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Mannam R, Sankara Narayanan R, Bansal A, Yanamaladoddi VR, Sarvepalli SS, Vemula SL, Aramadaka S. Laparoscopic Cholecystectomy Versus Open Cholecystectomy in Acute Cholecystitis: A Literature Review. Cureus 2023; 15:e45704. [PMID: 37868486 PMCID: PMC10590170 DOI: 10.7759/cureus.45704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Cholecystectomy is a common surgical procedure performed worldwide for acute cholecystitis. Acute cholecystitis occurs when the cystic duct is obstructed by a gallstone, which causes gallbladder distension and subsequent inflammation of the gallbladder. Acute cholecystitis is characterized by pain in the right upper quadrant, anorexia, nausea, fever, and vomiting. Cholecystectomy is the treatment of choice for acute cholecystitis. The two commonly performed types of cholecystectomies are open cholecystectomy and laparoscopic cholecystectomy. However, the approach of choice widely fluctuates with regard to various factors such as patient history and surgeon preference. It is imperative to understand the variations in outcomes of different approaches and how best they fit an individual patient when deciding the technique to be undertaken. This article reviews several studies and compares the two techniques in terms of procedure, mortality rate, complication rate, bile leak/injury rate, conversion rate, and bleeding rate.
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Affiliation(s)
- Raam Mannam
- General Surgery, Narayana Medical College, Nellore, IND
| | | | - Arpit Bansal
- Research, Narayana Medical College, Nellore, IND
| | | | | | - Shree Laya Vemula
- Research, Anam Chenchu Subba Reddy (ACSR) Government Medical College, Nellore, IND
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Kwan JY, Lainas P, Banks P, Jimenez De Veciana A, Said H, Mehrem A, Debbarma M, Matthews M, Etim G, Biyani CS, Rajpal S, Phillipson M, Palit V, Renwick P, Yiasemidou M. Five-Year results of a multi-specialty induction course for surgical training. Front Surg 2023; 10:1198696. [PMID: 37405057 PMCID: PMC10315573 DOI: 10.3389/fsurg.2023.1198696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
Background The Essential Surgical Skills Course (ESSC) is a multi-specialty induction "boot camp" style course that has been run successfully for five years. The aim of the current paper is to create an accurate guide for the replication of the course by other teams and assess the course's fitness for purpose, through the survey feedback provided by trainees. Methods The course's fitness for purpose was assessed through cumulative five-year survey feedback from trainees. This observational study describes the design and process of content adjustment according to feedback. Results The course its five-year span offered twelve different procedural skills in four different specialties. Feedback for each session was persistently >8/10. Key themes identified as beneficial include teacher-to-trainee ratio (often 1:1), teaching style, course structure and responsiveness. Conclusions The ESSC was found to be fit for purpose for the induction of trainees into surgical training. The key factors contributing to the success of the course include the structured method of curriculum design, outstanding teaching delivery methods, teacher-to-trainee ratio, the availability of appropriate faculty and infrastructure and the willingness to learn from trainee feedback and adjust the content of the course accordingly. It acts as a paradigm for courses aimed to prepare surgical trainees for a "step-up" in their careers.
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Affiliation(s)
- Jing Yi Kwan
- Department of Vascular Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Panagiotis Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academic, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Paris-Saclay University, Clamart, France
| | - Philippa Banks
- Department of General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | | | - Hagar Said
- School of Medicine, University of York, York, United Kingdom
| | - Anna Mehrem
- Department of General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | - Manash Debbarma
- Department of Urology, Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom
| | - Melissa Matthews
- School of Medicine, Hull York Medical School, Hull, United Kingdom
| | - Gloria Etim
- School of Medicine, Hull York Medical School, Hull, United Kingdom
| | | | - Sanjay Rajpal
- Department of Urology, Airedale General Hospital, Airedale, United Kingdom
| | - Mark Phillipson
- Department of Orthopaedics, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Victor Palit
- Department of Urology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Paul Renwick
- Department of Vascular Surgery, Hull University Teaching Hospitals, Hull, United Kingdom
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Lewandrowski KU, Elfar JC, Li ZM, Burkhardt BW, Lorio MP, Winkler PA, Oertel JM, Telfeian AE, Dowling Á, Vargas RAA, Ramina R, Abraham I, Assefi M, Yang H, Zhang X, Ramírez León JF, Fiorelli RKA, Pereira MG, de Carvalho PST, Defino H, Moyano J, Lim KT, Kim HS, Montemurro N, Yeung A, Novellino P. The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States. J Pers Med 2023; 13:852. [PMID: 37241022 PMCID: PMC10221956 DOI: 10.3390/jpm13050852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence. The postpandemic learning environment has also changed, emphasizing online learning and skill- and competency-based teaching models incorporating clinical and bench-top research. Attempts to improve work-life balance and minimize physician burnout have led to work-hour restrictions in postgraduate training programs. These restrictions have made it particularly challenging for orthopedic and neurosurgery residents to acquire the knowledge and skill set to meet the requirements for certification. The fast-paced flow of information and the rapid implementation of innovation require higher efficiencies in the modern postgraduate training environment. However, what is taught typically lags several years behind. Examples include minimally invasive tissue-sparing techniques through tubular small-bladed retractor systems, robotic and navigation, endoscopic, patient-specific implants made possible by advances in imaging technology and 3D printing, and regenerative strategies. Currently, the traditional roles of mentee and mentor are being redefined. The future orthopedic surgeons and neurosurgeons involved in personalized surgical pain management will need to be versed in several disciplines ranging from bioengineering, basic research, computer, social and health sciences, clinical study, trial design, public health policy development, and economic accountability. Solutions to the fast-paced innovation cycle in orthopedic surgery and neurosurgery include adaptive learning skills to seize opportunities for innovation with execution and implementation by facilitating translational research and clinical program development across traditional boundaries between clinical and nonclinical specialties. Preparing the future generation of surgeons to have the aptitude to keep up with the rapid technological advances is challenging for postgraduate residency programs and accreditation agencies. However, implementing clinical protocol change when the entrepreneur-investigator surgeon substantiates it with high-grade clinical evidence is at the heart of personalized surgical pain management.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center For Advanced Spine Care of Southern Arizona, 4787 E Camp Lowell Drive, Tucson, AZ 85719, USA
- Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia
| | - John C. Elfar
- Department of Orthopaedic Surgery, College of Medicine—Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA;
| | - Zong-Ming Li
- Departments of Orthopaedic Surgery and Biomedical Engineering, College of Medicine—Tucson Campus, Health Sciences Innovation Building (HSIB), University of Arizona, 1501 N. Campbell Avenue, Tower 4, 8th Floor, Suite 8401, Tucson, AZ 85721, USA;
| | - Benedikt W. Burkhardt
- Wirbelsäulenzentrum/Spine Center—WSC, Hirslanden Klinik Zurich, Witellikerstrasse 40, 8032 Zurich, Switzerland;
| | - Morgan P. Lorio
- Advanced Orthopaedics, 499 E. Central Pkwy, Ste. 130, Altamonte Springs, FL 32701, USA;
| | - Peter A. Winkler
- Department of Neurosurgery, Charite Universitaetsmedizin Berlin, 13353 Berlin, Germany;
| | - Joachim M. Oertel
- Klinik für Neurochirurgie, Universitätsdes Saarlandes, Kirrberger Straße 100, 66421 Homburg, Germany;
| | - Albert E. Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | - Álvaro Dowling
- Orthopaedic Surgery, University of São Paulo, Brazilian Spine Society (SBC), Ribeirão Preto 14071-550, Brazil; (Á.D.); (H.D.)
