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Anmolsingh R, Abrar R, Chandrasekar B, Salem J, Edmitson R, Advani R, Khwaja S, Watmough S, Kumar N. Higher Speciality Training Boot Camp in Otolaryngology: A Quantitative and Qualitative Analysis of the Northern National Formative Specialty Training 3 Induction Course. Cureus 2021; 13:e20308. [PMID: 35024258 PMCID: PMC8742674 DOI: 10.7759/cureus.20308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background Opportunities for new otolaryngology trainees to develop their skills as they embark on specialty training can be limited. Our facility hosted a national simulation-based boot camp for new otolaryngology trainees in the UK. This study aimed to assess the effectiveness of the boot camp in improving trainee confidence as they transitioned from core surgical training (CST) to higher specialty training (HST) in otolaryngology. Methodology We conducted a prospective study on the effectiveness of the boot camp on trainee induction. The boot camp included hands-on simulation, small group teaching and didactic lectures addressing technical skills in the fields of otology, laryngology, rhinology, facial plastics, and paediatrics, as well as non-technical skills involving human factors, simulated ward round, and cognitive simulation. The boot camp curriculum reflected the competencies expected by the Joint Committee of Surgical Training (JCST) at this level of training. Participants completed a pre- and post-course questionnaire addressing their self-confidence for the technical and non-technical skills they developed during the boot camp. All participants were invited to participate in an interview 12 months after the boot camp. Results A total of 27 new otolaryngology trainees (approximately half of all new otolaryngology trainees in the UK) participated in the boot camp. A significant increase in median confidence was observed for all technical and non-technical stations (p < 0.0001). The increase in confidence observed was similar for participants regardless of prior experience in otolaryngology. Five candidates were interviewed a year after the boot camp. Analysis of the transcripts generated distinct comments that were grouped into five key themes. Conclusions A simulation-based boot camp mapped to the JCST curriculum can increase the confidence of new otolaryngology Specialty Training 3 trainees during their transition from CST to HST. It can provide valuable and durable technical and non-technical skills to aid trainees in the clinic, theatre environment, and when on-call during their inaugural year of training.
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Affiliation(s)
- Rajesh Anmolsingh
- School of Surgery, Health Education England North West, Manchester, GBR
| | - Rohma Abrar
- Otolaryngology, Manchester University NHS Foundation Trust, Manchester, GBR
| | | | - Joseph Salem
- Otolaryngology, Alder Hey Children's Hospital, Liverpool, GBR
| | - Rachel Edmitson
- School of Surgery, Health Education England North West, Manchester, GBR
| | - Rajeev Advani
- School of Surgery, Health Education England North West, Manchester, GBR
| | - Sadie Khwaja
- Otolaryngology, Manchester University NHS Foundation Trust, Manchester, GBR
| | | | - Nirmal Kumar
- Otolaryngology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR
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Achievement of effective cardiopulmonary trauma surgical skills training throughout the incorporation of a low-cost and easy to implement pulsatile simulation model. Injury 2021; 52:1215-1220. [PMID: 33422290 DOI: 10.1016/j.injury.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES . In the last decade, concern regarding the preparedness of general surgery graduates to effectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experience implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation. DESIGN . Firstly, for validation purposes 8 junior residents, 8 recently graduated general surgeons, and 3 cardiothoracic surgery attendings from Pontificia Universidad Católica de Chile Clinical Hospital were recruited. Proficiency in performing a pulmonary tractotomy and a myocardial injury repair was assessed with global and specific rating scales. Secondly, to evaluate the effectiveness of the model as a learning tool, 16 general surgery residents from different programs across the country were recruited receiving intensive, personalized training on the models. Proficiency was measured before and after the training. RESULTS . For the validation phase, significant differences among groups according to the previous level of expertise were shown, and therefore construct validity was established. The results of the second phase showed a significant overall improvement in participant's performance. CONCLUSION . Effective training and assessment for advanced surgical skills in cardiothoracic trauma can be achieved using a low-cost pulsatile simulation model.
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Araujo SEA, Perez RO, Klajner S. Role of Simulation-Based Training in Minimally Invasive and Robotic Colorectal Surgery. Clin Colon Rectal Surg 2021; 34:136-143. [PMID: 33814994 DOI: 10.1055/s-0040-1718687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Properly performing minimally invasive colorectal procedures requires specific skills. With a focus on patient safety, the training of surgeons on patients is only accepted under exceptionally controlled, expensive, and challenging conditions. Moreover, many new techniques in colorectal surgery have been developed. Therefore, undertaking minimally invasive colorectal surgery in modern times requires specific psychomotor skills that trainee surgeons must gather in less time. In addition, there are not enough proctors with sufficient expertise for such an expressive number of new different techniques likes transanal and robotic procedures. Studies that have demonstrated an improvement in minimally invasive surgery skills to the actual operating room in general surgery and a stepwise approach to surgical simulation with a combination of various training methods appears to be useful in colorectal surgery training programs. However, the scientific evidence on the transfer of skills specifically for colorectal surgery is extremely scarce and very variable. Thus, the evaluation of the results remains quite difficult. In this review, we present the best available evidence on the types of training based on simulation, their characteristics, advantages and disadvantages, and finally the results available on their adoption. Nevertheless, scientific evidence about the benefit of simulation training in minimally invasive colorectal surgery is limited and there is a need to build more robust evidence.
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Affiliation(s)
| | - Rodrigo Oliva Perez
- Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Sidney Klajner
- Colorectal Surgery Division, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Rana T, Hackett C, Quezada T, Chaturvedi A, Bakalov V, Leonardo J, Rana S. Medicine and surgery residents' perspectives on the impact of COVID-19 on graduate medical education. MEDICAL EDUCATION ONLINE 2020; 25:1818439. [PMID: 32924869 PMCID: PMC7534325 DOI: 10.1080/10872981.2020.1818439] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/29/2020] [Indexed: 05/25/2023]
Abstract
The COVID-19 crisis has had an unprecedented impact on resident education and well-being: social distancing guidelines have limited patient volumes and forced virtual learning, while personal protective equipment (PPE) shortages, school/daycare closures, and visa restrictions have served as additional stressors. Our study aimed to analyze the effects of COVID-19 crisis-related stressors on residents' professional and personal lives. In April 2020, we administered a survey to residents at a large academic hospital system in order to assess the impact of the pandemic on residency training after >6 weeks of a modified schedule. The primary outcome was to determine which factors or resident characteristics were related to stress during the pandemic. Our secondary goals were to examine which resident characteristics were related to survey responses. Data were analyzed with regression analyses. Ninety-six of 205 residents completed the survey (47% response rate). For our primary outcome, anxiety about PPE (P < 0.001), female gender (P = 0.03), and the interaction between female gender and anxiety about PPE (P = 0.04) were significantly related to increased stress during the COVID-19 pandemic. Secondary analyses suggested that medicine residents were more comfortable than surgical residents using telemedicine (P > 0.001). Additionally, compared to juniors, seniors believed that the pandemic was more disruptive, modified schedules were effective, and virtual meetings were less effective while virtual lectures were more effective (all P ≤ 0.05) Furthermore, the pandemic experience has allowed seniors in particular to feel more confident to lead in future health crises (P ≤ 0.05). Medicine and surgery residency programs should be cognizant of and closely monitor the effects of COVID-19 crisis-related factors on residents' stress and anxiety levels. Transparent communication, telemedicine, online lectures/meetings, procedure simulations, advocacy groups, and wellness resources may help to mitigate some of the challenges posed by the pandemic.
