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Western LF, Roberts PG, Rees J, Howgate D. Construct validation of a novel synthetic tendon model used for assessing surgeon performance in a simulated core suture tendon repair technique. J Plast Reconstr Aesthet Surg 2024; 92:111-117. [PMID: 38518623 DOI: 10.1016/j.bjps.2024.02.057] [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: 10/22/2023] [Revised: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND The strength of tendon repair is dependent on the quality of the core suture. Organic and synthetic materials have been used to simulate tendon repair for training; however, no model has undergone construct validation. OBJECTIVES To determine the construct validity of a novel synthetic tendon repair model. METHODS Synthetic silicone tendon models were used to simulate adult Achilles tendon (AT) and digital flexor tendon (FT). Participants were categorised into novice, intermediate, and advanced groups based on prior surgical experience. Participants repaired tendons using the modified Kessler technique. A validated motion analysis system was used to measure the duration, path length, and movement count during the simulated task. A global rating score was also used to assess the performance. RESULTS All participants in the novice (n = 12), intermediate (n = 8) and advanced (n = 11) groups completed the tasks. The results (mean±standard deviation) were duration (872 ± 335, 492 ± 257 and 357 ± 40 s), path length (9493 ± 3173, 6668 ± 1740 and 4672 ± 1228 cm), movement count (4974 ± 673, 4228 ± 259 and 3962 ± 69) and global rating (39 ± 13, 61 ± 14, 81 ± 5), respectively. The Kruskal-Wallis test was significant for all outcome measures (p < 0.01). Significant differences in duration and movement count were identified post-hoc in the AT model for each experience group (p < 0.05), and between novice and intermediate participants for FT repair (p < 0.04). Global rating was significantly different between all groups and was highly correlated with motion metrics (p < 0.01). CONCLUSION The results support construct validity of this novel simulated tendon repair model. The global rating scores may allow wide utility of this simulation. This model provides a valid and safe environment for surgical trainees to practice tendon repair with several cost, ethical and logistical benefits over animal tendon use. 248/250.
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Affiliation(s)
- Luke F Western
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, England, UK.
| | - Patrick G Roberts
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, England, UK
| | - Jonathan Rees
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, England, UK
| | - Daniel Howgate
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, England, UK
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Ryan JF, Engels PT, Vogt KN, Minor S, Mador BD. Redefining Trauma Training in Canada: A National Delphi Study on Curriculum, Educational Resources, and Training Initiatives. JOURNAL OF SURGICAL EDUCATION 2024; 81:431-437. [PMID: 38281862 DOI: 10.1016/j.jsurg.2023.12.006] [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: 06/11/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE This study aims to develop a set of curriculum recommendations to support trauma training in Canadian general surgery residency programs. DESIGN A modified Delphi study was conducted with a panel of trauma and surgical education experts. Proposed curriculum components were developed from Canadian trauma surgery exposure and educational needs assessment data. Panelists were asked to rate each potential curriculum component for inclusion (mandatory or exemplary) or exclusion in the ideal and feasible trauma training curriculum. SETTING This national Delphi study was conducted in the Canadian trauma education context. PARTICIPANTS A panel of trauma experts and surgeons holding leadership positions in training programs and professional societies across Canada were invited to participate. RESULTS Nineteen panelists representing all geographic regions of Canada achieved consensus on a set of curriculum components. The panel was largely in agreement with the RCPSC trauma competencies. At the end of the study, 71 items were considered mandatory for all programs (such as dedicated trauma rotations, trauma resuscitation and operative skills courses, structured trauma teaching within academic half day, and simulation experiences), and 21 items were considered exemplary (such as program funding for trauma courses, and opportunities to participate in trauma research and quality improvement projects). CONCLUSIONS This study suggests a framework of education components for curricular reform for trauma training in Canadian general surgery residency programs. Such recommendations include rotations, formal courses and certifications, education resources, and simulation experiences to supplement limited clinical exposure.
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Affiliation(s)
- Joanna F Ryan
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Paul T Engels
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kelly N Vogt
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Samuel Minor
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brett D Mador
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Pakkasjärvi N, Anttila H, Pyhältö K. What are the learning objectives in surgical training - a systematic literature review of the surgical competence framework. BMC MEDICAL EDUCATION 2024; 24:119. [PMID: 38321437 PMCID: PMC10848354 DOI: 10.1186/s12909-024-05068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To map the landscape of contemporary surgical education through a competence framework by conducting a systematic literature review on learning outcomes of surgical education and the instructional methods applied to attain the outcomes. BACKGROUND Surgical education has seen a paradigm shift towards competence-based training. However, a gap remains in the literature regarding the specific components of competency taught and the instructional methods employed to achieve these outcomes. This paper aims to bridge this gap by conducting a systematic review on the learning outcomes of surgical education within a competence framework and the instructional methods applied. The primary outcome measure was to elucidate the components of competency emphasized by modern surgical curricula. The secondary outcome measure was to discern the instructional methods proven effective in achieving these competencies. METHODS A search was conducted across PubMed, Medline, ProQuest Eric, and Cochrane databases, adhering to PRISMA guidelines, limited to 2017-2021. Keywords included terms related to surgical education and training. Inclusion criteria mandated original empirical studies that described learning outcomes and methods, and targeted both medical students and surgical residents. RESULTS Out of 42 studies involving 2097 participants, most concentrated on technical skills within competency-based training, with a lesser emphasis on non-technical competencies. The effect on clinical outcomes was infrequently explored. CONCLUSION The shift towards competency in surgical training is evident. However, further studies on its ramifications on clinical outcomes are needed. The transition from technical to clinical competence and the creation of validated assessments are crucial for establishing a foundation for lifelong surgical learning.
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Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
- Department of Pediatric Surgery, Section of Urology, University Children's Hospital, Uppsala, Sweden.
| | - Henrika Anttila
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Kirsi Pyhältö
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
- Centre for Higher and Adult Education, Faculty of Education, Stellenbosch University, Stellenbosch, South Africa
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Andriollo L, Picchi A, Sangaletti R, Perticarini L, Rossi SMP, Logroscino G, Benazzo F. The Role of Artificial Intelligence in Anterior Cruciate Ligament Injuries: Current Concepts and Future Perspectives. Healthcare (Basel) 2024; 12:300. [PMID: 38338185 PMCID: PMC10855330 DOI: 10.3390/healthcare12030300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The remarkable progress in data aggregation and deep learning algorithms has positioned artificial intelligence (AI) and machine learning (ML) to revolutionize the field of medicine. AI is becoming more and more prevalent in the healthcare sector, and its impact on orthopedic surgery is already evident in several fields. This review aims to examine the literature that explores the comprehensive clinical relevance of AI-based tools utilized before, during, and after anterior cruciate ligament (ACL) reconstruction. The review focuses on current clinical applications and future prospects in preoperative management, encompassing risk prediction and diagnostics; intraoperative tools, specifically navigation, identifying complex anatomic landmarks during surgery; and postoperative applications in terms of postoperative care and rehabilitation. Additionally, AI tools in educational and training settings are presented. Orthopedic surgeons are showing a growing interest in AI, as evidenced by the applications discussed in this review, particularly those related to ACL injury. The exponential increase in studies on AI tools applicable to the management of ACL tears promises a significant future impact in its clinical application, with growing attention from orthopedic surgeons.
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Affiliation(s)
- Luca Andriollo
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (R.S.); (L.P.); (S.M.P.R.); (F.B.)
- Department of Orthopedics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Aurelio Picchi
- Unit of Orthopedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.P.); (G.L.)
| | - Rudy Sangaletti
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (R.S.); (L.P.); (S.M.P.R.); (F.B.)
| | - Loris Perticarini
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (R.S.); (L.P.); (S.M.P.R.); (F.B.)
| | - Stefano Marco Paolo Rossi
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (R.S.); (L.P.); (S.M.P.R.); (F.B.)
| | - Giandomenico Logroscino
- Unit of Orthopedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.P.); (G.L.)
| | - Francesco Benazzo
- Robotic Prosthetic Surgery Unit—Sports Traumatology Unit, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy; (R.S.); (L.P.); (S.M.P.R.); (F.B.)
- Biomedical Sciences Area, IUSS University School for Advanced Studies, 27100 Pavia, Italy
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Liu S, Li YY, Li D, Wang FY, Fan LJ, Zhou LX. Advances in objective assessment of ergonomics in endoscopic surgery: a review. Front Public Health 2024; 11:1281194. [PMID: 38249363 PMCID: PMC10796503 DOI: 10.3389/fpubh.2023.1281194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Background Minimally invasive surgery, in particular endoscopic surgery, has revolutionized the benefits for patients, but poses greater challenges for surgeons in terms of ergonomics. Integrating ergonomic assessments and interventions into the multi-stage endoscopic procedure contributes to the surgeon's musculoskeletal health and the patient's intraoperative safety and postoperative recovery. Objective The purpose of this study was to overview the objective assessment techniques, tools and assessment settings involved in endoscopic procedures over the past decade and to identify the potential factors that induce differences in high workloads in endoscopic procedures and ultimately to design a framework for ergonomic assessment in endoscopic surgery. Methods Literature searches were systematically conducted in the OVID, pubmed and web of science database before October 2022, and studies evaluating ergonomics during the process of endoscopic procedures or simulated procedures were both recognized. Results Our systematic review of 56 studies underscores ergonomic variations in endoscopic surgery. While endoscopic procedures, predominantly laparoscopy, typically incur less physical load than open surgery, extended surgical durations notably elevate ergonomic risks. Surgeon characteristics, such as experience level and gender, significantly influence these risks, with less experienced and female surgeons facing greater challenges. Key assessment tools employed include electromyography for muscle fatigue and motion analysis for postural evaluation. Conclusion This review aims to provide a comprehensive analysis and framework of objective ergonomic assessments in endoscopic surgery, and suggesting avenues for future research and intervention strategies. By improving the ergonomic conditions for surgeons, we can enhance their overall health, mitigate the risk of WMSDs, and ultimately improve patient outcomes.