| | - Roth A. A. Vargas
- Department of Neurosurgery, Foundation Hospital Centro Médico Campinas, Campinas 13083-210, Brazil;
| | - Ricardo Ramina
- Neurological Institute of Curitiba, Curitiba 80230-030, Brazil;
| | - Ivo Abraham
- Clinical Translational Sciences, University of Arizona, Roy P. Drachman Hall, Rm. B306H, Tucson, AZ 85721, USA;
| | - Marjan Assefi
- Department of Biology, Nano-Biology, University of North Carolina, Greensboro, NC 27413, USA;
| | - Huilin Yang
- Orthopaedic Department, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215031, China;
| | - Xifeng Zhang
- Department of Orthopaedics, First Medical Center, PLA General Hospital, Beijing 100853, China;
| | - Jorge Felipe Ramírez León
- Minimally Invasive Spine Center Bogotá D.C. Colombia, Reina Sofía Clinic Bogotá D.C. Colombia, Department of Orthopaedics Fundación Universitaria Sanitas, Bogotá 0819, Colombia;
| | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20270-004, Brazil;
| | - Mauricio G. Pereira
- Faculty of Medecine, University of Brasilia, Federal District, Brasilia 70919-900, Brazil;
| | | | - Helton Defino
- Orthopaedic Surgery, University of São Paulo, Brazilian Spine Society (SBC), Ribeirão Preto 14071-550, Brazil; (Á.D.); (H.D.)
| | - Jaime Moyano
- La Sociedad Iberolatinoamericana De Columna (SILACO), and the Spine Committee of the Ecuadorian Society of Orthopaedics and Traumatology (Comité de Columna de la Sociedad Ecuatoriana de Ortopedia y Traumatología), Quito 170521, Ecuador;
| | - Kang Taek Lim
- Good Doctor Teun Teun Spine Hospital, Anyang 14041, Republic of Korea;
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Seoul 06048, Republic of Korea;
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy;
| | - Anthony Yeung
- Desert Institute for Spine Care, Phoenix, AZ 85020, USA;
| | - Pietro Novellino
- Guinle and State Institute of Diabetes and Endocrinology, Rio de Janeiro 20270-004, Brazil;
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Maoz Breuer R, Waitzberg R, Breuer A, Cram P, Bryndova L, Williams GA, Kasekamp K, Keskimaki I, Tynkkynen LK, van Ginneken V, Kovács E, Burke S, McGlacken-Byrne D, Norton C, Whiston B, Behmane D, Grike I, Batenburg R, Albreh T, Pribakovic R, Bernal-Delgado E, Estupiñan-Romero F, Angulo-Pueyo E, Rose AJ. Work like a Doc: A comparison of regulations on residents' working hours in 14 high-income countries. Health Policy 2023; 130:104753. [PMID: 36827717 DOI: 10.1016/j.healthpol.2023.104753] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents' work hours. OBJECTIVES We aimed to review residents' work hours regulations in different countries with an emphasis on night shifts. METHODS Standardized qualitative data on residents' working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. RESULTS All countries reviewed limit the weekly working hours; North-American countries limit to 60-80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. CONCLUSIONS In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents' quality of life with mixed effects on quality of care and residents' education.
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Affiliation(s)
- Rina Maoz Breuer
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel
| | - Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Germany.
| | - Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Peter Cram
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Lucie Bryndova
- Center for Social and Economic Strategies, Faculty of Social Sciences, Charles University, Czechia
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London United Kingdom
| | | | | | - Liina-Kaisa Tynkkynen
- Faculty of Social Sciences, Tampere University, Finland; Welfare State Research and Reform, Finnish Institute for Health and Welfare, Finland
| | - Verena van Ginneken
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin, Germany
| | - Eszter Kovács
- Health Workforce Planning Knowledge Centre, Semmelweis University, Hungary
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Ireland
| | | | | | | | - Daiga Behmane
- Faculty of Public Health and Social Welfare, Riga Stradins University, Latvia
| | - Ieva Grike
- Faculty of Residency Manager of Residency study process Riga Stradins University, Latvia
| | - Ronald Batenburg
- Netherlands institute for Health Services Research (Nivel), Radboud University Nijmegen, Faculty of Social Sciences, the Netherlands
| | - Tit Albreh
- Centre for Health Care National Institute of Public Health Trubarjeva, Slovenia
| | - Rade Pribakovic
- Centre for Health Care at the National Institute of Public Health of Slovenia, Slovenia
| | | | | | | | - Adam J Rose
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; School of Public Health, Hebrew University, Jerusalem, Israel
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Skeletal muscle surrogates for the acquisition of muscle repair skills in upper limb surgery. J Mech Behav Biomed Mater 2022; 131:105216. [PMID: 35487107 DOI: 10.1016/j.jmbbm.2022.105216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The required fidelity of synthetic materials in surgical simulators to teach tissue handling and repair requirements should be as accurate as possible. There is a poor understanding of the relationship between choice of muscle surrogates and training outcome for trainee surgeons. To address this, the mechanical characteristics of several candidate synthetic muscle surrogates were measured, and their subjective biofidelity was qualitatively assessed by surgeons. METHODS Silicone was selected after assessing several material options and 16 silicone-based surrogates were evaluated. Three of the closest samples to muscle (Samples 1.1, 1.2, 1.3) and one with inserted longitudinal fibres (1.2F) were mechanically tested in the following: compression and tension, needle puncture force and suture pull-out in comparison with real muscle. The four samples were evaluated by 17 Plastic and Orthopaedic surgeons to determine their views of the fidelity with regard to the handling properties, needle insertion and ease of suture pull-out. RESULTS The mechanical testing showed the surrogates exhibited varying characteristics that matched some of the properties of muscle, though none recreated all the mechanical characteristics of native muscle. Good biofidelity was generally achieved for compression stiffness and needle puncture force, but it was evident that tensile stiff was too low for all samples. The pull-out forces were variable and too low, except for the sample with longitudinal fibres. In the qualitative assessment, the overall median scores for the four surrogate samples were all between 30 and 32 (possible range 9-45), indicating limited differentiation of the samples tested by the surgeons. CONCLUSIONS The surrogate materials showed a range of mechanical properties bracketing those of real muscle, thus presenting a suitable combination of candidates for use in simulators to attain the requirements as set out in the learning outcomes of muscle repair. However, despite significant mechanical differences between the samples, all surgeons found the samples to be similar to each other.
