1
|
Arora RK, Mittal RS, Khapre M, Kumar S, Singh B, Aggarwal SP, Arora P. Graduating from Laboratory to Operating Rooms-the Way Forward for Future Surgeons! Indian J Surg Oncol 2023; 14:445-451. [PMID: 37324286 PMCID: PMC10267084 DOI: 10.1007/s13193-021-01360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/31/2021] [Indexed: 11/27/2022] Open
Abstract
Background Changing healthcare and social scenarios are reducing the learning opportunities of surgical postgraduates in our country. Majority of surgical training centers in the developed world use laboratory training as an integral part of their curricula. However, in India, most of surgical residents are still trained by traditional apprenticeship model. Aims To describe the role of laboratory training in improving the competency of surgical postgraduates. Settings and Design Laboratory dissection was used as an educational intervention for postgraduates in tertiary care teaching hospital. Methods and Material Thirty-five (35) trainees from various surgical subspecialties performed cadaveric dissection led by senior faculty members. The perceived knowledge and operative confidence of trainees were assessed before and three weeks after the course using a five-point Likert scale. A structured questionnaire was administered to explore the experience of training. Results were tabulated in percentage and proportion. Wilcoxon signed-rank test was applied to find any difference between pre and post perception of knowledge and operative competence of participants. Results Thirty four (34/35; 96%) were males; 65.7% (23/35) trainees demonstrated improvement in knowledge level after dissection (p < 0.0001) and 74.3% (26/35) in operative confidence (p < 0.0001). Majority believe that cadaveric dissection helps to improve knowledge of procedural anatomy (33/35; 94.3%) and enhances technical skill (25/35; 71.4%). Thirty participants (86%) rated cadaveric dissection as the best tool for surgical training of postgraduates better than operative manuals, surgical videos, and virtual simulators. Conclusions Laboratory training including cadaveric dissection is feasible, relevant, effective, and acceptable to postgraduate surgical trainees with few disadvantages, which can be taken care of. Trainees felt it should be made part of curriculum.
Collapse
Affiliation(s)
- Rajnish K. Arora
- Department of Neurosurgery, AIIMS Rishikesh, 249203 Rishikesh, India
| | - Radhey S. Mittal
- Department of Neurosurgery, AIIMS Rishikesh, 249203 Rishikesh, India
| | - Meenakshi Khapre
- Department of Community and Family Medicine, AIIMS Rishikesh, Rishikesh, India
| | - Santosh Kumar
- Department of Community and Family Medicine, AIIMS Rishikesh, Rishikesh, India
| | | | | | - Poonam Arora
- Department of Trauma and Emergency, AIIMS Rishikesh, Rishikesh, India
| |
Collapse
|
2
|
Koppes DM, Vesseur MAM, Schepens-Franke AN, Kruitwagen RFPM, Notten KJB, Scheele F. Anatomy in the daily practice of the gynecologist, essential or just window dressing? ANATOMICAL SCIENCES EDUCATION 2023; 16:497-503. [PMID: 36448881 DOI: 10.1002/ase.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 09/17/2022] [Accepted: 11/26/2022] [Indexed: 05/11/2023]
Abstract
Traditionally, anatomy was one of the basic pillars of medical training. However, due to the expansion of medical science and medical knowledge in general, anatomy teaching has steadily declined and the way anatomy is taught has changed. These changes go hand in hand with growing literature about a perceived and proven lack of anatomical knowledge. While anatomy is important for all doctors, these developments seem to be more worrying for surgical residents. At the same time, little is known about how clinicians use anatomy in daily practice. The primary aim of this study was to increase understanding of the role of anatomy in the daily practice of gynecologists. An explorative qualitative study was performed to answer the question "What is the tangible utility of solid anatomical knowledge in the daily practice of the gynecologist"? Semi-structured interviews with gynecologists and obstetrics and gynecology (ObGyn) residents from Belgium and the Netherlands were held and the responses were analyzed using a phenomenographic inductive coding approach. Anatomical knowledge was important and used for technical skills and non-technical achievements in the daily practice of gynecologists, and three themes were distinguished. Specifically, anatomical knowledge was important and used (1) for daily activities, (2) for the feeling of self-efficacy, and (3) to gain a respected name as a doctor. These findings are discussed in light of (perceived) insufficient anatomical knowledge, and recommendations are made for the postgraduate education of ObGyn doctors.
Collapse
Affiliation(s)
- Dorothea M Koppes
- Department of Obstetrics and Gynecology, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands
- School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Maud A M Vesseur
- Faculty of Medicine, University Maastricht, Maastricht, the Netherlands
| | | | - Rutgerus F P M Kruitwagen
- Department of Obstetrics and Gynecology, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands
- School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Kim J B Notten
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Fedde Scheele
- Amsterdam Academic Medical Center, Research in Education, Location VUmc, Amsterdam, the Netherlands
- Athena Institute for Trans-Disciplinary Research, The Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Singh M, Sharma M, Nair AG, Mehta A, Kaur M, Gupta R, Gupta T, Sahni D. Cadaver dissection for oculoplastic procedures: A beginner's guide. Indian J Ophthalmol 2022; 70:3239-3244. [PMID: 36018092 DOI: 10.4103/ijo.ijo_3037_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this article is to form a basic guide for beginning the cadaver dissection training programs focused on oculoplastic surgical procedures. Ours was a collaborative study between the departments of Ophthalmology and Anatomy in a tertiary care teaching institute. We formed a step-wise approach to begin the cadaver dissection focused on the oculoplastic surgical procedures. The basics of cadaver procurement, processing, and preparation for dissections were described. The operative requirements of trainees, surgical handling of cadavers, and basic oculoplastic surgical steps were discussed. The types of embalming (cadaver preservation process) and steps have been described in detail. We have emphasized the preoperative discussion about the proposed dissections using standard teachings and skull models for easier understanding. Additional helping tools like soft embalming and injectable substances for better intra-dissection understanding (intra-arterial, intravenous and orbital injections) have been described. Post-dissection cadaver handing and soft-tissue disposal protocols have also been described. Overall, the cadaver dissections provide holistic surgical learning for the residents, specialty trainees, and practitioners. This article may act as a basic step-wise guide for starting the cadaver-based oculoplastics lab dissection in various institutes and workshops.
Collapse
Affiliation(s)
- Manpreet Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjula Sharma
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay G Nair
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai; Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital and Institute, A Unit of Dr. Agarwal's Eye Hospitals, Navi Mumbai; Lokmanya Tilak Municipal Medical College and General Hospital, Dr. Babasaheb Ambedkar Road, Sion, Mumbai, Maharashtra, India
| | - Aditi Mehta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
4
|
Streith L, Cadili L, Wiseman SM. Evolving anatomy education strategies for surgical residents: A scoping review. Am J Surg 2022; 224:681-693. [PMID: 35180995 DOI: 10.1016/j.amjsurg.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/26/2022] [Accepted: 02/07/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Dedicated anatomy educational time in medical schools has decreased significantly, disproportionately affecting surgical residents. In this scoping review, we aim to consolidate existing evidence, describe ongoing research, and highlight future directions for surgical anatomy education. METHODS Two independent investigators searched MEDLINE, EMBASE, and the Cochrane library, for educational interventions targeting anatomy knowledge in surgical residents. English articles until October 28, 2021, were reviewed. RESULTS 1135 abstracts were considered, and 59 (5.2%) included. Agreement on inclusion was excellent (k = 0.90). The majority were single-cohort studies (53%) and prospective cohort studies (17%). The most common disciplines were General Surgery (17%) and Obstetrics and Gynecology (17%). DISCUSSION Cadavers consistently produce positive knowledge gains and are heavily favored by residents. They remain the educational method to which new educational models are compared. New technologies do not yet match cadaver fidelity. Research showing knowledge translation from cadaver labs to patient outcomes remains limited.