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Affiliation(s)
- Tanvi Rana
- Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Christopher Hackett
- Department of Neurology, Neuroscience Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Timothy Quezada
- Department of Neurology, Neuroscience Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Abhishek Chaturvedi
- Department of Medicine, Medicine Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Veli Bakalov
- Department of Medicine, Medicine Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Jody Leonardo
- Neurosurgery, Neuroscience Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Sandeep Rana
- Department of Neurology, Neuroscience Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
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5
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Tejos R, Crovari F, Achurra P, Avila R, Inzunza M, Jarry C, Martinez J, Riquelme A, Alseidi A, Varas J. Video-Based Guided Simulation without Peer or Expert Feedback is Not Enough: A Randomized Controlled Trial of Simulation-Based Training for Medical Students. World J Surg 2020; 45:57-65. [PMID: 32892271 DOI: 10.1007/s00268-020-05766-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Feedback is a pivotal cornerstone and a challenge in psychomotor training. There are different teaching methodologies; however, some may be less effective. METHODS A prospective randomized controlled trial was conducted in 130 medical students to compare the effectiveness of the video-guided learning (VLG), peer-feedback (PFG) and the expert feedback (EFG) for teaching suturing skills. The program lasted 4 weeks. Students were recorded making 3-simple stitches (pre-assessment and post-assessment). The primary outcome was a global scale (OSATS). The secondary outcomes were performance time, specific rating scale (SRS) and the impact of the intervention (IOI), defined as the variation between the final and initial OSATS and SRS scores. RESULTS No significant differences were found between PFG and EFG in post-assessment results of OSATS, SRS scores or in the IOI for OSATS and SRS scores. Post-assessment results of PFG and EFG were significantly superior to VLG in OSATS and SRS scores [(19.8 (18.5-21); 16.6 (15.5-17.5)) and (20.3 (19.88-21); 16.8 (16-17.5)) vs (15.7 (15-16); 13.3 (12.5-14)) (p < 0.05)], respectively. The results of PFG and EFG were significantly superior to VLG in the IOI for OSATS [7 (4.5-9) and 7.4 (4.88-10) vs 3.5 (1.5-6) (p < 0.05)] and SRS scores [5.4 (3.5-7) and 6.3 (4-8.5) vs 3.1 (1.13-4.88) (p < 0.05)], respectively. CONCLUSION The video-guided learning methodology without any kind of feedback is not enough for teaching suturing skills compared to expert or peer feedback. The peer feedback methodology appears to be a viable alternative to handling the emerging demands in medical education.
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Affiliation(s)
- Rodrigo Tejos
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Fernando Crovari
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Ruben Avila
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Martín Inzunza
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Cristian Jarry
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Jorge Martinez
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile
| | - Arnoldo Riquelme
- Department of Gastroenterology and Centre for Medical Education, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Julian Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, 8330024, Santiago, Chile.
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Room HJ, Ji C, Kohli S, Choh C, Robinson P, Knight J, Dennis S. Core surgical field camps: a new deanery-based model for enhancing advanced skills in core surgical trainees through simulation. Br J Hosp Med (Lond) 2020; 81:1-6. [PMID: 32990069 DOI: 10.12968/hmed.2020.0333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical 'boot camps' have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical 'field camps' were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.
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Affiliation(s)
- H J Room
- Department of Upper Gastrointestinal Surgery, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
| | - C Ji
- Department of Upper Gastrointestinal Surgery, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
| | - S Kohli
- Department of Trauma and Orthopaedic Surgery, Salisbury District Hospital Foundation Trust, Salisbury, UK
| | - Ctp Choh
- Department of Upper Gastrointestinal Surgery, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Bournemouth, UK
| | - P Robinson
- Department of Colorectal Surgery, University Hospitals Southampton, Southampton, UK
| | - J Knight
- Department of Upper Gastrointestinal Surgery, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
| | - S Dennis
- Department of Otolaryngology, Salisbury District Hospital Foundation Trust, Salisbury, UK
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Oviedo-Peñata CA, Tapia-Araya AE, Lemos JD, Riaño-Benavides C, Case JB, Maldonado-Estrada JG. Validation of Training and Acquisition of Surgical Skills in Veterinary Laparoscopic Surgery: A Review. Front Vet Sci 2020; 7:306. [PMID: 32582781 PMCID: PMC7283875 DOI: 10.3389/fvets.2020.00306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
At present, veterinary laparoscopic surgery training is lacking in experiences that provide a controlled and safe environment where surgeons can practice specific techniques while receiving experts' feedback. Surgical skills acquired using simulators must be certified and transferable to the operating room. Most models for practicing laparoscopic skills in veterinary minimally invasive surgery are general task trainers and consist of boxes (simulators) designed for training human surgery. These simulators exhibit several limitations, including anatomic species and procedural differences, as well as general psychomotor training rather than in vivo skill recreation. In this paper, we review the existing methods of training, evaluation, and validation of technical skills in veterinary laparoscopic surgery. Content includes global and specific scales, and the conditions a structured curriculum should meet for improving the performance of novice surgeons during and after training. A focus on trainee-specific assessment and tailored-technical instruction should influence training programs. We provide a comprehensive analysis of current theories and concepts related to the evaluation and validation of simulators for training laparoscopic surgery in small animal surgery. We also highlight the need to develop new training models and complementary evaluation scales for the validation of training and acquisition of basic and advanced skills in veterinary laparoscopic surgery.
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Affiliation(s)
- Carlos A Oviedo-Peñata
- Tropical Animal Production Research Group, Faculty of Veterinary Medicine and Zootechny, University of Cordoba, Monteria, Colombia.,Surgery and Theriogenology Branch OHVRI-Group, College of Veterinary Medicine, University of Antioquia, Medellin, Colombia
| | | | - Juan D Lemos
- Bioinstrumentation and Clinical Engineering Research Group (GIBIC), Bioengineering Department, Engineering Faculty, Universidad de Antioquia, Medellín, Colombia
| | - Carlos Riaño-Benavides
- Surgery and Theriogenology Branch OHVRI-Group, College of Veterinary Medicine, University of Antioquia, Medellin, Colombia
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Juan G Maldonado-Estrada
- Surgery and Theriogenology Branch OHVRI-Group, College of Veterinary Medicine, University of Antioquia, Medellin, Colombia
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Suarez-Revelo JX, Ochoa-Gomez JF, Hernandez-Valdivieso AM. Neurophysiological changes associated with training in laparoscopic surgery using EEG: a pilot study .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4572-4575. [PMID: 31946882 DOI: 10.1109/embc.2019.8856980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laparoscopy is a minimally invasive technique that requires surgeons to acquire special motor skills derived from an extensive training. This work focuses on exploring the neurophysiological changes associated with motor learning. Electroencephalographic (EEG) signals were recorded from eight subjects while performing a bimanual coordination task in a laparoscopic simulator. Spectral power measurements in theta, alpha and beta bands during four training sessions were calculated. Power indices, task score and perception of mental workload were evaluated using analysis of variance to show the effect of training session. Results show improvements in task performance and changes in power measurements associated with the training process. This work opens the possibility to assess the training performance of surgical residents using electrophysiological recordings.