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Quality of sleep in a sample of Egyptian medical residency. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sleep disturbances among medical staff are common serious entities with devastating consequences. Numerous studies have analyzed the effects of residency on the quality of sleep of the medical trainees in various specialties, but only few studies were conducted in Egypt.
Results
One hundred fifty medical residents from various medical and surgical specialties who work in the hospitals of Ain Shams University, Egypt, agreed to participate in our study. Sociodemographic and work-related data were collected by a semi-structured sheet. Sleep quality was assessed by self-administered questionnaire—Pittsburgh Sleep Quality Index (PSQI). According to the PSQI, 96.7% of the residents had poor sleep quality with mean PSQI score of 10.4 ± 2.5. No statistically significant difference was detected among the different specialties. Poorer sleep quality was more frequent among senior residents who spent longer duration in residency. The number of hours of sleep before residency and the number of days off during residency were the main predictors of total PSQI score and determinants of sleep quality
Conclusions
Poor sleep quality is highly prevalent among medical residents and is associated with work-related factors. It is necessary to consider residents’ sleep estate and conduct more analyses to diagnose, treat, and improve their sleep quality.
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Queisner M, Pogorzhelskiy M, Remde C, Pratschke J, Sauer IM. VolumetricOR: A New Approach to Simulate Surgical Interventions in Virtual Reality for Training and Education. Surg Innov 2022; 29:406-415. [PMID: 35137646 PMCID: PMC9438748 DOI: 10.1177/15533506211054240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical training is primarily carried out through observation during assistance or on-site classes, by watching videos as well as by different formats of simulation. The simulation of physical presence in the operating theatre in virtual reality might complement these necessary experiences. A prerequisite is a new education concept for virtual classes that communicates the unique workflows and decision-making paths of surgical health professions (i.e. surgeons, anesthesiologists and surgical assistants) in an authentic and immersive way. For this project, media scientists, designers and surgeons worked together to develop the foundations for new ways of conveying knowledge using virtual reality in surgery. MATERIALS AND METHOD A technical workflow to record and present volumetric videos of surgical interventions in a photorealistic virtual operating room was developed. Situated in the virtual reality demonstrator called VolumetricOR, users can experience and navigate through surgical workflows as if they are physically present. The concept is compared with traditional video-based formats of digital simulation in surgical training. RESULTS VolumetricOR let trainees experience surgical action and workflows (a) three-dimensionally, (b) from any perspective and (c) in real scale. This improves the linking of theoretical expertise and practical application of knowledge and shifts the learning experience from observation to participation. DISCUSSION Volumetric training environments allow trainees to acquire procedural knowledge before going to the operating room and could improve the efficiency and quality of the learning and training process for professional staff by communicating techniques and workflows when the possibilities of training on-site are limited.
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Affiliation(s)
- Moritz Queisner
- Department of Surgery, CCM
- CVK, Experimental Surgery, 14903Charité - Universitätsmedizin Berlin, Germany.,University of Arts and Design Karlsruhe, Germany.,Cluster of Excellence Image Knowledge Gestaltung. Interdisciplinary Laboratory, Berlin, Germany
| | - Michael Pogorzhelskiy
- Cluster of Excellence Image Knowledge Gestaltung. Interdisciplinary Laboratory, Berlin, Germany
| | - Christopher Remde
- Cluster of Excellence Image Knowledge Gestaltung. Interdisciplinary Laboratory, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, CCM
- CVK, Experimental Surgery, 14903Charité - Universitätsmedizin Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, CCM
- CVK, Experimental Surgery, 14903Charité - Universitätsmedizin Berlin, Germany
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Coelho G, Trigo L, Faig F, Vieira EV, da Silva HPG, Acácio G, Zagatto G, Teles S, Gasparetto TPD, Freitas LF, Zanon N, Lapa DA. The Potential Applications of Augmented Reality in Fetoscopic Surgery for Antenatal Treatment of Myelomeningocele. World Neurosurg 2021; 159:27-32. [PMID: 34922026 DOI: 10.1016/j.wneu.2021.11.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To develop a preoperative planning method using augmented reality (AR) of a specific surgical procedure: fetoscopy for myelomeningocele repair. METHODS Imaging data were acquired of a pregnant woman at 27 weeks of gestation whose fetus was diagnosed with myelomeningocele. The patient was identified as a candidate for fetoscopic repair of the spine defect, and an AR application for mobile device simulation was developed. The virtual customized model was created by analysis of the presurgical magnetic resonance imaging. A real-time AR interface was developed by using an application that enhanced the anatomical aspects of both mother and fetus. RESULTS A virtual model for planning fetoscopy repair for myelomeningocele was developed. Preoperative and postoperative procedures were successfully carried out, emphasizing the beneficial role of the AR application. The use of the AR model allowed the multidisciplinary team to engage in discussion to determine the appropriate surgical approach. It also allowed a clearer explanation of the procedure to the parents enabling a better understanding of the parents regarding specifics characteristics of their baby's spine defect. CONCLUSIONS This new preoperative platform using a virtual model represents an important tool to improve patient's comprehension, multidisciplinary discussion, and surgical planning. In addition, it can be used worldwide as a teaching tool in the fetal surgery field.
