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Celentano C, Prefumo F, Matarrelli B, Mastracchio J, Mauri S, Rosati M. Comparison of practice vs theory model training for vacuum-assisted delivery: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2023; 290:109-114. [PMID: 37776704 DOI: 10.1016/j.ejogrb.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To assess the effect of two modalities of simulation training on acquisition/retention of skills for performing operative vaginal delivery. DESIGN Randomized, controlled, single-centre study. SETTING A tertiary referral hospital in Italy. PARTICIPANTS Twenty residents from a single university programme and two young specialists. INTERVENTION Group 1 had an individual training session with a single senior specialist using a fixed simulator model. After the session, trainees watched a pre-recorded 1-h lecture on vacuum-assisted operative vaginal delivery. Group 1 repeated the simulator session using the same test after 8-12 weeks and 12 months. Group 2 watched the pre-recorded lecture then undertook the same sessions as Group 1. Video recordings of all test performances were evaluated by five specialists in a blinded manner. MAIN OUTCOME MEASURE Each procedure was evaluated using a Global Rating Scale (GRS), scored with 0-5 points for each item on an Objective Structured Assessment of Technical Skills (OSATS) dataset with seven items (total 35 points). OSATS were evaluated over time, compared for the whole population, and weighted for route and year of residency. The primary outcome was comparison of the effectiveness of training between the two groups based on year of residency by assessing videos of the baseline test and GRS for OSATS scores. The secondary outcome was overall retention of skills at 8-12 weeks and 12 months. RESULTS Twenty-two participants were recruited and randomized to either Group 1 (n = 11) or Group 2 (n = 11). Five participants did not complete follow-up. The primary outcome of GRS for OSATS scores at time 0 differed significantly between groups for total GRS score, and 'Call for help' and 'Explanation to woman and relatives' item scores (p = 0.002 and p = 0.007, respectively). In a multiple linear regression analysis, OSATS scores were not independently influenced by year of residency. At 8-12-week follow-up, the 'Call for help' item score showed a significant improvement in Group 1 (p = 0.018), although this was not confirmed when year of residency was included as an independent variable. At 12-month follow-up, none of the item scores demonstrated a significant change (p = 0.033). Year of residency did not influence the difference between groups. One-way analysis of variance found significant differences between the groups for 'Localization of the flexion point' (p = 0.005), 'Traction of vacuum cup' (p = 0.039) and 'Use of second hand of the operator' (p = 0.009) item scores and total GRS score (p = 0.007). The values weighted by year of residency did not demonstrate any significant difference. The secondary outcomes evaluated all the candidates of both groups for retention of technical skills over time. A significant effect of time was found for total GRS score (p < 0.001) and OSATS item scores. CONCLUSIONS Independent of the sequence of theoretical teaching and simulation training, trainees demonstrated high retention - and, actually, improvement - of technical skills for operative vaginal delivery at 12-month follow-up.
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Affiliation(s)
- Claudio Celentano
- Department of Obstetrics and Gynaecology, Santo Spirito Hospital, Pescara, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy; Emergency Advanced Simulation Centre, Santo Spirito Hospital, Pescara, Italy.
