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Gonçalves MR, Mück B, Faure JP, Topart P, Sousa MCB. RoboticSurgery4all: are discovery courses important for robotic surgery skills acquisition? J Robot Surg 2024; 18:322. [PMID: 39141249 DOI: 10.1007/s11701-024-02077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 08/09/2024] [Indexed: 08/15/2024]
Abstract
Cost, logistics, and availability of robotic simulation opportunities suppose a real challenge for robotic surgery training. We aimed to test a new methodology for introduction to robotic surgery pre-congress courses. Two different "introduction to robotic surgery" pre-congress courses were developed. A new methodology using a sleeve/bypass, a ventral TAPP and an inguinal TAPP silicone models was implemented. After the session, the trainees answered a questionnaire to evaluate the course and the methodology using 1-5 Likert scales. A total of 21 participants participated in the courses and (72.2%) had no experience in robotic surgery. All trainees rated the course as good or excellent. There was a strong agreement between participants regarding the adequacy of the silicone models for this type of simulation/course. Trainees agree that the course gave them more confidence to perform a real robotic procedure, increased their interest in robotic surgery and made them feel ready to start their robotic surgery pathway. Congresses are a frequent way of contact between surgeons and robotic systems, mostly in the form of technical demonstrations or pre-congress courses. Our methodology showed that it is possible to allow for this contact in a low-cost way. This kind of courses is well received by congress delegates and have a positive educational impact. Despite of being "Discovery" courses, they have a positive impact on the congress, on the acquisition of robotic surgery skills and increase the interest in robotic surgery.
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Affiliation(s)
- Mário Rui Gonçalves
- Faculty of Health Sciences, Centro Académico Clínico das Beiras (Academic Clinical Center of Beiras), University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal.
| | - Björn Mück
- Klinikum Kempten, Klinikverbund Allgäu gGmbH, Kempten, Germany
| | - Jean-Pierre Faure
- Department of Digestive Surgery, CHU Poitiers, University of Poitiers, Poitiers, France
| | | | - Miguel Castelo-Branco Sousa
- Faculty of Health Sciences, Centro Académico Clínico das Beiras (Academic Clinical Center of Beiras), University of Beira Interior, Av. Infante D. Henrique, 6200-506, Covilhã, Portugal
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Rojas MF, Torres J, Figueroa Ú, Varas J, Achurra P, Navia A, Cuadra Á, Searle S. Validation of a synthetic simulation model of endoscopic rectus sheath plication. Hernia 2024; 28:1381-1390. [PMID: 38767716 DOI: 10.1007/s10029-024-03059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. METHODS A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. RESULTS Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24-25) vs 14 (range 5-22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10-11) vs 8 (range 3-10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. CONCLUSION Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication.
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Affiliation(s)
- María Fernanda Rojas
- General Surgeon at Clínica Bupa Santiago, Vaticano 4008, Las Condes, Región Metropolitana, Santiago, Chile.
| | - Javier Torres
- Plastic and Reconstructive Surgeon at Hospital Dr. Victor Ríos Ruiz, Los Angeles, Chile
| | - Úrsula Figueroa
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julian Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfonso Navia
- Plastic and Reconstructive Surgeon at Pontificia, Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Cuadra
- Plastic and Reconstructive Surgeon at Pontificia, Universidad Católica de Chile, Santiago, Chile
| | - Susana Searle
- Plastic and Reconstructive Surgeon at Pontificia, Universidad Católica de Chile, Santiago, Chile
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Mulherkar R, Shah C, Bulat M, Thaker NG, Kamrava M, Beriwal S. Role of simulation-based training and assessment to improve brachytherapy competency among radiation oncology residents. Brachytherapy 2024; 23:489-495. [PMID: 38643045 DOI: 10.1016/j.brachy.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/13/2024] [Accepted: 02/29/2024] [Indexed: 04/22/2024]
Abstract
Simulation is a technique used in healthcare to replicate clinical scenarios and improve patient safety, efficacy, and efficiency. Simulation-based medical education facilitates training and assessment in healthcare without increasing risk to patients, supported by ample evidence from surgical/procedural specialties. Simulation in radiation oncology has been leveraged to an extent, with successful examples of both screen-based and hands-on simulators that have improved confidence and performance in trainees. In the current era, evidence substantiates a significant deficit in brachytherapy procedure education, with radiation oncology residents reporting low confidence in this procedural skill, largely attributable to insufficient caseloads at some centers. Simulation-based medical education can facilitate structured training and competency-based assessment in brachytherapy skills. This review discusses existing advances and future directions in brachytherapy simulation, using examples from simulation in surgical specialties.
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Affiliation(s)
- Ria Mulherkar
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Cancer Center, Cleveland, OH
| | - Mitchell Bulat
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Nikhil G Thaker
- Department of Radiation Oncology, Capital Health Medical Center, Pennington, NJ
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sushil Beriwal
- Department of Radiation Oncology, AHN Cancer Institute, Pittsburgh, PA.
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Kheshvadjian M, Nazmifar M, Rawal R, Davood J, Castaneda P, Dadashian E, Dallmer J, Heard J, Masterson J, Lo E, Taich L, Naser-Tavakolian A, Kokorowski P, Ahdoot M. Implementation and Validation of a High-fidelity Simulation Model for Surgical Resident Training: Management of Acute Intraoperative Hemorrhage during Robot-assisted Surgery. Urology 2024:S0090-4295(24)00501-6. [PMID: 38936623 DOI: 10.1016/j.urology.2024.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/13/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To improve our previous simulation-based training module by using sustainable material to mold an anatomically accurate terrain and reproducing major vascular injuries encountered during robot-assisted nephrectomy. METHODS The simulator was built with a pump, gauge, and valve linked via silicone tubing. Artificial blood was made from cornstarch, water, and red dye, and pumped through 3D-Med artificial vessels with the dimensions of an average renal artery. Silicone was used to emulate the pliability of organic tissue and mold an anatomically accurate terrain. Eight urologic residents participated in the pilot simulation. We employed validated assessment tools including Non-Technical Skills for Surgeons and Objective Structured Assessment of Technical Skills forms to guide debrief sessions moderated by an expert physician after individual performance evaluations. RESULTS The apparatus demonstrated high reproducibility across all simulation scenarios, enhancing resident problem-solving skills. Residents' pre-simulation surveys revealed significant concern regarding their acute hemorrhage management. Residents' post-simulation survey demonstrated average realism scores increased from 4.375 to 4.75. Residents also felt the simulator enhanced learning, offering valuable practice and knowledge applicable to their surgical specialty. CONCLUSION The management of acute hemorrhage during robot-assisted surgery remains a space for additional surgical education and training. Our simulation successfully provided a reliable, reproducible training for residents to practice their technical and non-technical skills in managing acute hemorrhage.
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Affiliation(s)
- Michael Kheshvadjian
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; George Washington University School of Medicine, Washington, DC.
| | - Michael Nazmifar
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rushil Rawal
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joshua Davood
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Peris Castaneda
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eman Dadashian
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jeremiah Dallmer
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John Heard
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John Masterson
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eric Lo
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lior Taich
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Paul Kokorowski
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Ahdoot
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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Davidson EL, Penniston KL, Farhat WA. Advancements in surgical education: exploring animal and simulation models in fetal and neonatal surgery training. Front Pediatr 2024; 12:1402596. [PMID: 38887562 PMCID: PMC11180811 DOI: 10.3389/fped.2024.1402596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction Surgical education is undergoing a transformation, moving away from traditional models towards more modern approaches that integrate experiential and didactic methods. This shift is particularly pertinent in the realm of fetal and neonatal surgery, where specialized training is crucial. Historical training methods, such as cadaveric dissection, have been prevalent for centuries, but newer innovations, including animal and non-animal simulation models, are gaining prominence. This manuscript aims to explore the use of both animal and non-animal models in surgical education, with a specific focus on fetal and neonatal surgery. Animal models The use of animal models in surgical training has a long history, dating back to Halsted's introduction in 1889. These models, often utilizing large animals like swine and dogs, offer valuable insights into fetal and neonatal surgeries. They allow for the study of long-term outcomes and the simulation of various diseases and anomalies, providing essential training experiences not readily available in human surgeries. However, there are notable limitations, including anatomical and physiological differences from humans, ethical considerations, and substantial infrastructure and maintenance costs. Simulation models Simulation-based training offers several benefits, including standardized and safe learning environments without risks to real patients. Bench models, using synthetic materials or non-living animal tissue, provide cost-effective options for skills development. Virtual reality and 3-D printing technologies further enhance simulation experiences, allowing for the replication of complex clinical scenarios and patient-specific anatomies. While these models offer significant advantages, they lack the complexity of biological systems found in animal models. Conclusion In conclusion, both animal and non-animal simulation models play crucial roles in enhancing surgical education, particularly in fetal and neonatal surgery. While advancements in non-animal technologies are important for ethical reasons, the continued necessity of animal models in certain areas should be acknowledged. By responsibly integrating these models into training programs, surgical education can be further enriched while upholding ethical standards and ensuring optimal patient outcomes.
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Affiliation(s)
| | | | - Walid A. Farhat
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Andersen AG, Riparbelli AC, Siebner HR, Konge L, Bjerrum F. Using neuroimaging to assess brain activity and areas associated with surgical skills: a systematic review. Surg Endosc 2024; 38:3004-3026. [PMID: 38653901 DOI: 10.1007/s00464-024-10830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Surgical skills acquisition is under continuous development due to the emergence of new technologies, and there is a need for assessment tools to develop along with these. A range of neuroimaging modalities has been used to map the functional activation of brain networks while surgeons acquire novel surgical skills. These have been proposed as a method to provide a deeper understanding of surgical expertise and offer new possibilities for the personalized training of future surgeons. With studies differing in modalities, outcomes, and surgical skills there is a need for a systematic review of the evidence. This systematic review aims to summarize the current knowledge on the topic and evaluate the potential use of neuroimaging in surgical education. METHODS We conducted a systematic review of neuroimaging studies that mapped functional brain activation while surgeons with different levels of expertise learned and performed technical and non-technical surgical tasks. We included all studies published before July 1st, 2023, in MEDLINE, EMBASE and WEB OF SCIENCE. RESULTS 38 task-based brain mapping studies were identified, consisting of randomized controlled trials, case-control studies, and observational cohort or cross-sectional studies. The studies employed a wide range of brain mapping modalities, including electroencephalography, functional magnetic resonance imaging, positron emission tomography, and functional near-infrared spectroscopy, activating brain areas involved in the execution and sensorimotor or cognitive control of surgical skills, especially the prefrontal cortex, supplementary motor area, and primary motor area, showing significant changes between novices and experts. CONCLUSION Functional neuroimaging can reveal how task-related brain activity reflects technical and non-technical surgical skills. The existing body of work highlights the potential of neuroimaging to link task-related brain activity patterns with the individual level of competency or improvement in performance after training surgical skills. More research is needed to establish its validity and usefulness as an assessment tool.
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Affiliation(s)
- Annarita Ghosh Andersen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark.
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Agnes Cordelia Riparbelli
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Gastrounit, Surgical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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Sullivan J, Skladman R, Varagur K, Tenenbaum E, Sacks JL, Martin C, Gordon T, Murphy J, Moritz WR, Sacks JM. From Augmented to Virtual Reality in Plastic Surgery: Blazing the Trail to a New Frontier. J Reconstr Microsurg 2024; 40:398-406. [PMID: 37884060 DOI: 10.1055/a-2199-3870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Augmented reality (AR) and virtual reality (VR)-termed mixed reality-have shown promise in the care of operative patients. Currently, AR and VR have well-known applications for craniofacial surgery, specifically in preoperative planning. However, the application of AR/VR technology to other reconstructive challenges has not been widely adopted. Thus, the purpose of this investigation is to outline the current applications of AR and VR in the operative setting. METHODS The literature pertaining to the use of AR/VR technology in the operative setting was examined. Emphasis was placed on the use of mixed reality technology in surgical subspecialities, including plastic surgery, oral and maxillofacial surgery, colorectal surgery, neurosurgery, otolaryngology, neurosurgery, and orthopaedic surgery. RESULTS Presently, mixed reality is widely used in the care of patients requiring complex reconstruction of the craniomaxillofacial skeleton for pre- and intraoperative planning. For upper extremity amputees, there is evidence that VR may be efficacious in the treatment of phantom limb pain. Furthermore, VR has untapped potential as a cost-effective tool for microsurgical education and for training residents on techniques in surgical and nonsurgical aesthetic treatment. There is utility for mixed reality in breast reconstruction for preoperative planning, mapping perforators, and decreasing operative time. VR has well- documented applications in the planning of deep inferior epigastric perforator flaps by creating three-dimensional immersive simulations based on a patient's preoperative computed tomography angiogram. CONCLUSION The benefits of AR and VR are numerous for both patients and surgeons. VR has been shown to increase surgical precision and decrease operative time. Furthermore, it is effective for patient-specific rehearsal which uses the patient's exact anatomical data to rehearse the procedure before performing it on the actual patient. Taken together, AR/VR technology can improve patient outcomes, decrease operative times, and lower the burden of care on both patients and health care institutions.