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Affiliation(s)
- Shuang Liu
- Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Yuan-you Li
- Department of neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Dan Li
- College of Computer Science, Sichuan University, Chengdu, China
| | - Feng-Yi Wang
- School of Communication and Information Engineering, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Ling-Jie Fan
- Department of rehabilitation medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Liang-xue Zhou
- Department of neurosurgery, West China Hospital of Sichuan University, Chengdu, China
- The Fifth People’s hospital of Ningxia, Ningxia, China
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Jalolova M, Jankovic D, Sasaki K, Tanaka R, Kato Y. Simulation-Based Bypass Training and Learning Curves-Resident Experience. Asian J Neurosurg 2023; 18:773-776. [PMID: 38161618 PMCID: PMC10756769 DOI: 10.1055/s-0043-1775859] [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] [Indexed: 01/03/2024] Open
Abstract
Introduction Bypass surgery is a challenging operative procedure that requires surgical excellence. Achieving the skills required for vascular surgery is difficult to master in the operating room without intensive microsurgical training. Various models have been developed to provide training to young neurosurgeons and increase dexterity and patient safety. Bypass surgery requires complex microsurgical techniques. Methods Microanastomosis training was performed on plastic tubes and chicken wings for 2 months. Each microanastomosis was evaluated by a senior author. Results An improvement in the quality and patency of microanastomosis was observed. Conclusion Microsurgical simulation training can contribute to the improvement of surgical skills and dexterity.
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Affiliation(s)
- Mohira Jalolova
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
- Republican Scientific Center of Neurosurgery, Tashkent Medical Academy, Uzbekistan
| | - Dragan Jankovic
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Kento Sasaki
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
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Fernandes CO, Rodrigues LR, Amaral MLBSD, Rodrigues SJDM, Marton-Filho MA. Low-cost simulator for intra-abdominal bleeding. Rev Col Bras Cir 2023; 50:e20233512. [PMID: 37971114 PMCID: PMC10618030 DOI: 10.1590/0100-6991e-20233512-en] [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: 12/15/2022] [Accepted: 08/15/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND training in critical surgical situations is crucial for a safe outcome. The use of simulators is well established, although many are quite expensive, requiring the search for financially viable solutions for training centers. METHODS we built a low-cost simulator for intra-abdominal bleeding with inexpensive materials, such as a manikin chest, latex tubes, silicone rubber, and waterproof fabric, seeking to mimic the abdominal viscera and vessels and their anatomical correlations. An IV infusion set allowed simulated blood to flow under pressure, and the blood flowed freely during simulation. After obtaining a functional model, we selected general surgeons to validate the simulator and its use in teaching surgery. We used the content validity index (CVI), with a cutoff of 0.9. RESULTS the cost of building the prototype was US$71,00 in 2021, accounting for the purchase of the various necessary materials. Twelve raters participated in the validation tests. The results obtained from the feedback survey showed a good evaluation of all items, especially the recognition of the injured vessel, access to the vascular injury, hemostasis by manual compression, and hemostatic suturing. CONCLUSION the proposed simulator obtained good results in scenarios of intra-abdominal bleeding from large vessels, as well as for hemostasis by manual compression and suturing. It proved to be a useful tool for training in critical intra- abdominal bleeding situations, while maintaining a low cost of building.
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Soenens G, Lawaetz J, Doyen B, Fourneau I, Moreels N, Konge L, Eiberg J, Van Herzeele I. Massed Training is Logistically Superior to Distributed Training in Acquiring Basic Endovascular Skills. Eur J Vasc Endovasc Surg 2023; 66:730-737. [PMID: 37482280 DOI: 10.1016/j.ejvs.2023.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE A "PROficiency based StePwise Endovascular Curricular Training" (PROSPECT) has proven its superiority over traditional training in a randomised controlled trial to acquire basic endovascular skills outside theatre, but real life adherence is low. This study aimed to compare the original distributed training format, where trainees learn at their own pace, with a massed training format offering the same content within a limited time span while exempt from clinical duties. Secondly, long term skills retention was evaluated. METHODS A multicentre, prospective study allocated participants to the distributed D-PROSPECT or to a massed, compact version (C-PROSPECT) based on logistics such as travel time, participant and instructor availability. A multiple choice question (MCQ) test (max. score 20) tested cognitive skills. Technical skills were assessed using a global rating scale (GRS) (max. score 55), examiner's checklist (max. score 85), and validated simulator metrics. Data were collected pre- and post-programme and at three, six, and 12 months after programme completion. RESULTS Over four years and in two countries, D-PROSPECT was implemented in two centres and C-PROSPECT in three. A total of 22 participants completed D-PROSPECT with a 41% dropout rate, and 21 completed C-PROSPECT with 0% dropout rate. All participants showed significant improvement for all performance parameters after programme completion: MCQ test (median 14.5 vs. 18; p < .001), GRS (median 20 vs. 41; p < .001), examiner's checklist (median 49 vs. 78.5; p < .001), and simulation metrics (p < .001). Scores of C- or D-PROSPECT participants were not significantly different. No significant differences were seen between groups during the retention period. CONCLUSION PROSPECT significantly improves the quality of simulated endovascular performances using a massed or distributed training format. A massed training format of PROSPECT may be preferred to decrease dropout during standardised training to obtain basic endovascular skills in existing surgical curricula.
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Affiliation(s)
- Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Jonathan Lawaetz
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark; Department of Vascular Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Moreels
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jonas Eiberg
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark; Department of Vascular Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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Lawaetz J, Soenens G, Eiberg J, Van Herzeele I, Konge L, Nesbitt C, Gentile F, Stavroulakis K, Weiss S, Nayahangan LJ. Facilitators and Barriers to Implementation of Simulation Based Education in Vascular Surgery in Europe. Eur J Vasc Endovasc Surg 2023; 66:428-436. [PMID: 37330202 DOI: 10.1016/j.ejvs.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/27/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study explored the status and availability of simulation based education (SBE) for learning vascular surgical procedures identified in the 2019 General Needs Assessment in vascular surgery in Europe (GNA-2019) and identified facilitators and barriers to SBE implementation in vascular surgery. METHODS A three round iterative survey was distributed via the European Society for Vascular Surgery and the Union Européenne des Médecins Spécialistes. Members from leading committees and organisations within the European vascular surgical community were invited to participate as key opinion leaders (KOLs). Three online survey rounds explored demographics, SBE availability, and facilitators and barriers to SBE implementation. RESULTS Overall, 147 KOLs (target population 338) accepted invitation to round 1, representing 30 European countries. The dropout rates for rounds 2 and 3 were 29% and 40%, respectively. Most respondents (88%) were senior, consultant level or higher. No mandatory SBE training was required in their department before training on patients, according to 84% of the KOLs. There was high consensus on the need for structured SBE (87%) and mandatory SBE (81%). SBE is available for the top three prioritised procedures in GNA-2019 (basic open skills, basic endovascular skills, and vascular imaging interpretation) in 24, 23, and 20 of the 30 represented European countries, respectively. The highest ranking facilitators were structured SBE programmes, availability of simulation equipment locally and regionally, good quality simulators, and having a dedicated person running the SBE. The highest ranked barriers were lack of structured SBE curriculum, equipment costs, lack of SBE culture, no or limited dedicated time for faculty to teach in SBE, and clinical work overload. CONCLUSION Based largely on the opinions of KOLs in vascular surgery in Europe, this study revealed that SBE is needed in vascular surgery training and that systematic and structured programmes are required to ensure successful implementation.
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Affiliation(s)
- Jonathan Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Jonas Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Craig Nesbitt
- Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | | | | | - Salome Weiss
- Department of Vascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark
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Clarke SO, Ilgen JS, Regehr G. Fostering Adaptive Expertise Through Simulation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:994-1001. [PMID: 37094295 DOI: 10.1097/acm.0000000000005257] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Technology-enhanced simulation has been used to tackle myriad challenges within health professions education. Recently, work has typically adopted a mastery learning orientation that emphasizes trainees' sequential mastery of increasingly complex material. Doing so has privileged a focus on performance and task completion, as captured by trainees' observable behaviors and actions. Designing simulation in these ways has provided important advances to education, clinical care, and patient safety, yet also placed constraints around how simulation-based activities were enacted and learning outcomes were measured. In tracing the contemporary manifestations of simulation in health professions education, this article highlights several unintended consequences of this performance orientation and draws from principles of adaptive expertise to suggest new directions. Instructional approaches grounded in adaptive expertise in other contexts suggest that uncertainty, struggle, invention, and even failure help learners to develop deeper conceptual understanding and learn innovative approaches to novel problems. Adaptive expertise provides a new lens for simulation designers to think intentionally around how idiosyncrasy, individuality, and inventiveness could be enacted as central design principles, providing learners with opportunities to practice and receive feedback around the kinds of complex problems they are likely to encounter in practice. Fostering the growth of adaptive expertise through simulation will require a fundamental reimagining of the design of simulation scenarios, embracing the power of uncertainty and ill-defined problem spaces, and focusing on the structure and pedagogical stance of debriefing. Such an approach may reveal untapped potential within health care simulation.