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Barbara Matarrelli
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, Chieti, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy
| | - Jacopo Mastracchio
- Department of Obstetrics and Gynaecology, Santo Spirito Hospital, Pescara, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy; Emergency Advanced Simulation Centre, Santo Spirito Hospital, Pescara, Italy; Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, Chieti, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy
| | - Serena Mauri
- Department of Obstetrics and Gynaecology, Santo Spirito Hospital, Pescara, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy; Emergency Advanced Simulation Centre, Santo Spirito Hospital, Pescara, Italy; Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, Chieti, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy
| | - Maurizio Rosati
- Department of Obstetrics and Gynaecology, Santo Spirito Hospital, Pescara, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy; Emergency Advanced Simulation Centre, Santo Spirito Hospital, Pescara, Italy
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Seltzer H, Swayze E, Thottathil L, Dewey J, Jabara J, Mehta A, Frederick J, Yousif P, Parikh S, Tsuei A, Miller L, Linares LS. The Impact of Homemade Laparoscopic Box Trainers on Medical Student Surgical Skills: A Randomized Control Pilot Study. Surg Innov 2023; 30:84-93. [PMID: 35499271 DOI: 10.1177/15533506221094956] [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: 11/16/2022]
Abstract
Objective: While instructional videos are commonly used in surgical education, there is a paucity of data on home laparoscopic box trainers. This pilot study evaluated impacts of augmenting instructional videos with these devices. Design: This was a randomized controlled pilot study evaluating laparoscopic surgical performance on the LapSim virtual surgical simulator before and after a 2 week curriculum of instructional videos alone (n = 8, 47.1%) vs videos plus a home laparoscopic box trainer (n = 9, 52.9%). The LapSim recorded mistake number, time, and instrument path length to complete each task. Participants completed surveys about their perceptions of surgery before and after the course. Participants: Preclinical medical students were recruited. Those with extensive surgical experience or did not complete the course were excluded. Results: For the box trainer group vs the videos alone group: mean change in mistakes was -10.0 (standard deviation [SD]:17.1) vs +.5 (SD:21.59) (P = .28); mean change in time was -433.24 (SD:304.67) seconds vs -366.16 (SD:240.10) seconds (P = .62); mean change in instrument path length was -4.27 (SD:4.38) meters vs -3.19 (SD:4.86) meters (P = .64). The box trainer group ranked "I feel as though surgery comes naturally" 1.58 points higher (95% confidence interval [CI]: .85, 2.32; P < .01) and "I am worried about being skilled at surgery" 1.26 points lower (95% CI: 2.29, -.24; P = .02) upon completing the study. The videos alone group reported no significant changes in survey responses. Conclusion: Home laparoscopic box trainers can generate confidence and reduce anxiety regarding surgical fields. This study provides a framework for future larger scale works.
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Affiliation(s)
- Harrison Seltzer
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Emma Swayze
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Letty Thottathil
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - John Dewey
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jordan Jabara
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Aditya Mehta
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - John Frederick
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Paul Yousif
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Sonia Parikh
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Angie Tsuei
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - L Silvia Linares
- Medical Student, 51374Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Shafa A, Cope AG, Burnett TL, Kolish KP, Mara KC, Wyatt MA, Green IC. Interactive video module and simulated model for uterine manipulation during laparoscopic hysterectomy. Surg Endosc 2023; 37:443-449. [PMID: 35984522 DOI: 10.1007/s00464-022-09499-x] [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: 01/31/2022] [Accepted: 07/18/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hysterectomy is one of the most common gynecologic surgeries, with an increasing proportion of hysterectomies performed by a laparoscopic approach. Uterine manipulation is critical for patient safety and surgical efficiency; however, the most junior member of the surgical team assumes the responsibility of uterine manipulation, commonly without preparation. The objective of our study was to determine whether kinesthetic learning using a low-cost simulated pelvic model while learning the uterine manipulation maneuvers of a laparoscopic hysterectomy improves learning efficacy and application efficiency compared to an interactive video module alone. METHODS Our randomized control trial at an academic medical center included forty first-year and second-year medical students. Participants were randomized to the intervention group that used a low-cost simulated pelvic model for kinesthetic learning during the video module or the control group who only had the interactive video module to learn the uterine manipulation maneuvers of a laparoscopic hysterectomy. RESULTS Participants in the intervention group were less likely to make unnecessary movements with demonstration of both pelvic side walls (right wall: control 78.9%, intervention 42.9%, p < 0.027; left wall: control 94.7%, intervention 66.7%, p < 0.046), and this was more pronounced in novice first-year participants (p < 0.009). Additionally, participants in the intervention group reported higher perceived preparedness (100% versus 71.4% in control group, p < 0.037). However, there was no difference in verbal or physical cues required, time per task, or force used between the groups. CONCLUSION Kinesthetic practice may not be required for learning the uterine manipulation maneuvers of a laparoscopic hysterectomy, but it may be beneficial for more novice learners and to increase learners' perceived preparedness. Our novel interactive video module alone may be sufficient to prepare learners to perform uterine manipulation maneuvers prior to the operating room.