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Affiliation(s)
- Janessa Sullivan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Rachel Skladman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Kaamya Varagur
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Elijah Tenenbaum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jacob L Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Cameron Martin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Terry Gordon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - John Murphy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - William R Moritz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Jafarabadi M, Gorginzadeh M, Rezayof E. The Effect of a Short Training Course of Hysteroscopic Myoma Resection on the Non-Technical Skills of Gynecologic Surgeons. J Family Reprod Health 2024; 18:80-84. [PMID: 39011407 PMCID: PMC11246738 DOI: 10.18502/jfrh.v18i2.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024] Open
Abstract
Objective To assess the impact of a hysteroscopic myoma resection (HMR) two-day training course on non-technical (cognitive) surgical skills among gynecologists. Materials and methods A 2-day educational course was held in which 95 consultant gynecologic surgeons and beginner infertility fellowship residents took part. Among all 80 participants (84.2%) had ever performed diagnostic hysteroscopy and 30 (31.3%) had performed non-resectoscopic operative hysteroscopy. The training program included instructive speeches, simulated surgical presentations, and a live hands-on myomectomy workshop. Non-technical skills were assessed two times, once before and the other after the course through two written tests with 10 multiple-choice questions for each. Results Concerning the 95 participants, 43 (47.3%) took the pre-course test and all of them (100%) took the post-course one. The mean score improved significantly from 3 (interquartile range [IQR], 0-4.0) to 7 (IQR, 5.0- 8.0) [bootstrap p<0.0001] for each of the randomly chosen pairings. The majority of candidates showed significantly improved cognitive skills after the HMR course despite their poor cognitive skills before the course. According to further analysis, there were significant enhancements in grades for all topics, especially regarding the basic principles of the procedure and management of complications (bootstrap p<0.0001). The odds ratio for the pre- versus post-course mean test results was 5.23. Due to the confidentiality stipulation, the pre- and post-course scores were not matched. Conclusion A two-day continuing medical educational course could be efficient in improving the nontechnical (cognitive) skills for HMR.
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Affiliation(s)
- Mina Jafarabadi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Elahe Rezayof
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Brennan LJ, Balakumar R, Waite S, Bennett WO. An update on simulation training in rhinology: a systematic review of evidence. J Laryngol Otol 2024:1-7. [PMID: 38602176 DOI: 10.1017/s0022215124000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Rhinological procedures demand a high degree of technical expertise and anatomical knowledge. Because of limited surgical opportunities, ethical considerations and the complexity of these procedures, simulation-based training has become increasingly important. This review aimed to evaluate the effectiveness of simulation models used in rhinology training. METHODS Searches were conducted on PubMed, Embase, Cochrane and Google Scholar for studies conducted between July 2012 and July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis ('PRISMA') protocol defined a final list of articles. Each validated study was assigned a level of evidence and a level of recommendation based on the Oxford Centre of Evidence-Based Medicine classification. RESULTS Following exclusions, 42 articles were identified which encompassed six types of simulation models and 26 studies evaluated validity. The rhinological skills assessed included endoscopic sinus surgery (n = 28), skull base/cerebrospinal fluid leak repair (n = 14), management of epistaxis and/or sphenopalatine artery ligation (n = 8), and septoplasty and septorhinoplasty (n = 6). All studies reported the beneficial impact of their simulation models on trainee development. CONCLUSION Simulation training in rhinology is a valuable adjunct to traditional surgical education. Although evidence is of moderate quality, the findings highlight the importance of simulation-based training in rhinology training.
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Affiliation(s)
- Laura J Brennan
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Ramkishan Balakumar
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Seren Waite
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Warren O Bennett
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
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Alayande BT, Forbes C, Masimbi O, Kingpriest P, Shimelash N, Wina F, Hey MT, Philipo GS, Abahuje E, Robertson JM, Yule S, Riviello RR, Bekele A. The Implementation of Simulation-Based Learning for Training Undergraduate Medical Students in Essential Surgical Care Across Sub-Saharan Africa: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2024; 34:237-256. [PMID: 38510415 PMCID: PMC10948665 DOI: 10.1007/s40670-023-01898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 03/22/2024]
Abstract
Much surgery in sub-Saharan Africa is provided by non-specialists who lack postgraduate surgical training. These can benefit from simulation-based learning (SBL) for essential surgery. Whilst SBL in high-income contexts, and for training surgical specialists, has been explored, SBL for surgical training during undergraduate medical education needs to be better defined. From 26 studies, we identify gaps in application of simulation to African undergraduate surgical education, including lack of published SBL for most (65%) World Bank-defined essential operations. Most SBL is recent (2017-2021), unsustained, occurs in Eastern Africa (78%), and can be enriched by improving content, participant spread, and collaborations.
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Affiliation(s)
- Barnabas T. Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Callum Forbes
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Ornella Masimbi
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | | | - Natnael Shimelash
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Felix Wina
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Matthew T. Hey
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Godfrey Sama Philipo
- Research and Patient Outcomes, College of Surgeons of East Central and Southern Africa, Arusha, Tanzania
| | - Egide Abahuje
- Department of Surgery, University of Rwanda, Kigali, Rwanda
- Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Jamie M. Robertson
- Department of Surgery, Brigham and Women’s Hospital, Boston, USA
- Department of Surgery, Harvard Medical School, Boston, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Steven Yule
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland UK
| | - Robert R. Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Towning R, Rennie C, Ferguson M. Multidisciplinary Simulation Training for Surgical Tracheostomy in Patients Mechanically Ventilated Secondary to Severe Acute Respiratory Syndrome Coronavirus 2. EAR, NOSE & THROAT JOURNAL 2024; 103:NP89-NP97. [PMID: 34427150 DOI: 10.1177/01455613211042119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE A proportion of patients with coronavirus disease (COVID) and severe respiratory manifestations of disease will require admission to intensive care for intubation and ventilation. When anticipating prolonged ventilation, the patient may proceed to surgical tracheostomy to afford safe respiratory wean. As surgical tracheostomy is an aerosol-generating procedure, it poses a high risk of viral transmission and ultimately may prompt anxiety and caution in participating staff members. We aimed to mitigate these risks by providing staff with appropriate training and experience, to improve their confidence as well as practical ability. METHODS We developed a multidisciplinary simulation training experience and checklist in order to optimize team performance during the high-stakes procedure. We evaluated staff confidence before and after the training with questionnaires. RESULTS Post-simulation, surgeons were more confident with donning the high level personal protective equipment, and nurses were more confident in performing their role. CONCLUSIONS Simulation allows the multidisciplinary team an opportunity to practice high-risk procedures and prompts the team to assess staff knowledge base, troubleshoot queries, and teach roles and responsibilities in a safe environment. In the context of COVID-19, simulation encourages staff sense of preparedness and protection for true participation during a high-risk procedure.
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Affiliation(s)
- Rebecca Towning
- Department of Otolaryngology and Head and Neck Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Catherine Rennie
- Department of Otolaryngology and Head and Neck Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Mark Ferguson
- Department of Otolaryngology and Head and Neck Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
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Aboalazayem A, Ba'ath ME, Kaddah SN, El-Barbary MM, Marei MM. Teaching hypospadias repair by utilising a novel 3D-printed silicon model: An initial assessment using structured trainee and trainer feedback. J Pediatr Urol 2024:S1477-5131(24)00009-3. [PMID: 38824107 DOI: 10.1016/j.jpurol.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Simulated paediatric surgical training is inherently advantageous and flourishing. Moreover, several working conditions resulted in reduced training hours, index and subspecialty cases encountered, and the COVID-19 pandemic affected elective surgery backlogs, hence training opportunities. Hypospadias repair is technically-demanding and requires a spectrum of dissective and reconstructive skills. We therefore aimed to test a 3D-printed silicon model for hypospadias repair, in the context of hands-on surgical training. MATERIAL AND METHODS Twenty-Seven trainees, under the supervision of 15 instructors, completed the activity. They were given a seminar to show the relevant anatomy, and 8 key steps of the exercise: (1)-degloving; (2)-urethral plate marking; (3)-incision; (4)-tubularisation; (5)-glansplasty/glanuloplasty; (6)-dartos layer preparation; (7)-preputioplasty and (8)-skin closure. Each trainee completed a structured feedback assessment. An on-site trainer supervised and evaluated each exercise. Trainees and trainers rated the model through the above steps from unsatisfactory-(1/5) to excellent-(5/5), presented herein via cross-sectional analysis. RESULTS Eleven-(40.7 %) trainees were in years:1-3 of specialist training, 10-(37 %) were in years:4-6, and 6-(22.2 %) were beyond year-6. Two-(7.4 %) trainees had nil-hypospadias experience, 16-(59.2 %) previously assisted in procedures or performed steps, 5-(18.5 %) performed whole procedures supervised and 4-(14.8 %) independently. Twenty-(74 %) trainees and 15-(100 %) instructors judged the model to resemble the anomaly. Seventeen-(63 %) trainees and 13-(86.6 %) instructors rated the material needle-penetrability ≥3/5, compared to human tissue. Sixteen-(59 %) trainees and 13-(86.6 %) instructors rated the material suture holding ≥3/5. Eleven-(73.3 %) trainees and 13-(86.6 %) instructors rated sutures' evenness and edge coaptability ≥3/5. DISCUSSION Hypospadias is an index operation, which requires precision skills. Simulated training in Paediatric Surgery and Urology is gaining importance. 3D-printed models are gaining a key role in simulated training. The study presents a novel 3D-printed high-fidelity silicon-based hypospadias model designed for hands-on training. A structured pathway to divide a standard hypospadias repair into key steps is displayed to ensure skill acquisition and stabilisation. CONCLUSION This 3D-printed silicon-based hypospadias model is proven useful for hands-on training. The fidelity can still improve, especially regarding suture holding of the material. LEVEL OF EVIDENCE LEVEL III.
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Affiliation(s)
- Abeer Aboalazayem
- Cairo University, Faculty of Medicine (Kasr Alainy), Cairo University Hospitals, Paediatric Surgery Section/Units (Departments of General Surgery), Cairo University Specialized Paediatric Hospital [CUSPH] & Cairo University Children's Hospital [Abu El-Reesh El-Mounira], 11562, Cairo, Egypt.
| | - Muhammad Eyad Ba'ath
- American Hospital Dubai, Oud Maitha, Dubai & Gulf Medical University, Ajman, United Arab Emirates; King's College Hospital London, Dubai Branch, United Arab Emirates.
| | - Sherif Nabhan Kaddah
- Cairo University, Faculty of Medicine (Kasr Alainy), Cairo University Hospitals, Paediatric Surgery Section/Units (Departments of General Surgery), Cairo University Specialized Paediatric Hospital [CUSPH] & Cairo University Children's Hospital [Abu El-Reesh El-Mounira], 11562, Cairo, Egypt.
| | - Mohamed Magdy El-Barbary
- Cairo University, Faculty of Medicine (Kasr Alainy), Cairo University Hospitals, Paediatric Surgery Section/Units (Departments of General Surgery), Cairo University Specialized Paediatric Hospital [CUSPH] & Cairo University Children's Hospital [Abu El-Reesh El-Mounira], 11562, Cairo, Egypt.
| | - Mahmoud Marei Marei
- Cairo University, Faculty of Medicine (Kasr Alainy), Cairo University Hospitals, Paediatric Surgery Section/Units (Departments of General Surgery), Cairo University Specialized Paediatric Hospital [CUSPH] & Cairo University Children's Hospital [Abu El-Reesh El-Mounira], 11562, Cairo, Egypt.