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Affiliation(s)
- Samuel O Clarke
- S.O. Clarke is associate professor, Department of Emergency Medicine, University of California, Davis, Sacramento, California; ORCID: https://orcid.org/my-orcid?orcid=0000-0003-3762-1727
| | - Jonathan S Ilgen
- J.S. Ilgen is professor, Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington; ORCID: https://orcid.org/0000-0003-4590-6570
| | - Glenn Regehr
- G. Regehr is professor, Department of Surgery, and senior scientist, Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-3144-331X
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Chen G, Jin S, Xia Q, Wang Z, Shi Z, Chen G, Hong Y, Fan X, Lin H. Insight into the history and trends of surgical simulation training in education: a bibliometric analysis. Int J Surg 2023; 109:2204-2213. [PMID: 37204478 PMCID: PMC10442119 DOI: 10.1097/js9.0000000000000468] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Surgical simulation training enables surgeons to acquire clinical experience or skills from the operating room to the simulation environment. Historically, it has changed with advances in science and technology. Moreover, no previous study has analyzed this field from the bibliometric analysis dimension. The study aimed to review changes in surgical simulation training worldwide using bibliometric software. MATERIALS AND METHODS Two searches were performed on the core collection database, Web of Science, regarding data from 1991 to the end of 2020 using three topic words (surgery, training, and simulation). From 1 January 2000, to 15 May 2022, the keyword 'robotic' was added for the hotspot exploration. The data were chiefly analyzed by publication date, country, author(s), and keywords using bibliometric software. RESULTS A total of 5285 articles were initially analyzed, from which it was clear that laparoscopic skill, three-dimensional printing, and virtual reality were the main focuses during those study periods. Subsequently, 348 publications on robotic surgery training were identified. CONCLUSION This study systematically summarizes the current status in the field of surgical simulation training and provides insights into the research focuses and future hotspot in a global context.
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Affiliation(s)
- Guoqiao Chen
- Department of General Surgery
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | | | | | - Zhifei Wang
- Department of General Surgery, Zhejiang Province People’s Hospital
| | | | | | - Yucai Hong
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | | | - Hui Lin
- Department of General Surgery
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
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Pattathil N, Moon CC, Haq Z, Law C. Systematic review of simulation-based education in strabismus assessment and management. J AAPOS 2023; 27:183-187. [PMID: 37490980 DOI: 10.1016/j.jaapos.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Strabismus is a dynamic condition for which simulation-based training is valuable, given the variable complexity and relatively reduced exposure compared with other ophthalmic presentations. This study assessed the performance of simulation models available for medical training in the assessment and management of strabismus. METHODS A systematic review of relevant peer-reviewed academic databases was conducted, without publication date restrictions. English-language publications evaluating the performance of simulation models for education on strabismus were included. Risk of bias was assessed using the Cochrane RoB-2 tool and CLARITY Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Validity of evidence was evaluated using the Kirkpatrick framework. RESULTS Of the total 3,298 citations exported for title and abstract screening, 54 advanced to full-text screening, and 7 were included in final review. Model types were either dry (2), wet (4), or virtual reality (1). All models were deemed to be successful, but few standardized parameters were specified. Costs of models ranged from a few dollars (ball and wood), to moderate (non-cadaveric), to costly (virtual reality). All studies scored a moderate or high risk of bias, and the majority (4/7) of studies scored level 1 on the Kirkpatrick scale. CONCLUSIONS Research on simulation for strabismus assessment and management is limited and varied for model fidelity and testing audiences. All models were deemed individually successful compared to non-simulation-based teaching methodologies, although no direct comparisons were made. The limited evidence available suggests that low-fidelity and low-cost models can be used for trainees without sacrificing educational quality.
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Affiliation(s)
- Niveditha Pattathil
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Christine C Moon
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Zahra Haq
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Christine Law
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Canada; Department of Ophthalmology, Queen's University and Kingston Health Sciences Centre, Kingston, Canada.
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13
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Frithioff A, Frendø M, Weiss K, Foghsgaard S, Mikkelsen PT, Frederiksen TW, Pedersen DB, Sørensen MS, Andersen SAW. 3-D-Printed Models for Temporal Bone Training: A Validity Study. Otol Neurotol 2023; 44:e497-e503. [PMID: 37442608 DOI: 10.1097/mao.0000000000003936] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE 3-D printing offers convenient and low-cost mastoidectomy training; nonetheless, training benefits using 3-D-printed temporal bones remain largely unexplored. In this study, we have collected validity evidence for a low-cost, 3-D-printed temporal bone for mastoidectomy training and established a credible pass/fail score for performance on the model. STUDY DESIGN A prospective educational study gathering validity evidence using Messick's validity framework. SETTING Seven Danish otorhinolaryngology training institutions. PARTICIPANTS Eighteen otorhinolaryngology residents (novices) and 11 experienced otosurgeons (experts). INTERVENTION Residents and experienced otosurgeons each performed two to three anatomical mastoidectomies on a low-cost, 3-D-printed temporal bone model produced in-house. After drilling, mastoidectomy performances were rated by three blinded experts using a 25-item modified Welling scale (WS). MAIN OUTCOME MEASURE Validity evidence using Messick's framework including reliability assessment applying both classical test theory and Generalizability theory. RESULTS Novices achieved a mean score of 13.9 points; experienced otosurgeons achieved 23.2 points. Using the contrasting groups method, we established a 21/25-point pass/fail level. The Generalizability coefficient was 0.91, and 75% of the score variance was attributable to participant performance, indicating a high level of assessment reliability. Subsequent D studies revealed that two raters rating one performance or one rater rating two performances were sufficiently reliable for high-stakes assessment. CONCLUSION Validity evidence supports using a low-cost, 3-D-printed model for mastoidectomy training. The model can be printed in-house using consumer-grade 3-D printers and serves as an additional training tool in the temporal bone curriculum. For competency-based training, we established a cut-off score of 21 of 25 WS points using the contrasting groups method.
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Affiliation(s)
| | | | - Kenneth Weiss
- Department of Civil and Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby
| | - Søren Foghsgaard
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Trier Mikkelsen
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | | | - David Bue Pedersen
- Department of Civil and Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby
| | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
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14
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Wong K, Gorthey S, Arrighi-Allisan AE, Fan CJ, Barber SR, Schwam ZG, Wanna GB, Cosetti MK. Defining the Learning Curve for Endoscopic Ear Skills Using a Modular Trainer: A Multi-Institutional Study. Otol Neurotol 2023; 44:346-352. [PMID: 36805421 DOI: 10.1097/mao.0000000000003826] [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: 02/22/2023]
Abstract
OBJECTIVE Quantify the learning curve for endoscopic ear skills acquisition in otolaryngology residents using a simulator. The secondary objective was to determine if demographic factors or previous endoscopic experience influenced skill development. STUDY DESIGN Prospective, multicenter study. Resident participants each completed 10 amassed trials using a validated endoscopic ear skill trainer. SETTING Two academic teaching hospitals. SUBJECTS Otolaryngology residents. MAIN OUTCOME MEASURES Trial completion times; rate of improvement over time. RESULTS Thirty-eight residents completed the study, 26 from program A and 12 from program B. Fifteen participants were women and 23 were men. Mean age was 30 years old (range 26 to 34 years). Previous experience with otoendoscopy (B = -16.7, p = 0.005) and sinus endoscopy (B = -23.4, p = 0.001) independently correlated with lower overall trial times. Age, gender, postgraduate year, handedness, interest in otology, and video gaming were not associated with trial times. On multivariate logistic regression, resident completion times improved with trial number, and residents without previous endoscopy experience improved at a faster rate than those with experience ( p < 0.001). CONCLUSIONS Novice surgeons may acquire basic endoscopic ear experience with self-directed simulation training. The learning curve for transcanal endoscopic ear surgery is comparable to those demonstrated for other otologic surgeries, and specific task competencies can be achieved within 10 trials, suggesting that previous experiences, or lack thereof, may not dictate the ability to acquire new skills. There may be a translational value to previous endoscopic sinus experience on learning transcanal endoscopic ear surgery.
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Affiliation(s)
| | - Scott Gorthey
- Department of Otolaryngology, Albert Einstein College of Medicine, New York, NY
| | | | | | - Samuel R Barber
- Department of Otolaryngology, University of Arizona College of Medicine, Tucson, AZ
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15
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Frerejean J, van Merriënboer JJG, Condron C, Strauch U, Eppich W. Critical design choices in healthcare simulation education: a 4C/ID perspective on design that leads to transfer. Adv Simul (Lond) 2023; 8:5. [PMID: 36823641 PMCID: PMC9951482 DOI: 10.1186/s41077-023-00242-7] [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: 08/19/2022] [Accepted: 01/12/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Healthcare simulation education often aims to promote transfer of learning: the application of knowledge, skills, and attitudes acquired during simulations to new situations in the workplace. Although achieving transfer is challenging, existing theories and models can provide guidance. RECOMMENDATIONS This paper provides five general recommendations to design simulations that foster transfer: (1) emphasize whole-task practice, (2) consider a cognitive task analysis, (3) embed simulations within more comprehensive programs, (4) strategically combine and align simulation formats, and (5) optimize cognitive load. We illustrate the application of these five recommendations with a blueprint for an educational program focusing on simulation activities. CONCLUSIONS More evidence-informed approaches to healthcare simulation might require a paradigm shift. We must accept that a limited number of simulations is not enough to develop complex skills. It requires comprehensive programs that combine simulation sessions with workplace learning.
