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Ebrahim S, Kinoo SM, Naidoo M, Van Wyk JM. The use of household items to support online surgical knot-tying skills training: a mixed methods study. BMC MEDICAL EDUCATION 2024; 24:605. [PMID: 38822314 PMCID: PMC11143630 DOI: 10.1186/s12909-024-05549-1] [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: 11/17/2023] [Accepted: 05/10/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND This study investigated the perceptions and performance of medical students regarding their engagement and learning of a knot-tying skill presented in an online demonstration format due to the emergency remote measures that accompanied COVID-19 restrictions. METHODS Final-year undergraduate medical students were invited to view an online demonstration of a one-handed knot-tying skill and practice the skill using common household items. They recorded their attempts and uploaded them onto the Flipgrid application. Completed attempts were scored using an adapted Objective Structured Assessment of Technical Skill (OSATS) validated tool. We used a mixed-methods sequential explanatory design; data regarding students' engagement was gathered via a short questionnaire, and a Focus Group Discussion (FGD) was conducted to understand their learning experiences better. Descriptive statistics such as proportions and percentages were used to summarize categorical variables and median for continuous variables. Each video attempt was scored independently by two surgeons; reliability was determined using intraclass correlation; statistical tests were conducted at a 5% level of significance. Responses to open-ended survey questions and qualitative data from the FGDs were analysed using thematic analysis. RESULTS Seventy-one students participated in the exercise. Most students (91.5%) expressed confidence in their ability to perform the skill and were able to follow the steps in the video demonstration (83.1%). Median number of times needed to practice before video submission was 7.0 (Interquartile range [IQR] 5.0-10.0). Using the adapted OSATS tool; median scores on student attempts were 19.0 out of 21 (IQR: 17.0-20.0) for Assessor 1 and 18.0 out of 21 (IQR: 17.0-20.0) for Assessor 2, and overall scores showed good reliability between assessors based on intraclass correlation (0.86, 95% CI 0.79-0.90, p < 0.001). Qualitative insights from the students' experiences in learning the skill were generally positive; it was a practical, experiential learning process and they valued the social aspects of learning via Flipgrid. Challenges expressed related to the need for in-person training and formal feedback on how to improve their technique. Suggestions to improve their learning included a request for an interactive session with immediate feedback on attempts, and being able to practice with a friend who would assist with videoing. CONCLUSION Basic knot-tying can be taught with acceptable efficiency and student satisfaction using online methods with items available at home.
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Affiliation(s)
- Sumayyah Ebrahim
- Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Suman Mewa Kinoo
- Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Maheshwar Naidoo
- Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jacqueline Marina Van Wyk
- Department of Clinical and Professional Practice, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
- Department of Health Sciences Education, University of Cape Town, Observatory, South Africa.
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Carneiro A, Andrade GM. Technology description, initial experience and first impression of HUGO™ RAS robot platform in urologic procedures in Brazil. Int Braz J Urol 2023; 49:763-774. [PMID: 37903010 PMCID: PMC10947622 DOI: 10.1590/s1677-5538.ibju.2023.9910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 11/01/2023] Open
Affiliation(s)
- Arie Carneiro
- Hospital Israelita Albert EinsteinDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP. Brasil;
| | - Guilherme Miranda Andrade
- Hospital Israelita Albert EinsteinDepartamento de Uro-oncologia e Cirurgia RobóticaSão PauloSPBrasilDepartamento de Uro-oncologia e Cirurgia Robótica, Hospital Israelita Albert Einstein, São Paulo, SP. Brasil;
- FMABCFaculdade de Medicina do ABCDisciplina de UrologiaSanto AndréSPBrasilDisciplina de Urologia da Faculdade de Medicina do ABC – FMABC, Santo André, SP. Brasil
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Burke JR, Fleming CA, King M, El-Sayed C, Bolton WS, Munsch C, Harji D, Bach SP, Collins JW. Utilising an accelerated Delphi process to develop consensus on the requirement and components of a pre-procedural core robotic surgery curriculum. J Robot Surg 2023; 17:1443-1455. [PMID: 36757562 PMCID: PMC9909133 DOI: 10.1007/s11701-022-01518-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/31/2022] [Indexed: 02/10/2023]
Abstract