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13
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Miutescu B, Dhir V. Impact and assessment of training models in interventional endoscopic ultrasound. Dig Endosc 2024; 36:59-73. [PMID: 37634116 DOI: 10.1111/den.14667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023]
Abstract
Interventional endoscopic ultrasound (IEUS) has gained significant popularity in recent years because of its diagnostic and therapeutic capabilities. The proper training of endoscopists is critical to ensure safe and effective procedures. This review study aims to assess the impact of different training models on the competence of trainees performing IEUS. Eight studies that evaluated simulators for IEUS were identified in the medical literature. Various training models have been used, including the EASIE-R, Mumbai EUS, EUS Magic Box, EndoSim, Thai Association for Gastrointestinal Endoscopy model, and an ex vivo porcine model (HiFi SAM). The trainees underwent traditional didactic lectures, hands-on training using simulators, and direct supervision by experienced endoscopists. The effectiveness of these models has been evaluated based on objective and subjective parameters such as technical proficiency, operative time, diagnostic success, and participant feedback. As expected, the majority of skills were improved after the training sessions concluded, although the risk of bias is high in the absence of external validation. It is difficult to determine the ideal simulator among the existing ones because of the wide variation between them in terms of costs, reusability, design, fidelity of anatomical structures and feedback, and types of procedures performed. There is a need for a standardized approach for the evaluation of IEUS simulators and the ways skills are acquired by trainees, as well as a clearer definition of the key personal attributes necessary for developing a physician into a skilled endoscopist capable of performing basic and advanced therapeutic EUS interventions.
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Affiliation(s)
- Bogdan Miutescu
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India
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14
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Sim GY, Caparó M, Varrassi G, Lu CR, Ding ME, Singh R, Slinchenkova K, Shaparin N, Koushik SS, Viswanath O, Gitkind AI. Comparing the Effectiveness of Hands-on vs. Observational Training of Residents in Interlaminar Epidural Steroid Injections (ILESI) Using a High-Fidelity Spine Simulator. Cureus 2023; 15:e49829. [PMID: 38164314 PMCID: PMC10758203 DOI: 10.7759/cureus.49829] [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: 09/25/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction The Accreditation Council for Graduate Medical Education (ACGME) requires that residents in the Physical Medicine and Rehabilitation (PM&R) residency observe or perform certain interventional procedures, one of which is an interlaminar epidural steroid injection (ILESI). While the traditional learning model relying heavily on observation is commonplace, it leaves the practice phase of learning to happen on real patients. High-fidelity simulation may be a worthwhile alternative as a training approach to increase physician comfort with the procedure and improve patient safety. Methods Current PM&R residents from two programs between their second and fourth year, inclusively, who lacked prior training experience in ILESI attended one hour of either: (1) an experimental arm of supervised hands-on training on a simulation device or (2) a control arm observing the procedures performed by an attending on the same device. Assignments were made based on resident schedule availability. Pre-training knowledge, training, and post-training knowledge were assessed at the Multidisciplinary Pain Clinic at Montefiore Medical Center. Participants were assessed on their procedural competence using an adapted version of a previously published grading checklist before the session. Participants also evaluated their confidence in performing the procedure prior to and after training. Data was analyzed using the Wilcoxon signed-rank test and the Wilcoxon rank-sum test. SAS Version 9.4 was used for analysis. Results Fifteen residents initially participated, but three residents dropped out at the 15-week follow-up. There was a significant increase in test scores in both arms immediately after the intervention (p=0.008 in control, p=0.016 in the experiment), with greater improvement shown in the hands-on training group (p=0.063). At the 15-week follow-up, there was no significant change in test scores in the control arm (p=0.969) while there was a decrease in the experiment arm (p<0.001). Conclusion Hands-on learning with high-fidelity simulation demonstrated more improvement for short-term motor-skill acquisition, while observational learning with repetition showed more benefits for long-term retention. Optimal procedural training should employ both educational modalities for best short- and long-term results.
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Affiliation(s)
- Geum Y Sim
- Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, The Bronx, USA
| | - Moorice Caparó
- Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, The Bronx, USA
| | | | - Christopher R Lu
- Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, The Bronx, USA
| | - Michael E Ding
- Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, The Bronx, USA
| | - Rohini Singh
- Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, The Bronx, USA
| | | | - Naum Shaparin
- Anesthesiology, Albert Einstein College of Medicine, The Bronx, USA
| | - Sarang S Koushik
- Anesthesiology, Creighton University School of Medicine, Phoenix, USA
- Anesthesiology, Valleywise Health Medical Center, Phoenix, USA
| | - Omar Viswanath
- Anesthesiology, Creighton University School of Medicine, Phoenix, USA
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Andrew I Gitkind
- Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, The Bronx, USA
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15
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Fahy R, Corbett M, Crotty T, Chadwick L, Keogh I. Totally endoscopic cartilage tympanoplasty: a hierarchical task analysis. J Laryngol Otol 2023; 137:1326-1333. [PMID: 36093951 DOI: 10.1017/s0022215122001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Totally endoscopic ear surgery is a novel method of conducting otological surgery. Hierarchical task analysis and the systematic human error reduction and prediction approach ('SHERPA') are valuable tools that can effectively deconstruct the technical and non-technical skills required to successfully complete a surgical procedure. METHODS Twenty-five endoscopic tragal cartilage tympanoplasties were observed, to identify the tasks and subtasks required for completion of totally endoscopic tragal cartilage tympanoplasty. The systematic human error reduction and prediction approach was used to identify the potential risks and methods, to reduce or remediate these risks. RESULTS A hierarchical task analysis was performed, identifying 8 tasks and 50 subtasks for a safe approach to completing totally endoscopic tragal cartilage tympanoplasty. A risk score for each subtask was calculated to produce a systematic human error reduction and prediction approach and to highlight potential errors. CONCLUSION This hierarchical task analysis allowed for quick reference to a correct method of endoscopic tympanoplasty. The systematic human error reduction and prediction approach was employed to reduce the risks associated with undergoing endoscopic tympanoplasty, to improve patient safety.
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Affiliation(s)
- R Fahy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - M Corbett
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - T Crotty
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - L Chadwick
- Department of Mechanical and Biomedical Engineering, National University of Ireland, Galway, Ireland
| | - I Keogh
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
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Weber M, Backhaus J, Lutz R, Nobis CP, Zeichner S, Koenig S, Kesting M, Olmos M. A novel approach to microsurgical teaching in head and neck surgery leveraging modern 3D technologies. Sci Rep 2023; 13:20341. [PMID: 37990073 PMCID: PMC10663471 DOI: 10.1038/s41598-023-47225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023] Open
Abstract
The anatomically complex and often spatially restricted conditions of anastomosis in the head and neck region cannot be adequately reproduced by training exercises on current ex vivo or small animal models. With the development of a Realistic Anatomical Condition Experience (RACE) model, complex spatial-anatomical surgical areas and the associated intraoperative complexities could be transferred into a realistic training situation in head and neck surgery. The RACE model is based on a stereolithography file generated by intraoperative use of a three-dimensional surface scanner after neck dissection and before microvascular anastomosis. Modelling of the acquired STL file using three-dimensional processing software led to the model's final design. As a result, we have successfully created an economical, sustainable and realistic model for microsurgical education and provide a step-by-step workflow that can be used in surgical and general medical education to replicate and establish comparable models. We provide an open source stereolithography file of the head-and-neck RACE model for printing for educational purposes. Once implemented in other fields of surgery and general medicine, RACE models could mark a shift in medical education as a whole, away from traditional teaching principles and towards the use of realistic and individualised simulators.
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Affiliation(s)
- Manuel Weber
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany.
| | - Joy Backhaus
- Institute of Medical Teaching and Medical Education Research, University Hospital of Würzburg, Würzburg, Germany
| | - Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
| | - Christopher-Philipp Nobis
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
| | | | - Sarah Koenig
- Institute of Medical Teaching and Medical Education Research, University Hospital of Würzburg, Würzburg, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
| | - Manuel Olmos
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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17
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Donato Z, Syros A, Milner J, Pandya S, Tandron M, Hernandez G. "Sawbones": A pilot study assessing simulation-based orthopedic training for medical students. J Orthop 2023; 44:66-71. [PMID: 37700780 PMCID: PMC10493496 DOI: 10.1016/j.jor.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
Intro Simulation-based training has become a valuable new tool in medical education across the country. The Orthopedic Surgery Interest Group (OSIG) at the University of Miami Miller School of Medicine organized a benchtop training workshop known as "Sawbones" to give medical students essential exposure to basic techniques and instruments commonly used in orthopedic surgery. This pilot study seeks to investigate the participating students' perceptions of this workshop as part of a potential longitudinal intervention. Methods A total of 30 medical students (MS1-MS4) with a documented interest in orthopedic surgery were randomly selected via email invitation to participate in this workshop. Students first had a lecture-based training session with faculty on an overview of screw fixation. Participants then formed groups that were headed by an orthopedic resident or attending and took turns fixing fractures on model bones made of synthetic material. Following the session, students were sent an anonymous Qualtrics survey to assess their satisfaction with the workshop. Results A total of 22 students (73%), responded to the survey. On a ten-point scale, the average reported interest in orthopedics was 9.2 (SD 0.4). All students (n = 22, 100%) reported that they would like more hands-on orthopedic experiences as a component of their medical education. Nineteen students (86.4%) reported that this training increased their interest in pursuing a career in orthopedic surgery and twenty-one (95.5%) further stated that they would recommend this training to other students. Discussion Based on the results of this pilot study, Sawbones was promising at engaging students in orthopedics, providing a team environment, and introducing students to orthopedic skills and instrumentation. Providing these sessions in a longitudinal manner could provide opportunities for mentorship and better prepare students for a residency in orthopedics. We recommend a program like Sawbones to better address the lack of Orthopedic exposure in medical school.
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Affiliation(s)
- Zachary Donato
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Alina Syros
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Jacob Milner
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Shivani Pandya
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Marissa Tandron
- University of Miami/Jackson Health Systems Department of Orthopedic Surgery, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Giselle Hernandez
- University of Miami/Jackson Health Systems Department of Orthopedic Surgery, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
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Awad L, Langridge BJ, Jeon FHK, Bollen E, Butler PEM. A comparison of commercially available synthetic skin substitutes for surgical simulation training. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc62. [PMID: 37881521 PMCID: PMC10594032 DOI: 10.3205/zma001644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 05/13/2023] [Accepted: 07/07/2023] [Indexed: 10/27/2023]
Abstract
Objective Simulation training provides an important opportunity to accelerate surgical skills acquisition whilst safeguarding patients. This study compares the suitability of different synthetic skin substitutes for use in surgical simulation training. Design Data was collected for eight commercially available synthetic skin substitutes and included cost, delivery time, subjective assessment of fidelity by surgeons and trainees, and objective comparison with the biomechanics of human skin was made through cutometry and durometry measurements. Cutometry and durometry data was collected from three healthy adults from the forearm, forehead and back, with measurements being repeated in triplicate. Subjective assessment of skin pad quality was collected using an 8-criteria questionnaire, graded using a 5-point Likert scale for fidelity to normal skin. Results The questionnaire assessment was completed by 30 trainees and practitioners. Overall, felt pads received the poorest outcomes in all criteria; cutometry and durometry results demonstrate poor similarity to skin, and felt received the lowest scores in the questionnaire, although the cheapest. Foam dressings were similar in both cutometric and durometric properties to skin of the face, back and arm. Clinical outcomes of foam dressings were similar to the most expensive commercial skin pad. Conclusions Bilaminar foam-based dressings provide a low cost, high fidelity non-biological simulation of skin for surgical training, which is non-inferior to more expensive specifically designed products. Many products designed to act as skin substitutes for surgical simulation fail to adequately replicate the anatomical and mechanical properties of skin.