Collapse
Affiliation(s)
- Lucas Streith
- Department of Surgery, St. Paul's Hospital & University of British Columbia, C303-1081 Burrard Street, Vancouver, Canada
| | - Lina Cadili
- Department of Surgery, St. Paul's Hospital & University of British Columbia, C303-1081 Burrard Street, Vancouver, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, C303-1081 Burrard Street, Vancouver, Canada.
| |
Collapse
|
5
|
Establishment and evaluation of a training course in advanced laparoscopic surgery based on human body donors embalmed by ethanol-glycerol-lysoformin fixation. Surg Endosc 2020; 35:1385-1394. [PMID: 32444969 PMCID: PMC7886762 DOI: 10.1007/s00464-020-07523-6] [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: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 02/05/2023]
Abstract
Background Education of clinical anatomy and training of surgical skills are essential prerequisites for any surgical intervention in patients. Here, we evaluated a structured training program for advanced gynecologic laparoscopy based on human body donors and its impact on clinical practice. Methods The three-step training course included: (1) anatomical and surgical lectures, (2) demonstration and hands-on study of pre-dissected anatomical specimens, and (3) surgical training of a broad spectrum of gynecological laparoscopic procedures on human body donors embalmed by ethanol-glycerin-lysoformin. Two standardized questionnaires (after the course and 6 months later) evaluated the effectiveness of each of the training modules and the benefits to surgical practice. Results Eighty participants took part in 6 training courses using a total number of 24 body donors (3 trainees/body donor). Based on a 91.3% (73/80) response rate, participants rated high or very high the tissue and organ properties of the body donors (n = 72, 98.6%), the technical feasibility to perform laparoscopic surgery (n = 70, 95.9%), and the overall learning success (n = 72, 98.6%). Based on a 67.5% (54/80) response rate at 6 months, participants rated the benefit of the course to their daily routine as very high (mean 80.94 ± 24.61%, n = 53), and this correlated strongly with the use of body donors (r = 0.74) and the ability to train laparoscopic dissections (r = 0.77). Conclusions This study demonstrates the technical feasibility and didactic effectiveness of laparoscopic training courses in a professional and true-to-life setting by using ethanol-glycerol-lysoformin embalmed body donors. This cost-efficient fixation method offers the option to integrate advanced surgical training courses into structured postgraduate educational curricula to meet both the technical demands of minimal invasive surgery and the ethical concerns regarding patients´ safety.
Collapse
|
6
|
Dsouza Dias M, Patil R. Perceptions and attitudes of medical students toward the use of digital surgical operative video in lecture – A better anatomical understanding. NATIONAL JOURNAL OF CLINICAL ANATOMY 2020. [DOI: 10.4103/njca.njca_6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
A new human cadaver model for laparoscopic training using N-vinyl-2-pyrrolidone: a feasibility study. Anat Sci Int 2019; 95:156-164. [DOI: 10.1007/s12565-019-00494-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
|
8
|
Selcuk İ, Tatar I, Huri E. Cadaveric anatomy and dissection in surgical training. Turk J Obstet Gynecol 2019; 16:72-75. [PMID: 31019843 PMCID: PMC6463429 DOI: 10.4274/tjod.galenos.2018.15931] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/24/2018] [Indexed: 12/27/2022] Open
Abstract
Detailed knowledge of anatomy is an essential part of surgical practice. However, there are many drawbacks in anatomy education that make many residents feel inadequate when they start performing surgeries. Cadaveric dissection courses aim to close the gap between the anatomic knowledge and surgical practice. This review focuses on the role of cadaveric dissection on surgical education, and additionally states the panel decision of the Surgical Anatomy and Technologies Association on the proper use of cadavers.
Collapse
Affiliation(s)
- İlker Selcuk
- University of Health Sciences, Zekai Tahir Burak Woman's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Ilkan Tatar
- Hacettepe University Faculty of Medicine, Department of Anatomy, Ankara, Turkey
| | - Emre Huri
- Hacettepe University Faculty of Medicine, Department of Urology, Ankara, Turkey
| |
Collapse
|
9
|
Laparoscopic surgical anatomy for pelvic floor surgery. Best Pract Res Clin Obstet Gynaecol 2018; 54:89-102. [PMID: 30554856 DOI: 10.1016/j.bpobgyn.2018.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 11/22/2022]
Abstract
Understanding anatomy is one of the pillars for performing a safe, effective, and efficient surgery, but recently, it is reported that there has been a decline in teaching anatomy during the preclinical years of medical school. There is also evidence that by the time a medical student becomes a clinician, a considerable proportion of the basic anatomy knowledge is lost. Hence, it is crucial for surgeons performing or assisting in pelvic floor surgery to revisit this integral clinical aspect of pelvic anatomy for performing a safe surgery. Pelvic organ prolapse repair, especially abdominal laparoscopic sacrocolpopexy, which is the gold standard of pelvic organ prolapse repair, presents a significant challenge to surgeons because the technique requires thorough and meticulous negotiation through abdomino-pelvic vascular structures and nerves supplying the pelvis, rectum, and ureters. The abdominal laparoscopic sacrocolpopexy surgery requires surgeons to have a deep understanding of anatomy to prevent potential life-threatening complications, which is as critical as it is for a pilot to understand the navigation route for a safe landing. This review is an extensive look and a great reminder to laparoscopic surgeons working in the pelvic cavity, especially those performing a pelvic floor surgery, about the anatomical safe routes for performing laparoscopic pelvic floor repairs. For easy reading and clear understanding, we have described step by step the safe anatomical journey a surgeon needs to take during laparoscopic sacrocolpopexy. We divided the technique into five critical anatomic locations (landmarks), which serves as our "flight map" for performing safe and efficient laparoscopic sacrocolpopexy.
Collapse
|
10
|
Educational training in laparoscopic gynecological surgery based on ethanol-glycerol-lysoformin-preserved body donors. Ann Anat 2018; 221:157-164. [PMID: 30312766 DOI: 10.1016/j.aanat.2018.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE Educational training of laparoscopic skills performed on body donors is considered the gold standard prior to surgery in living patients. Appropriate, safe, and feasible fixation of body donors, reflecting true-to-life conditions of tissues, is an essential prerequisite for training workshops. MATERIALS AND METHODS Here we describe and evaluate a modified ethanol-glycerol-lysoformin-based fixation technique. Body donors were fixed by perfusion (70% ethanol, 30% glycerol, 0.3% lysoformin; ca. 20l) via femoral artery and stored in a humid atmosphere (1% thymol) at 4°C. Technical equipment included a mobile operating table, endoscopy system with gas insufflation, suction/irrigation pump, standard and electrosurgical instruments. The tissue properties of ethanol-glycerol-lysoformin-fixed body donors and their suitability for laparoscopic surgery were tested and compared to the in vivo situation. RESULTS Modified ethanol-glycerol-lysoformin fixation was a simple, cost-efficient and hazard-free procedure, resulting in near-to-life tissue conditions regarding consistency and flexibility, with moderate discoloration and greater viscosity of organs. Key laparoscopic procedures (trocar handling, pneumoperitoneum, blunt/sharp dissection, partial/total removal of organs, bi- or monopolar electrosurgery, suturing techniques) could be performed without difficulty. Multiple reuse of body donors was feasible over one year. Compared to the in vivo situation, the investigation of body donors required a greater degree of gas insufflation and more energy for electrosurgery. CONCLUSIONS Modified ethanol-glycerol-lysoformin fixation applied to body donors permitted laparoscopic surgery in a realistic and practical manner. Due to its logistic advantages, this technique provides appropriate conditions to train laparoscopic skills and implement novel minimally invasive approaches.