Robot-assisted surgery (RAS) continues to grow globally. Despite this, in the UK and Ireland, it is estimated that over 70% of surgical trainees across all specialities have no access to robot-assisted surgical training (RAST). This study aimed to provide educational stakeholders guidance on a pre-procedural core robotic surgery curriculum (PPCRC) from the perspective of the end user; the surgical trainee. The study was conducted in four Phases: P1: a steering group was formed to review current literature and summarise the evidence, P2: Pan-Specialty Trainee Panel Virtual Classroom Discussion, P3: Accelerated Delphi Process and P4: Formulation of Recommendations. Forty-three surgeons in training representing all surgical specialties and training levels contributed to the three round Delphi process. Additions to the second- and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement. There was 100% response from all three rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of > 0.8. There was 97.7% agreement that a standardised PPCRC would be advantageous to training and that, independent of speciality, there should be a common approach (95.5% agreement). Consensus was reached in multiple areas: 1. Experience and Exposure, 2. Access and context, 3. Curriculum Components, 4 Target Groups and Delivery, 5. Objective Metrics, Benchmarking and Assessment. Using the Delphi methodology, we achieved multispecialty consensus among trainees to develop and reach content validation for the requirements and components of a PPCRC. This guidance will benefit from further validation following implementation.
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Affiliation(s)
- Joshua Richard Burke
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Leeds Institute Medical Research, University of Leeds, Leeds, UK
| | - Christina A. Fleming
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- The Royal College of Surgeons, Dublin, Ireland
| | - Martin King
- The Association of Surgeons in Training, Royal College of Surgeons of England, London, England, UK
- Craigavon Area Hospital, Craigavon, Northern Ireland
| | - Charlotte El-Sayed
- Technology Enhanced Learning Directorate of Innovation, Digital and Transformation, Health Education England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | | | - Chris Munsch
- Technology Enhanced Learning Directorate of Innovation, Digital and Transformation, Health Education England, London, England
| | - Deena Harji
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon P. Bach
- Robotics and Digital Surgery Initiative, Royal College of Surgeons of England, London, England
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Justin W. Collins
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention, London, UK
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), UK, University College London, London, UK
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Kneifel F, Morgul H, Katou S, Hölzen JP, Strücker B, Juratli M, Pascher A, Becker F. Struggle in the bubble - a prospective study on the effect of remote learning and distance education on confidence in practical surgical skills acquired during COVID-19. BMC MEDICAL EDUCATION 2023; 23:115. [PMID: 36793029 PMCID: PMC9931444 DOI: 10.1186/s12909-023-04092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The coronavirus disease (COVID-19) has significantly changed healthcare systems and medical education. Universities were required to develop innovative curricula based on remote and distance education to continue medical education. This prospective questionnaire-based study aimed to investigate the impact of COVID-19-associated remote learning on the surgical training of medical students. METHODS A 16-item questionnaire-based survey was distributed to medical students at the University Hospital of Münster before and after a surgical skills laboratory (SSL). Two cohorts were included: summer semester 2021 (COV-19), with rigorous social-distancing restrictions requiered SSL to be remotely, and winter semester 2021 (postCOV-19), in which the SSL was provided as a face-to-face, hands-on course. RESULTS Both, cohorts showed a significant improvement in self-assessment of pre- and post-course confidence. While no significant difference in the average gain in self-confidence for sterile working was observed between the two cohorts, improvement in self-confidence was significantly higher in the COV-19 cohort regarding skin suturing and knot tying (p < 0.0001). However the average improvement regarding history and physical was significantly higher in the postCOV-19 cohort (p < 0.0001). In subgroup analysis, gender-associated differences varied in the two cohorts and were not related to specific subtasks, while age-stratified analysis revealed superior results for younger students. CONCLUSION The results of our study underline the usability, feasibility, and adequacy of remote learning for the surgical training of medical students. The on-site distance education version, presented in the study, allows the continuing of hands-on experience in a safe environment in compliance with governmental social-distancing restrictions.