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Affiliation(s)
- Laura Awad
- Royal Free Hospital, Charles Wolfson Center for Reconstructive Surgery, London, United Kingdom
| | - Benjamin J. Langridge
- Royal Free Hospital, Charles Wolfson Center for Reconstructive Surgery, London, United Kingdom
- Royal Free Hospital, Department of Plastic Surgery, London, United Kingdom
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, London, United Kingdom
| | - Faith H. K. Jeon
- Royal Free Hospital, Charles Wolfson Center for Reconstructive Surgery, London, United Kingdom
- Royal Free Hospital, Department of Plastic Surgery, London, United Kingdom
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, London, United Kingdom
| | - Edward Bollen
- Royal Free Hospital, Charles Wolfson Center for Reconstructive Surgery, London, United Kingdom
| | - Peter E. M. Butler
- Royal Free Hospital, Charles Wolfson Center for Reconstructive Surgery, London, United Kingdom
- Royal Free Hospital, Department of Plastic Surgery, London, United Kingdom
- Royal Free Hospital, Department of Plastic and Reconstructive Surgery, London, United Kingdom
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Manavalan V, Dutt RA. Skill-Based Surgical Training: the Need of the Hour. Indian J Surg Oncol 2023; 14:531-536. [PMID: 37900648 PMCID: PMC10611636 DOI: 10.1007/s13193-023-01820-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/06/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Vijayakumar Manavalan
- Department of Surgical Oncology, Yenepoya Medical College, Yenepoya (Deemed to Be University), Mangalore, Karnataka India
| | - R. Aswini Dutt
- Department of Physiology, Yenepoya Medical College, Yenepoya (Deemed to Be University), Mangalore, Karnataka India
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20
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Saleem M, Khan Z. Healthcare Simulation: An effective way of learning in health care. Pak J Med Sci 2023; 39:1185-1190. [PMID: 37492303 PMCID: PMC10364267 DOI: 10.12669/pjms.39.4.7145] [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: 09/19/2022] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 07/27/2023] Open
Abstract
Background and Objective Simulation-based learning has been a part of teaching in healthcare for a long time; however, in recent decades, simulation-based learning has been adopted by a significant number of healthcare institutes at different levels to improve practical skills, confidence, and preparedness to ensure patient safety and its application in real-life situations towards better patient care. The main objective of this paper was to use existing literature to explore aspects of simulation in healthcare teaching. Methods It is a narrative review on simulation in healthcare that was conducted by using various search engines for English-language articles published between 2010 and August 2020. The main search terms were simulation, healthcare teaching, and simulation in healthcare. All articles found relevant to the title and/or abstract were retrieved. Searches were conducted using the academic databases PubMed, Google Scholar, MEDLINE, CINAHL, and Athabasca University (AU) library site. The studies were reviewed if they were considered relevant to the search by the primary authors. Results Thirty-nine articles, which met the pre-set criteria, were analyzed and employed as a reference in this paper to support the idea that simulation is an effective way of learning in healthcare. Conclusion This paper reviewed various aspects of simulation, including its background, philosophies, and highlighted the advantages and disadvantages of incorporating simulation as a pedagogical approach into current educational curriculums for healthcare students. Furthermore, it presents a brief discussion on the current uses of simulation, followed by the educational strategies related to simulation and the importance of debriefing in simulation activities.
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Affiliation(s)
- Munazza Saleem
- Dr. Munazza Saleem, M.B.B.S., MHST, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, Pakistan. Athabasca University, Faculty of Health Disciplines, Calgary, Alberta, Canada
| | - Zuhera Khan
- Dr. Zuhera khan, FCPS (Plast) Assistant Professor, Plastic Surgery, Indus Medical College, Tando Muhammad Khan, Pakistan
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Gholinejadzirmanlou M, Aghazadeh Attari AM, Sheikhalipour Z, Lotfi M, Ghaffarifar S, Qayumi K. An appropriate simulation-based training for surgical technology students. Nurse Educ Pract 2023; 70:103680. [PMID: 37354693 DOI: 10.1016/j.nepr.2023.103680] [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: 03/12/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Using simulation in an appropriate education plan which has always been challenging; To be used alone or in combination with other methods and the order of it's use. This article was intended to compare student's knowledge, clinical skill and readiness-capability using simulation and combination of it with traditional training methods to collect necessary evidence for development of an appropriate simulation- based educational plan for surgical technology students. METHODS This is a controlled pre/post-test quasi-experimental study in 2019. All surgical technology students who had selected the scrub and circulate course (n = 28) were randomly divided into two groups. One of the groups was educated with traditional training method (TTM). On the same day, the other group was educated with simulation training method (STM). After two weeks, group α received simulation training and group β was subject to traditional training. Multiple-Choice Test for Knowledge Assessment and Clinical Skills as well as Readiness-Capability (KCSRC) of appendectomy Surgery checklist were used in this study. Data were analysed after each training method, after Two weeks and after blended education.For data analysis, Mixed-Design ANOVA and SPSS software 24/v were employed. RESULTS The mean scores of knowledge, clinical skills, and readiness-capability were 14.2 ± 2.91, 44.42 ± 17.74, 21.58 ± 4.18 in group α and 12.66 ± 3.21, 41.17 ± 16.19, and 18.58 ± 7.85 in group β, respectively. The comparison between mean scores of KCSRC before the first training and after combined training in each group showed that the mean of all scores significantly increased in group α (p < 0.0001), which indicates that the education plan starting with TTM and continued with STM has the most significant effect on results. CONCLUSION According to the results of the study, it seems that starting the education plan for surgical students with TTM and then continuing with STM would be more effective on education of students, especially on students' long term learning.
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Affiliation(s)
- Mahsa Gholinejadzirmanlou
- Student of Medical Surgical Nursing, Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Zahra Sheikhalipour
- Medical, Surgical Nursing Department, Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Lotfi
- Medical Education Research Center, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Karim Qayumi
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Kirsch MJ, Mangham C, Lin Y. GlobalSurgBox: A Portable Surgical Simulator for Surgical Trainees Worldwide. JOURNAL OF SURGICAL EDUCATION 2023; 80:720-725. [PMID: 36797147 DOI: 10.1016/j.jsurg.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/02/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Identify barriers to surgical simulation in multiple countries across the income spectrum. Evaluate whether a novel, portable surgical simulator (GlobalSurgBox) would be valuable to surgical trainees and overcome these barriers. DESIGN Trainees from high-, middle-, and low-income countries were instructed on how to perform surgical skills using the GlobalSurgBox. Participants were sent an anonymized survey after 1 week to evaluate practicality and helpfulness of the trainer. SETTING Academic medical centers in 3 countries: USA, Kenya, and Rwanda. PARTICIPANTS 48 medical students, 48 surgery residents, 3 medical officers, and 3 cardiothoracic surgery fellows. RESULTS 99.0% of respondents agreed surgical simulation was an important aspect of surgical education. Despite 60.8% having access to simulation resources, only 3 of 40 (7.5%) US trainees, 2 of 12 (16.7%) of Kenyan trainees, and 1 of 10 (10.0%) Rwandan trainees used these resources routinely. 38 (95.0%) US trainees, 9 (75.0%) Kenyan trainees, and 8 (80.0%) Rwandan trainees with access to simulation resources stated there were barriers to using them. The frequently cited barriers included lack of convenient access and lack of time. After using the GlobalSurgBox, 5 (7.8%) US participants, 0 (0%) Kenyan participants, and 5 (38.5%) Rwandan participants reported lack of convenient access as a continued barrier to simulation. 52 (81.3%) US trainees, 24 (96.0%) Kenyan trainees, and 12 (92.3%) Rwandan trainees stated the GlobalSurgBox was a good facsimile of the operating room. 59 (92.2%) US trainees, 24 (96.0%) Kenyan trainees, and 13 (100%) Rwandan trainees stated the GlobalSurgBox better prepared them for clinical settings. CONCLUSIONS A majority of trainees across all 3 countries reported multiple barriers to simulation in their current surgical training. The GlobalSurgBox eliminates many of these barriers by providing a portable, affordable, and realistic way to practice skills needed in the operating room.
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Affiliation(s)
- Michael J Kirsch
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | | | - Yihan Lin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Shahkoo AA, Abin AA. Deep reinforcement learning in continuous action space for autonomous robotic surgery. Int J Comput Assist Radiol Surg 2023; 18:423-431. [PMID: 36383302 DOI: 10.1007/s11548-022-02789-8] [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: 03/01/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Reinforcement learning methods have shown promising results for the automation of sub-tasks in robotic surgery systems. With the development of these methods, surgical robots have been able to achieve good performances, so that they can be used in complex and high-risk environments such as surgical pattern cutting to reduce stress and pressure on the surgeon and increase surgical accuracy. This study has aimed at providing a deep reinforcement learning-based approach to control the gripper arm when cutting soft tissue in a continuous action space. METHODS Surgical soft tissue cutting in this study is performed by controlling the gripper arm in a continuous action space and a grid observation space. In the proposed method using deep reinforcement learning, we find an optimal tensioning policy in the continuous action space that increases the cutting accuracy of the predetermined pattern. RESULTS The simulation results demonstrated that in the cutting of many complex patterns, the proposed method works better than the methods in which the tensioning was performed in a discrete action space and the observation space was modeled as a partial and random representation. CONCLUSION We introduced a deep reinforcement learning-based method for obtaining the optimal tensioning policy in a continuous action space when cutting a predetermined pattern. We showed that the proposed approach outperforms the state-of-the-art method in the soft pattern cutting task with respect to accuracy.
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Affiliation(s)
- Amin Abbasi Shahkoo
- Faculty of Computer Science and Engineering, Shahid Beheshti University, Daneshjou Blvd., Tehran, Tehran, 1983969411, Iran
| | - Ahmad Ali Abin
- Faculty of Computer Science and Engineering, Shahid Beheshti University, Daneshjou Blvd., Tehran, Tehran, 1983969411, Iran.
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Shbool MA, Al-Bazi A, Kokash A, AlAlaween WH, Albashabsheh NT, Al-Taher R. The Economy of Motion for Laparoscopic Ball Clamping Surgery: A Feedback Educational Tool. MethodsX 2023; 10:102168. [PMID: 37095868 PMCID: PMC10122053 DOI: 10.1016/j.mex.2023.102168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
The Ball Clamping module of the Laparoscopic Surgery Training Box involves the transfer of beads across the training board using laparoscopic tools. Fundamentals of Laparoscopic Surgery (FLS) requires practitioners to move their hands at as short a distance as possible to perform the functions in the shortest amount of time. This study introduces a feedback tool that presents to the student, after attempting their exam, the right direction (step by step) of obtaining the optimal pathway for minimizing distance traveled in the Ball Clamping Module of the Laparoscopic Surgery Training Box. The shortest distance tour for the ball clamping task is determined using the Traveling Salesman Model (TSM). A sensitivity analysis is conducted to assess the model's applicability to different types and settings of trainer boxes.•Find the best sequence of points resulting in the shortest distance tour for the ball clamping task.•The effects of adding or removing columns from the box cannot be intuitively predicted.
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Affiliation(s)
- Mohammad A. Shbool
- Industrial Engineering Department, School of Engineering, The University of Jordan, Amman 11942, Jordan
- Corresponding author.
| | - Ammar Al-Bazi
- Aston Business School, Aston University, Birmingham, Northern Ireland B4 7ER, UK
| | - Alma Kokash
- Industrial Engineering Department, School of Engineering, The University of Jordan, Amman 11942, Jordan
| | - Wafa' H. AlAlaween
- Industrial Engineering Department, School of Engineering, The University of Jordan, Amman 11942, Jordan
| | - Nibal T. Albashabsheh
- Industrial Engineering Department, School of Engineering, The University of Jordan, Amman 11942, Jordan
| | - Raed Al-Taher
- Department of General Surgery, Division of Pediatric Surgery, School of Medicine, The University of Jordan, Amman 11942, Jordan
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Awad L, Langridge B, Bollen E, Abdi Z, E.M Butler P. Development of a low-cost, remote plastic surgery skills training course during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2023; 14:1-3. [PMID: 36688516 PMCID: PMC10693400 DOI: 10.5116/ijme.63b4.081d] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Laura Awad
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Benjamin Langridge
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
| | - Edward Bollen
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Zakee Abdi
- Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Peter E.M Butler
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
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Joosten M, Wijnen R, de Blaauw I, Botden SMBI. A Promising Future for Hands-On At-Home Training in Pediatric Surgery. Eur J Pediatr Surg 2022; 33:234-240. [PMID: 36049776 DOI: 10.1055/s-0042-1745784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Sufficient training is needed to acquire and retain the procedural skills needed for the surgical correction of congenital anatomical malformations. This study aims to assess the opinions of trainees and pediatric surgeons on the use of simulation-based continued at-home training, which can help to acquire these skills. METHODS This study consisted of two parts. First, an international survey among trainees and pediatric surgeons assessed their opinions on simulation-based at-home training for pediatric surgical procedures (5-point Likert scale). Second, participants of pediatric colorectal courses were instructed to practice the posterior sagittal anorectoplasty procedure at-home on a simulation model and, subsequently, complete a questionnaire regarding their opinions on continuous at-home training (5-point Likert scale). RESULTS A total of 163 participants (83% pediatric surgeons) completed the international survey (response rate 43%). Overall, participants considered the training useful for both laparoscopic (mean 4.7) and open procedures (mean 4.2) and agreed that it may be used at home after a hands-on course (mean 4.3).Twenty participants completed the questionnaire on continued training (response rate 36%). All agreed that at-home training was of added value (mean 4.5) and that the skills were transferable to the clinical setting (mean 4.3). At-home training was regarded a suitable exercise after a hands-on workshop (mean 4.3), but less so without a workshop (mean 3.7, p=0.017). CONCLUSION Participating trainees and pediatric surgeons were of the opinion that simulation models and at-home training have added value. This implies that simulation-based training may be used more often in pediatric surgical training.