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Affiliation(s)
- Anousheh Shafa
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA.
| | - Adela G Cope
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA
| | - Tatnai L Burnett
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA
| | | | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michelle A Wyatt
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA
| | - Isabel C Green
- Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA
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Madavan KT. Effectiveness and perception of demonstration-observation- assistance-performance (DOAP) versus video-assisted learning (VAL) in training advanced cardiac life support (ACLS) among medical interns - A comparative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:412. [PMID: 36824401 PMCID: PMC9942143 DOI: 10.4103/jehp.jehp_1663_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 10/14/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Demonstration-Observation-Assistance-Performance (DOAP) and Video-Assisted Learning (VAL) are small-group teaching/learning methods (TLM) in medical education. Comparison studies between the two are scanty. There is a gap in knowledge, skills, and attitude among medical interns toward Advanced Cardiac Life Support (ACLS). The author studied the effectiveness of DOAP and VAL in training ACLS using mannequins and automated external defibrillator (AED)-simulators among interns in 2021. MATERIALS AND METHODS This descriptive study was done in the Emergency Department of a tertiary teaching hospital in South India. Out of 80 medical interns, 39 and 41 were allocated to ACLS training by DOAP (Group 1) and VAL (Group 2), respectively, by convenient sampling with random allocation, with the use of mannequins and AED-Simulators (10 interventions in each small group; three-five participants in each session). Pre-validated pre-test and posttest multiple-choice questionnaires (MCQs) and attitude questionnaires, OSCE by two blinded assessors, and perception by Likert-based questionnaire were analyzed with appropriate statistical analysis. RESULTS The mean pretest and posttest MCQs and Attitude and OSCE scores of DOAP and VAL showed no statistically significant difference between them (MCQ pre-test 44.51 (11.43); 42.54 (6.56); p = 0.350 and MCQ posttest, 78.97 (8.59); 77.22 (11.29); p = 0.438; OSCE 40.51 (2.43) and 40.63 (1.92); p = 0.804; Attitude: 11 (3), 11 (2); p = 0.567; 14 (2), 14 (3); p = 0.095). MCQ post-tests showed improved scores (p < 0.001) in both the methods and the standardized mean difference based on the MCQ scores for the DOAP group was 3.02, and for the VAL group 3, showed the effectiveness of both methods. Perception scores showed learners' interest and positive feedback to both methods and ACLS. CONCLUSION Both DOAP and VAL were equally effective TLMs in imparting knowledge, skills, and attitude to medical interns with positive feedback. In DOAP, the learner performs under supervision and clarifies doubts. As repeatable and cost-effective, VAL is useful in resource-limited settings. Both can be used as complementary methods in training ACLS. The attitude of learners towards ACLS improved with training.
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Combing pre-workshop, web-based learning and hands-on workshop as a flipped classroom clinical skill training model during the COVID-19 pandemic. Taiwan J Obstet Gynecol 2022; 61:755-760. [PMID: 36088041 PMCID: PMC9279488 DOI: 10.1016/j.tjog.2021.10.008] [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] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Due to the COVID-19 pandemic, there is a dramatic drop in in-person residency training due to the implementation of isolation and triage measurements. Here, we propose a new flipped classroom clinical skill training model utilizing a combination of pre-workshop, web-based learning and hands-on workshop that shortens in-person contact time to maintain residency training during the pandemic. Effectiveness of this training model was evaluated with a pre-test and post-test skills competency assessment, two-way feedback, and a five-point Likert scale structured survey questionnaire. Materials and methods The workshop was conducted in a flipped classroom fashion by the obstetrics and gynecology (OBGYN) department of a single tertiary teaching medical center covering topics from five OBGYN subspecialities. Every topic consisted of a pre-workshop, web-based, mini lecture (PWML) followed by a hands-on workshop (HW). All first to fourth year OBGYN residents were invited to attend the workshop. All the trainees were required to complete the PWML prior to the day of HW. The workshop consisted of rotational station for each topic and was conducted within one afternoon. A 0-100-point scale pre-test and post-test skills competency evaluation were performed for each station and was assessed by the attending doctor or fellow doctor of each subspeciality. Two-way feedback was done after the post-test evaluation. A five-point Likert scale structured survey instrument consisting of participant’s perceptions of the workshop design, relevance to clinical practice, and quality of instructors and materials was created during the curriculum development process and sent to each participant one month after the workshop. Results A total of 19 residents including five first-year, six second-year, three third-year, and five fourth-year residents completed the entire pre-workshop lecture, workshop, pre-test, and post-test. For all residents, the average post-test score of 5 stations was 95 and was significantly higher than the pre-test score of 60 (p < 0.001). For both junior residents and senior residents, the average post-test scores of 5 stations were also significantly higher than pre-test scores (p < 0.001). Survey generated one month after the workshop showed a high overall satisfaction with the workshop instructors on their professional knowledge, communication skills, and interactions between the instructors and trainees. The average satisfaction scores for manipulation of vaginal breech delivery (VBD), semen analysis (SA), cervical conization (CC), obstetrics anal sphincter injury (OASIS), and laparoscopic suture techniques (LST) were 4.84, 4.96, 4.92, 4.88, and 4.92, respectively The average score for practical application of the training materials, class design and teaching method, overall satisfaction of the session, and time scheduling was 4.84, 4.96, 4.96, and 4.48, respectively. The entire HW was completed within 180 min and was carried out within half a day. Conclusion With the implementation of isolation and triage measures in the COVID-19 pandemic, there is a dramatic drop in in-person exposure to all aspects of the residency training, in particular, non-emergent surgeries. Utilization of PWML saved 1/3 of in-person time and the entire workshop was completed within 180 min that could be carried out within half a day. The decrease of person-to-person contact time during the COVID-19 pandemic is necessary while still providing curriculum-based residency training in spite of decreased hands-on experience.