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Affiliation(s)
- Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany.
| | - Haluk Morgul
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Jens P Hölzen
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Benjamin Strücker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Mazen Juratli
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
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Van Es SL, Tan AJ, Vial T, Burnand J, Blizard CM. Harnessing the disruption on medical trainee education due to COVID-19 in New South Wales, Australia. MEDEDPUBLISH 2022; 12:34. [PMID: 37869563 PMCID: PMC10587661 DOI: 10.12688/mep.19122.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has caused disruption and uncertainty for junior medical doctor training and education. This has compounded the existing stress experienced by this cohort. However, by choosing appropriate educational models, as well as using novel educational approaches and advancing our online technology capabilities, we may be able to provide acceptable and even, superior solutions for educational training moving forward, as well as promote trainee wellbeing during these uncertain times.
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Affiliation(s)
- Simone L. Van Es
- NSW Health Education and Training Institute (HETI), Sydney, Australia
- School of Biomedical Sciences, Faculty of Medicine and Health, The University of NSW, Sydney, Australia
| | - Aaron J.H. Tan
- NSW Health Education and Training Institute (HETI), Sydney, Australia
| | - Toni Vial
- NSW Health Education and Training Institute (HETI), Sydney, Australia
| | - Jo Burnand
- NSW Health Education and Training Institute (HETI), Sydney, Australia
| | - Claire M. Blizard
- NSW Health Education and Training Institute (HETI), Sydney, Australia
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Nathan A, Patel S, Georgi M, Fricker M, Asif A, Ng A, Mullins W, Hang MK, Light A, Nathan S, Francis N, Kelly J, Collins J, Sridhar A. Virtual classroom proficiency-based progression for robotic surgery training (VROBOT): a randomised, prospective, cross-over, effectiveness study. J Robot Surg 2022; 17:629-635. [PMID: 36253574 PMCID: PMC9576128 DOI: 10.1007/s11701-022-01467-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Robotic surgery training has lacked evidence-based standardisation. We aimed to determine the effectiveness of adjunctive interactive virtual classroom training (VCT) in concordance with the self-directed Fundamentals of Robotic Surgery (FRS) curriculum. The virtual classroom is comprised of a studio with multiple audio–visual inputs to which participants can connect remotely via the BARCO weConnect platform. Eleven novice surgical trainees were randomly allocated to two training groups (A and B). In week 1, both groups completed a robotic skills induction. In week 2, Group A received training with the FRS curriculum and adjunctive VCT; Group B only received access to the FRS curriculum. In week 3, the groups received the alternate intervention. The primary outcome was measured using the validated robotic-objective structured assessment of technical skills (R-OSAT) at the end of week 2 (time-point 1) and 3 (time-point 2). All participants completed the training curriculum and were included in the final analyses. At time-point 1, Group A achieved a statistically significant greater mean proficiency score compared to Group B (44.80 vs 35.33 points, p = 0.006). At time-point 2, there was no significant difference in mean proficiency score in Group A from time-point 1. In contrast, Group B, who received further adjunctive VCT showed significant improvement in mean proficiency by 9.67 points from time-point 1 (95% CI 5.18–14.15, p = 0.003). VCT is an effective, accessible training adjunct to self-directed robotic skills training. With the steep learning curve in robotic surgery training, VCT offers interactive, expert-led learning and can increase training effectiveness and accessibility.
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Affiliation(s)
- Arjun Nathan
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK. .,Royal College of Surgeons of England, London, UK. .,University College London Hospitals NHS Foundation Trust, London, UK.
| | - Sonam Patel
- University College London Medical School, London, UK
| | - Maria Georgi
- University College London Medical School, London, UK
| | | | - Aqua Asif
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Alexander Ng
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Medical School, London, UK
| | | | - Man Kien Hang
- University College London Medical School, London, UK
| | - Alexander Light
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Senthil Nathan
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Nader Francis
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Justin Collins
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT, UK.,University College London Hospitals NHS Foundation Trust, London, UK
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