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Affiliation(s)
- Maja Joosten
- Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Rene Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
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Joosten M, Bökkerink GMJ, Levitt MA, Diefenbach KA, Reck CA, Krois W, de Blaauw I, Botden SMBI. The Use of an Inanimate Simulation Model for the Correction of an Anorectal Malformation in the Training of Colorectal Pediatric Surgery. Eur J Pediatr Surg 2022; 32:287-293. [PMID: 33567465 DOI: 10.1055/s-0041-1723035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION An anorectal malformation (ARM) is a congenital malformation that requires surgical correction. To acquire the skills needed to perform this complex procedure, an affordable simulation model has previously been developed and validated. The aim of this study is to evaluate the suitability of this ARM model (with perineal fistula) for training in hands-on workshops. MATERIALS AND METHODS The ARM model consists of a wooden casing with disposable perineal body. Participants in several international pediatric colorectal hands-on workshops in 2019 and 2020 were asked to participate. They were divided in a target group and an experienced group based on experience. All practiced the posterior sagittal anorectoplasty procedure on the model with multimodality guidance. Subsequently, statements on the suitability of the model for use during hands-on workshops were scored on a 5-point Likert scale. RESULTS A total of 80 participants were included (43 surgical specialists, 13 pediatric surgery fellows, and 25 residents). Nearly, all statements scored at least a mean of >4.0, all scored significantly better than a neutral opinion. The target group (n = 58) scored higher compared with the experienced group (n = 22) on "transferability of the skills to the clinical setting" (means 4.4 vs. 4.0, p = 0.038); however, the "suitability as a replacement for an animal model" scored significantly lower (means 3.6 vs. 3.9, p = 0.049). No other differences were found. CONCLUSION This affordable ARM model was regarded a suitable model for training during preclinical hands-on workshops and could be used for the specified steps of the procedure.
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Affiliation(s)
- Maja Joosten
- Department of Pediatric Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Guus M J Bökkerink
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc A Levitt
- Department of Pediatric Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Carlos A Reck
- Department of Pediatric Surgery, Medical University of Vienna, Wien, Austria
| | - Wilfried Krois
- Department of Pediatric Surgery, Medical University of Vienna, Wien, Austria
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
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Taher A, Chow J, Kwon MS, Hunter D, Lucewicz A, Samarawickrama C. Determining the learning curve for a novel microsurgical procedure using histopathology. BMC MEDICAL EDUCATION 2022; 22:342. [PMID: 35509098 PMCID: PMC9066982 DOI: 10.1186/s12909-022-03407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Wet laboratories are becoming an increasingly important training tool as part of a push to a proficiency-based training model. We created a microsurgical wet laboratory to investigate the utility of histopathology use in assessing surgical outcomes and determine the learning curve of a novel microsurgical procedure. METHODS A microsurgical wet laboratory was established using pig eyes to simulate the human cornea. Three novice surgeons and an experienced surgeon performed an anterior cornea lamellar dissection and the duration of the procedure was recorded. With the aid of histological analysis, the thickness and characteristics of the dissected graft was recorded. The number of attempts to complete the experiment, defined as three successful dissections with mean thickness below 100 μm, was documented. RESULTS The use of histopathology was highly successful allowing in-depth analysis of the dissected graft for each attempt. Trainees reached the endpoint of the study in 21, 26 and 36 attempts (mean: 28 attempts) whilst the corneal surgeon completed the experiment in 12 attempts (p = 0.07). Mean dissection thickness decreased over time for all participants. The mean dissection time for trainees was 10.6 ± 4.2 min compared to the corneal surgeon with a mean of 8.2 ± 3.1 min (p = 0.03). CONCLUSION We propose a corneal wet laboratory model that allows for simple, efficient, and flexible microsurgical training. The use of histopathological analysis allows for careful graft analysis, providing objective feedback throughout the training exercise. Trainees demonstrated improvements in the three key aspects of the procedure: accuracy as evidenced by decreasing histological thickness, confidence by self-report and fluidity by decreasing duration of the procedure.
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Affiliation(s)
- Amir Taher
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW, 2050, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW, 2145, Australia
| | - Joanne Chow
- Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW, 2145, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Min Sung Kwon
- Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW, 2145, Australia
| | - Damien Hunter
- Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW, 2145, Australia
- Westmead Clinical School, Discipline of Ophthalmology, University of Sydney, Darcy Rd, Westmead, NSW, 2145, Australia
| | - Ania Lucewicz
- University of Sydney, Darcy Rd, Westmead, NSW, 2145, Australia
| | - Chameen Samarawickrama
- Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW, 2145, Australia.
- Westmead Clinical School, Discipline of Ophthalmology, University of Sydney, Darcy Rd, Westmead, NSW, 2145, Australia.
- Central Clinical School, Sydney University, Johns Hopkins Dr, Camperdown, NSW, 2050, Australia.
- Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.
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29
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McCormack L, Nesbitt-Hawes E, Deans R, Alonso A, Lim C, Li F, Knapman B, Abbott JA. A review of gynaecological surgical practices for trainees and certified specialists in Australia by volume using MBS and AIHW databases. Aust N Z J Obstet Gynaecol 2022; 62:574-580. [PMID: 35474508 PMCID: PMC9542106 DOI: 10.1111/ajo.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a finite volume of surgery performed annually by trainees and certified specialists alike. The detailed assessment of this surgical substrate is important, since it guides true exposure in gynaecological surgical training and practice after fellowship. AIMS This study quantifies the volume and profile of major gynaecological surgical procedures performed in Australia within a specified five-year period and discusses the implications for training and practice. MATERIALS AND METHODS Australian Institute of Health and Welfare data were examined to quantify the total number of major gynaecological procedures performed between 2013 and 2018. Medicare data were analysed to quantify the number of billed procedures. These data were compared with published Australian RANZCOG trainees and operative gynaecologists, to estimate the potential annual average exposure for each procedure. RESULTS Major open, laparoscopic and vaginal surgeries constitute less than 27% of the 600 000 gynaecological procedures performed annually in Australia. Most major gynaecological surgeries are performed at rates lower than 12 cases per year for both trainees and specialists. Over the study period, laparotomies, vaginal hysterectomies and continence procedures decreased, and operative laparoscopies and laparoscopic hysterectomies increased. CONCLUSIONS The volume of available major gynaecological procedures in Australia may not allow sufficient exposure for optimal training and practice for all trainees and specialists in operative gynaecology. This shortfall may compromise the ability to obtain and maintain proficiency in some core gynaecological operative procedures.
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Affiliation(s)
- Lalla McCormack
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Rebecca Deans
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Anais Alonso
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Claire Lim
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Fiona Li
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Blake Knapman
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Jason A Abbott
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
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Chawla S, Devi S, Calvachi P, Gormley WB, Rueda-Esteban R. Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review. Acta Neurochir (Wien) 2022; 164:947-966. [PMID: 35122126 PMCID: PMC8815386 DOI: 10.1007/s00701-021-05003-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees' operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education. METHODS PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review. RESULTS Neurosurgical skills assessed included aneurysm clipping (n = 6), craniotomy and burr hole drilling (n = 2), tumour resection (n = 4), and vessel suturing (n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models (n = 5), synthetic models (n = 7), and VR models (n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities. CONCLUSION Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models.
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Affiliation(s)
- Shreya Chawla
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sharmila Devi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paola Calvachi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - William B Gormley
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roberto Rueda-Esteban
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Universidad de los Andes School of Medicine, Bogotá, Colombia.
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Heskin L, Galvin R, Traynor O, Simms C. Simulation in Upper and Lower Limb Trauma Skill Acquisition: A Review. Simul Healthc 2022; 17:54-65. [PMID: 34009908 DOI: 10.1097/sih.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT This review aimed to explore the published evidence with regard to the types and composition of both full- and part-task trainers to teach surgeons extremity exploration procedures in limb trauma management. Studies were included if they reported the development and/or validation of synthetic or virtual task trainers. Studies were evaluated to determine their derivation, usability, and clinical utility.A total of 638 citations were identified and 63 satisfied the inclusion criteria. Twenty-five articles addressed simulator validation and 36 addressed level of learning achieved with simulator engagement. Two studies described a dedicated limb simulator. Simulators were developed to repair limb structures including skin (n = 15), tendon (n = 7), nerve (n = 1), fascia (n = 1), muscle (n = 1), vascular (n = 24), and bone (n = 11). Considerations such as material fidelity, learning outcomes, cost or reusability, validity, and effectiveness are inconsistently reported. Future studies should address design standards for the effective production of synthetic or virtual simulators for limb trauma management.
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Affiliation(s)
- Leonie Heskin
- From the Department of Surgical Affairs, Royal College of Surgeons in Ireland (L.H., O.T.); University of Limerick (R.G.); and Trinity College Dublin (C.S.), Dublin, Ireland
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Saleem HY, Kaplan JL, Torres-Guzman RA, Avila FR, Forte AJ. Simulation in Hand Surgery: A Literature Review. World J Surg 2022; 46:718-724. [PMID: 34993601 DOI: 10.1007/s00268-021-06400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Due to duty hour regulations, patient safety and inadequate operative time simulation have become a necessary part of surgical education and training in residency. Currently, there is no formal adoption of simulators for the use of surgical education or assessment in hand surgery. This literature review analyzes that the simulation techniques established thus far in hand surgery. METHODS A comprehensive literature search was performed on PubMed. Search results were filtered by title and abstract to isolate articles that were relevant to simulation in hand surgery. Articles that were nonspecific to the hand, non-English and cadaveric were excluded. Additional articles were identified through references from the initial search. RESULTS A total of 1192 articles were yielded from the initial query. After the application of the inclusion criteria, this was narrowed down to 28 articles. Another 8 additional articles were excluded as they did not pertain to the hand although the simulators could be adapted for hand surgery. A total of 20 articles were included in this study. CONCLUSIONS Surgical simulation is a growing and essential field of surgical education. Simulators in hand surgery are limited and require further research and validation. Like other surgical subspecialties, hand surgery may benefit from the adoption of an official simulation curriculum for the assessment of residents and enhancement of technical skills.
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Affiliation(s)
- Humza Y Saleem
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Jamie L Kaplan
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Schmidt PC, Fairchild PS, Fenner DE, Rooney DM. The Fundamentals of Vaginal Surgery pilot study: developing, validating, and setting proficiency scores for a vaginal surgical skills simulation system. Am J Obstet Gynecol 2021; 225:558.e1-558.e11. [PMID: 34464583 DOI: 10.1016/j.ajog.2021.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical training in the simulation lab can develop basic skills that translate to the operating room. Standardized, basic skills programs that are supported by validated assessment measures exist for open, laparoscopic, and endoscopic surgery; however, there is yet to be a nationally recognized and widely implemented basic skills program specifically for vaginal surgery. OBJECTIVE Develop a vaginal surgical simulation system; evaluate robust validity evidence for the simulation system and its related performance measures; and establish a proficiency score that discriminates between novice and experienced vaginal surgeon performance. STUDY DESIGN In this 3-phased study, we developed the Fundamentals of Vaginal Surgery simulation system consisting of (1) the Fundamentals of Vaginal Surgery Trainer, a task trainer; (2) a validated regimen of tasks to be performed on the trainer; and (3) performance measures to determine proficiency. In Phase I, we developed the task trainer and selected surgical tasks by performing a needs assessment and hierarchical task analyses, with review and consensus from an expert panel. In Phase II, we conducted a national survey of vaginal surgeons to collect validity evidence regarding test content, response process, and internal structure relevant to the simulation system. In Phase III, we compared performance of novice (first and second year residents) and experienced (third and fourth year residents, fellows, and faculty) surgeons on the simulation system to evaluate relevant relationships to other variables and consequences. Performance measures were analyzed to set a proficiency score that would discriminate between novice and expert (faculty) vaginal surgical performance. RESULTS A novel task trainer and 6 basic vaginal surgical skills were developed in Phase I. In Phase II, the survey responses of 48 participants (27 faculty surgeons, 6 fellows, and 14 residents) were evaluated on the dimensions of test content, response process, and internal structure. To support evidence of test content, the participants deemed the task trainer and surgical tasks representative of intended surgical field and supportive of typical surgical actions (mean scores, 3.8-4.4/5). For response process, rater-data analysis revealed high rating variability regarding prototype color. This early evidence confirmed the value of a white prototype. For internal structure, there was high agreement among rater groups (obstetricians and gynecologists generalists vs Female Pelvic Medicine and Reconstructive Surgery specialists: interclass correlation coefficient range, 0.59-0.91; learners vs faculty interclass correlation coefficient range, 0.64-1.0). There were no differences in ratings across institution type, surgeon volume, expertise (P>.14). In Phase III, we analyzed performance from 23 participants (15 [65%] obstetricians and gynecologists residents, 3 [13%] fellows, and 5 [22%] Female Pelvic Medicine and Reconstructive Surgery faculty). Experienced surgeons scored significantly higher than novice surgeons (median, 467.5; interquartile range, [402.5-542.5] vs median, 261.5; interquartile range, [211.5-351.0]; P<.001). Based on these data, setting a proficiency score threshold at 400 results in 0% (0/6) novices attaining the score, with 100% (5/5) experts exceeding it. CONCLUSION We present validity evidence relevant to all 5 sources which supports the use of this novel simulation system for basic vaginal surgical skills. To complement the system, a proficiency score of 400 was established to discriminate between novices and experts.