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Syamsuri DD, Askandar Tjokroprawiro B, Kurniawati EM, Utomo B, Kuswanto D. Simulation-based training using a novel Surabaya hysterectomy mannequin following video demonstration to improve abdominal hysterectomy skills of obstetrics and gynecology residents during the COVID-19 pandemic in Indonesia: a pre- and post-intervention study. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2022; 19:11. [PMID: 35614019 PMCID: PMC9149772 DOI: 10.3352/jeehp.2022.19.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE During the coronavirus disease 2019 (COVID-19) pandemic, the number of abdominal hysterectomy procedures decreased in Indonesia. The existing commercial abdominal hysterectomy simulation model is expensive and difficult to reuse. This study compared residents' abdominal hysterectomy skills after simulation-based training using the Surabaya hysterectomy mannequin following a video demonstration. METHODS We randomized 3rd- and 4th-year obstetrics and gynecology residents to a video-based group (group 1), a simulation-based group (group 2), and a combination group (group 3). Abdominal hysterectomy skills were compared between before and after the educational intervention. The pre- and post-tests were scored by blinded experts using the validated Objective Structured Assessment of Technical Skills (OSATS) and Global Rating Scale (GRS). RESULTS A total of 33 residents were included in the pre- and post-tests. The OSATS and GRS mean differences after the intervention were higher in group 3 than in groups 1 and 2 (OSATS: 4.64 [95% CI, 2.90-6.37] vs. 2.55 [95% CI, 2.19-2.90] vs. 3.82 [95% CI, 2.41-5.22], P=0.047; GRS: 10.00 [95% CI, 7.01-12.99] vs. 5.18 [95% CI, 3.99-6.38] vs. 7.18 [95% CI, 6.11-8.26], P=0.006). The 3rd-year residents in group 3 had greater mean differences in OSATS and GRS scores than the 4th-year residents (OSATS: 5.67 [95% CI, 2.88-8.46]; GRS: 12.83 [95% CI, 8.61-17.05] vs. OSATS: 3.40 [95% CI, 0.83-5.97]; GRS: 5.67 [95% CI, 2.80-8.54]). CONCLUSION Simulation-based training using the Surabaya hysterectomy mannequin following video demonstration can be a bridge to learning about abdominal hysterectomy for residents who had less surgical experience during the COVID-19 pandemic.
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Affiliation(s)
- Dara Dasawulansari Syamsuri
- Department of Obstetrics and Gynecology, Dr. Soetomo General Academic Hospital, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
| | - Brahmana Askandar Tjokroprawiro
- Department of Obstetrics and Gynecology, Dr. Soetomo General Academic Hospital, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
| | - Eighty Mardiyan Kurniawati
- Department of Obstetrics and Gynecology, Dr. Soetomo General Academic Hospital, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
| | - Budi Utomo
- Department of Public Health-Preventive Medicine, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
| | - Djoko Kuswanto
- Integrated Digital Design Laboratory, Industrial Design Department, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
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Thakur K, Khedkar D, Palal D, Subhash J, Jadhav S, Rathod H, Jadav V, Sohkhlet G, Verma P, Borah N, Nallapu S, Gangurde S, Mahajan A. Introduction of spatial technology for surveillance of vectors of mosquito-borne diseases as an innovative training tool for undergraduate medical students: Qualitative assessment. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_975_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Marschalek J, Kuessel L, Stammler-Safar M, Kiss H, Ott J, Husslein H. Comparison of a practice-based versus theory-based training program for conducting vacuum-assisted deliveries: a randomized-controlled trial. Arch Gynecol Obstet 2021; 305:365-372. [PMID: 34363518 PMCID: PMC8840931 DOI: 10.1007/s00404-021-06159-8] [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: 03/13/2021] [Accepted: 07/21/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE Vacuum-assisted deliveries (VAD) are complex procedures that require training and experience to be performed proficiently. We aimed to evaluate if a more resource intensive practice-based training program for conducting VAD is more efficient compared to a purely theory-based training program, with respect to immediate training effects and persistence of skills 4-8 weeks after the initial training. METHODS In this randomized-controlled study conducted in maternity staff, participants performed a simulated low-cavity non-rotational vacuum delivery before (baseline test) and immediately after the training (first post-training test) as well as 4-8 weeks thereafter (second post-training test). The study's primary endpoint was to compare training effectiveness between the two study groups using a validated objective structured assessment of technical skills (OSATS) rating scale. RESULTS Sixty-two participants were randomized to either