Collapse
|
11
|
Sharma G, Aycart MA, O'Mara L, Havens J, Nehs M, Shimizu N, Smink DS, Gravereaux E, Gates JD, Askari R. A cadaveric procedural anatomy simulation course improves video-based assessment of operative performance. J Surg Res 2017; 223:64-71. [PMID: 29433887 DOI: 10.1016/j.jss.2017.05.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/04/2017] [Accepted: 05/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Inadequate anatomic knowledge has been cited as a major contributor to declining surgical resident operative competence. We analyzed the impact of a comprehensive, procedurally oriented cadaveric procedural anatomy dissection laboratory on the operative performance of surgery residents, hypothesizing that trainees' performance of surgical procedures would improve after such a dissection course. MATERIALS AND METHODS Midlevel general surgery residents (n = 9) participated in an 8 wk, 16-h surgery faculty-led procedurally oriented cadaver simulation course. Both before and after completion of the course, residents participated in a practical examination, in which they were randomized to perform one of nine Surgical Council on Resident Education-designated "essential" procedures. The procedures were recorded using wearable video technology. Videos were deidentified before evaluation by six faculty raters blinded to examinee and whether performances occurred before or after an examinee had taken the course. Raters used the validated Operative Performance Rating System and Objective Structured Assessment of Technical Skill scales. RESULTS After the course residents had higher procedure-specific scores (median, 4.0 versus 2.4, P < 0.0001), instrument-handling (4.0 versus 3.0, P = 0.006), respect for tissue (4.0 versus 3.0, P = 0.0004), time and motion (3.0 versus 2.0, P = 0.0007), operation flow (3.0 versus 2.0, P = 0.0005), procedural knowledge (4.0 versus 2.0, P = 0.0001), and overall performance scores (4.0 versus 2.0, P < 0.0001). Operative Performance Rating System and Objective Structured Assessment of Technical Skill scales averaged by number of items in each were also higher (3.2 versus 2.0, P = 0.0002 and 3.1 versus 2.2, P = 0.002, respectively). CONCLUSIONS A cadaveric procedural anatomy simulation course covering a broad range of open general surgery procedures was associated with significant improvements in trainees' operative performance.
Collapse
Affiliation(s)
- Gaurav Sharma
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mario A Aycart
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lynne O'Mara
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joaquim Havens
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Nehs
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Naomi Shimizu
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edwin Gravereaux
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan D Gates
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
12
|
Tam V, Zenati M, Novak S, Chen Y, Zureikat AH, Zeh HJ, Hogg ME. Robotic Pancreatoduodenectomy Biotissue Curriculum has Validity and Improves Technical Performance for Surgical Oncology Fellows. JOURNAL OF SURGICAL EDUCATION 2017; 74:1057-1065. [PMID: 28578981 DOI: 10.1016/j.jsurg.2017.05.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/26/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Obtaining the proficiency on the robotic platform necessary to safely perform a robotic pancreatoduodenectomy is particularly challenging. We hypothesize that by instituting a proficiency-based robotic training curriculum we can enhance novice surgeons' skills outside of the operating room, leading to a shorter learning curve. DESIGN A biotissue curriculum was designed consisting of sewing artificial organs to simulate a hepaticojejunostomy (HJ), gastrojejunostomy (GJ), and pancreaticojejunostomy (PJ). Three master robotic surgeons performed each biotissue anastomosis to assess validity. Using video review, trainee performance on biotissue drills was evaluated for time, errors and objective structured assessment of technical skills (OSATS) by 2 blinded graders. SETTING This study is conducted at the University of Pittsburgh Medical Center (Pittsburgh, PA), a tertiary care academic teaching hospital. PARTICIPANTS In total, 14 surgical oncology fellows completed the biotissue curriculum. RESULTS Fourteen fellows performed 196 anastomotic drills during the first year: 66 (HJ), 64 (GJ), and 66 (PJ). The fellows' performances were analyzed as a group by attempt. The attendings' first attempt outperformed the fellows' first attempt in all metrics for every drill (all p < 0.05). More than 5 analyzed attempts of the HJ, there was improvement in time, errors, and OSATS (all p < 0.01); however, no metric reached attending performance. For the GJ, time, errors, and OSATS all improved more than 5 attempts (all p < 0.01), whereas only errors and OSATS reached proficiency. For the PJ, errors and OSATS both improved over attempts (p < 0.01) and reached proficiency; however, time did not statistically improve nor reach proficiency. The graders scoring correlated for errors and OSATS (p < 0.0001). CONCLUSION A pancreatoduodenectomy biotissue curriculum has face and construct validity. The curriculum is feasible and improves errors and technical performance. Time is the most difficult technical parameter to improve. This curriculum is a valid tool for teaching robotic pancreatoduodenectomies with established milestones for reaching optimum performance.
Collapse
Affiliation(s)
- Vernissia Tam
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mazen Zenati
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephanie Novak
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yong Chen
- Hepatobiliary Surgery Department, Chongqing Medical University Affiliated First Hospital, Chongqing, China
| | - Amer H Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Herbert J Zeh
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa E Hogg
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| |
Collapse
|
13
|
Ghosh SK. Cadaveric dissection as an educational tool for anatomical sciences in the 21st century. ANATOMICAL SCIENCES EDUCATION 2017; 10:286-299. [PMID: 27574911 DOI: 10.1002/ase.1649] [Citation(s) in RCA: 214] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/12/2016] [Accepted: 08/14/2016] [Indexed: 05/20/2023]
Abstract
Anatomical education has been undergoing reforms in line with the demands of medical profession. The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student-centered, integrated, clinical application models. The article undertakes a review of literature and analyzes the observations made therein reflecting on the relevance of cadaveric dissection in anatomical education of 21st century. Despite the advent of modern technology and evolved teaching methods, dissection continues to remain a cornerstone of anatomy curriculum. Medical professionals of all levels believe that dissection enables learning anatomy with relevant clinical correlates. Moreover dissection helps to build discipline independent skills which are essential requirements of modern health care setup. It has been supplemented by other teaching/learning methods due to limited availability of cadavers in some countries. However, in the developing world due to good access to cadavers, dissection based teaching is central to anatomy education till date. Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills. Researchers have even suggested that time has come to reinstate dissection as the core method of teaching gross anatomy to ensure safe medical practice. Nevertheless, as dissection alone cannot provide uniform learning experience hence needs to be complemented with other innovative learning methods in the future education model of anatomy. Anat Sci Educ 10: 286-299. © 2016 American Association of Anatomists.
Collapse
Affiliation(s)
- Sanjib Kumar Ghosh
- Department of Anatomy, Employees' State Insurance, Post Graduate Institute of Medical Sciences and Research (ESI-PGIMSR), Employees' State Insurance Corporation Medical College, Joka, Kolkata, West Bengal, India
| |
Collapse
|
14
|
Isaacson D, Green C, Topp K, O'Sullivan P, Kim E. Guided Laparoscopic Video Tutorials for Medical Student Instruction in Abdominal Anatomy. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10559. [PMID: 30800761 PMCID: PMC6342516 DOI: 10.15766/mep_2374-8265.10559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/05/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION As technological advances present new forms of media to anatomy educators involved in medical education, there is opportunity to expand on traditional dissection of embalmed cadavers. At the University of California, San Francisco School of Medicine, the surgery and anatomy departments collaborated to create guided video tutorials using laparoscopic surgical footage to teach the anatomy of the lesser sac and gastroesophageal junction. METHODS These tutorials are instructional adjuncts to a laparoscopy session on fresh cadavers with first-year medical students. Students view the videos on their own before attending the anatomy lab. The anatomy lab includes six 30-minute sessions, in which approximately 22 students at a time leave their cadaver lab to participate in this laparoscopy session taught by colorectal surgeons and general surgery residents. RESULTS Learner interest and satisfaction was measured through a postsession survey. Nearly all respondents indicated that the videos helped them learn the anatomy of the gastroesophageal junction and lesser sac, and were a valuable addition to dissection of embalmed cadavers. A second session was conducted with first-year medical students in which a pretest and posttest were administered before and after a screening of the tutorial on the gastroesophageal junction. Learners' average scores on the test improved from 39% to 88% after watching the video. DISCUSSION These data indicate that learners appreciate the incorporation of laparoscopy and video tutorials into anatomy education. These data further corroborate the measures of student enthusiasm, and support the value of the tutorials in short-term acquisition of anatomic knowledge.