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Affiliation(s)
- Payton C Schmidt
- Division Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - Pamela S Fairchild
- Division Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Dee E Fenner
- Division Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Deborah M Rooney
- Department of Learning and Health Sciences, University of Michigan, Ann Arbor, MI
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Nair D, Wells JM, Yi M, Beasley S. Is Technical Expertise Necessary to Assess Technical Expertise? Let's Ask the Kids. J Laparoendosc Adv Surg Tech A 2021; 31:1363-1366. [PMID: 34677094 DOI: 10.1089/lap.2021.0321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Simulation has an increasing role in surgical training; however, using validated tools such as the Objective Structured Assessment of Technical Skills (OSATS) is time-consuming, which may be a potential barrier to simulation-based training. This study tests the hypothesis that assessors with technical expertise are necessary to objectively score a technical task. Methods: Three tasks, ring transfer, needle pass, and atresia cut, were performed using a synthetic thoracoscopic simulator for esophageal atresia/tracheoesophageal fistula. Three pediatric surgeons, 6 novice adults, and 3 children aged 9-13 years scored each attempt using the overall global OSATS rating from 1 to 5 (1 "repeated or awkward movements" to 5 "fluid movement. No awkwardness"). Results: For the ring transfer, all assessors scored novice participants significantly less than expert and intermediate scores (surgeon P = .0004, nonsurgeon adults P = .0009 and children P = .0003). For the needle pass, all assessors gave significantly different scores between novices and experts (surgeon P = .0007, nonsurgeon adult P = .0008, and children P = .0040). For the atresia cut, surgeon assessors gave significantly higher scores for experts and intermediate and novice (P = .0004). Nonsurgeon assessors gave experts and intermediates significantly higher scores than novices (P = .0001). Surgeon assessors achieved good reliability for ring transfer (0.8252) and needle pass (0.7769) compared with nonsurgeon assessors who showed poor reliability for the ring transfer (0.3959) and moderate for the needle pass (0.6551). Conclusions: Expertise in performing these procedures is not a prerequisite for an assessor to evaluate the technical skill, hence assessors of skill acquisition can be nonexpert, a nonsurgeon, or even a child. The variability in all groups suggests that reliability overall is increased with multiple assessors. Although nonsurgeon assessors may be appropriate for formative assessments, they lack the reliability to provide assessment of competence for high stakes complex tasks. Summative assessment will likely require at least 1 surgeon/expert assessor to provide reliability.
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Affiliation(s)
- David Nair
- Canterbury District Health Board, Department of Paediatric Surgery, Christchurch, New Zealand
| | - Jonathan M Wells
- Canterbury District Health Board, Department of Paediatric Surgery, Christchurch, New Zealand.,University of Otago, Department of Surgery, Christchurch, New Zealand
| | - Ma Yi
- Canterbury District Health Board, Department of Biostatistics, Christchurch, New Zealand
| | - Spencer Beasley
- Canterbury District Health Board, Department of Paediatric Surgery, Christchurch, New Zealand.,University of Otago, Department of Surgery, Christchurch, New Zealand
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Does simulation improve clinical performance in management of postpartum hemorrhage? Am J Obstet Gynecol 2021; 225:435.e1-435.e8. [PMID: 34052191 DOI: 10.1016/j.ajog.2021.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although simulation is now widely used to improve teamwork and communication, data demonstrating improvement in clinical outcomes are limited. OBJECTIVE This study aimed to examine the clinical performance and outcomes associated with postpartum hemorrhage because of uterine atony following the implementation of a multidisciplinary simulation program. STUDY DESIGN This was a prospective observational study of response to postpartum hemorrhage because of uterine atony in an academic medical center before (epoch 1: July 2017-June 2018) and after (epoch 2: July 2019-June 2020) implementing a multidisciplinary simulation program. A total of 22 postpartum hemorrhage simulations were performed from July 2018 to June 2019 involving more than 300 nursing, obstetrical, and anesthesia providers. The simulation program focused on managing postpartum hemorrhage events and improving teamwork and communication of the multidisciplinary teams. To evaluate the clinical effectiveness of the simulation program, the primary outcome was response to postpartum hemorrhage defined as the time from the administration of uterotonic medications to transfusion of the first unit of blood in the first 12 hours following delivery, comparing epoch 2 to epoch 1 following the implementation of a simulation program. Statistical analysis included the use of the Pearson chi-square test, Wilcoxon rank-sum test, Hodges-Lehmann statistic for differences, and bootstrap methods with a P value of <.05 considered significant. RESULTS Between July 1, 2017, and June 30, 2018, there were 12,305 patients who delivered, of which 495 patients (4%) required transfusion. Between July 1, 2019, and June 30, 2020, there were 12,414 patients who delivered, of which 480 patients (4%) required transfusion. When isolating cases of postpartum hemorrhage because of uterine atony in both transfused groups, there were 157 women in the presimulation group (epoch 1) and 165 women in the postsimulation group (epoch 2), respectively. There was no difference in age, race, parity, or perinatal outcomes between the 2 epochs. Women in epoch 2 began receiving blood products significantly earlier in the first 12 hours following delivery compared with women in epoch 1 (51 [range, 28-125] minutes vs 102 [range, 32-320] minutes; P=.005). In addition, there was a significantly decreased variation in the time from the administration of uterotonic medications to transfusion of blood in epoch 2 (P=.035). Furthermore, women in epoch 2 had significantly lower estimated blood loss than women in epoch 1 (1250 [range, 1000-1750] mL vs 1500 [range, 1000-2000] mL; P=.032). CONCLUSION The implementation of a multidisciplinary simulation program at a large academic center focusing on the management of postpartum hemorrhage was associated with an improved clinical response. Specifically, there were significantly faster times from the administration of uterotonic medications to transfusion of blood, decreased variance in the time from the administration of uterotonic medications to transfusion of blood, and lower estimated blood loss following the implementation of a simulation program. Because delay in treatment is a major cause of preventable maternal death in obstetrical hemorrhage, the results in our study provided clinical evidence that a simulation program may improve patient outcomes in such emergencies.
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Aseni P, Santaniello T, Rizzetto F, Gentili L, Pezzotta F, Cavaliere F, Vertemati M, Milani P. Hybrid Additive Fabrication of a Transparent Liver with Biosimilar Haptic Response for Preoperative Planning. Diagnostics (Basel) 2021; 11:1734. [PMID: 34574075 PMCID: PMC8471167 DOI: 10.3390/diagnostics11091734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022] Open
Abstract
Due to the complexity of liver surgery, the interest in 3D printing is constantly increasing among hepatobiliary surgeons. The aim of this study was to produce a patient-specific transparent life-sized liver model with tissue-like haptic properties by combining additive manufacturing and 3D moulding. A multistep pipeline was adopted to obtain accurate 3D printable models. Semiautomatic segmentation and registration of routine medical imaging using 3D Slicer software allowed to obtain digital objects representing the structures of interest (liver parenchyma, vasculo-biliary branching, and intrahepatic lesion). The virtual models were used as the source data for a hybrid fabrication process based on additive manufacturing using soft resins and casting of tissue-mimicking silicone-based blend into 3D moulds. The model of the haptic liver reproduced with high fidelity the vasculo-biliary branching and the relationship with the intrahepatic lesion embedded into the transparent parenchyma. It offered high-quality haptic perception and a remarkable degree of surgical and anatomical information. Our 3D transparent model with haptic properties can help surgeons understand the spatial changes of intrahepatic structures during surgical manoeuvres, optimising preoperative surgical planning.
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Affiliation(s)
- Paolo Aseni
- Department of Emergency, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy;
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, Via Giovanni Battista Grassi 74, 20157 Milano, Italy
| | - Tommaso Santaniello
- Centro Interdisciplinare Materiali e Interfacce Nanostrutturati (CIMaINa), Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (T.S.); (L.G.); (F.P.); (F.C.)
- Dipartimento di Fisica “A. Pontremoli”, Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy
| | - Francesco Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy;
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Lorenzo Gentili
- Centro Interdisciplinare Materiali e Interfacce Nanostrutturati (CIMaINa), Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (T.S.); (L.G.); (F.P.); (F.C.)
- Dipartimento di Fisica “A. Pontremoli”, Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy
| | - Federico Pezzotta
- Centro Interdisciplinare Materiali e Interfacce Nanostrutturati (CIMaINa), Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (T.S.); (L.G.); (F.P.); (F.C.)
- Dipartimento di Fisica “A. Pontremoli”, Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy
| | - Francesco Cavaliere
- Centro Interdisciplinare Materiali e Interfacce Nanostrutturati (CIMaINa), Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (T.S.); (L.G.); (F.P.); (F.C.)
- Dipartimento di Fisica “A. Pontremoli”, Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, Via Giovanni Battista Grassi 74, 20157 Milano, Italy
- Centro Interdisciplinare Materiali e Interfacce Nanostrutturati (CIMaINa), Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (T.S.); (L.G.); (F.P.); (F.C.)
| | - Paolo Milani
- Centro Interdisciplinare Materiali e Interfacce Nanostrutturati (CIMaINa), Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy; (T.S.); (L.G.); (F.P.); (F.C.)
- Dipartimento di Fisica “A. Pontremoli”, Università degli Studi di Milano, Via Celoria 16, 20133 Milano, Italy
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Abstract
OBJECTIVE This systematic review aims to examine the use of standard-setting methods in the context of simulation-based training of surgical procedures. SUMMARY OF BACKGROUND Simulation-based training is increasingly used in surgical education. However, it is important to determine which level of competency trainees must reach during simulation-based training before operating on patients. Therefore, pass/fail standards must be established using systematic, transparent, and valid methods. METHODS Systematic literature search was done in four databases (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library). Original studies investigating simulation-based assessment of surgical procedures with application of a standard setting were included. Quality of evidence was appraised using GRADE. RESULTS Of 24,299 studies identified by searches, 232 studies met the inclusion criteria. Publications using already established standard settings were excluded (N = 70), resulting in 162 original studies included in the final analyses. Most studies described how the standard setting was determined (N = 147, 91%) and most used the mean or median performance score of experienced surgeons (n = 65, 40%) for standard setting. We found considerable differences across most of the studies regarding study design, set-up, and expert level classification. The studies were appraised as having low and moderate evidence. CONCLUSION Surgical education is shifting towards competency-based education, and simulation-based training is increasingly used for acquiring skills and assessment. Most studies consider and describe how standard settings are established using more or less structured methods but for current and future educational programs, a critical approach is needed so that the learners receive a fair, valid and reliable assessment.