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9
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Pepley DF, Chen HE, Tang Y, Adhikary SD, Miller SR, Moore JZ. Low-Cost Haptic Simulation Using Material Fracture. IEEE TRANSACTIONS ON HAPTICS 2019; 12:563-570. [PMID: 31056520 PMCID: PMC6944059 DOI: 10.1109/toh.2019.2914441] [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] [Indexed: 06/09/2023]
Abstract
Medical simulation training is widely used to effectively train for invasive medical procedures such as peripheral nerve blocks. Traditionally, accurate haptic training relies on expensive cadavers, manikins, or advanced haptic robots. Proposed herein is a novel concept for haptic training called the low-cost haptic force needle insertion simulator (LCNIS), which uses material fracture inside disposable cartridges to accurately replicate the force of inserting a needle into tissue. Cadaver and material fracture experiments were performed to develop and determine the accuracy of the LCNIS. The material testing showed that polycarbonate had the highest maximum needle puncture force of the materials tested, 9.85 N, and that fluorinated ethylene propylene had the lowest maximum puncture force, 0.84 N. The cadaver results showed that the error between the three peak forces in a cadaver and a cadaver mimicking cartridge was 1.00 N, 0.01 N, and 1.54 N. The standard deviation of these peaks was 0.60 N, 0.55 N, and 0.41 N. This novel method of haptic simulation can easily be adapted to recreate any type of force and, therefore, could be utilized to train for a wide variety of medical procedures.
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10
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Nakazato T, Callahan Z, Kuchta K, Linn JG, Joehl RJ, Ujiki MB. A 1-day simulation-based boot camp for incoming general surgery residents improves confidence and technical skills. Surgery 2019; 166:572-579. [DOI: 10.1016/j.surg.2019.05.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/19/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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Sugand K, Wescott RA, Carrington R, Hart A, van Duren BH. Training and Transfer Effect of FluoroSim, an Augmented Reality Fluoroscopic Simulator for Dynamic Hip Screw Guidewire Insertion: A Single-Blinded Randomized Controlled Trial. J Bone Joint Surg Am 2019; 101:e88. [PMID: 31483408 DOI: 10.2106/jbjs.18.00928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND FluoroSim, a novel fluoroscopic simulator, can be used to practice dynamic hip screw (DHS) guidewire insertion in a high-fidelity clinical scenario. Our aim was to demonstrate a training effect in undergraduate medical students who are not familiar with this operation and its simulation. METHODS Forty-five undergraduate medical students were recruited and randomized to either training (n = 23) or control (n = 22) cohorts. The training cohort had more exposure to FluoroSim (5 attempts each week) over a 2-week period (with a 1-week washout period in between) compared with the control cohort (a single attempt 1 week apart) over a 2-week period. Five real-time objective performance metrics were recorded: (1) tip-apex distance (TAD) (mm), (2) predicted cut-out rate (%), (3) total procedural time (sec), (4) total number of radiographs (n), and (5) total number of guidewire retries (n). RESULTS At baseline, there was no significant difference in the performance metrics, which confirmed the absence of a selection bias. The intragroup training effect demonstrated a significant improvement in all metrics for the training cohort only. A significant difference between groups was demonstrated as the training cohort significantly outperformed the control cohort in 3 metrics (procedural time [25%], number of radiographs [57%], and number of guidewire retries [100%]; p < 0.001). A learning curve showed an inversely proportional correlation between frequency of attempts and procedural time as well as the number of digital fluoroscopic radiographs that were made, indicating the development of psychomotor skills. There was also an improved baseline of the learning curve after the 1-week washout period, suggesting skill retention. CONCLUSIONS Skill acquisition with the FluoroSim system was demonstrated with repeat exposure in a safe, radiation-free high-fidelity clinical simulation with actual operating room equipment. The task of DHS guidewire insertion requires cognitive and psychomotor skills that take a variable number of attempts to acquire, as demonstrated on the learning curve. Additional work is required to demonstrate that the skill tested by the FluoroSim is the same skill that is required for intraoperative DHS guidewire insertion. However, use of the FluoroSim provides improvement in skills with extra-clinical training opportunities for orthopaedic trainees. CLINICAL RELEVANCE FluoroSim has demonstrated validity and training effect. It has the potential to be approved for possible use on patients in the operating room to help surgeons with the operation. Consequently, operating time, accuracy of TAD, and surgical outcomes may all be improved.
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Affiliation(s)
- Kapil Sugand
- MSk Lab, Imperial College London, London, United Kingdom.,Royal National Orthopedic Hospital, Stanmore, United Kingdom
| | - Robert A Wescott
- Institute of Orthopedics & Musculoskeletal Sciences, University College London, London, United Kingdom
| | | | - Alister Hart
- Royal National Orthopedic Hospital, Stanmore, United Kingdom.,Institute of Orthopedics & Musculoskeletal Sciences, University College London, London, United Kingdom
| | - Bernard H van Duren
- Institute of Orthopedics & Musculoskeletal Sciences, University College London, London, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Leeds, United Kingdom
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12
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Blackhall VI, Cleland J, Wilson P, Moug SJ, Walker KG. Barriers and facilitators to deliberate practice using take-home laparoscopic simulators. Surg Endosc 2019; 33:2951-2959. [PMID: 30456507 PMCID: PMC6684499 DOI: 10.1007/s00464-018-6599-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several regions in the UK and Ireland have delivered home-based laparoscopic simulation programmes in an attempt to progress surgical trainees' skills through deliberate practice. However, engagement with these programmes has been poor. This study aims to uncover the barriers to engagement with home-based simulation, with a view to developing an improved programme. METHODS This was a qualitative study using focus groups with key stakeholders including junior surgical trainees, consultants/attendings and simulation faculty. Data were collected across four regions in three countries. Data were audio-recorded, transcribed and a thematic analysis was performed using NVivo software. RESULTS Sixty-three individuals were interviewed in 12 focus groups (43 trainees, 20 trainers). Trainees cited competing commitments as a barrier to engaging with home-based simulation. They tended to focus on scoring 'points' towards career progression rather than viewing tasks as interesting, or associated with personal development. Their view was that this approach is perpetuated by the training system, which rewards trainees for publications and exams, but not for operative skill. Trainees were unsatisfied with metric feedback and wanted individual feedback from consultants (attendings). Trainees perceived consultants as lacking interest in the programmes and training in general. However, some consultants were unaware of the programmes being delivered and others felt lacking in confidence to deliver the necessary training. CONCLUSIONS Scheduled simulation sessions which provide trainees with the opportunity for consultant feedback may improve engagement. Tackling the 'point-scoring' culture is more challenging. This could be addressed by modified assessment structures, greater recognition and accountability for trainers, and recognition and funding of simulation strategies including in-house skills sessions.