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Affiliation(s)
- Jimmy Frerejean
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. .,Simulation Center Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - Jeroen J. G. van Merriënboer
- grid.5012.60000 0001 0481 6099School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Claire Condron
- grid.4912.e0000 0004 0488 7120RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ulrich Strauch
- grid.412966.e0000 0004 0480 1382Simulation Center Maastricht University Medical Center+, Maastricht, the Netherlands ,grid.412966.e0000 0004 0480 1382Department of Intensive Care, Maastricht University Medical Center +, Maastricht, the Netherlands
| | - Walter Eppich
- grid.4912.e0000 0004 0488 7120RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Rotin LE, Pavenski K, Petrosoniak A. Simulation-based medical education in transfusion medicine: Current state and future applications. Transfus Apher Sci 2023; 62:103628. [PMID: 36586811 DOI: 10.1016/j.transci.2022.103628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lianne E Rotin
- Adult Hematology Residency Program, Department of Medicine, University of Toronto Temerty Faculty of Medicine, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine, St. Michael's Hospital, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.
| | - Andrew Petrosoniak
- Department of Emergency Medicine, St. Michael's Hospital, Canada; Department of Medicine, University of Toronto, Canada
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17
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Whitfield L. Watching me … watching you: Training and assessment in a virtual world. Lab Anim 2023; 57:117-126. [PMID: 36647628 DOI: 10.1177/00236772221146824] [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: 01/18/2023]
Abstract
Virtual education isn't new. Teaching has been delivered remotely for many years, although it came to prominence with the enforced move to online learning during the COVID-19 pandemic. Technologies provide tools that are integral to our everyday lives, and training and assessment are no different. Stepping back from the obligatory remote delivery of practical skills training, now we have the opportunity to review and evaluate our own learning (as educators) about the value of resources for training delivery. Combining sound educational principles with the available technologies, we can use remotely delivered learning to enhance our teaching and to increase access to learning, without hindrance because of distance or the type of facility. Remote connections allow expertise and best practice to become suddenly available to a wider cohort of researchers, rapidly spreading new ideas about refinement of in vivo procedures and supporting colleagues to learn and develop. We currently use only a few of the technological tools available, and there is much to learn from other disciplines where virtual and augmented reality are assisting surgeons, aircraft pilots and others daily. By harnessing remote and assisted technologies in teaching, we can also develop the mindset and ability of the biomedical community to use them to augment, or even to replace, animal studies in future and to democratise training globally.
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18
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Upadhyay K, Goel S, John P. Developing a capacity building training model for public health managers of low and middle income countries. PLoS One 2023; 18:e0272793. [PMID: 37083569 PMCID: PMC10121058 DOI: 10.1371/journal.pone.0272793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/26/2022] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The challenges faced by the low and middle-income countries (LMIC) in the field of public health management calls for the capacity building of qualified and trained public health managers in order to improve the effectiveness and efficiency of the health care delivery system. Most of the existing training programs for public health management are based in the settings of developed countries, which hinders their application in LMIC countries. The objective of this paper is to document the process of development and evaluation of a capacity building program for public health managers of various LMICs. MATERIAL AND METHODS A training program was developed using Kern's six-step framework with several innovative learning and assessment methodologies and evaluation using Kirkpatrick training evaluation model. Delphi technique was used for program development. RESULTS This five to ten-day partly/fully funded six International Public Health Management Development Programs (IPHMDP) programs was conceptualized which enrolled 178 participants from 42 countries between years 2016 and 2019. Based upon the elaborative discussion in four rounds of Delphi technique, the problem and challenges faced by public health mangers and eight key competencies (viz. Leadership and governance, Project/ program planning, financial management, supply chain management, quality management, Human Resource management, monitoring and evaluation, and communication.) were identified. The group consensually agree upon a blended teaching methodology comprising of chalk and talk approach, inquiry based learning, participatory student based learning, small group instructions, gamification, project-based learning and field-based learning. There was a significant increase in participants' knowledge score (P<0.0001) after all programs especially in the competencies of monitoring and evaluation, followed by project/ program planning, supply chain management and quality management. The majority (90%) submitted their action plan one week following the program, out of which 64% implemented their action plans within six months. A majority (54.7%) of participants were able to implement their learning once they went back by conducting similar training/ workshop/webinars in their settings. CONCLUSION The comprehensive public health management program in LMIC settings strengthens the competencies of public health managers which can be replicated in similar settings across LMIC to mitigate diverse challenges in public health management.
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Affiliation(s)
- Kritika Upadhyay
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Faculty of Education & Health Sciences, School of Medicine, University of Limerick, Limerick, Ireland
| | - Preethi John
- Global Business School for Health, University College London, London, United Kingdom
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19
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Filliquist B, Kapatkin AS, Vernau KM, Nakatani JY, Chou PY, Ilkiw JE. Training Surgical Residents Utilizing an Animal Shelter Fracture Program. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:778-784. [PMID: 34779752 DOI: 10.3138/jvme-2021-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Working relationships between veterinary medical teaching hospitals, animal shelters, and rescue groups are one way to increase veterinary students' and residents' hands-on training. The goal of this study is to describe the use of a shelter fracture program to improve the surgical skills of surgical residents. In this program, the participating shelter and rescue organizations electronically submit cases. Following evaluation of radiographs and case approval by the orthopedic faculty, the case is scheduled for a physical evaluation. A resident takes primary surgical care together with a fourth-year student rotating through the orthopedic surgery service to ensure the proper pre-, peri-, and post-operative standard of care. All care is overseen by the orthopedic faculty. A veterinary student-run fracture foster program allows students to gain additional experience in the pre-, peri-, and post-operative care of shelter animals. The total number of shelter animals treated during a 9-year period was 373, with a mean annual case load of 41.1 cases (± 10.3). During the same time period, a total of 435 client-owned cases underwent surgical fracture treatment, with a mean annual case load of 48 cases (± 11.7). Surgical resident and student surveys show that this program contributes to their knowledge, skills, and confidence in treating fracture patients. A successful cooperative program provides advanced surgical fracture treatment of shelter animals, improving animals' quality of life as well as surgical residents' and veterinary students' skills training.
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20
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Ding J, Xiao X, Biagi S, Varkey T. Dyad learning versus individual learning under medical simulation conditions: a systematic review. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.19285.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Dyad learning is a two-person learning dynamic in which one student observes the other performing tasks, with their roles then being reversed such that both students experience the observer and the performer role. The efficacy of dyad learning has been tested in medical education contexts, such as in medical simulation. To our knowledge, this is the first systematic review that has evaluated the efficacy of dyad learning in a medical simulation context. Methods: PubMed, Google Scholar, Cochrane Library databases were searched in September 2021 and January 2022. Prospective studies of randomized design that compared dyad learning to a single medical student or physician learning in a medical simulation were included. Non-English language studies, secondary literature papers, non-human based studies, and papers that were published prior to 2000 were excluded. The methodological quality of these studies was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The Kirkpatrick model was used to conceptualize study outcomes. Results: The identified papers included eight studies from four countries that totaled 475 participants. Students reported positively on their experiences as dyads, especially regarding the social aspects of it. Studies showed non-inferior learning outcomes for dyads. As most studies were one or two days long, there is limited evidence that this non-inferiority extends to longer term training modules. There is some evidence to suggest that dyad learning outcomes may be replicable in a clinical context following simulation training. Conclusions: Dyad learning in medical simulation is a pleasant experience for students and may be as effective as conventional learning. These findings set the foundation for future studies of longer duration, which is needed to determine the efficacy of dyad learning in lengthier curriculums and long-term knowledge retention. While cost-reduction is an implied benefit, studies that explicate cost reduction are needed to formalize this.
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21
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Ljuhar D, Nayahangan LJ, Nataraja R, Nestel D. A Bi-national needs assessment to identify and prioritise procedures in paediatric surgery for simulation-based training. J Pediatr Surg 2022:S0022-3468(22)00657-1. [PMID: 36336540 DOI: 10.1016/j.jpedsurg.2022.10.001] [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: 07/10/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Simulation-based education (SBE) has led to significant changes in healthcare education. However, SBE has often been based on available resources and local expertise rather than a systematic approach to curriculum development. The aim of this study was to perform a bi-national needs assessment to identify and prioritise procedures in a paediatric surgery curriculum that can be supported using SBE. METHOD A modified 3-round Delphi technique was used to gather consensus from education leaders and trainees in paediatric surgery in Australia and Aotearoa New Zealand (ANZ). Round 1 identified all procedures a newly specialised paediatric surgeon should be able to perform. In Round 2, each procedure was explored for the need for SBE using the Copenhagen Academy for Medical Education and Simulation (CAMES) Needs-Assessment Formula (NAF). This pre-prioritised list from Round 2 was sent back to participants for final exclusion and ranking in Round 3. Results 88 participants were identified and invited. From 174 procedures identified in Round 1, 71 procedures were grouped and categorised for Round 2 using the CAMES NAF. In Round 3, 17 procedures were eliminated resulting in 54 procedures. Appendicectomy, inguinal herniotomy, and central venous access were the highest rank procedures after prioritisation in Round 3. There was a strong correlation (r = 0.99) between the NAF score and the prioritised ranking, as well as between consultants and trainees (r = 0.92 in Round 2 and 0.98 in Round 3). CONCLUSION The prioritised list represents a consensus document decided upon by education leaders and stakeholders in paediatric surgery. These procedures should be an integral part of the SBE of paediatric surgeons in the region. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Damir Ljuhar
- Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, Copenhagen, Denmark
| | - Ram Nataraja
- Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Debra Nestel
- Department of Surgery (Austin), The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
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22
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Bube SH, Brix R, Christensen MB, Thostrup M, Grimstrup S, Hansen RB, Dahl C, Konge L, Azawi N. Surgical experience is predictive for bladder tumour resection quality. Scand J Urol 2022; 56:391-396. [PMID: 36065477 DOI: 10.1080/21681805.2022.2119271] [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: 12/30/2022]
Abstract
OBJECTIVES To assess the resection quality of transurethral bladder tumour resection (TURBT) and the association to surgeon experience depending on the presence of detrusor muscle. METHODS A retrospective study on 640 TURBT procedures performed at Zealand University Hospital, Denmark, from 1 January 2015 - 31 December 2016. Data included patient characteristics, procedure type, surgeon category, supervisor presence, surgical report data, pathological data, complications data and recurrence data. Analysis was performed using simple and multiple logistic regression on the association between surgeon experience and the presence of detrusor muscle in resected tissue from TURBT. RESULTS Supervised junior residents had significant lower detrusor muscle presence (73%) compared with consultants (83%) (OR = 0.4, 95% CI = 0.21-0.83). Limitations were the retrospective design and the diversity of included TURBT. CONCLUSIONS It was found that surgical experience predicts detrusor muscle presence and supervised junior residents performing TURBT on patients resulted in less detrusor muscle than consultants.