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Affiliation(s)
- Giselle Coelho
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Scientific Department, EDUCSIM Institute, São Paulo, São Paulo, Brazil; Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil.
| | - Lucas Trigo
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | - Fernanda Faig
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | - Eduardo Varjão Vieira
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil; Department of Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil
| | | | - Gregório Acácio
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | - Gustavo Zagatto
- Scientific Department, EDUCSIM Institute, São Paulo, São Paulo, Brazil
| | - Sylker Teles
- Scientific Department, State University of Amazonas, Manaus, Amazonas, Brazil
| | - Taísa Pallú Davaus Gasparetto
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Radiology, Diagnósticos da América SA, São Paulo, São Paulo, Brazil
| | | | - Nelci Zanon
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Neurosurgery, CENEPE, Centro de Neurocirurgia Pediátrica, São Paulo, São Paulo, Brazil
| | - Denise Araújo Lapa
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Fetal Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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Guo Z, Tai Y, Du J, Chen Z, Li Q, Shi J. Automatically Addressing System for Ultrasound-Guided Renal Biopsy Training Based on Augmented Reality. IEEE J Biomed Health Inform 2021; 25:1495-1507. [PMID: 33684049 DOI: 10.1109/jbhi.2021.3064308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic kidney disease has become one of the diseases with the highest morbidity and mortality in kidney diseases, and there are still some problems in surgery. During the operation, the surgeon can only operate on two-dimensional ultrasound images and cannot determine the spatial position relationship between the lesion and the medical puncture needle in real-time. The average number of punctures per patient will reach 3 to 4, Increasing the incidence of complications after a puncture. This article starts with ultrasound-guided renal biopsy navigation training, optimizes puncture path planning, and puncture training assistance. The augmented reality technology, combined with renal puncture surgery training was studied. This paper develops a prototype ultrasound-guided renal biopsy surgery training system, which improves the accuracy and reliability of the system training. The system is compared with the VR training system. The results show that the augmented reality training platform is more suitable as a surgical training platform. Because it takes a short time and has a good training effect.
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Warchałowski Ł, Łuszczki E, Bartosiewicz A, Dereń K, Warchałowska M, Oleksy Ł, Stolarczyk A, Podlasek R. The Analysis of Risk Factors in the Conversion from Laparoscopic to Open Cholecystectomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207571. [PMID: 33080991 PMCID: PMC7588875 DOI: 10.3390/ijerph17207571] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 12/24/2022]
Abstract
Laparoscopic cholecystectomy is a standard treatment for cholelithiasis. In situations where laparoscopic cholecystectomy is dangerous, a surgeon may be forced to change from laparoscopy to an open procedure. Data from the literature shows that 2 to 15% of laparoscopic cholecystectomies are converted to open surgery during surgery for various reasons. The aim of this study was to identify the risk factors for the conversion of laparoscopic cholecystectomy to open surgery. A retrospective analysis of medical records and operation protocols was performed. The study group consisted of 263 patients who were converted into open surgery during laparoscopic surgery, and 264 randomly selected patients in the control group. Conversion risk factors were assessed using logistic regression analysis that modeled the probability of a certain event as a function of independent factors. Statistically significant factors in the regression model with all explanatory variables were age, emergency treatment, acute cholecystitis, peritoneal adhesions, chronic cholecystitis, and inflammatory infiltration. The use of predictive risk assessments or nomograms can be the most helpful tool for risk stratification in a clinical scenario. With such predictive tools, clinicians can optimize care based on the known risk factors for the conversion, and patients can be better informed about the risks of their surgery.
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Affiliation(s)
- Łukasz Warchałowski
- Department of General Surgery, Clinical Regional Hospital No. 2 in Rzeszów, 35-301 Rzeszów, Poland;
- Correspondence: ; Tel.: +48-17-866-47-01
| | - Edyta Łuszczki
- Institute of Health Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland; (E.Ł.); (A.B.); (K.D.)
| | - Anna Bartosiewicz
- Institute of Health Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland; (E.Ł.); (A.B.); (K.D.)
| | - Katarzyna Dereń
- Institute of Health Sciences, Medical College of Rzeszów University, 35-959 Rzeszów, Poland; (E.Ł.); (A.B.); (K.D.)
| | | | - Łukasz Oleksy
- Orthopaedic and Rehabilitation Department, Medical University of Warsaw, 02-091 Warszawa, Poland; (Ł.O.); (A.S.)
- Oleksy Medical & Sports Sciences, 37-100 Łańcut, Poland
| | - Artur Stolarczyk
- Orthopaedic and Rehabilitation Department, Medical University of Warsaw, 02-091 Warszawa, Poland; (Ł.O.); (A.S.)
| | - Robert Podlasek
- Department of General Surgery, Clinical Regional Hospital No. 2 in Rzeszów, 35-301 Rzeszów, Poland;
- Department of Surgery with the Trauma and Orthopedic Division, District Hospital in Strzyżów, 38-100 Strzyżów, Poland
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Chang RE, Yu TH, Shih CL. The number and composition of work hours for attending physicians in Taiwan. Sci Rep 2020; 10:14934. [PMID: 32913272 PMCID: PMC7483534 DOI: 10.1038/s41598-020-71873-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
Long work hours among physicians is a worldwide issue in the healthcare arena. Previous studies have largely focused on the work hours of resident physicians rather than those of attending physicians. The purpose of this study was to investigate total work hours and the composition of those work hours for attending physicians across different hospital settings and across different medical specialties through a nationwide survey. This included examining differences in physician workload and its composition with respect to different hospital characteristics, and grouping medical specialties according to the work similarities. A cross-sectional self-reported nationwide survey was conducted from June to September of 2018, and the two questionnaires were distributed to all accredited hospitals in Taiwan. The number of physician work hours in different types of duty shifts were answered by medical specialty in each surveyed hospital. Each medical specialty in a hospital filled only one response for its attending physicians. The findings reveal that the average total work hours per week of an attending physician is around 69.1 h, but the total work hours and their composition of different duty shifts varied among hospital accreditation levels, geographic locations, emergency care responsibilities, and medical specialties. Because of the variance in the number and composition of attending physicians' work hours, adjusting physician work hours to a reasonable level will be a major challenge for health authority and hospital managers.