Collapse
Affiliation(s)
- Dylan Isaacson
- Fourth-year Medical Student, University of California, San Francisco, School of Medicine
| | - Courtney Green
- Surgical Resident, Department of Surgery, University of California, San Francisco, School of Medicine
| | - Kimberly Topp
- Professor, Department of Anatomy, University of California, San Francisco, School of Medicine
- Chair of the Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, School of Medicine
| | - Patricia O'Sullivan
- Professor, Department of Medicine, University of California, San Francisco, School of Medicine
- Director of Research and Development in Medical Education, Center for Faculty Educators, University of California, San Francisco, School of Medicine
| | - Edward Kim
- Associate Professor, Department of Surgery, University of California, San Francisco, School of Medicine
| |
Collapse
|
15
|
Sharma G, Aycart MA, Najjar PA, van Houten T, Smink DS, Askari R, Gates JD. A cadaveric procedural anatomy course enhances operative competence. J Surg Res 2016; 201:22-8. [DOI: 10.1016/j.jss.2015.09.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/08/2015] [Accepted: 09/25/2015] [Indexed: 11/15/2022]
|
16
|
A cadaver lab training facility to facilitate laparoscopic liver resection. Surg Laparosc Endosc Percutan Tech 2015; 24:357-60. [PMID: 24752163 DOI: 10.1097/sle.0000000000000046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Laparoscopic liver surgery is becoming increasingly common; however, doubts still remain regarding its more widespread application and whether it improves patient outcome. The authors would like to present their experience of using a dedicated cadaver laparoscopic training laboratory to facilitate the introduction of a laparoscopic liver resection (LLR) program. METHODS A course was designed by a faculty of experienced, advanced laparoscopic surgeons providing an intensive 2-day course of lectures, debate, exchange, and practical hands-on with a live link to clinical LLR operations. Participant evaluation and feedback for each course was analyzed. RESULTS After 4 courses (2007 to 2009) and 32 participants, scores were graded from 1 (poor) to 6 (excellent no improvement). The course was graded for content, structure, delivery, resources, facility, and value for money. The overall rating for cadaver teaching sessions scored as follows: score 6 (43%), score 5 (32%), and score 4 (25%). CONCLUSIONS A dedicated cadaver LLR facility is not only an excellent method to train individuals for safe introduction of clinical liver resection program but it also has the potential to provide certification within this growing technique.
Collapse
|
17
|
Phitayakorn R, Lachman N. Getting back together after a break-up: Relationship advice for anatomists and surgeons. Clin Anat 2015; 28:931-4. [PMID: 26174432 DOI: 10.1002/ca.22596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 11/11/2022]
Abstract
The "surgeon-anatomist" was originally a single individual who self-pursued knowledge and understanding of anatomy as the foundation for successful surgical outcomes. However, recent advances in medical education have ironically led to the separation of anatomy and surgery. This physical and emotional "divorce" of anatomists and surgeons into separate individuals has created several critical educational issues for medical and surgical educators including a general lack of anatomical knowledge in medical students and misalignment of graduate medical education procedural specialty training with the Accreditation Council of Graduate Medical Education Core Competencies and now the Next Accreditation System. There are numerous opportunities for anatomists and surgeons to work together to improve educational instruction of established difficult anatomical regions, procedural training, or even develop new techniques and procedures. Similarly, anatomists with specialized training in medical education would be invaluable partners to ensure that procedural assessments align with instructional technologies for truly longitudinal curricula that starts at the medical student level, but stops at the patient outcomes of attending surgeons. This mutually beneficial relationship would be similar to multidisciplinary care teams and current surgeon and PhD/EdD partnerships. The restoration of the relationship between anatomists and surgeons would be invaluable to surgical education and remains an exciting research opportunity.
Collapse
Affiliation(s)
- Roy Phitayakorn
- Department of Surgery, The Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nirusha Lachman
- Department of Anatomy, College of Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
18
|
Perfused fresh cadavers: method for application to surgical simulation. Am J Surg 2015; 210:179-87. [DOI: 10.1016/j.amjsurg.2014.10.027] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 10/11/2014] [Accepted: 10/19/2014] [Indexed: 11/22/2022]
|
19
|
|
20
|
Lisk K, Flannery JF, Loh EY, Richardson D, Agur AMR, Woods NN. Determination of clinically relevant content for a musculoskeletal anatomy curriculum for physical medicine and rehabilitation residents. ANATOMICAL SCIENCES EDUCATION 2014; 7:135-43. [PMID: 23922307 DOI: 10.1002/ase.1393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/07/2013] [Accepted: 06/30/2013] [Indexed: 05/20/2023]
Abstract
To address the need for more clinical anatomy training in residency education, many postgraduate programs have implemented structured anatomy courses into their curriculum. Consensus often does not exist on specific content and level of detail of the content that should be included in such curricula. This article describes the use of the Delphi method to identify clinically relevant content to incorporate in a musculoskeletal anatomy curriculum for Physical Medicine and Rehabilitation (PM&R) residents. A two round modified Delphi involving PM&R experts was used to establish the curricular content. The anatomical structures and clinical conditions presented to the expert group were compiled using multiple sources: clinical musculoskeletal anatomy cases from the PM&R residency program at the University of Toronto; consultation with PM&R experts; and textbooks. In each round, experts rated the importance of each curricular item to PM&R residency education using a five-point Likert scale. Internal consistency (Cronbach's alpha) was used to determine consensus at the end of each round and agreement scores were used as an outcome measure to determine the content to include in the curriculum. The overall internal consistency in both rounds was 0.99. A total of 37 physiatrists from across Canada participated and the overall response rate over two rounds was 97%. The initial curricular list consisted of 361 items. After the second iteration, the list was reduced by 44%. By using a national consensus method we were able to objectively determine the relevant anatomical structures and clinical musculoskeletal conditions important in daily PM&R practice.
Collapse
Affiliation(s)
- Kristina Lisk
- Graduate Department of Rehabilitation Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
21
|
Sheckter CC, Kane JT, Minneti M, Garner W, Sullivan M, Talving P, Sherman R, Urata M, Carey JN. Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience. JOURNAL OF SURGICAL EDUCATION 2013; 70:466-474. [PMID: 23725934 DOI: 10.1016/j.jsurg.2013.02.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/05/2013] [Accepted: 02/16/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND As interest in surgical simulation grows, plastic surgical educators are pressed to provide realistic surgical experience outside of the operating suite. Simulation models of plastic surgery procedures have been developed, but they are incomparable to the dissection of fresh tissue. We evolved a fresh tissue dissection (FTD) and simulation program with emphasis on surgical technique and simulation of clinical surgery. We hypothesized that resident confidence could be improved by adding FTD to our resident curriculum. METHODS Over a 5-year period, FTD was incorporated into the curriculum. Participants included clinical medical students, postgraduate year 1 to 7 residents, and attending surgeons. Participants performed dissections and procedures with structured emphasis on anatomical detail, surgical technique, and rehearsal of operative sequence. Resident confidence was evaluated using retrospective pretest and posttest analysis with a 5-point scale, ranging from 1 (least confident) to 5 (most confident). Confidence was evaluated according to postgraduate year level, anatomical region, and procedure. RESULTS A total of 103 dissection days occurred, and a total of 192 dissections were reported, representing 73 different procedures. Overall, resident predissection confidence was 1.90±1.02 and postdissection confidence was 4.20±0.94 (p<0.001). The average increase in confidence correlated with training year, such that senior residents had greater gains. When compared by anatomical region, confidence was lowest for the head and neck region. When compared by procedure, confidence was lowest for rhinoplasty and face-lift, and highest for radial forearm and latissimus flaps. CONCLUSIONS A high-volume FTD experience was successfully incorporated into the residency program over 5 years. Training with FTD improves resident confidence, and this effect increases with seniority of training. Although initial data demonstrate that resident confidence is improved with FTD, additional evaluation is needed to establish objective evidence that patient outcomes and surgical quality can be improved with FTD.