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Affiliation(s)
- Sarah H Bube
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Brix
- Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | | | - Mathias Thostrup
- Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | - Søren Grimstrup
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
| | - Rikke B Hansen
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,Department of Urology, Herlev/Gentofte University Hospital, Gentofte, Denmark
| | - Claus Dahl
- Department of Urology, Capio Ramsay Santé, Hellerup, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark.,Department of Urology, Capio Ramsay Santé, Hellerup, Denmark
| | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,University of Copenhagen, Copenhagen, Denmark
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23
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Identifying technical skills and clinical procedures for simulation-based training in emergency medicine: A nationwide needs assessment. Am J Emerg Med 2022; 62:140-143. [PMID: 36167748 DOI: 10.1016/j.ajem.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/01/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022] Open
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Harrison NM, Dennis A. Developing an integrated national simulation-based educational programme for Scottish junior doctors through structured, multistep action research cycles. BMJ Open 2022; 12:e059229. [PMID: 36002212 PMCID: PMC9413192 DOI: 10.1136/bmjopen-2021-059229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Simulation is widely employed to teach a range of skills, across healthcare professions and is most effective when embedded within a standarised curriculum. Although recommended by many governing bodies, establishing a national programme of simulation presents many challenges. Successful implementation requires a clear understanding of the priorities and needs of those it seeks to serve yet there are limited examples of how best to do this. This study aimed to develop an integrated national simulation-based educational programme for junior doctors in Scotland through a structed, multistep prioritisation process. DESIGN A series of action research cycles were undertaken to develop and evaluate a national simulation programme. This paper describes cycle 1, which employed a six-step structured approach to understand and prioritise learner needs. SETTING The study considered the educational needs of Scottish junior doctors in the UK Foundation Programme (UKFP). PARTICIPANTS Multiple stakeholder groups were involved in each stage of the process including recent Scottish UKFP graduates, clinical educators, UKFP programme directors and postgraduate deans. RESULTS Key stakeholders reviewed the 370 competencies in the UKFP curriculum and identified 18 initial competency areas. These 18 areas were subsequently prioritised through the analytical hierarchy process, resulting in a carefully ordered list of 12 competencies from which a targeted simulation-based educational programme could be developed. CONCLUSIONS To our knowledge, this is the first study to outline the methods of competency prioritisation to create a simulation curriculum that is integrated within a national curriculum in the medical education context. As well as demonstrating the practical steps of such a process, key implications for practice are identified. This robust approach to educational design also resulted in unexpected benefits, including educator and clinician acceptance and programme funding sustainability.
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Affiliation(s)
| | - Ashley Dennis
- Office of Medical Education, Billings Clinic, Billings, Montana, USA
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25
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Arif MA, Stylianou AP, Bachar A, King GW, Sutkin G. Retropubic trocar modified with a load cell to verify contact with pubic bone. Surgery 2022; 172:1024-1028. [PMID: 35820973 DOI: 10.1016/j.surg.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vital injuries during midurethral sling surgery are avoided by maintaining constant trocar contact with bone, and yet this is challenging for a teaching surgeon to monitor during this blind procedure. We modified a retropubic trocar with a load cell to distinguish on-bone and off-bone movement and tested it on a midurethral sling surgery 3-dimensional surgery simulator. METHODS Two experts and 3 novice surgeons performed retropubic trocar passage on the physical pelvic floor model using the modified trocar. Biofidelity was assessed comparing expert performance on a Thiel-embalmed cadaver and the physical model. The test-retest was assessed comparing performance on the physical pelvic model 2 weeks apart. The force variables were analyzed with paired and independent t tests. We performed post hoc analyses comparing the experts to novices on the physical model. RESULTS The root-mean-squared force was similar between the cadaver and model (24.3 vs 21.1 pounds, P = .62), suggesting biofidelity. Root-mean-squared force was also similar between the test and retest (14.0 vs 19.1 pounds, P =. 30). The expert surgeons exhibited a larger maximum force amplitude (51.2 vs 22.7 pounds, P = .03), shorter time to maximum force (2.7 vs 9.5 seconds, P = .03) and larger maximum rate of force development (171.5 vs 54.0 pounds/second, P = .01). CONCLUSION This study suggested high test-retest reliability and adequate biofidelity of the modified trocar used on our midurethral sling surgery 3-dimensional surgery simulator. This innovative trocar can be used both in simulation and in the operating room to help the novice surgeons stay on the bone and to help the attending surgeon monitor safe surgery.
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Affiliation(s)
- Md A Arif
- School of Computing and Engineering, University of Missouri Kansas City, MO
| | | | - Austin Bachar
- Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, MO
| | - Gregory W King
- School of Computing and Engineering, University of Missouri Kansas City, MO
| | - Gary Sutkin
- Female Pelvic Medicine and Reconstructive Surgery, University of Missouri Kansas City School of Medicine, MO.
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Chillemi C, Paolicelli D, Paglialunga C, Campopiano G, Guerrisi M, Proietti R, Carnevali C. Use of a Dry Surgical Simulator Improves Orthopaedic Residents’ Competency and Technical Skills for Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2022; 4:e1039-e1049. [PMID: 35747668 PMCID: PMC9210362 DOI: 10.1016/j.asmr.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Methods Results Clinical Relevance
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Bube SH, Kingo PS, Madsen MG, Vásquez JL, Norus T, Olsen RG, Dahl C, Hansen RB, Konge L, Azawi N. National Implementation of Simulator Training Improves Transurethral Resection of Bladder Tumours in Patients. EUR UROL SUPPL 2022; 39:29-35. [PMID: 35528788 PMCID: PMC9068726 DOI: 10.1016/j.euros.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/02/2022] Open
Abstract
Background Objective Design, setting, and participants Outcome measurements and statistical analyses Results and limitations Conclusions Patient summary
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Herrera-Aliaga E, Estrada LD. Trends and Innovations of Simulation for Twenty First Century Medical Education. Front Public Health 2022; 10:619769. [PMID: 35309206 PMCID: PMC8929194 DOI: 10.3389/fpubh.2022.619769] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
In the last two decades there has been an enormous growth in the use of clinical simulation. This teaching-learning methodology is currently the main tool used in the training of healthcare professionals. Clinical simulation is in tune with new paradigms in education and is consistent with educational theories that support the use of experiential learning. It promotes the development of psychomotor skills and strengthens executive functions. This pedagogical approach can be applied in many healthcare topics and is particularly relevant in the context of restricted access to clinical settings. This is particularly relevant considering the current crisis caused by the COVID-19 pandemic, or when trying to reduce the frequency of accidents attributed to errors in clinical practice. This mini-review provides an overview of the current literature on healthcare simulation methods, as well as prospects for education and public health benefits. A literature search was conducted in order to find the most current trends and state of the art in medical education simulation. Presently, there are many areas of application for this methodology and new areas are constantly being explored. It is concluded that medical education simulation has a solid theoretical basis and wide application in the training of health professionals at present. In addition, it is consolidated as an unavoidable methodology both in undergraduate curricula and in continuing medical education. A promising scenario for medical education simulation is envisaged in the future, hand in hand with the development of technological advances.
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Affiliation(s)
| | - Lisbell D. Estrada
- Faculty of Health Sciences, Universidad Bernardo O'Higgins, Santiago, Chile
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Devgan Y, Idrees S, Mayilvaganan S. Letter to editor: "Sim life model: introducing a new teaching device in endocrine surgery simulation". Updates Surg 2022; 74:791. [PMID: 35001251 DOI: 10.1007/s13304-021-01221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Yuvraj Devgan
- Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sarrah Idrees
- Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sabaretnam Mayilvaganan
- Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Toale C, Morris M, Kavanagh DO. Training to proficiency in surgery using simulation: is there a moral obligation? JOURNAL OF MEDICAL ETHICS 2022; 49:medethics-2021-107678. [PMID: 34992083 DOI: 10.1136/medethics-2021-107678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The 'learning curve' in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.
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Affiliation(s)
- Conor Toale
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
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Cubas WS. Building and training a low-cost and portable vascular anastomosis simulator: Initial experience of a surgical resident. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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SMaRT Assessment Tool: An Innovative Approach for Objective Assessment of Flap Designs. Plast Reconstr Surg 2021; 148:837e-840e. [PMID: 34705793 DOI: 10.1097/prs.0000000000008422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY The teaching and assessment of ideal surgical markings for local flaps required for optimal aesthetic and functional outcomes remain a challenge in the present era of competency-based surgical education. The authors utilized the bilobed flap for nasal reconstruction as a proof of concept for the development of an innovative objective assessment tool based on statistical shape analysis, with a focus on providing automated, evidence-based, objective, specific, and practical feedback to the learner. The proposed tool is based on Procrustes statistical shape analysis, previously used for the assessment of facial asymmetry in plastic surgery. For performance boundary testing, a series of optimal and suboptimal designs generated in deliberate violation of the established ideals of optimal bilobed flap design were evaluated, and a four-component feedback score of Scale, Mismatch, Rotation, and Translation (SMaRT) was generated. The SMaRT assessment tool demonstrated the capacity to proportionally score a spectrum of designs (n = 36) ranging from subtle to significant variations of optimal, with excellent computational and clinically reasonable performance boundaries. In terms of shape mismatch, changes in SMaRT score also correlated with intended violations in designs away from the ideal flap design. This innovative educational approach could aid in incorporating objective feedback in simulation-based platforms in order to facilitate deliberate practice in flap design, with the potential for adoption in other fields of plastic surgery to automate assessment processes.