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Affiliation(s)
- Ray-E Chang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Institute of Health Policy and Management, National Taiwan University, Room 639, No 17, Hsu-Chow Road, Taipei, 100, Taiwan.
| | - Tsung-Hsien Yu
- Department of Health Care Management, National Taipei University of Nursing and Science, Taipei, Taiwan
| | - Chung-Liang Shih
- Department of Medical Affairs, Ministry of Health and Welfare, Taipei, Taiwan
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12
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Moeckli B, Burgermeister LC, Siegrist M, Clavien PA, Käser SA. Evolution of the Surgical Residency System in Switzerland: An In-Depth Analysis Over 15 Years. World J Surg 2020; 44:2850-2856. [PMID: 32367397 DOI: 10.1007/s00268-020-05552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The landscape of surgical training has been subject to many changes over the past 15 years. This study examines resident satisfaction, determinants of satisfaction, demographics, working hours and the teaching rate of common operations in a longitudinal fashion with the aim to identify trends, shortcomings and possible ways to improve the current training system. METHODS The Swiss Medical Association administers an annual survey to all Swiss residents to evaluate the quality of postgraduate medical training (yearly respondents: 687-825, response rate: 68-72%). Teaching rates for general surgical procedures were obtained from the Swiss association for quality management in surgery. RESULTS During the study period (2003-2018), the number of surgical residents (408-655 (+61%)) and graduates in general surgery per year (42-63 (+50%)) increased disproportionately to the Swiss population. While the 52 working hour restriction was introduced in 2005 reported average weekly working hours did not decline (59.9-58.4 h (-3%)). Workplace satisfaction (6 being highest) rose from 4.3 to 4.6 (+7%). Working climate and leadership culture were the main determinants for resident satisfaction. The proportion of taught basic surgical procedures fell from 24.6 to 18.9% (-23%). CONCLUSIONS The number of residents and graduates in general surgery has risen markedly. At the same time, the proportion of taught operations is diminishing. Despite the introduction of working hour restrictions, the self-reported hours never reached the limit. The low teaching rate combined with the increasing resident number represents a major challenge to the maintenance of the current training quality.
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Affiliation(s)
- Beat Moeckli
- Department of Visceral- and Transplantation Surgery, Zurich University Hospital, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Lea C Burgermeister
- Department of Health Sciences and Technology (HEST), ETH Zurich, Zürich, Switzerland
| | - Michael Siegrist
- Department of Health Sciences and Technology (HEST), ETH Zurich, Zürich, Switzerland
| | - Pierre A Clavien
- Department of Visceral- and Transplantation Surgery, Zurich University Hospital, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Samuel A Käser
- Department of Visceral- and Transplantation Surgery, Zurich University Hospital, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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Yiasemidou M, Glassman D, Khan K, Downing J, Sivakumar R, Fawole A, Biyani CS. Validation of a cost-effective appendicectomy model for surgical training. Scott Med J 2020; 65:46-51. [PMID: 31959075 DOI: 10.1177/0036933019900340] [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: 01/07/2023]
Abstract
BACKGROUND Appendicitis is a commonly occurring condition worldwide. The gold standard treatment is appendicectomy. Although training models are commercially available for this procedure, they are often associated with high cost. Here we present a cost-effective model. AIM To establish construct validity of a cost-effective laparoscopic appendicectomy simulation model. METHODS Three groups of surgeons were recruited; novices (n = 31), of intermediate expertise (n = 13) and experts (n = 5) and asked to perform a simulated laparoscopic appendicectomy using the new model. Their performance was assessed by a faculty member and compared between the three groups using a validated scoring system (Global Operative Assessment of Laparoscopic Skills [GOALS] score). RESULTS One-way ANOVA test showed a significant difference in task performance between groups (p < 0.0001). Post-hoc comparisons after the application of Bonferroni correction (statistically significant p value <0.017) demonstrate a significant difference in performance between all groups for all GOALS categories as well as the total score. Effect size calculations showed that experience level had moderate (Eta-squared >0.5 and <0.8) and significant (>0.8) impact on the performance of the simulated procedure. CONCLUSION The model described in this study is cost-effective, valid and can adequately simulate appendicectomy. The authors recommend inclusion of this model to postgraduate surgical training.
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Affiliation(s)
- Marina Yiasemidou
- Honorary Research Fellow, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St. James University Hospital, Leeds, UK.,Specialty Registrar Colorectal Surgery, Mid Yorkshire NHS Trust, West Yorkshire, UK
| | - Daniel Glassman
- TIG Oncoplastic Fellow Breast Surgery, York Teaching Hospital, York, UK
| | - Khalid Khan
- Registrar Colorectal Surgery, Hull and East Riding NHS Trust, Hull, UK
| | - Justine Downing
- Specialty Registrar Breast Surgery, Barnsley District General Hospital, Barnsley, UK
| | | | - Adeshina Fawole
- Consultant Colorectal Surgeon, Mid Yorkshire NHS Trust, West Yorkshire, UK
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14
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Provision of simulation-based training (SBT) within UK vascular surgery training programmes. Surgeon 2019; 17:321-325. [DOI: 10.1016/j.surge.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/25/2018] [Accepted: 10/03/2018] [Indexed: 11/23/2022]
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Nordquist J, Hall J, Caverzagie K, Snell L, Chan MK, Thoma B, Razack S, Philibert I. The clinical learning environment. MEDICAL TEACHER 2019; 41:366-372. [PMID: 30880530 DOI: 10.1080/0142159x.2019.1566601] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Learning in a clinical context is foundational in the training of health professionals; there is simply no alternative. The subject of the clinical learning environment (CLE) is at the forefront of discussions. In this introduction to a themed issue on the CLE, we present an expanded conceptual model that approaches the CLE through six different lenses, termed "avenues:" architectural, digital, diversity and inclusion, education, psychological, and sociocultural, with each avenue represented by a paper. The aim is to facilitate dialog around the contributions of different academic disciplines to research on the CLE. Collectively the papers highlight the overlap between the various "avenues" in how they influence each other, and how they collectively have shaped the work to understand and improve the CLE. The expectation is that the various avenues can add to existing knowledge and create new ideas for interventions to improve the clinical learning environment across nations for learners and teachers with the ultimate aim of improving patient care. Research and efforts to improve the CLE are critical to learning, professional socialization and well-being for trainees as they learn and participate in patient care, and to the quality of care they will deliver over decades of practice after graduation.