Collapse
Affiliation(s)
- Clifford C Sheckter
- Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Tocco N, Brunsvold M, Kabbani L, Lin J, Stansfield B, Mueller D, Minter RM. Innovation in internship preparation: an operative anatomy course increases senior medical students' knowledge and confidence. Am J Surg 2013; 206:269-79. [PMID: 23433887 DOI: 10.1016/j.amjsurg.2012.07.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/17/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND An operative anatomy course was developed within the construct of a surgical internship preparatory curriculum. This course provided fourth-year medical students matching into a surgical residency the opportunity to perform intern-level procedures on cadavers under the guidance of surgical faculty members. METHODS Senior medical students performed intern-level procedures on cadavers with the assistance of faculty surgeons. Students' confidence, anxiety, and procedural knowledge were evaluated both preoperatively and postoperatively. Preoperative and postoperative data were compared both collectively and based on individual procedures. RESULTS Student confidence and procedural knowledge significantly increased and anxiety significantly decreased when preoperative and postoperative data were compared (P < .05). Students reported moderate to significant improvement in their ability to perform a variety of surgical tasks. CONCLUSIONS The consistent improvement in confidence, knowledge, and anxiety justifies further development of an operative anatomy course, with future assessment of the impact on performance in surgical residency.
Collapse
Affiliation(s)
- Nikki Tocco
- University of Michigan Medical School, 1500 East Medical Center Drive, SPC 5343, Taubman Center TC2210D, Ann Arbor, MI 48109-5343, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Halou H, Chalkias A, Mystrioti D, Iacovidou N, Vasileiou PVS, Xanthos T. Evaluation of the willingness for cadaveric donation in Greece: a population-based study. ANATOMICAL SCIENCES EDUCATION 2013; 6:48-55. [PMID: 22851304 DOI: 10.1002/ase.1304] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 05/05/2012] [Accepted: 06/22/2012] [Indexed: 06/01/2023]
Abstract
Despite the importance of body donation for medical education and the advancement of medical science, cadaveric donation remains suboptimal worldwide. The purpose of this study was to evaluate the willingness of body donation in Greece and determine the characteristics of donors. This cross-sectional questionnaire survey was conducted from January to June 2011. A specially designed questionnaire was distributed to 1,700 individuals who were randomly selected from five major Greek cities. It was found that higher educational levels (P = 0.002), annual family income below 30,000 Euros (P = 0.001), guaranteed employment status (P = 0.02), and the presence of comorbid conditions (P = 0.004) seemed to affect potential donors' willingness for cadaveric donation. Those with strong religious beliefs were found to be unwilling to donate their bodies to medical science. Interestingly, the majority of participants who believed that hospitalized patients are deceived or are used for harmful experiments were willing to become whole body donors (P = 0.043). In Greece, the rate of body donation to medical science remains low, and most Greek citizens are not willing to become body donors. Efforts to encourage discussions about whole body donation should be implemented in order to improve current low levels of donation.
Collapse
Affiliation(s)
- Heidi Halou
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | | | | |
Collapse
|
24
|
Lewis CE, Peacock WJ, Tillou A, Hines OJ, Hiatt JR. A novel cadaver-based educational program in general surgery training. JOURNAL OF SURGICAL EDUCATION 2012; 69:693-8. [PMID: 23111032 DOI: 10.1016/j.jsurg.2012.06.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 06/08/2012] [Accepted: 06/12/2012] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To describe the development of a cadaver-based educational program and report our residents' assessment of the new program. DESIGN An anatomy-based educational program was developed using fresh frozen cadavers to teach surgical anatomy and operative skills to general surgery (GS) trainees. Residents were asked to complete a voluntary, anonymous survey evaluating perceptions of the program (6 questions formulated on a 5-point Likert scale) and comparing cadaver sessions to other types of learning (4 rank order questions). SETTING Large university teaching hospital. PARTICIPANTS Medical students, residents, and faculty members were participants in the cadaver programs. Only GS residents were asked to complete the survey. RESULTS Since its implementation, 150 residents of all levels participated in 13 sessions. A total of 40 surveys were returned for a response rate of 89%. Overall, respondents held a positive view of the cadaver sessions and believed them to be useful for learning anatomy (94% agree or strongly agree), learning the steps of an operation (76% agree or strongly agree), and increasing confidence in doing an operation (53% agree or strongly agree). Trainees wanted to have more sessions (87% agree or strongly agree), and believed they would spend free time in the cadaver laboratory (58% agree or strongly agree). Compared with other learning modalities, cadaver sessions were ranked first for learning surgical anatomy, followed by textbooks, simulators, web sites, animate laboratories, and lectures. Respondents also ranked cadaver sessions first for increasing confidence in performing a procedure and for learning the steps of an operation. Cost of cadavers represented the major expense of the program. CONCLUSIONS Fresh cadaver dissections represent a solution to the challenges of efficient, safe, and effective general surgery education. Residents have a positive attitude toward these teaching sessions and found them to be more effective than other learning modalities.
Collapse
Affiliation(s)
- Catherine E Lewis
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095-1722, USA
| | | | | | | | | |
Collapse
|
25
|
Sharma M, Macafee D, Pranesh N, Horgan AF. Construct validity of fresh frozen human cadaver as a training model in minimal access surgery. JSLS 2012; 16:345-52. [PMID: 23318058 PMCID: PMC3535798 DOI: 10.4293/108680812x13462882735818] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The construct validity of fresh human cadaver as a training tool has not been established previously. The aims of this study were to investigate the construct validity of fresh frozen human cadaver as a method of training in minimal access surgery and determine if novices can be rapidly trained using this model to a safe level of performance. METHODS Junior surgical trainees, novices (<3 laparoscopic procedure performed) in laparoscopic surgery, performed 10 repetitions of a set of structured laparoscopic tasks on fresh frozen cadavers. Expert laparoscopists (>100 laparoscopic procedures) performed 3 repetitions of identical tasks. Performances were scored using a validated, objective Global Operative Assessment of Laparoscopic Skills scale. Scores for 3 consecutive repetitions were compared between experts and novices to determine construct validity. Furthermore, to determine if the novices reached a safe level, a trimmed mean of the experts score was used to define a benchmark. Mann-Whitney Utest was used for construct validity analysis and 1-sample t test to compare performances of the novice group with the benchmark safe score. RESULTS Ten novices and 2 experts were recruited. Four out of 5 tasks (nondominant to dominant hand transfer; simulated appendicectomy; intracorporeal and extracorporeal knot tying) showed construct validity. Novices' scores became comparable to benchmark scores between the eighth and tenth repetition. CONCLUSION Minimal access surgical training using fresh frozen human cadavers appears to have construct validity. The laparoscopic skills of novices can be accelerated through to a safe level within 8 to 10 repetitions.
Collapse
Affiliation(s)
- Mitesh Sharma
- Newcastle Surgical Training Centre, Department of General Surgery, Freeman Hospital NHS Trust, Newcastle Upon Tyne, NE7 7DN, UK.
| | | | | | | |
Collapse
|
26
|
Mitchell EL, Sevdalis N, Arora S, Azarbal AF, Liem TK, Landry GJ, Moneta GL. A fresh cadaver laboratory to conceptualize troublesome anatomic relationships in vascular surgery. J Vasc Surg 2012; 55:1187-94. [DOI: 10.1016/j.jvs.2011.09.098] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 08/31/2011] [Accepted: 09/03/2011] [Indexed: 01/22/2023]
|
27
|
Heisler CA. Importance of adequate gross anatomy education: the impact of a structured pelvic anatomy course during gynecology fellowship. ANATOMICAL SCIENCES EDUCATION 2011; 4:302-304. [PMID: 21656916 DOI: 10.1002/ase.235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 05/15/2011] [Accepted: 05/16/2011] [Indexed: 05/30/2023]
Abstract
Medical education underwent standardization at the turn of the 20th century and remained fairly consistent until recently. Incorporation of a patient-centered or case-based curriculum is believed to reinforce basic science concepts. One negative aspect is a reduction in hours spent with cadaveric dissection in the gross anatomy laboratory. For those entering a surgical career, limited anatomical exposure leaves knowledge deficits that must be corrected during further education during residency training. The benefit of providing formal anatomy education to residents and surgical fellows is described in the literature, specifically noting improvement in written test scores and surgical application.