the theory-based group (n = 31) or the practice-based group (n = 31). Total global and specific OSATS scores, as well as distance of cup application to the flexion point improved significantly from baseline test to the first post-training test in both groups (pall < 0.007). Skill deterioration after 4-8 weeks was only found in the theory-based group, whereas skills remained stable in the practice-based group. CONCLUSION A practice-based training program for conducting VAD results in comparable immediate improvement of skills compared to a theory-based training program, but the retention of skills 4-8 weeks after training is superior in a practice-based program. Future studies need to evaluate, whether VAD simulation training improves maternal and neonatal outcome after VAD.
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Affiliation(s)
- Julian Marschalek
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Lorenz Kuessel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Maria Stammler-Safar
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Heinrich Husslein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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A randomized comparison of training programs using a pelvic model designed to enhance pelvic floor examination in patients presenting with chronic pelvic pain. Int Urogynecol J 2020; 32:423-431. [PMID: 32897461 PMCID: PMC7477739 DOI: 10.1007/s00192-020-04487-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/30/2020] [Indexed: 11/07/2022]
Abstract
Introduction Pelvic floor myalgia is a common cause and contributor to chronic pelvic pain [Neurourol Urodyn 4:984–1008 (2017)]. The purpose of this study was to compare in-person versus video-based teaching methods of a comprehensive assessment of the pelvic floor musculature on a pelvic model. Methods A randomized controlled trial of 46 participants was conducted. The participants were randomized into two groups. Both groups were taught by the same pelvic floor physiotherapist using two different teaching methods on a pelvic model. Group 1 watched an instructional video, whereas group 2 had in-person training. Both groups underwent pre- and post-training assessments consisting of a written examination and an Objective Structured Clinical Examination (OSCE). Primary outcome measure was the change in participants’ pre- and post-training assessment scores. Secondary outcome measures were perceived changes in both participants’ comfort level in performing pelvic floor examination and applicability of the training program to clinical practice. Results There was no statistically significant difference between the teaching methods in the degree of improvement of the participants’ mean written assessment scores (p = 0.58), OSCE scores (p = 0.15), and perceived comfort level (p = 0.19). Participants’ mean pre- and post-assessment scores improved significantly (p < 0.001). Participants reported the training program to be applicable towards their clinical practice. Conclusions This study demonstrates that learners’ assessment of pelvic floor musculature can be enhanced using varied teaching methods on a pelvic model.
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Evaluation of Surgical Skills during Robotic Surgery by Deep Learning-Based Multiple Surgical Instrument Tracking in Training and Actual Operations. J Clin Med 2020; 9:jcm9061964. [PMID: 32585953 PMCID: PMC7355689 DOI: 10.3390/jcm9061964] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
As the number of robotic surgery procedures has increased, so has the importance of evaluating surgical skills in these techniques. It is difficult, however, to automatically and quantitatively evaluate surgical skills during robotic surgery, as these skills are primarily associated with the movement of surgical instruments. This study proposes a deep learning-based surgical instrument tracking algorithm to evaluate surgeons’ skills in performing procedures by robotic surgery. This method overcame two main drawbacks: occlusion and maintenance of the identity of the surgical instruments. In addition, surgical skill prediction models were developed using motion metrics calculated from the motion of the instruments. The tracking method was applied to 54 video segments and evaluated by root mean squared error (RMSE), area under the curve (AUC), and Pearson correlation analysis. The RMSE was 3.52 mm, the AUC of 1 mm, 2 mm, and 5 mm were 0.7, 0.78, and 0.86, respectively, and Pearson’s correlation coefficients were 0.9 on the x-axis and 0.87 on the y-axis. The surgical skill prediction models showed an accuracy of 83% with Objective Structured Assessment of Technical Skill (OSATS) and Global Evaluative Assessment of Robotic Surgery (GEARS). The proposed method was able to track instruments during robotic surgery, suggesting that the current method of surgical skill assessment by surgeons can be replaced by the proposed automatic and quantitative evaluation method.