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Affiliation(s)
- Jonas Nordquist
- a Department of Medicine (Huddinge) , Karolinska Institutet , Stockholm , Sweden
- b Department of Research and Education , Karolinska University Hospital , Stockholm , Sweden
| | - Jena Hall
- c Department of Obstetrics and Gynecology , Queen's University , Kingston , Canada
| | - Kelly Caverzagie
- d Internal Medicine , University of Nebraska Medical Center , Omaha , NE , USA
| | - Linda Snell
- e Medicine , McGill University , Montreal , Canada
- f Royal College of Physicians and Surgeons of Canada , Ottawa , Canada
| | | | - Brent Thoma
- h University of Saskatchewan , Saskatoon , Canada
| | | | - Ingrid Philibert
- i Accreditation Council of Graduate Medical Education , Chicago , IL , USA
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Jung S, Lee J, Biocca F, Kim JW. Augmented Reality in the Health Domain: Projecting Spatial Augmented Reality Visualizations on a Perceiver's Body for Health Communication Effects. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 22:142-150. [PMID: 30668138 DOI: 10.1089/cyber.2018.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An experiment is reported that studied the effects of spatial embodiment in augmented reality on medical attitudes about the self. College students (N = 90) viewed public service announcements (PSAs) with overlaid virtual fetuses and X-rayed images of lungs on various interfaces representing embodiment-a two-dimensional screen, a three-dimensional (3D) mannequin, and the participants' bodies (3D). Results indicated that PSA messages with richer embodied interfaces increase the sense of "being there," also known as spatial presence (SP), in sequential order; this leads to increased negative emotion regarding smoking cigarettes and an increased willingness to engage with a cigarette cessation campaign. When the SP mediates the dual model process, only affective attitudes increase the behavioral intention to engage with the campaign.
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Affiliation(s)
- Soyoung Jung
- 1 S.I. School of Newhouse Public Communications, Syracuse University, Syracuse, New York.,2 M.I.N.D. Lab, Digital Design, School of Art & Design College of Architecture & Design, New Jersey Institute of Technology. Newark, New Jersey
| | - Jiyoung Lee
- 1 S.I. School of Newhouse Public Communications, Syracuse University, Syracuse, New York
| | - Frank Biocca
- 3 Department of Informatics, Ying Wu College of Computing, New Jersey Institute of Technology, Newark, New Jersey
| | - Ji Won Kim
- 1 S.I. School of Newhouse Public Communications, Syracuse University, Syracuse, New York
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Abstract
BACKGROUND New regulations for working hours of medical doctors have been implemented in Austria based on the European directive 2003/88/EG, limiting on-duty working hours to 48 h per week. Clinical work is, therefore, substantially reduced compared to previous decades, and little is known on physician and students' opinions on this matter. We illustrate survey results concerning on-job training, its difficulties, and implications for restricted working hours. METHODS We conducted an internal survey among M.D. and Ph.D. students and medical staff members at the Medical University of Vienna using the MedCampus system (CAMPUSOnline, Graz, Austria) and SPSS (V.21, IBM Corp, Armonk, NY, USA). RESULTS Participants were 36.5% staff members and 63.5% students. Students rated continuous education of physicians high at 9.19 ± 1.76 and staff members at 8.90 ± 2.48 on a 1-10 (1 unimportant, 10 most important) scale. Students rated limited time resources, while staff considered financial resources as the greatest challenge for in-hospital education. Overall, 28.85% thought that restricted working hours can positively influence education, while 19.04% thought the opposite and 52.11% were undecided. DISCUSSION Considering the limited available time and financial resources, education of tomorrow's medical doctors remains an important but difficult task. While participants of our survey rated education as very important despite its many challenges, the opinions towards limited working hours were not as clear. Given that over 50% are still undecided whether reduced work hours may also positively influence medical education, it clearly presents an opportunity to include the next generations of physicians in this undertaking.
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Affiliation(s)
- Konstantin D Bergmeister
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research at the Center of Biomedical Research, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Martin Aman
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research at the Center of Biomedical Research, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Bruno K Podesser
- Ludwig Boltzmann Cluster for Cardiovascular Research at the Center of Biomedical Research, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Yiasemidou M, Galli R, Glassman D, Tang M, Aziz R, Jayne D, Miskovic D. Patient-specific mental rehearsal with interactive visual aids: a path worth exploring? Surg Endosc 2017; 32:1165-1173. [PMID: 28840324 PMCID: PMC5807505 DOI: 10.1007/s00464-017-5788-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 11/06/2022]
Abstract
Background Surgeons of today are faced with unprecedented challenges; necessitating a novel approach to pre-operative preparation which takes into account the specific tests each case poses. In this study, we examine patient-specific mental rehearsal for pre-surgical practice and assess whether this method has an additional effect when compared to generic mental rehearsal. Methods Sixteen medical students were trained how to perform a simulated laparoscopic cholecystectomy (SLC). After baseline assessments, they were randomised to two equal groups and asked to complete three SLCs involving different anatomical variants. Prior to each procedure, Group A practiced mental rehearsal with the use of a pre-prepared checklist and Group B mental rehearsal with the checklist combined with virtual models matching the anatomical variations of the SLCs. The performance of the two groups was compared using simulator provided metrics and competency assessment tool (CAT) scoring by two blinded assessors. Results The participants performed equally well when presented with a “straight-forward” anatomy [Group A vs. Group B—time sec: 445.5 vs. 496 p = 0.64—NOM: 437 vs. 413 p = 0.88—PL cm: 1317 vs. 1059 p = 0.32—per: 0.5 vs. 0 p = 0.22—NCB: 0 vs. 0 p = 0.71—DVS: 0 vs. 0 p = 0.2]; however, Group B performed significantly better [Group A vs. B Total CAT score—Short Cystic Duct (SCD): 20.5 vs. 26.31 p = 0.02 η2 = 0.32—Double cystic Artery (DA): 24.75 vs. 30.5 p = 0.03 η2 = 0.28] and committed less errors (Damage to Vital Structures—DVS, SCD: 4 vs. 0 p = 0.03 η2=0.34, DA: 0 vs. 1 p = 0.02 η2 = 0.22). in the cases with more challenging anatomies. Conclusion These results suggest that patient-specific preparation with the combination of anatomical models and mental rehearsal may increase operative quality of complex procedures.