Collapse
Affiliation(s)
- Christine Aminda Heisler
- Department of Obstetrics, Gynecology and Women's Health, Division of Female Pelvic Medicine and Reconstructive Surgery, Spectrum Health Medical Group, Grand Rapids, Michigan 49546, USA.
| |
Collapse
|
28
|
Jaung R, Cook P, Blyth P. A comparison of embalming fluids for use in surgical workshops. Clin Anat 2011; 24:155-61. [DOI: 10.1002/ca.21118] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 04/14/2010] [Accepted: 09/20/2010] [Indexed: 11/07/2022]
|
29
|
Reed AB, Crafton C, Giglia JS, Hutto JD. Back to basics: Use of fresh cadavers in vascular surgery training. Surgery 2009; 146:757-62; discussion 762-3. [DOI: 10.1016/j.surg.2009.06.048] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Accepted: 06/06/2009] [Indexed: 01/22/2023]
|
30
|
Rathat G, Hoa D, Gagnayre R, Hoffet M, Mares P. Formation chirurgicale des internes, spécialistes en gynécologie-obstétrique : résultats d’une enquête électronique nationale. ACTA ACUST UNITED AC 2008; 37:672-84. [DOI: 10.1016/j.jgyn.2008.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 06/02/2008] [Accepted: 06/16/2008] [Indexed: 11/24/2022]
|
31
|
Geoffrion R. Standing on the Shoulders of Giants: Contemplating a Standard National Curriculum for Surgical Training in Gynaecology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:684-695. [DOI: 10.1016/s1701-2163(16)32917-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
32
|
Abstract
Surgical practice is undergoing fundamental changes, and this is having a significant effect on the training of surgeons. Learning the craft of surgery is threatened by reduced elective operative exposure and general service cuts within public teaching hospitals, safer working hour legislation and pressures to accelerate the training of young surgeons. Rapid technological changes mean that 'old dogs' have to teach 'young dogs' many new tricks in a relatively adverse environment. This review outlines the great variety of resources available for skills-based training outside the operating room. These resources are ready to be used as a necessary adjunct to the training of competent surgeons in Australasia.
Collapse
Affiliation(s)
- Peter Cosman
- Northern Clinical Skills Centre, Division of Surgery, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia.
| | | | | | | |
Collapse
|
33
|
Gogalniceanu P, Madani H, Paraskeva PA, Darzi A. A minimally invasive approach to undergraduate anatomy teaching. ANATOMICAL SCIENCES EDUCATION 2008; 1:46-47. [PMID: 19177378 DOI: 10.1002/ase.9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Anatomy is one of the cornerstones of medical education. Unfortunately, sufficient evidence has accumulated to suggest a worldwide decline in the resources and time allocated to its teaching. Integration of anatomy with clinical medicine has been frequently advocated as the solution to this academic crisis. Consequently, new ways of harnessing clinical relevance to the teaching of anatomy must be sought to make it applicable to contemporary clinical practice. Human cadavers have been used to teach laparoscopic skills to surgical trainees for some time. More recently, centers in the United States have piloted the use of minimally invasive techniques in the teaching of anatomy to undergraduates. We believe that the use of laparoscopy on human cadavers may also be used to complement the teaching of anatomy to United Kingdom and European medical students. This would not only familiarize students with the topography and morphology of human anatomy, but also with the concept of manipulating anatomical structures to achieve a clinical outcome. Other benefits include improved three-dimensional orientation, increased dexterity, and development team-working skills amongst students. A UK feasibility study is currently underway.
Collapse
|
34
|
Helling TS, Khandelwal A. The challenges of resident training in complex hepatic, pancreatic, and biliary procedures. J Gastrointest Surg 2008; 12:153-8. [PMID: 17955309 DOI: 10.1007/s11605-007-0378-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 09/26/2007] [Indexed: 01/31/2023]
Abstract
Operations on the liver and pancreas have fallen within the domain of the general surgeon and have been part of general surgery training. The more complex procedures involving these organs are limited in number in most general surgery residencies and do not afford an opportunity for vast experience. Moreover, fellowship programs in hepato-bilio-pancreatic (HPB) surgery and the development of laparoscopic techniques may have further limited the familiarity of general surgery residents with these operations. To determine the experience accrued by finishing general surgery residents, we accessed, through the Residency Review Committee of the Accreditation Council for Graduate Medical Education, the Resident Case Log System used by general surgery residents throughout their training to document operative cases. The number of operations on the gallbladder, bile ducts, pancreas, and liver was examined over the past 16 years (there were missing data for 3 years). Reference years 1995 and 2005 were compared to detect trends. Experience with laparoscopic cholecystectomy has steadily increased and averaged more than 100 cases in 2006. Experience in liver resection, distal pancreatectomy, and partial (Whipple) pancreatectomy has statistically improved from 1995 to 2005, but the numbers of cases are low, generally less than five per finishing resident. Experience in open common bile duct and choledocho-enteric anastomoses has statistically declined from 1995 to 2005, averaging less than four cases per finishing resident. The mode (most frequently performed number) for liver and pancreas resections was either 0 or 1. It is doubtful this experience in HPB surgery engenders confidence in many finishing residents. Attention should be focused on augmenting training in HPB surgery for general surgery residents perhaps through a combination of programmatic initiatives, ex vivo experiences, and minifellowships. Institutional initiatives might consist of defined HPB services with appropriate expertise, infrastructure, process, and outcome measures in which a resident-oriented, competency-based curriculum could be developed.
Collapse
Affiliation(s)
- Thomas S Helling
- Department of Surgery, Conemaugh Memorial Medical Center, 1086 Franklin Street, Johnstown, PA 15905, USA.
| | | |
Collapse
|
35
|
Ascher-Walsh CJ, Capes T. An evaluation of the resident learning curve in performing laparoscopic supracervical hysterectomies as compared with patient outcome: Five-year experience. J Minim Invasive Gynecol 2007; 14:719-23. [DOI: 10.1016/j.jmig.2007.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 06/26/2007] [Accepted: 07/11/2007] [Indexed: 11/30/2022]
|
36
|
A curriculum for Burch colposuspension and diagnostic cystoscopy evaluated by an objective structured assessment of technical skills. Am J Obstet Gynecol 2007; 197:544.e1-6. [PMID: 17980204 DOI: 10.1016/j.ajog.2007.07.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 06/12/2007] [Accepted: 07/23/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to develop an effective curriculum for teaching colposuspension and diagnostic cystoscopy. STUDY DESIGN Fifty-five residents underwent an Objective Structured Assessment of Technical Skills that was composed of a task-specific checklist and validated global assessment. Thirty of the residents had been exposed to a training curriculum, and 25 residents served as untrained control subjects. RESULTS For the colposuspension and cystoscopy checklists, the reliability coefficient was 0.85 and 0.72, and the interrater reliability was 0.92 and 0.68, respectively. Although residents who were provided the curriculum performed better on both task-specific checklists, the differences did not reach statistical significance. Senior residents performed consistently better than junior residents for both tasks. When a comparison was made of the junior residents separately to account for previous experience, trained residents performed significantly better on the cystoscopy checklist (P = .029). CONCLUSION This curriculum is an effective way to teach diagnostic cystoscopy to junior residents. The checklist for this Objective Structured Assessment of Technical Skills has good reliability and construct validity.
