciated in phase 1 ([Formula: see text]) and phase 2 ([Formula: see text]) with normalized time-related metrics and camera movement-related metrics, respectively. On the other hand, considering experience grouping shows that both metrics are able to highlight statistically significant differences between novice and expert performances in the control protocol. It also shows that the camera-related performance of experts is significantly different ([Formula: see text]) when handling the endoscope manually and when it is automatic.

CONCLUSION

Surgical skill evaluation, using the approach in this paper, can effectively measure surgical procedures of surgeons with different experience. Preliminary results demonstrate that different surgical data can be fully utilized to improve the reliability of surgical evaluation. It also demonstrates its versatility and potential in the quantitative assessment of various surgical operations.

Empowering the Resident Learner

Surgical resident autonomy is an essential element of the transition from supervised training to independent practice. However, in an age of duty hour restrictions, legislative constraints, increased litigation, and heightened societal expectations, training an autonomous resident proves increasingly difficult. To tackle these barriers to training successful surgeons, the American College of Surgeons Committee on Resident Education initiated the Resident Mentored Autonomy Project. As a subdivision of this project, the Empowered Learner research team here presents a framework for training the self-directed and empowered surgical resident learner. There are many strategies by which surgical faculty, program directors and chairs, and residents themselves may engage to improve resident operative autonomy.

Public Perceptions of General Surgery Residency Training

OBJECTIVE

Patients are integral to surgical training. Understanding our patients' perceptions of surgical training, resident involvement and autonomy is crucial to optimizing surgical education and thus patient care. In the modern, connected world many factors extrinsic to a patient's experience of healthcare may influence their opinion of our training systems (i.e., social media, television shows, and internet searches). The purpose of this article is to contextualize the literature investigating public perceptions of general surgery training to allow us to effect patient education initiatives to optimize both surgical training and patient safety.

DESIGN

This is a perspective including a literature review summarizing the current knowledge of public perceptions of general surgery training.

CONCLUSIONS

Little is published regarding patient and public perceptions of general surgery residency training and the role of residents within this. Current literature demonstrates that the majority of patients are willing to have residents participate in their care. Patients' attitude toward resident involvement in their operation is improved by utilizing educational materials and by ensuring a supervising attending is present within the operating room. These observations, coupled with future work to delve deeper into factors affecting public perceptions of surgical training and resident involvement within this, can guide strategies to improve surgical education.

Gender perception bias of operative autonomy evaluations among residents and faculty in general surgery training

BACKGROUND

Resident operative autonomy (ROA) is critical and a shared responsibility of both faculty and residents during training. We hypothesize that there is a perception of gender bias in residents' performance as evaluated by faculty and residents.

METHOD

Over a period of five academic years, between July 2014 and June 2019, ROA was evaluated using the Zwisch score. Reciprocal evaluations were completed by faculty and residents.

RESULTS

39 surgeons (30 males, 9 females) and 42 residents (25 males, 15 females) completed 2360 evaluations (1180 by faculty, and a matched number by residents). PGY level was significantly associated with granting a higher level of autonomy. Gender of residents didn't affect the level of granted autonomy as evaluated by faculty. However, on self-evaluations, female residents rated their degree of autonomy lower than that of their male counterparts.

CONCLUSION

Gender did not influence the perception of autonomy granted as evaluated by faculty. However, on self-evaluations, female residents reported a lower degree of autonomy received.