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Affiliation(s)
- Vivienne I Blackhall
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Edinburgh, UK.
- Highland Academic Surgical Unit, Raigmore Hospital and Centre for Health Science, Inverness, UK.
- Centre for Health Education Research and Innovation, University of Aberdeen, Aberdeen, UK.
- Centre for Rural Health, University of Aberdeen, Aberdeen, UK.
| | - Jennifer Cleland
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Edinburgh, UK
- Centre for Health Education Research and Innovation, University of Aberdeen, Aberdeen, UK
| | - Philip Wilson
- Centre for Health Education Research and Innovation, University of Aberdeen, Aberdeen, UK
| | - Susan J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Kenneth G Walker
- Scottish Surgical Simulation Collaborative, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow, Edinburgh, UK
- Highland Academic Surgical Unit, Raigmore Hospital and Centre for Health Science, Inverness, UK
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13
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Tejos R, Chahuán J, Uslar T, Inzunza M, Villagrán I, Riquelme V, Padilla O, Pizarro M, Corvetto M, Varas J, Riquelme A. Simulated training program in abdominal paracentesis for undergraduate medical students. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:239-247. [PMID: 30471721 DOI: 10.1016/j.gastrohep.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Abdominal paracentesis is an area that every general physician should know about, and the current learning model is unsafe for patients. Simulation allows students to develop their skills prior to clinical confrontation with minimal risks. The aims of this study were to design and evaluate a paracentesis simulation workshop for undergraduate students. METHODS A workshop was implemented using a specially designed and validated simulation model for abdominal paracentesis. The simulated technique considered the recognition of materials, operator equipment, asepsis, anesthesia, puncture and obtaining liquid, collecting samples for analysis, withdrawal of the material and occlusion. A 24-point direct observation checklist was administered to assess the student. We assessed two students at the beginning of the workshop and all the students at the end. A perception survey was applied to attendees at the end of the workshop. RESULTS 247 students were included and a workshop that involved 8 students per session was held. Students significantly improved their skills comparing pre- and post-evaluation results [13.36±4.46 (55.7%) vs. 22.3±1.83 (92.9%) respectively (n=69) p<0.001]. The students' perception questionnaire (n=38) showed that the training sessions were highly valued, averaging 4.8±0.38 on a Likert scale of 1-5. CONCLUSIONS Simulated training in abdominal paracentesis is a very good teaching method. This teaching methodology should be highly recommended as an educational strategy in medicine because it could accelerate the acquisition of clinical skills in a safe learning environment.
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Affiliation(s)
- Rodrigo Tejos
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Javier Chahuán
- Departamento Medicina Interna, Escuela de Medicina. Pontificia Universidad Católica de Chile, Chile
| | - Thomas Uslar
- Departamento Medicina Interna, Escuela de Medicina. Pontificia Universidad Católica de Chile, Chile
| | - Martin Inzunza
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Ignacio Villagrán
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Valentina Riquelme
- Escuela de Arte, Facultad de Artes, Pontificia Universidad Católica de Chile, Chile
| | - Oslando Padilla
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Margarita Pizarro
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Marcia Corvetto
- Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Julián Varas
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Arnoldo Riquelme
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Educación Médica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile.
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Lichtman AS, Parker W, Goff B, Mehra N, Shore EM, Lefebvre G, Chiang A, Lenihan J, Schreuder HWR. A Randomized Multicenter Study Assessing the Educational Impact of a Computerized Interactive Hysterectomy Trainer on Gynecology Residents. J Minim Invasive Gynecol 2018; 25:1035-1043. [PMID: 29410142 DOI: 10.1016/j.jmig.2018.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To assess the improvement of cognitive surgical knowledge of laparoscopic hysterectomy in postgraduate year (PGY) 1 and 2 gynecology residents who used an interactive computer-based Laparoscopic Hysterectomy Trainer (Red Llama, Inc., Seattle, WA). DESIGN A multicenter, randomized, controlled study (Canadian Task Force classification I). SETTING Five departments of obstetrics and gynecology: Keck School of Medicine of the University of Southern California, Los Angeles, CA; University of California, Los Angeles, Los Angeles, CA; University of Washington, Seattle, WA; University of British Columbia, Vancouver, British Columbia, Canada; and University of Toronto, Toronto, Ontario, Canada. PARTICIPANTS Gynecology residents, fellows, faculty, and minimally invasive surgeons. INTERVENTIONS The use of an interactive computer-based Laparoscopic Hysterectomy Trainer. MEASUREMENTS AND MAIN RESULTS In phase 1 of this 3-phase multicenter study, 2 hysterectomy knowledge assessment tests (A and B) were developed using a modified Delphi technique. Phase 2 administered these 2 online tests to PGY 3 and 4 gynecology residents, gynecology surgical fellows, faculty, and minimally invasive surgeons (n = 60). In phase 3, PGY 1 and 2 gynecology residents (n = 128) were recruited, and 101 chose to participate, were pretested (test A), and then randomized to the control or intervention group. Both groups continued site-specific training while the intervention group additionally used the Laparoscopic Hysterectomy Trainer. Participant residents were subsequently posttested (test B). Phase 2 results showed no differences between cognitive tests A and B when assessed for equivalence, internal consistency, and reliability. Construct validity was shown for both tests (p < .001). In phase 3, the pretest mean score for the control group was 242 (standard deviation [SD] = 56.5), and for the intervention group it was 217 (SD = 57.6) (nonsignificant difference, p = .089). The t test comparing the posttest control group (mean = 297, SD = 53.6) and the posttest intervention group (mean = 343, SD = 50.9) yielded a significant difference (p < .001, 95% confidence interval, 48.4-108.8). Posttest scores for the intervention group were significantly better than for the control group (p < .001). CONCLUSION Using the Laparoscopic Hysterectomy Trainer significantly increased knowledge of the hysterectomy procedure in PGY 1 and 2 gynecology residents.