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Hertz P, Houlind K, Jepsen J, Bundgaard L, Jensen P, Friis M, Konge L, Bjerrum F. Identifying curriculum content for a cross-specialty robotic-assisted surgery training program: a Delphi study. Surg Endosc 2021; 36:4786-4794. [PMID: 34708292 DOI: 10.1007/s00464-021-08821-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robotic-assisted surgery is increasing and there is a need for a structured and evidence-based curriculum to learn basic robotic competencies. Relevant training tasks, eligible trainees, realistic learning goals, and suitable training methods must be identified. We sought to develop a common curriculum that can ensure basic competencies across specialties. METHODS Two robotic surgeons from all departments in Denmark conducting robotic-assisted surgery within gynecology, urology, and gastrointestinal surgery, were invited to participate in a three-round Delphi study to identify learning goals and rank them according to relevance for a basic curriculum. An additional survey was conducted after the Delphi rounds on what training methods were considered best for each learning goal and who (console surgeon/patient-side assistant) should master each learning goal. RESULTS Fifty-six robotic surgeons participated and the response rates were 86%, 89%, and 77%, for rounds 1, 2 and 3, respectively. The Delphi study identified 40 potential learning goals, of which 29 were ranked as essential, e.g., Understand the link between arm placement and freedom of movement or Be able to perform emergency un-docking. In the additional survey, the response rate was 70%. Twenty-two (55%) of the identified learning goals were found relevant for the patient-side assistant and twenty-four (60%) were linked to a specific suitable learning method with > 75% agreement. CONCLUSIONS Our findings can help training centers plan their training programs concerning educational content and methods for training/learning. Furthermore, patient-side assistants should also receive basic skills training in robotic surgery.
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Affiliation(s)
- Peter Hertz
- Department of Surgery, Hospital Lillebaelt, University of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Kolding, Denmark.
| | - Kim Houlind
- Department of Regional Health Research, University of Southern Denmark, Kolding, Denmark
- Department of Vascular Surgery, Hospital Lillebaelt, University of Southern Denmark, Kolding, Denmark
| | - Jan Jepsen
- Department of Urology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Center for HR and Education, Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Denmark
| | - Lars Bundgaard
- Department of Surgery, Hospital Lillebaelt, University of Southern Denmark, Vejle, Denmark
| | - Pernille Jensen
- Department of Gynecology, Faculty of Health, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mikkel Friis
- Department of Skills Training and Simulation, NordSim, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Konge
- Center for HR and Education, Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Center for HR and Education, Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Denmark
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Lukanović D, Laganà AS. The impact of Covid-19 on simulation-based learning of gynecology and obstetrics skills. MINIM INVASIV THER 2021; 31:684-689. [PMID: 34651559 DOI: 10.1080/13645706.2021.1987923] [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: 10/20/2022]
Abstract
Simulation-based learning can be defined as a modern learning and training method. The pan-European curriculum for training in obstetrics and gynecology PACT (Project for Achieving Consensus in Training) incorporates medical simulation and recommends its urgent implementation in the national residency programs of individual countries. The current Covid-19 pandemic presents challenges to the medical community. During the first wave of the pandemic, Italy was the most severely affected EU country, whereas during the second wave Slovenia was among those most affected. The severe limitations of the lockdown and post-lockdown led to significant changes in all healthcare organizations and, consequently, also training activities in obstetrics and gynecology. Limitations on training during the Covid-19 pandemic may have severely impacted the opportunity to learn basic clinical and surgical skills. A potential strategy for overcoming these limitations was offered by simulation activities, which allowed trainees to receive basic training in our discipline and prevented an additional "lockdown" of their learning and development of skills. This type of simulation training will be of paramount importance, considering the paradigm shift caused by the Covid-19 pandemic in lifestyle and healthcare activities.Abbreviations: ACOG: American college of obstetricians and gynecologists; EBCOG: European board and college of obstetrics and gynaecology; ICU: intensive care unit; OR: operating room; PACT: project for achieving consensus in training; PUI: patient under investigation.
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Affiliation(s)
- David Lukanović
- Division of Gynecology and Obstetrics, Ljubljana University Medical Center, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Paysan D, Haug L, Bajka M, Oelhafen M, Buhmann JM. Self-supervised representation learning for surgical activity recognition. Int J Comput Assist Radiol Surg 2021; 16:2037-2044. [PMID: 34542839 PMCID: PMC8589823 DOI: 10.1007/s11548-021-02493-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
Purpose: Virtual reality-based simulators have the potential to become an essential part of surgical education. To make full use of this potential, they must be able to automatically recognize activities performed by users and assess those. Since annotations of trajectories by human experts are expensive, there is a need for methods that can learn to recognize surgical activities in a data-efficient way. Methods: We use self-supervised training of deep encoder–decoder architectures to learn representations of surgical trajectories from video data. These representations allow for semi-automatic extraction of features that capture information about semantically important events in the trajectories. Such features are processed as inputs of an unsupervised surgical activity recognition pipeline. Results: Our experiments document that the performance of hidden semi-Markov models used for recognizing activities in a simulated myomectomy scenario benefits from using features extracted from representations learned while training a deep encoder–decoder network on the task of predicting the remaining surgery progress. Conclusion: Our work is an important first step in the direction of making efficient use of features obtained from deep representation learning for surgical activity recognition in settings where only a small fraction of the existing data is annotated by human domain experts and where those annotations are potentially incomplete.
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Affiliation(s)
- Daniel Paysan
- Department of Computer Science, ETH Zurich, Zurich, Switzerland.
| | - Luis Haug
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Michael Bajka
- Division of Gynecology Department OB/GYN, University Hospital, Zurich, Switzerland
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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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Facilitators and Barriers for Young Medical Doctors Writing Their First Manuscript for Publication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168571. [PMID: 34444318 PMCID: PMC8394666 DOI: 10.3390/ijerph18168571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
Although scientific publication is often mandatory in medical professions, writing the first research article for publication is challenging, especially as medical curricula have only a minor focus on scientific writing. The aim was therefore to identify facilitators and barriers experienced by medical doctors writing their first scientific article for publication. An explorative inductive approach made use of semi-structured interviews for collecting data until saturation. Data were analyzed with systematic text condensation. Several barriers were identified: (a) writing in general; (b) writing in English; (c) dealing with content, structure, and presentation; and (d) navigating in the author group. Good supervision in the initial writing phase was a facilitating factor. Medical doctors requested a course in which they could work on their own articles and give feedback to fellow students. They valued skilled lecturers and individual supervision, and they wanted to learn about author instructions, how to present text correctly, and how to sell their core message. Their goal was to create a useful end product and to obtain European Credit Transfer System (ECTS) points. The facilitators and barriers that medical doctors experience when writing their first scientific article for publication and their course requests should be reflected in the learning objectives and content of future courses.
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Please H, Biyani CS. How to Implement a Simulation-Based Education Programme: Lessons from the UK Urology Simulation Boot Camp. Indian J Surg 2021; 84:18-26. [PMID: 34248308 PMCID: PMC8260348 DOI: 10.1007/s12262-021-03016-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 11/28/2022] Open
Abstract
The operative and non-technical skills exposure of urology trainees has reduced due to a number of factors, including the European Working Time Directive, and the COVID-19 pandemic. Simulation-based education (SBE) is an innovative addition to clinical experience which can begin to address the skills-based learning deficiency in order to help trainees meet their curriculum requirements and optimise the exposure required for a trainee to become a competent general urology consultant. Surgical simulation is an effective training tool but has a complex implementation process, requiring considerable planning tailored to specific educational targets, to ensure it is sustainable and reproducible. Methodology from the field of implementation science offers an invaluable approach to design an effective simulation-based training adjunct, as exemplified by the example of the UK Urology Simulation Boot Camp (USBC), a comprehensive training course which incorporates core technical and non-technical skills based on the current Joint Committee on Surgical Training (JCST) urological training curriculum to equip newly appointed urology trainees to work as competent junior registrars. Delivered annually in Leeds since 2015, the course has had excellent feedback and results in improving the urological knowledge of trainees, as well as increases in trainees’ confidence. This paper will provide a summary of how the course was designed, delivered, reproduced, sustained and evaluated. Its success is demonstrated by its incorporation into the UK urology training programme, and since 2018, it is now recommended to all new urology residents in the UK. The course implementation model would be applicable to other surgical specialties.
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Affiliation(s)
- Helen Please
- Department of Urology, Saint James' Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chandra Shekhar Biyani
- Department of Urology, Saint James' Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Jørgensen R, Laursen CB, Konge L, Pietersen PI. Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review. Scand J Trauma Resusc Emerg Med 2021; 29:83. [PMID: 34176508 PMCID: PMC8237454 DOI: 10.1186/s13049-021-00897-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education. METHODS In accordance with PRISMA-guidelines, a systematic search was performed using three databases (PubMed, EMBASE, CINAHL). Two reviewers screened titles and abstracts, subsequently full-text of the relevant articles. The risk of bias was assessed using the Cochrane Collaboration risk of bias assessment tool and the New Ottawa scale. RESULTS Of 3409 identified publications, 64 were included. The studies were different in target learners, study design, assessment tools, and outcome measures, which made direct comparison difficult. The studies addressed a possible effect of mastery learning and found e-learning and didactic classroom teaching to be equally effective. CONCLUSION Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted.