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Affiliation(s)
- Marina Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | - Raffaele Galli
- John Goligher Surgery Unit, St. James University Hospital, Leeds, UK
| | | | | | - Rahoz Aziz
- Medical School, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Danilo Miskovic
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Boettcher M, Boettcher J, Mietzsch S, Krebs T, Bergholz R, Reinshagen K. The spaced learning concept significantly improves training for laparoscopic suturing: a pilot randomized controlled study. Surg Endosc 2017. [PMID: 28643052 DOI: 10.1007/s00464-017-5650-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Spaced learning has been shown to be effective in various areas like traditional knowledge or motor skill acquisition. To evaluate the impact of implementation of the spaced learning concept in laparoscopic training was the aim of this study. METHODS To evaluate the effectiveness of spaced learning, subjects were asked to perform four surgeon's square knots on a bowel model prior and post 3 h of hands-on training. All subjects were medical students and novice in laparoscopic suturing. Total time, knot stability (evaluated via tensiometer), suture accuracy, knot quality (Muresan score), and laparoscopic performance (Munz checklist) were assessed. Moreover, motivation was accessed using Questionnaire on Current Motivation. RESULTS Twenty students were included in the study; after simple randomization, ten were trained using "spaced learning" concept and ten conservatively. Both groups had comparable baseline characteristics and improved after training significantly regarding all aspects assessed in this study. Subjects that trained via spaced learning were superior in terms of suture performance, knot quality, and suture strength. Ultimately, spaced learning significantly decreased anxiety and impression of challenge compared to controls. CONCLUSION The spaced learning concept is very suitable for complex motor skill acquisition like laparoscopic suturing and knot tying. It significantly improves laparoscopic performance and knot quality as shown by the knot score and suture strength. Thus, we recommend to incorporate spaced learning into training courses and surgical programs.
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Affiliation(s)
- Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Johannes Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Institute of Psychology, University Kiel, Olshausenstr. 40, 24118, Kiel, Germany
| | - Stefan Mietzsch
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Thomas Krebs
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Department of Pediatric Surgery, Children's Hospital, Claudiusstr. 6, 9000, St. Gallen, Switzerland
| | - Robert Bergholz
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Elsey EJ, Griffiths G, Humes DJ, West J. Meta-analysis of operative experiences of general surgery trainees during training. Br J Surg 2017; 104:22-33. [PMID: 28000937 DOI: 10.1002/bjs.10396] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/20/2016] [Accepted: 08/24/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND General surgical training curricula around the world set defined operative numbers to be achieved before completion of training. However, there are few studies reporting total operative experience in training. This systematic review aimed to quantify the published global operative experience at completion of training in general surgery. METHODS Electronic databases were searched systematically for articles in any language relating to operative experience in trainees completing postgraduate general surgical training. Two reviewers independently assessed citations for inclusion using agreed criteria. Studies were assessed for quantitative data in addition to study design and purpose. A meta-analysis was performed using a random-effects model of studies with appropriate data. RESULTS The search resulted in 1979 titles for review. Of these, 24 studies were eligible for inclusion in the review and data from five studies were used in the meta-analysis. Studies with published data of operative experience at completion of surgical training originated from the USA (19), UK (2), the Netherlands (1), Spain (1) and Thailand (1). Mean total operative experience in training varied from 783 procedures in Thailand to 1915 in the UK. Meta-analysis produced a mean pooled estimate of 1366 (95 per cent c.i. 1026 to 1707) procedures per trainee at completion of training. There was marked heterogeneity between studies (I2 = 99·6 per cent). CONCLUSION There is a lack of robust data describing the operative experiences of general surgical trainees outside the USA. The number of surgical procedures performed by general surgeons in training varies considerably across the world.
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Affiliation(s)
- E J Elsey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - G Griffiths
- Department of Vascular Surgery, Ninewells Hospital, Dundee, UK
| | - D J Humes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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Role of Simulation in Endovascular Aneurysm Repair (EVAR) Training: A Preliminary Study. Eur J Vasc Endovasc Surg 2017; 53:193-198. [DOI: 10.1016/j.ejvs.2016.11.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/14/2016] [Indexed: 01/22/2023]
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22
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Janki S, Mulder EEAP, IJzermans JNM, Tran TCK. Ergonomics in the operating room. Surg Endosc 2016; 31:2457-2466. [PMID: 27752811 PMCID: PMC5443844 DOI: 10.1007/s00464-016-5247-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/12/2016] [Indexed: 12/31/2022]
Abstract
Background Since the introduction of minimally invasive surgery, surgeons appear to be experiencing more occupational musculoskeletal injuries. The aim of this study is to investigate the current frequency and effects of occupational musculoskeletal injuries on work absence. Methods An online questionnaire was conducted among all surgeons affiliated to the Dutch Society for Endoscopic Surgery, Gastrointestinal Surgery, and Surgical Oncology. In addition, this survey was conducted among surgeons, gynaecologists, and urologists of one cluster of training hospitals in the Netherlands. Results There were 127 respondents. Fifty-six surgeons currently suffer from musculoskeletal complaints, and 30 have previously suffered from musculoskeletal complaints with no current complaints. Frequently reported localizations were the neck (39.5 %), the erector spinae muscle (34.9 %), and the right deltoid muscle (18.6 %). Most of the musculoskeletal complaints were present while operating (41.8 %). Currently, 37.5 % uses medication and/or therapy to reduce complaints. Of surgeons with past complaints, 26.7 % required work leave and 40.0 % made intraoperative adjustments. More surgeons with a medical history of musculoskeletal complaints have current complaints (OR 6.1, 95 % CI 1.9–19.6). There were no significant differences between surgeons of different operating techniques in localizations and frequency of complaints, or work leave. Conclusions Despite previous various ergonomic recommendations in the operating room, the current study demonstrated that musculoskeletal complaints and subsequent work absence are still present among surgeons, especially among surgeons with a positive medical history for musculoskeletal complaints. Even sick leave was necessary to fully recover. There were no significant differences in reported complaints between surgeons of different operating techniques. Almost half of the respondents with complaints made intraoperative ergonomic adjustments to prevent future complaints. The latter would be interesting for future research.