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Affiliation(s)
- Allan S Lichtman
- Keck School of Medicine of the University of Southern California, Los Angeles, California.
| | - William Parker
- Geffen School of Medicine at the University of California, Los Angeles, California
| | - Barbara Goff
- University of Washington School of Medicine, Seattle, Washington
| | - Neeraj Mehra
- University of British Columbia School of Medicine, Vancouver, British Columbia, Canada
| | - Eliane M Shore
- University of Toronto School of Medicine, Toronto, Ontario, Canada
| | | | - Alexander Chiang
- Geffen School of Medicine at the University of California, Los Angeles, California
| | - John Lenihan
- Multicare Womens Specialists, Tacoma, Washington
| | - Henk W R Schreuder
- Department of Gynaecolgic Oncology, University Medical Center, Utrecht, Netherlands
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Hysteroscopic resection on virtual reality simulator: What do we measure? J Gynecol Obstet Hum Reprod 2018; 47:247-252. [DOI: 10.1016/j.jogoh.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/13/2018] [Accepted: 02/27/2018] [Indexed: 01/22/2023]
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Ferreira Filho F, Moura Júnior LGD, Rocha HAL, Rocha SGMO, Ferreira LFP, Ferreira AFP. Abdominal cavity simulator for skill progression in videolaparoscopic sutures in Brazil. Acta Cir Bras 2018; 33:75-85. [PMID: 29412235 DOI: 10.1590/s0102-865020180010000008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/19/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To develop and test a model of teaching by means of an abdominal cavity simulator. METHODS This study had two stages: development of a teaching model and an experimental prospective study that aimed to evaluate the residents' competence. The participants were divided into 3 groups: first-year resident, second-year resident, and senior surgeon. The two groups of resident physicians received training in the simulator, under instructor supervision for skill acquisition, according to the model proposed in first stage. The surgeons did not receive this intervention. The correlations and associations were verified through simple and multiple linear regressions. The learning curves were analysed using Cox regression models. The impact of the epidemiological characteristics was tested. RESULTS All residents reached the maximum score at the end of 16 steps and were comparable to the experimental (p<0.001). CONCLUSION Residents who underwent training using the methodology of the proposed teaching model, which is based on realistic simulation, acquired proficiency in the accomplishment of endosutures in up to 16 hours of training in the laboratory.
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Affiliation(s)
- Francisco Ferreira Filho
- MD, Centro Universitário Unichristus, Fortaleza-CE, Brazil. Conception, design and intellectual content of the study; critical revision; approved the final version
| | - Luiz Gonzaga de Moura Júnior
- PhD, Centro Universitário Unichristus, Fortaleza-CE, Brazil. Conception, design and intellectual content of the study; critical revision; approved the final version
| | - Hermano Alexandre Lima Rocha
- PhD, Community Health Department, Universidade Federal do Ceará (UFC), Fortaleza-CE, Brazil. Conception, design and intellectual content of the study; critical revision; approved the final version
| | - Sabrina Gabriele Maia Oliveira Rocha
- MD, Community Health Department, UFC, Fortaleza-CE, Brazil. Conception, design and intellectual content of the study; critical revision; approved the final version
| | - Lucas Fortes Portela Ferreira
- MD, Universidade Federal do Cariri (UFCA), Juazeiro do Norte-CE, Brazil. Intellectual content of the study, analysis and interpretation of data, critical revision, approved the final version
| | - Amanda Fortes Portela Ferreira
- MD, Centro Universitário Unichristus, Fortaleza-CE, Brazil. Intellectual content of the study, analysis and interpretation of data, critical revision, approved the final version
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Forgione A, Guraya SY. The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:51. [PMID: 28567070 PMCID: PMC5426099 DOI: 10.4103/jrms.jrms_809_16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/10/2016] [Accepted: 12/27/2016] [Indexed: 11/18/2022]
Abstract
Background: Historically, operating room (OR) has always been considered as a stand-alone trusted platform for surgical education and training. However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators to develop more cost-effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeons need to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explore the value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopic surgical training programs in world-class centers across the globe with a view to formulate a blended and unified structured surgical training program. Materials and Methods: Several data sources were searched using MeSH terms “Laparoscopic surgery” and “Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery” and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and by excluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesis and data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles were excluded from the study. Results: Finally, 12 articles were selected for this systematic review. Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators, animal and cadaveric labs, telementoring, telerobotic-assisted surgery, and video games. Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints. Conclusion: The existing world-renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisition of knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.
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Affiliation(s)
- Antonello Forgione
- Department of Surgical Oncology and Minimally Invasive Surgery, AIMS Academy, Niguarda Hospital, Milan, Italy
| | - Salman Y Guraya
- Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
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A low-fidelity, high-functionality, inexpensive ultrasound-guided nerve block model. CAN J EMERG MED 2016; 19:58-60. [PMID: 27478036 DOI: 10.1017/cem.2016.335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Cleland J, Walker KG, Gale M, Nicol LG. Simulation-based education: understanding the socio-cultural complexity of a surgical training 'boot camp'. MEDICAL EDUCATION 2016; 50:829-841. [PMID: 27402043 DOI: 10.1111/medu.13064] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/07/2015] [Accepted: 01/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The focus of simulation-based education (SBE) research has been limited to outcome and effectiveness studies. The effect of social and cultural influences on SBE is unclear and empirical work is lacking. Our objective in this study was to explore and understand the complexity of context and social factors at a surgical boot camp (BC). METHODS A rapid ethnographic study, employing the theoretical lenses of complexity and activity theory and Bourdieu's concept of 'capital', to better understand the socio-cultural influences acting upon, and during, two surgical BCs, and their implications for SBE. Over two 4-day BCs held in Scotland, UK, an observer and two preceptors conducted 81 hours of observations, 14 field interviews and 11 formal interviews with faculty members (n = 10, including the lead faculty member, session leaders and junior faculty members) and participants (n = 19 core surgical trainees and early-stage residents). RESULTS Data collection and inductive analysis for emergent themes proceeded iteratively. This paper focuses on three analytical themes. First, the complexity of the surgical training system and wider health care education context, and how this influenced the development of the BC. Second, participants' views of the BC as a vehicle not just for learning skills but for gaining 'insider information' on how best to progress in surgical training. Finally, the explicit aim of faculty members to use the Scottish Surgical Bootcamp to welcome trainees and residents into the world of surgery, and how this occurred. CONCLUSIONS To the best of our knowledge, this is the first empirical study of a surgical BC that takes a socio-cultural approach to exploring and understanding context, complexities, uncertainties and learning associated with one example of SBE. Our findings suggest that a BC is as much about social and cultural processes as it is about individual, cognitive and acquisitive learning. Acknowledging this explicitly will help those planning similar enterprises and open up a new perspective on SBE research.