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Affiliation(s)
- Rasmus Jørgensen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark. .,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.,Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark
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Nayahangan LJ, Konge L, Russell L, Andersen S. Training and education of healthcare workers during viral epidemics: a systematic review. BMJ Open 2021; 11:e044111. [PMID: 34049907 PMCID: PMC8166630 DOI: 10.1136/bmjopen-2020-044111] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is necessary to train a large number of healthcare workers (HCW) within a limited time to ensure adequate human resources during an epidemic. There remains an urgent need for best practices on development and implementation of training programmes. OBJECTIVE To explore published literature in relation to training and education for viral epidemics as well as the effect of these interventions to inform training of HCW. DATA SOURCES Systematic searches in five databases performed between 1 January 2000 and 24 April 2020 for studies reporting on educational interventions in response to major viral epidemics. STUDY ELIGIBILITY CRITERIA All studies on educational interventions developed, implemented and evaluated in response to major global viral outbreaks from 2000 to 2020. PARTICIPANTS Healthcare workers. INTERVENTIONS Educational or training interventions. STUDY APPRAISAL AND SYNTHESIS METHODS Descriptive information were extracted and synthesised according to content, competency category, educational methodology, educational effects and level of educational outcome. Quality appraisal was performed using a criterion-based checklist. RESULTS A total of 15 676 records were identified and 46 studies were included. Most studies were motivated by the Ebola virus outbreak with doctors and nurses as primary learners. Traditional didactic methods were commonly used to teach theoretical knowledge. Simulation-based training was used mainly for training of technical skills, such as donning and doffing of personal protective equipment. Evaluation of the interventions consisted mostly of surveys on learner satisfaction and confidence or tests of knowledge and skills. Only three studies investigated transfer to the clinical setting or effect on patient outcomes. CONCLUSIONS AND IMPLICATIONS OF FINDINGS The included studies describe important educational experiences from past epidemics with a variety of educational content, design and modes of delivery. High-level educational evidence is limited. Evidence-based and standardised training programmes that are easily adapted locally are recommended in preparation for future outbreaks.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Steven Andersen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Otolaryngology, Ohio State University, Columbus, Ohio, USA
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Byvaltsev V, Polkin R, Bereznyak D, Giers MB, Hernandez PA, Shepelev V, Aliyev M. 3D-printed cranial models simulating operative field depth for microvascular training in neurosurgery. Surg Neurol Int 2021; 12:213. [PMID: 34084640 PMCID: PMC8168712 DOI: 10.25259/sni_849_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The skills required for neurosurgical operations using microsurgical techniques in a deep operating field are difficult to master in the operating room without risk to patients. Although there are many microsurgical training models, most do not use a skull model to simulate a deep field. To solve this problem, 3D models were created to provide increased training in the laboratory before the operating room, improving patient safety. METHODS A patient's head was scanned using computed tomography. The data were reconstructed and converted into a standard 3D printing file. The skull was printed with several openings to simulate common surgical approaches. These models were then used to create a deep operating field while practicing on a chicken thigh (femoral artery anastomosis) and on a rat (abdominal aortic anastomosis). RESULTS The advantages of practicing with the 3D printed models were clearly demonstrated by our trainees, including appropriate hand position on the skull, becoming comfortable with the depth of the anastomosis, and simulating proper skull angle and rigid fixation. One limitation is the absence of intracranial structures, which is being explored in future work. CONCLUSION This neurosurgical model can improve microsurgery training by recapitulating the depth of a real operating field. Improved training can lead to increased accuracy and efficiency of surgical procedures, thereby minimizing the risk to patients.
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Affiliation(s)
- Vadim Byvaltsev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Roman Polkin
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Dmitry Bereznyak
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Morgan B. Giers
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon, United States
| | - Phillip A. Hernandez
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon, United States
| | - Valery Shepelev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Marat Aliyev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
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Olsen RG, Bjerrum F, Konge L, Jepsen JV, Azawi NH, Bube SH. Validation of a Novel Simulation-Based Test in Robot-Assisted Radical Prostatectomy. J Endourol 2021; 35:1265-1272. [PMID: 33530867 DOI: 10.1089/end.2020.0986] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: To investigate validity evidence for a simulator-based test in robot-assisted radical prostatectomy (RARP). Materials and Methods: The test consisted of three modules on the RobotiX Mentor VR-simulator: Bladder Neck Dissection, Neurovascular Bundle Dissection, and Ureterovesical Anastomosis. Validity evidence was investigated by using Messick's framework by including doctors with different RARP experience: novices (who had assisted for RARP), intermediates (robotic surgeons, but not RARP surgeons), or experienced (RARP surgeons). The simulator metrics were analyzed, and Cronbach's alpha and generalizability theory were used to explore reliability. Intergroup comparisons were done with mixed-model, repeated measurement analysis of variance and the correlation between the number of robotic procedures and the mean test score were examined. A pass/fail score was established by using the contrasting groups' method. Results: Ten novices, 11 intermediates, and 6 experienced RARP surgeons were included. Six metrics could discriminate between groups and showed acceptable internal consistency reliability, Cronbach's alpha = 0.49, p < 0.001. Test-retest reliability was 0.75, 0.85, and 0.90 for one, two, and three repetitions of tests, respectively. Six metrics were combined into a simulator score that could discriminate between all three groups, p = 0.002, p < 0.001, and p = 0.029 for novices vs intermediates, novices vs experienced, and intermediates vs experienced, respectively. Total number of robotic operations and the mean score of the three repetitions were significantly correlated, Pearson's r = 0.74, p < 0.001. Conclusion: This study provides validity evidence for a simulator-based test in RARP. We determined a pass/fail level that can be used to ensure competency before proceeding to supervised clinical training.
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Affiliation(s)
- Rikke Groth Olsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Department of Surgery, Herlev/Gentofte Hospital, Herlev, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Viberg Jepsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Department of Urology, Herlev/Gentofte Hospital, Herlev, Denmark
| | - Nessn H Azawi
- Department of Surgery, Herlev/Gentofte Hospital, Herlev, Denmark.,Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Sarah Hjartbro Bube
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Department of Urology, Zealand University Hospital, Roskilde, Denmark
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Identifying technical skills and clinical procedures in surgery for a simulation-based curriculum: a national general needs assessment. Surg Endosc 2021; 36:47-56. [PMID: 33398569 DOI: 10.1007/s00464-020-08235-7] [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] [Received: 08/18/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The efficacy of simulation-based training in surgical education is well known. However, the development of training programs should start with problem identification and a general needs assessment to ensure that the content is aligned with current surgical trainee needs. The objective of the present study is to identify the technical skills and clinical procedures that should be included in a simulation-based curriculum in general surgery. METHODS A national, three-round Delphi process was conducted to achieve consensus on which technical skills and clinical procedures should be included in a simulation-based curriculum in general surgery. In total, 87 key opinion leaders were identified and invited to the study. RESULTS Round 1 of the Delphi process had a response rate of 64% (56/87) and a total of 245 suggestions. Based on these suggestions, a consolidated list of 51 technical skills or clinical procedures was made. The response rate in Delphi round 2 was 62% (54/87) resulting in a pre-prioritized order of procedures for round 3. The response rate in Delphi round 3 was 65% (35/54). The final list included 13 technical skills and clinical procedures. Training was predominantly requested within general open surgical skills, laparoscopic skills, and endoscopic skills, and a few specific procedures such as appendectomy and cholecystectomy were included in the final prioritized list. CONCLUSION Based on the Delphi process 13 technical skills and clinical procedures were included in the final prioritized list, which can serve as a point of departure when developing simulation-based training in surgery.
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Lemarteleur V, Peycelon M, Sablayrolles JL, Plaisance P, El-Ghoneimi A, Ceccaldi PF. Realization of Open Software Chain for 3D Modeling and Printing of Organs in Simulation Centers: Example of Renal Pelvis Reconstruction. JOURNAL OF SURGICAL EDUCATION 2021; 78:232-244. [PMID: 32703739 DOI: 10.1016/j.jsurg.2020.06.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/26/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Three-dimensional (3D) printing has many uses in healthcare such as in surgical training. It is becoming an interesting tool finding new pedagogical purposes in medical simulation. In this study, using a process consisting of 3D modeling, a simulator dedicated to pyeloplasty was designed, manufactured, and evaluated by experts. DESIGN With the aid of open-source software and computer-aided design software, 3D models of a renal parenchyma, a renal pelvis and a ureter were created. This renal apparatus was processed and crafted with additive manufacturing using soft polymer materials. Polyvinyl alcohol material was used to print the components in order to make them dissectible and to evaluate their use in surgical teaching. SETTING AND PARTICIPANTS Seven expert surgeons evaluated the model by performing a pyeloplasty sequence established in a previous work. An evaluation grid with 8 items related to surgical movement was rated on a 5-point Likert scale to assess how similar working with the model was to actual surgery. RESULTS Three items were rated with a score greater than or equal to 4 (Needle penetration, Thread-sliding, and Cutting Strength). Suture strength was rated with a score above 3.5 for both renal pelvis and ureter, whereas elasticity was rated below 3. Handling and mobility properties were rated above 3 for the renal pelvis and below 3 for the ureter. The cost of the unit was $0.30 per renal unit. The primary difference identified was a difference in elongation between polyvinyl alcohol material and real biological tissue. CONCLUSIONS It is feasible to generate and print a low cost upper urinary tract model from patient data imagery using environmentally friendly products that can be used effectively in surgical training. The simulator has been able to reproduce sensations related to surgical movements for a low cost. Hereafter, research into the pedagogical benefits provided to students, and through them, patients, should be performed. 3D printing models can offer new opportunities for healthcare simulation specific to different surgical fields.