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Affiliation(s)
- Shiromani Janki
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Evalyn E A P Mulder
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - T C Khe Tran
- Division of HPB and Transplant Surgery, Erasmus MC, Department of Surgery, University Medical Center, Room no. H-822k, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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Dubov A, Fraenkel L, Seng E. The Importance of Fostering Ownership During Medical Training. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:3-12. [PMID: 27471927 PMCID: PMC4968578 DOI: 10.1080/15265161.2016.1197338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
There is a need to consider the impact of the new resident-hours regulations on the variety of aspects of medical education and patient care. Most existing literature about this subject has focused on the role of fatigue in resident performance, education, and health care delivery. However, there are other possible consequences of these new regulations, including a negative impact on decision ownership. Our main assumption of is that increased shift work in medicine can decrease ownership of treatment decisions and impact negatively on quality of care. We review some potential components of decision ownership in treatment context and suggest possible ways in which the absence of decision ownership may decrease the quality of medical decision making. The article opens with the definition of decision ownership and the overview of some contextual factors that may contribute to the development of ownership in medical residency. The following section discusses decision ownership in medical care from the perspective of "diffusion of responsibility." We question the quality of choices made within narrow decisional frames. We also compare isolated and interrelated choices, assuming that residents make more isolated decisions during their shifts. Lastly, we discuss the consequences of decreased decision ownership impacting the delivery of health care.
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Brandacher G, Berli JU. Surgical residency in the United States–a personal European perspective. Eur Surg 2016. [DOI: 10.1007/s10353-016-0432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Plastic Surgery Training Worldwide: Part 1. The United States and Europe. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e641. [PMID: 27257571 PMCID: PMC4874285 DOI: 10.1097/gox.0000000000000627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/21/2016] [Indexed: 12/20/2022]
Abstract
Background: Major differences exist in residency training, and the structure and quality of residency programs differ between different countries and teaching centers. It is of vital importance that a better understanding of the similarities and differences in plastic surgery training be ascertained as a means of initiating constructive discussion and commentary among training programs worldwide. In this study, the authors provide an overview of plastic surgery training in the United States and Europe. Methods: A survey was sent to select surgeons in 10 European countries that were deemed to be regular contributors to the plastic surgery literature. The questions focused on pathway to plastic surgery residency, length of training, required pretraining experience, training scheme, research opportunities, and examinations during and after plastic surgery residency. Results: Plastic surgery residency training programs in the United States differ from the various (selected) countries in Europe and are described in detail. Conclusions: Plastic surgery education is vastly different between the United States and Europe, and even within Europe, training programs remain heterogeneous. Standardization of curricula across the different countries would improve the interaction of different centers and facilitate the exchange of vital information for quality control and future improvements. The unique characteristics of the various training programs potentially provide a basis from which to learn and to gain from one another.
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Barsom EZ, Graafland M, Schijven MP. Systematic review on the effectiveness of augmented reality applications in medical training. Surg Endosc 2016; 30:4174-83. [PMID: 26905573 PMCID: PMC5009168 DOI: 10.1007/s00464-016-4800-6] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 02/03/2016] [Indexed: 12/16/2022]
Abstract
Background Computer-based applications are increasingly used to support the training of medical professionals. Augmented reality applications (ARAs) render an interactive virtual layer on top of reality. The use of ARAs is of real interest to medical education because they blend digital elements with the physical learning environment. This will result in new educational opportunities. The aim of this systematic review is to investigate to which extent augmented reality applications are currently used to validly support medical professionals training. Methods PubMed, Embase, INSPEC and PsychInfo were searched using predefined inclusion criteria for relevant articles up to August 2015. All study types were considered eligible. Articles concerning AR applications used to train or educate medical professionals were evaluated. Results Twenty-seven studies were found relevant, describing a total of seven augmented reality applications. Applications were assigned to three different categories. The first category is directed toward laparoscopic surgical training, the second category toward mixed reality training of neurosurgical procedures and the third category toward training echocardiography. Statistical pooling of data could not be performed due to heterogeneity of study designs. Face-, construct- and concurrent validity was proven for two applications directed at laparoscopic training, face- and construct validity for neurosurgical procedures and face-, content- and construct validity in echocardiography training. In the literature, none of the ARAs completed a full validation process for the purpose of use. Conclusion Augmented reality applications that support blended learning in medical training have gained public and scientific interest. In order to be of value, applications must be able to transfer information to the user. Although promising, the literature to date is lacking to support such evidence.
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Affiliation(s)
- E Z Barsom
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M Graafland
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.,Department of Surgery, Flevo Hospital, Almere, The Netherlands
| | - M P Schijven
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Lambert TW, Smith F, Goldacre MJ. The impact of the European Working Time Directive 10 years on: views of the UK medical graduates of 2002 surveyed in 2013-2014. JRSM Open 2016; 7:2054270416632703. [PMID: 26981257 PMCID: PMC4776251 DOI: 10.1177/2054270416632703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives To report doctors’ views about the European Working Time Directive (‘the Directive’). Design Survey of the medical graduates of 2002 (surveyed in 2013–2014). Participants Medical graduates. Setting UK. Main outcome measures Questions on views about the Directive. Results The response rate was 64% (2056/3196). Twelve per cent of respondents agreed that the Directive had benefited senior doctors, 39% that it benefited junior doctors, and 17% that it had benefited the NHS. More women (41%) than men (35%) agreed that the Directive had benefited junior doctors. Surgeons (6%) and adult medical specialists (8%) were least likely to agree that the Directive had benefited senior doctors. Surgeons (20%) were less likely than others to agree that the Directive had benefited junior doctors, whilst specialists in emergency medicine (57%) and psychiatry (52%) were more likely to agree. Surgeons (7%) were least likely to agree that the Directive had benefited the NHS. Most respondents (62%) reported a positive effect upon work–life balance. With regard to quality of patient care, 45% reported a neutral effect, 40% reported a negative effect, and 15% a positive effect. Most respondents (71%) reported a negative effect of the Directive on continuity of patient care, and 71% felt that the Directive had a negative effect upon junior doctors’ training opportunities. Fifty-two per cent reported a negative effect on efficiency in managing patient care. Conclusions Senior doctors agreed that the Directive benefited doctors’ work–life balance. In other respects, they were more negative about it. Surgeons were the least positive about aspects of the Directive.
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Affiliation(s)
- Trevor W Lambert
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX7 3LF, UK
| | - Fay Smith
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX7 3LF, UK
| | - Michael J Goldacre
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX7 3LF, UK
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Horvath KD, Pellegrini CA. Commentary on: “Impact of the European Working Time Directive (EWTD) on the operative experience of surgical residents”. Surgery 2015; 157:642-4. [DOI: 10.1016/j.surg.2014.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
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