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Affiliation(s)
- Jennifer Cleland
- Institute of Education for Medical and Dental Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- Highland Surgical Research Unit, Raigmore Hospital and the Centre for Health Science, NHS Highland and University of Stirling, Inverness, UK
| | - Michael Gale
- Highland Medical Education Centre, The Centre for Health Science, NHS Highland and University of Aberdeen, Inverness, UK
| | - Laura G Nicol
- Highland Surgical Research Unit, Raigmore Hospital and the Centre for Health Science, NHS Highland and University of Stirling, Inverness, UK
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Chugh AJ, Pace JR, Singer J, Tatsuoka C, Hoffer A, Selman WR, Bambakidis NC. Use of a surgical rehearsal platform and improvement in aneurysm clipping measures: results of a prospective, randomized trial. J Neurosurg 2016; 126:838-844. [PMID: 27177182 DOI: 10.3171/2016.1.jns152576] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The field of neurosurgery is constantly undergoing improvements and advances, both in technique and technology. Cerebrovascular neurosurgery is no exception, with endovascular treatments changing the treatment paradigm. Clipping of aneurysms is still necessary, however, and advances are still being made to improve patient outcomes within the microsurgical treatment of aneurysms. Surgical rehearsal platforms are surgical simulators that offer the opportunity to rehearse a procedure prior to entering the operative suite. This study is designed to determine whether use of a surgical rehearsal platform in aneurysm surgery is helpful in decreasing aneurysm dissection time and clip manipulation of the aneurysm. METHODS The authors conducted a blinded, prospective, randomized study comparing key effort and time variables in aneurysm clip ligation surgery with and without preoperative use of the SuRgical Planner (SRP) surgical rehearsal platform. Initially, 40 patients were randomly assigned to either of two groups: one in which surgery was performed after use of the SRP (SRP group) and one in which surgery was performed without use of the SRP (control group). All operations were videotaped. After exclusion of 6 patients from the SRP group and 9 from the control group, a total of 25 surgical cases were analyzed by a reviewer blinded to group assignment. The videos were analyzed for total microsurgical time, number of clips used, and number of clip placement attempts. Means and standard deviations (SDs) were calculated and compared between groups. RESULTS The mean (± SD) amount of operative time per clip used was 920 ± 770 seconds in the SRP group and 1294 ± 678 seconds in the control group (p = 0.05). In addition, the mean values for the number of clip attempts, total operative time, ratio of clip attempts to clips used, and time per clip attempt were all lower in the SRP group, although the between-group differences were not statistically significant. CONCLUSIONS Preoperative rehearsal with SRP increased efficiency and safety in aneurysm microsurgery as demonstrated by the statistically significant improvement in time per clip used. Although the rest of the outcomes did not demonstrate statistically significant between-group differences, the fact that the SRP group showed improvement in mean values for all measures studied suggests that preoperative rehearsal may increase the efficiency and safety of aneurysm microsurgery. Future studies aimed at improving patient outcome and safety during surgical clipping of aneurysms will be needed to keep pace with the quickly advancing endovascular field.
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Affiliation(s)
| | | | | | - Curtis Tatsuoka
- Neurology, University Hospitals Case Medical Center, Cleveland, Ohio
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Wong IH, Denkers MR, Urquhart NA, Farrokhyar F. Systematic instruction of arthroscopic knot tying with the ArK Trainer: an objective evaluation tool. Knee Surg Sports Traumatol Arthrosc 2015; 23:912-8. [PMID: 23807030 DOI: 10.1007/s00167-013-2567-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 06/10/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE A Proficiency Formula was introduced as an objective self-evaluation method for evaluating basic arthroscopic knot tying in a laboratory setting. The correlation between the Proficiency Formula and gold standard pass/fail dichotomy was demonstrated, as well as with other popular evaluation tools--task-specific checklist (TSC) and global rating scale (GRS). METHOD A step-by-step video tutorial was used to instruct 35 medical students on how to tie an arthroscopic Samsung Medical Center (SMC) knot secured by three half hitches. Participants were video recorded performing arthroscopic knot tying and assessed on their success tying an SMC knot, pass or fail, and through three outcome tools: the Proficiency Formula, GRS and the TSC. Independent samples t test was used to compare the GRS, TSC and Proficiency Formula scores, between those who were passed or failed by the evaluators. Correlation between the measurement scales was tested using Spearman's rho correlation coefficient. RESULTS Participants received a mean proficiency score of 195 (140-249). The mean Proficiency score for those that passed was 323 (95 % CI 272-374), for those that failed, 87 (95 % CI 26-148, p < 0.001). We found strong linear correlation between the Proficiency Formula and GRS and TSE (0.83 and 0.78, respectively). CONCLUSION The Proficiency Formula has high correlation with gold standard GRS and TSC measurements when used to assess arthroscopic knot tying skills on a model. It has the added advantage of being able to be self-assessed.
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Affiliation(s)
- Ivan H Wong
- , 2nd Floor Rm 2106, QEII Camp Hill Veteran's Memorial Building, 5655 Veterans' Memorial Building, Halifax, NS, B3H 2E1, Canada,
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Wong IH, Denkers M, Urquhart N, Farrokhyar F. Construct validity testing of the Arthroscopic Knot Trainer (ArK). Knee Surg Sports Traumatol Arthrosc 2015; 23:906-11. [PMID: 23685634 DOI: 10.1007/s00167-013-2524-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 05/06/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE This study introduced a novel simulator called the Arthroscopic Knot Trainer (ArK) and reports preliminary evidence to support its construct validity. To our knowledge, the ArK is the first non-anatomical tissue reduction simulator designed to meet learning objectives specific for developing knot-tying skills. MATERIALS AND METHODS A step-by-step instructional video was used to teach orthopaedic residents how to tie an arthroscopic SMC knot. Residents were video recorded to assess time of completion, number of knots tied in 10 min and re-assessed 6 months later. Subjects were surveyed for content evidence after using the ArK. Data were analysed by paired t test and independent sample t test in order to compare the mean time to tie knots from test at baseline to retest at 6 months and the between group mean time, respectively. RESULTS Content evidence supports the ArK trainer as appropriate for teaching and assessing arthroscopic knot-tying skills. Relation to other variables evidence supports the ArK trainer model whether stratified by year of training or by self-reported experience; time required for knot tying was inversely correlated with experience in tying arthroscopic knots. Internal structure evidence was supported with similar findings at retesting. CONCLUSIONS There are three sources of evidence supporting the construct validity of the ArK as a simulator for arthroscopic knot tying: content, relationship to other variable and internal structure evidence. The ArK is easy to use and has the capacity to distinguish between groups with different skill levels.