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Affiliation(s)
- Vincent Lemarteleur
- Simulation Centre of University of Paris, iLumens Paris Diderot, Paris, France.
| | - Matthieu Peycelon
- Pediatric Urology Department, Robert Debré University Hospital, AP-HP Nord, APHP; Reference Center for Rare Diseases (CRMR) Malformations Rares des Voies Urinaires (MARVU), Paris, France
| | | | - Patrick Plaisance
- Simulation Centre of University of Paris, iLumens Paris Diderot, Paris, France
| | - Alaa El-Ghoneimi
- Pediatric Urology Department, Robert Debré University Hospital, AP-HP Nord, APHP; Reference Center for Rare Diseases (CRMR) Malformations Rares des Voies Urinaires (MARVU), Paris, France
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Establishing Validity of a Comprehensive Hand Surgical Training and Educational Platform (STEP). J Hand Surg Am 2020; 45:1105-1114. [PMID: 33008694 DOI: 10.1016/j.jhsa.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to develop and perform the initial validation for the Surgical Training and Educational Platform (STEP), a cost-effective psychomotor training and assessment instrument designed to teach and evaluate fundamental skills considered critical to competency in hand surgery. METHODS An American Society for Surgery of the Hand (ASSH) taskforce of 13 board-certified hand surgeons developed 8 skills considered fundamental to competency in hand surgery including: (1) lag screw fixation of an oblique fracture, (2) depth of plunge during bicortical drilling, (3) central axis scaphoid fixation, (4) phalangeal fracture pinning, (5) flexor tendon repair, (6) microsurgical suturing, (7) full-thickness skin graft harvest, and (8) wrist arthroscopy. The tasks were developed from commercially available, nonclinical supplies at low cost. The startup cost for the entire system was less than $600 USD, with a cost-per-trainee-assessment of approximately $25 USD. After the tasks were finalized, 2 examiners traveled to 8 sites around the country to evaluate 93 surgeons, including 57 board-certified hand surgeons and 36 first-year orthopedic and plastic surgical residents. Scoring criteria for each task were based on a combination of time and clinically relevant quality metrics. RESULTS Board-certified hand surgeons significantly outperformed surgical trainees on all 8 tasks, demonstrating that the STEP appropriately differentiates the skill level of expert and novice hand surgeons. CONCLUSIONS The STEP is an effective simulator that encompasses a wide range of fundamental psychomotor skills considered critical to competency in hand surgery. Although the STEP tasks are a valuable surgical training tool, further work is required to evaluate and refine the scoring system prior to using it as a critical evaluation of performance. CLINICAL RELEVANCE The STEP simulator is a valuable, validated instrument for resident and fellow education and evaluation in hand surgery outside of the operating room.
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Joseph FJ, Weber S, Raabe A, Bervini D. Neurosurgical simulator for training aneurysm microsurgery-a user suitability study involving neurosurgeons and residents. Acta Neurochir (Wien) 2020; 162:2313-2321. [PMID: 32780255 PMCID: PMC7496061 DOI: 10.1007/s00701-020-04522-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to its complexity and to existing treatment alternatives, exposure to intracranial aneurysm microsurgery at the time of neurosurgical residency is limited. The current state of the art includes training methods like assisting in surgeries, operating under supervision, and video training. These approaches are labor-intensive and difficult to fit into a timetable limited by the new work regulations. Existing virtual reality (VR)-based training modules lack patient-specific exercises and haptic properties and are thus inferior to hands-on training sessions and exposure to real surgical procedures. MATERIALS AND METHODS We developed a physical simulator able to reproduce the experience of clipping an intracranial aneurysm based on a patient-specific 3D-printed model of the skull, brain, and arteries. The simulator is made of materials that not only imitate tissue properties including arterial wall patency, thickness, and elasticity but also able to recreate a pulsatile blood flow. A sample group of 25 neurosurgeons and residents (n = 16: early residency with less than 4 years of neurosurgical exposure; n = 9: late residency and board-certified neurosurgeons, 4-15 years of neurosurgical exposure) took part to the study. Participants evaluated the simulator and were asked to answer questions about surgical simulation anatomy, realism, haptics, tactility, and general usage, scored on a 5-point Likert scale. In order to evaluate the feasibility of a future validation study on the role of the simulator in neurosurgical postgraduate training, an expert neurosurgeon assessed participants' clipping performance and a comparison between groups was done. RESULTS The proposed simulator is reliable and potentially useful for training neurosurgical residents and board-certified neurosurgeons. A large majority of participants (84%) found it a better alternative than conventional neurosurgical training methods. CONCLUSION The integration of a new surgical simulator including blood circulation and pulsatility should be considered as part of the future armamentarium of postgraduate education aimed to ensure high training standards for current and future generations of neurosurgeons involved in intracranial aneurysm surgery.
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Affiliation(s)
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
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Nazari T, Dankbaar MEW, Sanders DL, Anderegg MCJ, Wiggers T, Simons MP. Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents. Hernia 2020; 24:995-1002. [PMID: 32889641 PMCID: PMC7520418 DOI: 10.1007/s10029-020-02270-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022]
Abstract
Purpose During surgical residency, many learning methods are available to learn an inguinal hernia repair (IHR). This study aimed to investigate which learning methods are most commonly used and which are perceived as most important by surgical residents for open and endoscopic IHR. Methods European general surgery residents were invited to participate in a 9-item web-based survey that inquired which of the learning methods were used (checking one or more of 13 options) and what their perceived importance was on a 5-point Likert scale (1 = completely not important to 5 = very important). Results In total, 323 residents participated. The five most commonly used learning methods for open and endoscopic IHR were apprenticeship style learning in the operation room (OR) (98% and 96%, respectively), textbooks (67% and 49%, respectively), lectures (50% and 44%, respectively), video-demonstrations (53% and 66%, respectively) and journal articles (54% and 54%, respectively). The three most important learning methods for the open and endoscopic IHR were participation in the OR [5.00 (5.00–5.00) and 5.00 (5.00–5.00), respectively], video-demonstrations [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively], and hands-on hernia courses [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively]. Conclusion This study demonstrated a discrepancy between learning methods that are currently used by surgical residents to learn the open and endoscopic IHR and preferred learning methods. There is a need for more emphasis on practising before entering the OR. This would support surgical residents’ training by first observing, then practising and finally performing the surgery in the OR. Electronic supplementary material The online version of this article (10.1007/s10029-020-02270-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Nazari
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M E W Dankbaar
- The Institute of Medical Education Research Rotterdam (iMERR), Rotterdam, The Netherlands
- Department of Education, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D L Sanders
- North Devon District Hospital, Barnstaple, UK
| | - M C J Anderegg
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - T Wiggers
- Incision Academy, Amsterdam, The Netherlands
| | - M P Simons
- Department of Surgery, OLVG, Amsterdam, The Netherlands
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Commentary on Simulation Training in Neuroangiography: Transfer to Reality. Cardiovasc Intervent Radiol 2020; 43:1192-1193. [DOI: 10.1007/s00270-020-02559-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
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Nielsen CAB, Lönn L, Konge L, Taudorf M. Simulation-Based Virtual-Reality Patient-Specific Rehearsal Prior to Endovascular Procedures: A Systematic Review. Diagnostics (Basel) 2020; 10:diagnostics10070500. [PMID: 32698437 PMCID: PMC7400356 DOI: 10.3390/diagnostics10070500] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022] Open
Abstract
Patient-specific rehearsal (PsR) is a new concept whereby a procedure can be rehearsed virtually using the exact patient’s anatomical data prior to performing the real procedure. The aim of this study was to ascertain if endovascular virtual-reality PsR simulation enhanced performance in real life. This was done by performing a systematic review following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A literature search was conducted in PubMed, Embase, The Cochrane Library and Web of Science concerning PsR in endovascular procedures. All publications were handled using Covidence. Reference lists were also screened. Data extracted from the studies were realism rating, procedure time, fluoroscopy time, contrast volume, number of angiograms and reduction of errors. Kirkpatrick’s four-level model for measuring the efficiency of training was used for guidance of the relevance of studies. The search yielded 1155 results after the exclusion of duplicates, and 11 studies were included. Four studies had a control group, including one randomized trial; the remaining seven were feasibility studies. The realism was rated high, and overall, the studies showed improvements in procedure time, fluoroscopy time and contrast volume after PsR. One study assessed and confirmed the reduction in errors after PsR. Only two studies included more than 15 patients in their cohort. Kirkpatrick’s model was applied to all studies, with one study reaching level 4. All studies found the concept of PsR to be feasible and realistic. The studies with a control group showed a reduction of overall procedure time, radiation exposure and potential errors in endovascular procedures following PsR.
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Affiliation(s)
- Caroline Albrecht-Beste Nielsen
- Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark; (L.L.); (M.T.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence: or
| | - Lars Lönn
- Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark; (L.L.); (M.T.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, 2100 Copenhagen, Denmark;
| | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, 2100 Copenhagen, Denmark; (L.L.); (M.T.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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A simulation-based selection process for trying to identify medical students who will become outstanding general surgery residents. Am J Surg 2020; 220:76-82. [DOI: 10.1016/j.amjsurg.2019.10.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/05/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022]
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