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Gaba F, Blyuss O, Rodriguez I, Dilley J, Wan YLL, Saiz A, Razumova Z, Zalewski K, Nikolova T, Selcuk I, Bizzarri N, Theofanakis C, Lanner M, Pletnev A, Gurumurthy M, Manchanda R. Impact of SARS-CoV-2 on training and mental well-being of surgical gynecological oncology trainees. Int J Gynecol Cancer 2021; 31:1268-1277. [PMID: 34326158 DOI: 10.1136/ijgc-2021-002803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The SARS-CoV-2 global pandemic has caused a crisis disrupting health systems worldwide. While efforts are being made to determine the extent of the disruption, the impact on gynecological oncology trainees/training has not been explored. We conducted an international survey of the impact of SARS-CoV-2 on clinical practice, medical education, and mental well-being of surgical gynecological oncology trainees. METHODS In our cross-sectional study, a customized web-based survey was circulated to surgical gynecological oncology trainees from national/international organizations from May to November 2020. Validated questionnaires assessed mental well-being. The Wilcoxon rank-sum test and Fisher's exact test were used to analyse differences in means and proportions. Multiple linear regression was used to evaluate the effect of variables on psychological/mental well-being outcomes. Outcomes included clinical practice, medical education, anxiety and depression, distress, and mental well-being. RESULTS A total of 127 trainees from 34 countries responded. Of these, 52% (66/127) were from countries with national training programs (UK/USA/Netherlands/Canada/Australia) and 48% (61/127) from countries with no national training programs. Altogether, 28% (35/125) had suspected/confirmed COVID-19, 28% (35/125) experienced a fall in household income, 20% (18/90) were self-isolated from households, 45% (57/126) had to re-use personal protective equipment, and 22% (28/126) purchased their own. In total, 32.3% (41/127) of trainees (16.6% (11/66) from countries with a national training program vs 49.1% (30/61) from countries with no national training program, p=0.02) perceived they would require additional time to complete their training fellowship. The additional training time anticipated did not differ between trainees from countries with or without national training programs (p=0.11) or trainees at the beginning or end of their fellowship (p=0.12). Surgical exposure was reduced for 50% of trainees. Departmental teaching continued throughout the pandemic for 69% (87/126) of trainees, although at reduced frequency for 16.1% (14/87), and virtually for 88.5% (77/87). Trainees reporting adequate pastoral support (defined as allocation of a dedicated mentor/access to occupational health support services) had better mental well-being with lower levels of anxiety/depression (p=0.02) and distress (p<0.001). Trainees from countries with a national training program experienced higher levels of distress (p=0.01). Mean (SD) pre-pandemic mental well-being scores were significantly higher than post-pandemic scores (8.3 (1.6) vs 7 (1.8); p<0.01). CONCLUSION SARS-CoV-2 has negatively impacted the surgical training, household income, and psychological/mental well-being of surgical gynecological oncology trainees. The overall clinical impact was worse for trainees in countries with no national training program than for those in countries with a national training program, although national training program trainees reported greater distress. COVID-19 sickness increased anxiety/depression. The recovery phase must focus on improving mental well-being and addressing lost training opportunities.
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Affiliation(s)
- Faiza Gaba
- Department of Gynaecological Oncology, NHS Grampian, Aberdeen, UK .,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Oleg Blyuss
- Department of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield, UK.,Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov University, Moskva, Russian Federation
| | - Isabel Rodriguez
- Department of Gynecologic Oncology, University of Washington, Seattle, Washington, USA
| | - James Dilley
- Department of Gynaecological Oncology, Barts and The London NHS Trust, London, UK
| | - Yee-Loi Louise Wan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Allison Saiz
- Department of Gynecologic Oncology, Northwestern University in Chicago, Chicago, Illinois, USA
| | - Zoia Razumova
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Kamil Zalewski
- Department of Gynecologic Oncology, Świętokrzyskie Cancer Centre, Kielce, Poland
| | - Tanja Nikolova
- Department of Gynecologic Oncology, Academic Teaching Hospital of Heidelberg University, Baden-Baden, Germany
| | - Ilker Selcuk
- Department of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Charalampos Theofanakis
- Department of Gynaecological Oncology, General Hospital of Athens Alexandra, Athens, Attica, Greece
| | - Maximilian Lanner
- Department of Obstetrics/Gynaecology, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
| | - Andrei Pletnev
- Department of Gynecology and Obstetrics, University of Zielona Góra, Zielona Góra, Poland
| | | | - Ranjit Manchanda
- Department of Gynaecological Oncology, Barts and The London NHS Trust, London, UK .,Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK
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Moran K, Rotenberg C, AlHussain A, Reda B, Gordey E, Wong I. Mixed-Methods Analysis of a Validated Arthroscopic Knot-Tying Simulator With New Indirect Visualization Condition. Orthop J Sports Med 2021; 9:23259671211013815. [PMID: 34368379 PMCID: PMC8312180 DOI: 10.1177/23259671211013815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Simulation provides low-risk opportunities for surgical trainees to learn and practice fundamental skills. One simulation tool for orthopaedics is the Arthroscopic Knot (ArK) Trainer, which has been validated as an effective simulation tool across multiple methodologies. Previous studies have investigated the ArK Trainer in its basic form using clear plexiglass, which allows direct visualization of tissue anchors. Purpose: Using a mixed-methods approach, we assessed and compared junior and senior trainees’ Seoul Medical Center (SMC) knot–tying performance under direct and indirect visualization. Study Design: Cross-sectional study. Methods: Fourteen orthopaedic surgery postgraduate trainees at a single medical school were recruited to participate. Trainees tied SMC knots using the Ark Trainer under direct and indirect visualization. A mixed-methods approach was used to evaluate knot-tying proficiency and characterize participants’ approach to knot-tying. Knot-tying proficiency was evaluated using validated tools: a task-specific checklist (TSC), a global rating scale (GRS), and a proficiency scale (PS). Participants’ approach to knot-tying was characterized using Likert-type questionnaires and semistructured interviews. An α level of .10 was set a priori owing to the small pool of trainees. Results: The 14 participants included 7 junior residents (postgraduate years [PGYs] 1 and 2) and 7 senior residents (PGY ≥3), of whom 3 were fellows (PGY 6). Senior trainees outperformed junior trainees on both versions of the ArK Trainer: clear (GRS, P = .055; PS, P = .075) and covered (TSC, P = .05). Overall, participants performed better under direct visualization conditions (GRS, P = .05). In semistructured interviews, significantly more senior trainees discussed relying on haptic cues while tying knots under direct visualization (P = .021). The majority of trainees agreed that both versions of the ArK Trainer were realistic and appropriate practice formats for their level of training. Conclusion: Senior trainees were significantly more experienced than were junior trainees in arthroscopic skill and outperformed them on both configurations: direct (PS and GRS) and indirect (TSC) visualization. Experienced trainees were significantly more likely to report using tactile cues to aid knot-tying under indirect visualization. It is likely that inexperienced trainees rely more heavily on direct visualization and that the use of tactile cues may be an indicator of knot-tying proficiency. Trainees recommended progression from direct to indirect visualization configurations for inexperienced learners.
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Affiliation(s)
- Kit Moran
- Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carolyn Rotenberg
- Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ahmed AlHussain
- Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bashar Reda
- Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Erin Gordey
- Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Division of Orthopaedic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Salomao D, Wu RI, Hatlak K, Khanafshar E, Monaco SE. Fine-needle aspiration performance during cytopathology fellowship: what do the ACGME case logs show us? J Am Soc Cytopathol 2021; 10:504-509. [PMID: 34229981 DOI: 10.1016/j.jasc.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Cytopathology fellows are required to enter their fine-needle aspiration (FNA) case numbers in an online data collection system, the Accreditation Council for Graduate Medical Education (ACGME) Case Log system. This study reviewed this data to examine trends in FNA case numbers during fellowship training. METHODS A retrospective review of the ACGME Accreditation Data System (ADS) FNA Case Log data was performed for academic years 2006-2019. For 2006-2016, total and average numbers of FNAs performed per academic year were available. After 2016, data also included the number of programs and trainees, national averages, standard deviation, minimum, median, maximum, and percentiles for the number of FNAs performed. RESULTS The number of FNAs documented by cytopathology fellows has gradually increased from 2006 (average 10.9) to 2013 (average 18.6) and dramatically increased in 2014 (average 38.0). Averages have remained greater than 30 FNAs documented per academic year since 2014, with some variation. However, a decline was observed in 2019, likely due to the COVID-19 pandemic. CONCLUSIONS FNA procedures reported in the ACGME Case Log System indicate vast differences in cytopathology fellowship educational experiences and settings. After logging FNAs becoming an ACGME requirement in 2013, the average number of FNAs has been greater than 30 per year and provides some guidance for programs with respect to the number of FNAs being reported by cytopathology fellows nationally.
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Affiliation(s)
- Diva Salomao
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
| | - Roseann I Wu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kate Hatlak
- Review Committees for Medical Genetics and Genomics, Pathology, and Preventive Medicine, Accreditation Council for Graduate Medical Education, Chicago, Illinois
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Rajgor HD, Rajgor AD, Sidhu MS, Khan SA, Hossain F, Moores TS. Is Surgical Training Prepared for the "Second Wave" of COVID-19? A Collaborative Perspective. ANNALS OF SURGERY OPEN 2021; 2:e045. [PMID: 37638235 PMCID: PMC10455365 DOI: 10.1097/as9.0000000000000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022] Open
Abstract
Restructuring of surgical services during the 'first wave' of the coronavirus-disease 2019 pandemic led to significant disruption in surgical learning opportunities provided to junior surgeons. Recent challenges faced by trainees have never been faced before. These include disruption to surgical opportunities available, completing assessments and attending educational events. With a 'second wave' now upon the United Kingdom it is vitally important we reflect upon the 'first wave' to ensure junior surgeons are able to achieve appropriate surgical case numbers, complete assessments and progress to the next stage of training. Alternate assessment methods in the United Kingdom need to be considered should the pandemic continue and clear information should be provided to surgical trainees regarding career progression. These are difficult times for surgical training and we need to endeavor that trainees are provided with opportunities similar to their predecessors albeit in difficult circumstances. This is to ensure the future standard of surgical patient care remains of the highest standard.
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Affiliation(s)
| | - Amarkumar Dhirajlal Rajgor
- Department of ENT, National Institute for Health Research Academic Clinical Fellow in Otolaryngology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Manpreet Singh Sidhu
- From the Department of Orthopaedics, Walsall Manor Hospital, Walsall, United Kingdom
| | - Shehzaad Aziz Khan
- Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Fahad Hossain
- From the Department of Orthopaedics, Walsall Manor Hospital, Walsall, United Kingdom
| | - Thomas Steven Moores
- From the Department of Orthopaedics, Walsall Manor Hospital, Walsall, United Kingdom
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Affiliation(s)
- Faiz Tuma
- Department of Surgery, 26588Central Michigan University College of Medicine, Saginaw, MI, USA
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Aspari AR, Ramesh V, Lakshman K. An Indigenous Virtual Reality-Based Simulator—a Tool in Surgical Training. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02347-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Fekri P, Dargahi J, Zadeh M. Deep Learning-Based Haptic Guidance for Surgical Skills Transfer. Front Robot AI 2021; 7:586707. [PMID: 33553246 PMCID: PMC7854567 DOI: 10.3389/frobt.2020.586707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
Having a trusted and useful system that helps to diminish the risk of medical errors and facilitate the improvement of quality in the medical education is indispensable. Thousands of surgical errors are occurred annually with high adverse event rate, despite inordinate number of devised patients safety initiatives. Inadvertently or otherwise, surgeons play a critical role in the aforementioned errors. Training surgeons is one of the most crucial and delicate parts of medical education and needs more attention due to its practical intrinsic. In contrast to engineering, dealing with mortal alive creatures provides a minuscule chance of trial and error for trainees. Training in operative rooms, on the other hand, is extremely expensive in terms of not only equipment but also hiring professional trainers. In addition, the COVID-19 pandemic has caused to establish initiatives such as social distancing in order to mitigate the rate of outbreak. This leads surgeons to postpone some non-urgent surgeries or operate with restrictions in terms of safety. Subsequently, educational systems are affected by the limitations due to the pandemic. Skill transfer systems in cooperation with a virtual training environment is thought as a solution to address aforesaid issues. This enables not only novice surgeons to enrich their proficiency but also helps expert surgeons to be supervised during the operation. This paper focuses on devising a solution based on deep leaning algorithms to model the behavior of experts during the operation. In other words, the proposed solution is a skill transfer method that learns professional demonstrations using different effective factors from the body of experts. The trained model then provides a real-time haptic guidance signal for either instructing trainees or supervising expert surgeons. A simulation is utilized to emulate an operating room for femur drilling surgery, which is a common invasive treatment for osteoporosis. This helps us with both collecting the essential data and assessing the obtained models. Experimental results show that the proposed method is capable of emitting guidance force haptic signal with an acceptable error rate.