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Affiliation(s)
- Ivan H Wong
- , 2nd Floor Rm 2106, QEII Camp Hill Veteran's Memorial Building, 5655 Veterans' Memorial Building, Halifax, NS, Canada,
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Sujatta S. First of all: Do not harm! Use of simulation for the training of regional anaesthesia techniques: Which skills can be trained without the patient as substitute for a mannequin. Best Pract Res Clin Anaesthesiol 2015; 29:69-80. [DOI: 10.1016/j.bpa.2015.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 11/30/2022]
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Powers WF, Hooks WB, Kilbourne SN, Clancy TV, Hope WW. Assessing Competency and Training of Upper Endoscopy in a General Surgery Residency Program. Gastroenterology Res 2013; 6:180-184. [PMID: 27785251 PMCID: PMC5051093 DOI: 10.4021/gr520w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Guidelines for optimal endoscopic training for surgical residents have not been formally integrated into modern teaching programs. Our purpose was to apply two endoscopic evaluation tools (EE-1 and EE-2) designed to measure surgical resident competency in the performance of esophagogastroduodenoscopy (EGD). METHODS Prospectively collected data were reviewed from consecutive EGDs in a single institution by a single attending surgeon over 3 years (July 2008 to July 2011). Demographic, procedural, and outcome data were collected. Residents were graded at the completion of each procedure by the attending surgeon using EE-1 and EE-2. Descriptive statistics were calculated, and comparisons based on PGY levels were made using Fisher's exact and Kruskal-Wallis tests. P < 0.05 was considered significant. RESULTS All procedures (N = 50) were performed by residents under the direct attending surgeon supervision. Average patient age was 51 years (range, 31-79 years), 66% were women, and 66% were Caucasian. PGY-3 residents performed 62% of the procedures. Average resident participation was 84% of each procedure. Biopsies were performed in 80% of patients and dilatations in 16%. All EGDs were successfully completed (average time, 13.1 min). EE-1 results demonstrated significantly different grades (P < 0.05) among PGY levels in seven of eight variables. EE-2 grades were significantly different (P < 0.05) among PGY levels in all 10 variables with a general trend of improvement as PGY level increased. There were no mortalities or morbidities. CONCLUSIONS Residents can perform EGDs safely and expeditiously with appropriate supervision. Methods to assess competency continue to evolve and should remain an area of active research.
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Affiliation(s)
- William F Powers
- Department of Surgery, South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - W Borden Hooks
- Department of Surgery, South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - S Nicole Kilbourne
- Department of Surgery, South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - Thomas V Clancy
- Department of Surgery, South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - William W Hope
- Department of Surgery, South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA
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Mahmoud A, Galante J, Wisner D, Farmer D, Sims D. Small community hospitals programs affiliation with university programs; "lessons learned" in 28-year successful affiliation. JOURNAL OF SURGICAL EDUCATION 2013; 70:636-639. [PMID: 24016375 DOI: 10.1016/j.jsurg.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/10/2013] [Accepted: 05/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Community hospitals affiliation with university hospitals in post graduate surgical education is essential for the 2 types of training programs. Many factors affect the success of the affiliation process. Additionally, various pitfalls and challenges are encountered. The goal of this work is to study the lessons learned in 28 years successful affiliation. DESIGN/SETTING small community hospital affiliation with university program for 28 years. PARTICIPANTS surgery residency programs in small community hospital and university hospital. RESULTS successful affiliation for 28 years between community hospital and university program.
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Affiliation(s)
- Ahmed Mahmoud
- University of California, Davis, California; San Joaquin General Hospital, French Camp, California.
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Johnson J, Salisbury H, Deaver S, Johansson M, Calisch A. Standardized Patients in Art Therapy Education: A Phenomenological Study. ART THERAPY 2013. [DOI: 10.1080/07421656.2013.786983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Morbidity assessment in surgery: refinement proposal based on a concept of perioperative adverse events. ISRN SURGERY 2013; 2013:625093. [PMID: 23762627 PMCID: PMC3671541 DOI: 10.1155/2013/625093] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/22/2013] [Indexed: 12/27/2022]
Abstract
Background. Morbidity is a cornerstone assessing surgical treatment; nevertheless surgeons have not reached extensive consensus on this problem. Methods and Findings. Clavien, Dindo, and Strasberg with coauthors (1992, 2004, 2009, and 2010) made significant efforts to the standardization of surgical morbidity (Clavien-Dindo-Strasberg classification, last revision, the Accordion classification). However, this classification includes only postoperative complications and has two principal shortcomings: disregard of intraoperative events and confusing terminology. Postoperative events have a major impact on patient well-being. However, intraoperative events should also be recorded and reported even if they do not evidently affect the patient's postoperative well-being. The term surgical complication applied in the Clavien-Dindo-Strasberg classification may be regarded as an incident resulting in a complication caused by technical failure of surgery, in contrast to the so-called medical complications. Therefore, the term surgical complication contributes to misinterpretation of perioperative morbidity. The term perioperative adverse events comprising both intraoperative unfavourable incidents and postoperative complications could be regarded as better alternative. In 2005, Satava suggested a simple grading to evaluate intraoperative surgical errors. Based on that approach, we have elaborated a 3-grade classification of intraoperative incidents so that it can be used to grade intraoperative events of any type of surgery. Refinements have been made to the Accordion classification of postoperative complications. Interpretation. The proposed systematization of perioperative adverse events utilizing the combined application of two appraisal tools, that is, the elaborated classification of intraoperative incidents on the basis of the Satava approach to surgical error evaluation together with the modified Accordion classification of postoperative complication, appears to be an effective tool for comprehensive assessment of surgical outcomes. This concept was validated in regard to various surgical procedures. Broad implementation of this approach will promote the development of surgical science and practice.
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Multimedia-based training on Internet platforms improves surgical performance: a randomized controlled trial. Surg Endosc 2013; 27:1737-47. [PMID: 23475016 PMCID: PMC3624003 DOI: 10.1007/s00464-012-2672-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/25/2012] [Indexed: 12/31/2022]
Abstract
Background Surgical procedures are complex motion sequences that require a high level of preparation, training, and concentration. In recent years, Internet platforms providing surgical content have been established. Used as a surgical training method, the effect of multimedia-based training on practical surgical skills has not yet been evaluated. This study aimed to evaluate the effect of multimedia-based training on surgical performance. Methods A 2 × 2 factorial, randomized controlled trial with a pre- and posttest design was used to test the effect of multimedia-based training in addition to or without practical training on 70 participants in four groups defined by the intervention used: multimedia-based training, practical training, and combination training (multimedia-based training + practical training) or no training (control group). The pre- and posttest consisted of a laparoscopic cholecystectomy in a Pelvi-Trainer and was video recorded, encoded, and saved on DVDs. These were evaluated by blinded raters using a modified objective structured assessment of technical skills (OSATS). The main evaluation criterion was the difference in OSATS score between the pre- and posttest (ΔOSATS) results in terms of a task-specific checklist (procedural steps scored as correct or incorrect). Results The groups were homogeneous in terms of demographic parameters, surgical experience, and pretest OSATS scores. The ΔOSATS results were highest in the multimedia-based training group (4.7 ± 3.3; p < 0.001). The practical training group achieved 2.5 ± 4.3 (p = 0.028), whereas the combination training group achieved 4.6 ± 3.5 (p < 0.001), and the control group achieved 0.8 ± 2.9 (p = 0.294). Conclusion Multimedia-based training improved surgical performance significantly and thus could be considered a reasonable tool for inclusion in surgical curricula.