Collapse
|
37
|
Levine RL, Kives S, Cathey G, Blinchevsky A, Acland R, Thompson C, Pasic R. The use of lightly embalmed (fresh tissue) cadavers for resident laparoscopic training. J Minim Invasive Gynecol 2007; 13:451-6. [PMID: 16962531 DOI: 10.1016/j.jmig.2006.06.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 06/08/2006] [Accepted: 06/09/2006] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE The value of a cadaver training program in laparoscopic surgery has rarely been studied. As there is a dearth of cadaver training programs, it is important to evaluate them. The goal of this study was to estimate if our cadaver training program significantly and relatively rapidly taught residents laparoscopic surgical skills. DESIGN Observational, timed comparative study (Canadian Task Force classification II-3). SETTING University of Louisville School of Medicine, Fresh Tissue Laboratory, Louisville, KY. PARTICIPANTS Twenty-nine obstetric/gynecology residents (15 postgraduate year PGY 2 and 14 PGY 3) participated in the study. INTERVENTION During 5 half days, we compared the performance of each postgraduate year (PGY) 2 and PGY 3 obstetric/gynecology resident to his or her own results on five outcome skills before and after training in lightly embalmed cadavers. The testing was performed at the beginning and at the end of the week so that all improvement was secondary only to the training experience with the cadaver. Residents were assessed using laparoscopic techniques in a physical-reality simulator for three outcomes: bead transfer time, number of beads transferred, and suturing time on a stuffed vinyl glove and in two specific areas of the cadaver pelvis, with one slightly more difficult than the other. Assessment of suturing time was made on the two distinct tasks using the embalmed cadavers. Although the number of residents was relatively small, it covered two levels for one year. MEASUREMENTS AND MAIN RESULTS The residents were assessed on a simulator before and after laparoscopic surgical training on the cadaver. The median decrease in bead transfer time (task I, simulator) was 38.5 seconds (p=.02); 69% of the residents showed some reduction in time to complete this task. The median increase in the number of beads transferred (task II, simulator) was 2.5 beads (p=.0001); 72.4% of the residents transferred at least one more bead after training. The median decrease in suture time (task III, simulator) was 63.5 seconds (p=.001); 79.3% of the residents performed this task more quickly after training. The median decrease in suture time (task IV, cadaver) was 54.5 seconds (p=.001); 72.4% of the residents showed improved performance on this task after training. The median reduction in suture time (task V, cadaver) was 53.5 seconds (p<.001); 82.8% of the residents completed this task more quickly after training. CONCLUSIONS This cadaver surgical training program appeared to significantly improve laparoscopic surgical techniques in PGY 2 and PGY 3 obstetric/gynecology residents in a relatively short time. This model teaches residents specific training in the handling and manipulation of tissue as well as practice in surgical techniques for adnexal surgery, pelvic dissection, laparoscopic hysterectomy, and dissection within the space of Retzius that is not possible with mechanical trainers.
Collapse
Affiliation(s)
- Ronald L Levine
- Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA, and Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
38
|
Corton MM, McIntire DD, Wai CY, Ling FW, Wendel GD. A comparison of an interactive computer-based method with a conventional reading approach for learning pelvic anatomy. Am J Obstet Gynecol 2006; 195:1438-43. [PMID: 16996462 DOI: 10.1016/j.ajog.2006.06.076] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 05/23/2006] [Accepted: 06/27/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study was undertaken to assess the impact of interactive, computer-based versus conventional, paper-based format in student, resident, and fellow learning and retention of anatomy knowledge. STUDY DESIGN Randomized longitudinal cohort design with scores repeated as pre-, post-, and follow-up tests. Subjects were randomly assigned to an anatomy module in computer-based (CD-ROM) format and 1 in paper-based format. A follow-up examination was administered 3 weeks after the posttest to evaluate retention of knowledge. Tests results were analyzed by using Student t tests and analysis of variance. RESULTS Thirty-nine subjects completed all testing. Regardless of instructional method, pretest to posttest scores improved (P < .01), and posttest to follow-up test scores decreased among all levels of training (P < .01). Student satisfaction was highest with CD-ROM format. CONCLUSION Improvement and retention of anatomy knowledge was not significantly different when comparing a new CD-ROM interactive approach with a traditional paper-based method.
Collapse
Affiliation(s)
- Marlene M Corton
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | |
Collapse
|
39
|
Lamb D. Could simulated emergency procedures practised in a static environment improve the clinical performance of a Critical Care Air Support Team (CCAST)? A literature review. Intensive Crit Care Nurs 2006; 23:33-42. [PMID: 17071086 DOI: 10.1016/j.iccn.2006.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 06/23/2006] [Accepted: 07/09/2006] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The Royal Air Force Critical Care Air Support Teams (CCASTs) have a philosophy to undertake transfers of critically ill patients from anywhere in the world back to a UK medical facility in a stable or improved clinical condition. The training they receive is primarily taught by traditional didactic methods, with no standardisation of education between teams that are expected to deliver care to the same standard. Notwithstanding there being no current compromise to patient care during air transfer, it was important to consider the benefits of an alternative experiential teaching modality. Experiential learning utilised in the static environment could potentially improve the current CCAST training curriculum and, therefore, improve clinical performance during air transfer. METHOD In the absence of primary research evidence investigating beneficial teaching modalities for medical flight crews, a review of recent literature was undertaken to observe any potential relevance to the aeromedical specialty. This critical review examined recent quantitative research on various modalities of experiential learning and their influence on the critical thinking, higher cognitive and psychomotor skill acquisition by healthcare professionals in a static hospital environment. The main databases were interrogated using the following inclusion criteria: patient simulation, clinical competence, aeromedical, education, computer simulation, critical thinking and problem-based learning. The number of articles obtained was 13; these were coded on methodological strength to reduce the potential for inclusion bias. Nine studies were finally selected for review. RESULTS Many small studies have been undertaken, primarily observing benefits of experiential learning to medical students and doctors. No studies show conclusively that simulated learning improves patient outcome, but the body of evidence suggests human patient simulators to be advantageous over other modalities because of their realistic recreation of critical events. They have proven to be at least as effective as traditional teaching by didactic methods. CONCLUSION For CCASTs to have a standardised training curriculum, they should undertake real-time missions in a flight simulator, supported by a human patient simulator programmed to respond to the physiological changes associated with altitude. Real scenarios could then be practised, on demand, in a safe environment as an augmentation to the current training programme. Consequently, those acquired skills could then be carried out with improved proficiency during real missions with a concomitant potential for improvement in the standard of patient care.
Collapse
Affiliation(s)
- Di Lamb
- RAF Lyneham, Aeromedical Evacuation Squadron, CHIPPENHAM, Wiltshire SN15 4PZ, United Kingdom.
| |
Collapse
|
40
|
Abstract
Laparoscopy is a major part of urologists' daily practice. It is becoming more and more popular and interest in it is increasing, as is the number of urologists attracted by it. Patients also frequently demand a treatment through a laparoscopic approach. Nevertheless, laparoscopy is a physically and technically demanding surgery. It has been proven that it has a long learning curve with a high complication rate at the beginning. Thus, there is need for a training program that can effectively reduce its time of apprenticeship. The learning path is a multistep process that involves several phases. The pelvic trainer is the first step of this path that is made with increasing difficulty. Gradually and gently the trainee faces up to different levels under the guidance of a mentor. At the end of training, trainees should be able to perform every procedure, both easy and difficult ones, by themselves.
Collapse
Affiliation(s)
- P Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, 114 Avenue d'Ares, 33074 Bordeauz, France.
| | | |
Collapse
|
41
|
Pavlidis TE, Menenakos E. Practice in laparoscopic colectomy on human cadaver. J Laparoendosc Adv Surg Tech A 2006; 16:78-9. [PMID: 16494558 DOI: 10.1089/lap.2006.16.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
42
|
Pavlidis TE. Laparoscopic cholecystectomy for gangrenous cholecystitis in the elderly. J Laparoendosc Adv Surg Tech A 2006; 16:79-80; author reply 80. [PMID: 16526934 DOI: 10.1089/lap.2006.16.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
43
|
Dharia SP, Falcone T. Robotics in reproductive medicine. Fertil Steril 2005; 84:1-11. [PMID: 16009146 DOI: 10.1016/j.fertnstert.2005.02.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Revised: 02/07/2005] [Accepted: 02/07/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review the history, development, current applications, and future of robotic technology. DESIGN The MEDLINE database was reviewed for all publications on robotic technology in medicine, surgery, reproductive endocrinology, its role in surgical education, and telepresence surgery. SETTING University medical center. CONCLUSION(S) Robotic-assisted surgery is an emerging technology, which provides an alternative to traditional surgical techniques in reproductive medicine and may have a role in surgical education and telepresence surgery.