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Affiliation(s)
- Pedram Fekri
- Mehchanical, Industrial, and Aerospace Engineering Department, Concordia University, Montreal, QC, Canada
| | - Javad Dargahi
- Mehchanical, Industrial, and Aerospace Engineering Department, Concordia University, Montreal, QC, Canada
| | - Mehrdad Zadeh
- Electrical and Computer Engineering Department, Kettering University, Flint, MI, United States
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Mak ST, Lam CW, Ng DSC, Chong KKL, Yuen HKL. Oculoplastic surgical simulation using goat sockets. Orbit 2021; 41:292-296. [PMID: 33427549 DOI: 10.1080/01676830.2021.1872091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To describe a reproducible and easily available goat socket model for training of various oculoplastic operations, and to evaluate trainees' perception of this training model in terms of their learning progress and satisfaction.Methods: Goat sockets including orbital rim and eye with eyelids were harvested in form of a split-head model. Ophthalmology residents underwent individual surgical training using the goat socket model, supervised by an oculoplastic attending. Participants completed a questionnaire in form of a 5-point Likert Scale to evaluate their learning progress and satisfaction.Outcome Measures: Types of oculoplastic operations performed using the goat socket models, and participants' rating of their learning progress and satisfaction were reported.Results: A wide range of oculoplastic operations including both eyelid and orbital operations could be simulated because of similarities of the goat eye model to the human eye anatomy. Fifteen ophthalmic trainees participated in surgical training using the goat eye model. All (100%) participants agreed that surgical simulation using the goat socket model increased their skills in surgical instrumentation and carrying out surgical steps, and their confidence in operating on patients. Most (87%) agreed the model resembled reasonably well compared to surgeries in human, and 93% would recommend training with the model to fellow resident ophthalmologists before operating on human patients.Conclusions: Oculoplastic surgical training using goat sockets is simple, readily available, and inexpensive. Trainee users showed promising feedback and positive learning progress using the goat socket model.
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Affiliation(s)
- Shiu Ting Mak
- Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong.,Quality and Safety Office, Kowloon East Cluster, Hospital Authority, Kowloon, Hong Kong
| | - Chun Wah Lam
- Hong Kong Eye Hospital, Kowloon, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Danny S C Ng
- Hong Kong Eye Hospital, Kowloon, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Kelvin K L Chong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, New Territories, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, New Territories, Hong Kong
| | - Hunter K L Yuen
- Hong Kong Eye Hospital, Kowloon, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, New Territories, Hong Kong
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Castillo-Segura P, Fernández-Panadero C, Alario-Hoyos C, Muñoz-Merino PJ, Delgado Kloos C. Objective and automated assessment of surgical technical skills with IoT systems: A systematic literature review. Artif Intell Med 2021; 112:102007. [PMID: 33581827 DOI: 10.1016/j.artmed.2020.102007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/25/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022]
Abstract
The assessment of surgical technical skills to be acquired by novice surgeons has been traditionally done by an expert surgeon and is therefore of a subjective nature. Nevertheless, the recent advances on IoT (Internet of Things), the possibility of incorporating sensors into objects and environments in order to collect large amounts of data, and the progress on machine learning are facilitating a more objective and automated assessment of surgical technical skills. This paper presents a systematic literature review of papers published after 2013 discussing the objective and automated assessment of surgical technical skills. 101 out of an initial list of 537 papers were analyzed to identify: 1) the sensors used; 2) the data collected by these sensors and the relationship between these data, surgical technical skills and surgeons' levels of expertise; 3) the statistical methods and algorithms used to process these data; and 4) the feedback provided based on the outputs of these statistical methods and algorithms. Particularly, 1) mechanical and electromagnetic sensors are widely used for tool tracking, while inertial measurement units are widely used for body tracking; 2) path length, number of sub-movements, smoothness, fixation, saccade and total time are the main indicators obtained from raw data and serve to assess surgical technical skills such as economy, efficiency, hand tremor, or mind control, and distinguish between two or three levels of expertise (novice/intermediate/advanced surgeons); 3) SVM (Support Vector Machines) and Neural Networks are the preferred statistical methods and algorithms for processing the data collected, while new opportunities are opened up to combine various algorithms and use deep learning; and 4) feedback is provided by matching performance indicators and a lexicon of words and visualizations, although there is considerable room for research in the context of feedback and visualizations, taking, for example, ideas from learning analytics.
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Affiliation(s)
- Pablo Castillo-Segura
- Universidad Carlos III de Madrid, Av. Universidad 30, 28911, Leganés, Madrid, Spain.
| | | | - Carlos Alario-Hoyos
- Universidad Carlos III de Madrid, Av. Universidad 30, 28911, Leganés, Madrid, Spain.
| | - Pedro J Muñoz-Merino
- Universidad Carlos III de Madrid, Av. Universidad 30, 28911, Leganés, Madrid, Spain.
| | - Carlos Delgado Kloos
- Universidad Carlos III de Madrid, Av. Universidad 30, 28911, Leganés, Madrid, Spain.
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Dillon SJ, Kleinmann W, Seasely A, Ames R, Dyess-Nugent P, McIntire DD, Suen E, Nelson DB. How personality affects teamwork: a study in multidisciplinary obstetrical simulation. Am J Obstet Gynecol MFM 2020; 3:100303. [PMID: 33383231 DOI: 10.1016/j.ajogmf.2020.100303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multidisciplinary simulation has been shown to improve teamwork in the obstetrical literature by providing a safe, but realistic, environment for participants to learn. However, the impact of team members' personality traits on how the team performs during an obstetrical emergency has not been studied in medicine. OBJECTIVE Our objective was to evaluate teamwork and communication of simulation participants in association with personality traits within a multidisciplinary obstetrical simulation program. STUDY DESIGN This was a prospective observational study of postpartum hemorrhage simulations involving participants from Obstetrics, Nursing, Midwifery, and Anesthesia. Before simulation, individual personality testing was performed on participants using the Big Five Inventory. Each team was scored using the Clinical Teamwork Scale after simulation. Communication and teamwork scores were evaluated for association, and personality traits were analyzed for association with teamwork and communication. For each personality trait, an interaction model was tested for 3 of the team scores: teamwork, communication, and situational awareness. Analysis of variance with 2 level interactions was used in this effort. RESULTS From July 2018 to June 2019, 22 obstetrical simulations were performed with a total of 270 staff. Overall, teamwork was significantly associated with communication for each team. When examining individual personality scores, neuroticism was negatively associated with teamwork when coupled with communication. That is, increased neuroticism was significantly associated with increased communication that was detrimental to the overall teamwork. Other personality traits were not significantly associated with teamwork and communication (P=.03). CONCLUSION In a multidisciplinary simulation, communication was positively associated with teamwork, and specific personality traits negatively affected team performance.
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Affiliation(s)
- Shena J Dillon
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Whitney Kleinmann
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Angela Seasely
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rebecca Ames
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Phyllis Dyess-Nugent
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Donald D McIntire
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ellen Suen
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - David B Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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Beeharry MW, Moqeem K. The London Major Trauma Network System: A Literature Review. Cureus 2020; 12:e12000. [PMID: 33324530 PMCID: PMC7732139 DOI: 10.7759/cureus.12000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Trauma is one of the leading causes of death and disability worldwide and is a major global public health problem. The provision of trauma care has been substandard in England and Wales prior to the implementation of an inclusive major trauma network system in London in 2010 and subsequently across the rest of England two years later. The implementation of the London trauma system has brought about improvements to the delivery of trauma care by decreasing the overall morbidity and mortality significantly. This framework encompasses the collaboration of emergency services, designated Major Trauma Centres (MTCs), Trauma Units (TUs) and community providers which have been optimized with the expertise and resources to provide the best outcomes for major trauma patients. Specific triage protocols, consultant-led trauma service and on-the-spot access to radiology services and operating theatres have played a pivotal role in the improvement of trauma care. In spite of several strengths, however, the London major trauma network system is by no means without its limitations. The emergence of the new coronavirus disease 2019 (COVID-19) pandemic has created major barriers to the smooth running of trauma services by exhausting resources due to infection control measures, reduced theatre space and re-deployment of medical staffs. In addition, the cancellation of elective surgeries has impacted directly on the training of surgical trainees by leaving them with significantly reduced surgical exposure. As a results of this ever changing surgical landscape, a need to urgently review these traditional surgical training methods with a view to modernize the curriculum. Although the London trauma system has evolved significantly since its implementation, its limitations should be recognized and addressed to enhance performance and improve patient outcomes.
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Affiliation(s)
| | - Komal Moqeem
- Internal Medicine, Royal Surrey County Hospital, Guildford, GBR
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Melkonian V, Huy T, Varma CR, Nazzal M, Randall HB, Nguyen MTJ. The Creation of a Novel Low-Cost Bench-Top Kidney Transplant Surgery Simulator and a Survey on Its Fidelity and Educational Utility. Cureus 2020; 12:e11427. [PMID: 33312823 PMCID: PMC7727770 DOI: 10.7759/cureus.11427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Resident inexperience during time-sensitive vascular anastomoses of a kidney transplant can negatively impact outcomes. In light of this, we created a low-cost bench-top kidney transplant surgery simulator to help residents practice vascular anastomoses. Methods We searched for inexpensive materials to design an iliac fossa and kidney allograft. Eighteen residents with real-life kidney transplant experience trialed the simulator and scored its fidelity and educational utility on a 0-100 visual analog scale (VAS) survey. Results A 35.9 x 19.4 x 12.4 cm plastic box mimicked the iliac fossa. Hooks attached to the box's sidewall held under tension 1.27 and 0.64 cm diameter Penrose drains to replicate the external iliac vein and artery. A modified kidney-shaped stress ball with 1.27 x 4, 0.64 x 4, and 0.64 x 15 cm Penrose drains replicated a kidney allograft with its vein, artery, and ureter, respectively. Residents performed and assisted in vascular anastomoses on the simulator. The iliac fossa and allograft cost $20.20 and each practice run cost $7.20. Residents thought that the simulator was less difficult than real-life procedure, had acceptable fidelity levels, and they highly rated its educational utility. Conclusion Our novel low-cost bench-top kidney transplant surgery simulator focusing on vascular anastomoses received positive educational feedback from residents.
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Affiliation(s)
- Vatche Melkonian
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Tess Huy
- Surgery, University of California Los Angeles, Los Angeles, USA
| | - Chintalapati R Varma
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Mustafa Nazzal
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Henry B Randall
- Surgery, Abdominal Transplant Center, Saint Louis University Hospital, St. Louis, USA
| | - Minh-Tri J Nguyen
- Transplant Surgery, Transplant Institute, Loma Linda University Medical Center, Loma Linda, USA
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Al-Sharshahi ZF, Hoz SS, Alrawi MA, Sabah MA, Albanaa SA, Moscote-Salazar LR. The use of non-living animals as simulation models for cranial neurosurgical procedures: a literature review. Chin Neurosurg J 2020; 6:24. [PMID: 32922953 PMCID: PMC7398263 DOI: 10.1186/s41016-020-00203-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/23/2020] [Indexed: 11/15/2022] Open
Abstract
Simulation plays a pivotal role in neurosurgical training by allowing trainees to develop the requisite expertise to enhance patient safety. Several models have been used for simulation purposes. Non-living animal models offer a range of benefits, including affordability, availability, biological texture, and a comparable similarity to human anatomy. In this paper, we review the available literature on the use of non-living animals in neurosurgical simulation training. We aim to answer the following questions: (1) what animals have been used so far, (2) what neurosurgical approaches have been simulated, (3) what were the trainee tasks, and (4) what was the experience of the authors with these models. A search of the PubMed Medline database was performed to identify studies that examined the use of non-living animals in cranial neurosurgical simulation between 1990 and 2020. Our initial search yielded a total of 70 results. After careful screening, we included 22 articles for qualitative analysis. We compared the reports in terms of the (1) animal used, (2) type of surgery, and (3) trainee tasks. All articles were published between 2003 and 2019. These simulations were performed on three types of animals, namely sheep, cow, and swine. All authors designed specific, task-oriented approaches and concluded that the models used were adequate for replicating the surgical approaches. Simulation on non-living animal heads has recently gained popularity in the field of neurosurgical training. Non-living animal models are an increasingly attractive option for cranial neurosurgical simulation training. These models enable the acquisition and refinement of surgical skills, with the added benefits of accessibility and cost-effectiveness. To date, 16 different microneurosurgical cranial approaches have been replicated on three non-living animal models, including sheep, cows, and swine. This review summarizes the experience reported with the use of non-living animal models as alternative laboratory tools for cranial neurosurgical training, with particular attention to the set of tasks that could be performed on them.
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Affiliation(s)
| | - Samer S Hoz
- Department of Neurosurgery, Neurosurgery teaching Hospital, Baghdad, Iraq
| | - Mohammed A Alrawi
- Department of Neurosurgery, Neurosurgery teaching Hospital, Baghdad, Iraq
| | - Mohammed A Sabah
- Department of Neurosurgery, Neurosurgery teaching Hospital, Baghdad, Iraq
| | - Saja A Albanaa
- College of Medicine, University of Baghdad, Baghdad, Iraq
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