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Bidarkar SS, Wood J, Cohen RC, Holland AJA. Role of simulation for paediatric proceduralists: practice makes perfect or trial and error? J Paediatr Child Health 2013; 49:94-8. [PMID: 23253077 DOI: 10.1111/jpc.12039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 01/22/2023]
Affiliation(s)
- Sandeep S Bidarkar
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Carr J, Deal AM, Dehmer J, Amos KD, Farrell TM, Meyer AA, Meyers MO. Who teaches basic procedural skills: Student experience versus faculty opinion. J Surg Res 2012; 177:196-200. [DOI: 10.1016/j.jss.2012.05.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 05/09/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
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Choy I, Fecso A, Kwong J, Jackson T, Okrainec A. Remote evaluation of laparoscopic performance using the global operative assessment of laparoscopic skills. Surg Endosc 2012; 27:378-83. [PMID: 22890477 DOI: 10.1007/s00464-012-2456-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/09/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although numerous assessment tools currently exist to evaluate laparoscopic surgical skills, no studies have demonstrated the reliability of such tools when used with telementoring technology. This study aimed to determine the reliability of the Global Operative Assessment of Laparoscopic Skills (GOALS) rating scale for assessing laparoscopic skills remotely and to identify how factors unique to remote assessment such as bandwidth and image quality influence its reliability. METHODS Four trained observers evaluated 19 participants for their technical performance during a laparoscopic cholecystectomy using the GOALS assessment tool. One observer assessed the study participants directly in the operating room, whereas the three remaining observers were randomly assigned and blinded to a high- (1.5 Mbps), medium- (256 kbps), or low- (64.4 kbps) bandwidth restriction and observed remotely via Skype. The Maryland Visual Comfort Scale was used to evaluate the video quality of the respective connections. RESULTS The intraclass correlation coefficient (ICC) calculated for the total GOALS score demonstrated a statistically significant correlation of high, medium, and low bandwidths respectively with ICC 0.693 (95 % confidence interval [CI], 0.226-0.883), 0.518 (95 % CI 0.089-0.783), and 0.499 (95 % CI 0.025-0.781). There was a statistically significant difference in the overall perceived visual quality between the high/low (Z = -3.222; P = 0.001) and the medium/low (Z = -3.567; P < 0.001) bandwidth comparison but no difference between the high/medium bandwidths (Z = -0.610; P = 0.542). CONCLUSION The data suggest that the GOALS assessment tool retains its reliability for intraoperative assessment of laparoscopic skills when used remotely. This is a key requirement in telesimulation programs allowing for structured feedback between the mentor and the mentee. This study quantifies the effect that bandwidth has on the reliability of remote assessment, demonstrating that higher bandwidths improve the utility of these tools.
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Affiliation(s)
- Ian Choy
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Wiet GJ, Stredney D, Kerwin T, Hittle B, Fernandez SA, Abdel-Rasoul M, Welling DB. Virtual temporal bone dissection system: OSU virtual temporal bone system: development and testing. Laryngoscope 2012; 122 Suppl 1:S1-12. [PMID: 22294268 DOI: 10.1002/lary.22499] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/21/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this project was to develop a virtual temporal bone dissection system that would provide an enhanced educational experience for the training of otologic surgeons. STUDY DESIGN A randomized, controlled, multi-institutional, single-blinded validation study. METHODS The project encompassed four areas of emphasis: structural data acquisition, integration of the system, dissemination of the system, and validation. RESULTS Structural acquisition was performed on multiple imaging platforms. Integration achieved a cost-effective system. Dissemination was achieved on different levels including casual interest, downloading of software, and full involvement in development and validation studies. A validation study was performed at eight different training institutions across the country using a two-arm randomized trial where study subjects were randomized to a 2-week practice session using either the virtual temporal bone or standard cadaveric temporal bones. Eighty subjects were enrolled and randomized to one of the two treatment arms; 65 completed the study. There was no difference between the two groups using a blinded rating tool to assess performance after training. CONCLUSIONS A virtual temporal bone dissection system has been developed and compared to cadaveric temporal bones for practice using a multicenter trial. There was no statistical difference between practice on the current simulator compared to practice on human cadaveric temporal bones. Further refinements in structural acquisition and interface design have been identified, which can be implemented prior to full incorporation into training programs and used for objective skills assessment.
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Affiliation(s)
- Gregory J Wiet
- Department of Otolaryngology, The Ohio State University, Columbus, Ohio 43205, USA.
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Sleep deprivation increases cognitive workload during simulated surgical tasks. Am J Surg 2012; 203:37-43. [DOI: 10.1016/j.amjsurg.2011.08.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 08/22/2011] [Accepted: 08/22/2011] [Indexed: 01/22/2023]
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Sachdeva AK, Buyske J, Dunnington GL, Sanfey HA, Mellinger JD, Scott DJ, Satava R, Fried GM, Jacobs LM, Burns KJ. A new paradigm for surgical procedural training. Curr Probl Surg 2011; 48:854-968. [PMID: 22078788 DOI: 10.1067/j.cpsurg.2011.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, Illinois, USA
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Filho FVG, Coelho G, Cavalheiro S, Lyra M, Zymberg ST. Quality assessment of a new surgical simulator for neuroendoscopic training. Neurosurg Focus 2011; 30:E17. [DOI: 10.3171/2011.2.focus10321] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Ideal surgical training models should be entirely reliable, atoxic, easy to handle, and, if possible, low cost. All available models have their advantages and disadvantages. The choice of one or another will depend on the type of surgery to be performed. The authors created an anatomical model called the S.I.M.O.N.T. (Sinus Model Oto-Rhino Neuro Trainer) Neurosurgical Endotrainer, which can provide reliable neuroendoscopic training. The aim in the present study was to assess both the quality of the model and the development of surgical skills by trainees.
Methods
The S.I.M.O.N.T. is built of a synthetic thermoretractable, thermosensible rubber called Neoderma, which, combined with different polymers, produces more than 30 different formulas. Quality assessment of the model was based on qualitative and quantitative data obtained from training sessions with 9 experienced and 13 inexperienced neurosurgeons. The techniques used for evaluation were face validation, retest and interrater reliability, and construct validation.
Results
The experts considered the S.I.M.O.N.T. capable of reproducing surgical situations as if they were real and presenting great similarity with the human brain. Surgical results of serial training showed that the model could be considered precise. Finally, development and improvement in surgical skills by the trainees were observed and considered relevant to further training. It was also observed that the probability of any single error was dramatically decreased after each training session, with a mean reduction of 41.65% (range 38.7%–45.6%).
Conclusions
Neuroendoscopic training has some specific requirements. A unique set of instruments is required, as is a model that can resemble real-life situations. The S.I.M.O.N.T. is a new alternative model specially designed for this purpose. Validation techniques followed by precision assessments attested to the model's feasibility.
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Affiliation(s)
| | | | - Sergio Cavalheiro
- 1Discipline of Neurosurgery, Escola Paulista de Medicina da Universidade Federal de São Paulo
| | - Marcos Lyra
- 3Department of Gynecology, Universidade Federal de Pernambuco, Recife, Brasil
| | - Samuel T. Zymberg
- 1Discipline of Neurosurgery, Escola Paulista de Medicina da Universidade Federal de São Paulo
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