Collapse
Affiliation(s)
- Sejal P Dharia
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama, USA
| | | |
Collapse
|
44
|
Katz R, Hoznek A, Antiphon P, Van Velthoven R, Delmas V, Abbou CC. Cadaveric versus porcine models in urological laparoscopic training. Urol Int 2004; 71:310-5. [PMID: 14512654 DOI: 10.1159/000072684] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 10/04/2002] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Laparoscopy performed on anesthetized pigs is an established training model. In this pilot study, we performed laparoscopy on cadavers as a training modality for urologists participating in a laparoscopic seminar. MATERIALS AND METHODS We compared data from two consecutive laparoscopy seminars performed at our institution. The first included a laparoscopy session performed on pigs. The second was in the same setup, yet laparoscopy was performed on fresh cadavers. We analyzed and compared the trainees' perspectives regarding the 2 modalities using a 5-scale satisfaction questionnaire. RESULTS Seven trainees attended the cadaveric and 9 the porcine laparoscopy session. The two groups were similar in terms of age and previous laparoscopic and urological experience. The general satisfaction of the two training modalities was high in the two groups, as well as their will for another session of the same kind. Yet the trainees ranked their understanding of the surgical anatomy, laparoscopic technique and use of instruments significantly higher in the cadaveric laparoscopy group (p values were 0.007, 0.006 and 0.032, respectively). CONCLUSIONS Cadaveric laparoscopy may offer an ideal surgical environment allowing dissection and performance of complete procedures. In this pilot study, we conducted the first reported cadaveric laparoscopy training seminar in urology. The trainees preferred the cadaveric laparoscopy and found it superior to porcine laparoscopy. We believe that cadaveric laparoscopy is an important training tool, which may be added to the armamentarium of urological laparoscopy training courses.
Collapse
Affiliation(s)
- Ran Katz
- Service d'Urologie, Centre Hospitalier Universitaire Henri-Mondor, Créteil, France.
| | | | | | | | | | | |
Collapse
|
45
|
Boulware LE, Ratner LE, Cooper LA, LaVeist TA, Powe NR. Whole body donation for medical science: A population-based study. Clin Anat 2004; 17:570-7. [PMID: 15376295 DOI: 10.1002/ca.10225] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although cadaveric whole-body donation for the purposes of medical science is extremely important for medical education, the number of persons who choose to donate remains low. We assessed persons' willingness to consider whole body donation in a standardized telephone survey of Maryland households, identified using random digit dialing. In multivariable analyses, we assessed the independent relation of sociodemographics and attitudinal factors to willingness to consider donation, and we determined the amount of variation in willingness to consider donation among the study population that could be explained by these factors. Of 385 participants (84% of randomized homes), 49% reported they would consider whole body donation. In bivariate analysis, younger age, African-American race/ethnicity, less education and income, greater number of dependents, marital status, and attitudes about religion/spirituality, trust in hospitals, and income, gender, and racial/ethnic discrimination in hospitals were statistically significantly associated with 40-70% less odds of willingness to consider donation. After adjustment, persons of African-American race/ethnicity, less education, and those agreeing with the statements, "Rich patients receive better care at hospitals than poor patients," and "White patients receive better care at hospitals than other racial or ethnic groups," had 40-60% less odds of willingness to consider donation when compared to their counterparts. Respondents' race/ethnicity and education contributed most to willingness to consider donation. We conclude that demographic and attitudinal factors are strongly related to willingness to consider whole body donation. Efforts to enhance donation should seek to identify ways in which potential barriers to donation can be addressed by health professionals.
Collapse
Affiliation(s)
- L Ebony Boulware
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | | | | | | | | |
Collapse
|
46
|
Corton MM, Wai CY, Vakili B, Boreham MK, Schaffer JI, Coleman RL. A comprehensive pelvic dissection course improves obstetrics and gynecology resident proficiency in surgical anatomy. Am J Obstet Gynecol 2003; 189:647-51. [PMID: 14526284 DOI: 10.1067/s0002-9378(03)00881-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate the impact of a pelvic dissection course on resident proficiency in surgical anatomy. STUDY DESIGN Over a 1-year period, residents attended a course consisting of pretesting and posttesting, lectures, and pelvic dissection. Tests results were analyzed using paired Student t test, analysis of variance, and Kruskal-Wallis statistics. RESULTS Of 42 residents, 24 completed all testing (study cohort). On written and practical examinations, resident scores improved a median of 42% and 29% (both P<.0001). Postgraduate year (PGY) 2 demonstrated the greatest improvement on the practical and PGY-3s demonstrated the greatest improvement on the written. Baseline written and practical results discriminated PGY level (construct validity): PGY-2=PGY-3<PGY-4 on written pretest, PGY-2<PGY-3=PGY-4 on practical pretest. No difference between resident cohorts was seen in either posttest. CONCLUSION Resident surgical anatomy proficiency is measurably improved by a comprehensive course.
Collapse
Affiliation(s)
- Marlene M Corton
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA
| | | | | | | | | | | |
Collapse
|
47
|
Affiliation(s)
- Gabriella G Gosman
- Department of Obstetrics, Gynecology and Reproductive Services, University of Pittsburgh School of Medicine, Magee--Womens Hospital, Pennsylvania, USA.
| |
Collapse
|
48
|
Block EF, Lottenberg L, Flint L, Jakobsen J, Liebnitzky D. Use of a Human Patient Simulator for the Advanced Trauma Life Support Course. Am Surg 2002. [DOI: 10.1177/000313480206800720] [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
A highly anticipated and rewarding component of the Advanced Trauma Life Support (ATLS) program is the surgical skill station. Logistic, societal, and economic issues have resulted in development of human patient simulators (HPSs) as an alternative to the animal model. We studied initial student reaction to a simulator designed for this skill station. Fourteen participants in an ATLS Provider course completed the standard surgical skill stations and an experimental station using the Simulab Trauma Man HPS. After completion of the stations the students were asked to complete a 13-point satisfaction survey using a modified Likert scale (1 = strongly negative/dissatisfied, 5 = strongly positive/satisfied). Overall response was favorable. Students found the HPS to be superior to the animal model in teaching surgical airways [mean 3.64; standard deviation (SD) 0.93] and for management of pneumothorax (mean 3.86; SD 0.77). The students felt the HPS would be useful in ATLS and should be included as an option in training (mean 4.07; SD 0.92). Preliminary experience with an interactive HPS to teach the ATLS surgical skill station is well received by students when compared with standard methods. This strong acceptance supports inclusion of simulators in teaching ATLS skills.
Collapse
Affiliation(s)
- Ernest F.J. Block
- Departments of Surgery Orlando Regional Medical Center, Orlando
- Florida Committee on Trauma, Jacksonville, Florida
| | - Lawrence Lottenberg
- Memorial Regional Hospital, Hollywood
- Florida Committee on Trauma, Jacksonville, Florida
| | - Lewis Flint
- Tampa General Hospital, Tampa, Jacksonville, Florida
- Florida Committee on Trauma, Jacksonville, Florida
| | - Joelle Jakobsen
- Departments of Surgery Orlando Regional Medical Center, Orlando
- Florida Committee on Trauma, Jacksonville, Florida
| | - Dianna Liebnitzky
- Departments of Surgery Orlando Regional Medical Center, Orlando
- Florida Committee on Trauma, Jacksonville, Florida
| |
Collapse
|
49
|
LiteratureWatch. J Endourol 2001; 15:761-6. [PMID: 11697411 DOI: 10.1089/08927790152596389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|