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Mannella P, Malacarne E, Giannini A, Russo E, Caretto M, Papini F, Montt Guevara MM, Pancetti F, Simoncini T. Simulation as tool for evaluating and improving technical skills in laparoscopic gynecological surgery. BMC Surg 2019; 19:146. [PMID: 31619236 PMCID: PMC6796391 DOI: 10.1186/s12893-019-0610-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 09/20/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Simulation in laparoscopic surgery is nowadays recognized as a valid instrument for learning and training surgeons in different procedures. However, its role as evaluation test and self-assessment tool to verify basic surgical skills is still under discussion. METHODS Thirty-three residents in obstetrics and gynecology at University of Pisa, Italy were recruited, and they received a simulation program consisting of 5 tasks. They had to perform basic laparoscopic surgery maneuvers as creating pneumoperitoneum, positioning trocars under vision, demonstrating the appropriate use of dominant and non-dominant hand and making single stitch and knot. They were evaluated with a modified OSATs scale. RESULTS Senior trainees had better score than junior trainees (p value< 0,005) and after different sessions of simulation scores of both groups significantly improved (p < 0,001), especially for the junior group. All the trainees reported self-assessments that matched with the evaluation of external observers demonstrating the importance of simulation also as auto-evaluation test. CONCLUSIONS In this study, we demonstrated the role of simulation as powerful tool to evaluate and to self-assess surgical technical skills and to improve own capacities, with the use of a modified OSATs scale adapted to specific exercises.
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Affiliation(s)
- Paolo Mannella
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Elisa Malacarne
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Eleonora Russo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Marta Caretto
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Francesca Papini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | | | - Federica Pancetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
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Bock A, Modabber A, Hölzle F, Prescher A, Classen-Linke I. Improvement of anatomical knowledge and surgical skills in head and neck region — An interdisciplinary hands-on course for clinical students. Ann Anat 2019; 224:97-101. [DOI: 10.1016/j.aanat.2019.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
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13
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Julian O, Patrick H, Felix N, Tilman W, Mirco F, Beat-Peter MS, Gerhard S, Tanner MC. Development and validation of an objective assessment scale for chest tube insertion under 'direct' and 'indirect' rating. BMC MEDICAL EDUCATION 2018; 18:320. [PMID: 30587187 PMCID: PMC6307220 DOI: 10.1186/s12909-018-1430-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is an increasing need for objective and validated educational concepts. This holds especially true for surgical procedures like chest tube insertion (CTI). Thus, we developed an instrument for objectification of learning successes: the assessment scale based on Objective Structured Assessment of Technical Skill (OSATS) for chest tube insertion, which is evaluated in this study. Primary endpoint was the evaluation of intermethod reliability (IM). Secondary endpoints are 'indirect' interrater reliability (IR) and construct validity of the scale (CV). METHODS Every participant (N = 59) performed a CTI on a porcine thorax. Participants received three ratings (one 'direct' on site, two 'indirect' via video rating). IM compares 'direct' with 'indirect' ratings. IR was assessed between 'indirect' ratings. CV was investigated by subgroup analysis based on prior experience in CTI for 'direct' and 'indirect' rating. RESULTS We included 59 medical students to our study. IM showed moderate conformity ('direct' vs. 'indirect 1' ICC = 0.735, 95% CI: 0.554-0.843; 'direct' vs. 'indirect 2' ICC = 0.722, 95% CI 0.533-0.835) and good conformity between 'direct' vs. 'average indirect' rating (ICC = 0.764, 95% CI: 0.6-0.86). IR showed good conformity (ICC = 0.84, 95% CI: 0.707-0.91). CV was proven between subgroups in 'direct' (p = 0.037) and 'indirect' rating (p = 0.013). CONCLUSION Results for IM suggest equivalence for 'direct' and 'indirect' ratings, while both IR and CV was demonstrated in both rating methods. Thus, the assessment scale seems a reliable method for rating trainees' performances 'directly' as well as 'indirectly'. It may help to objectify and facilitate the assessment of training of chest tube insertion.
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Affiliation(s)
- Ober Julian
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - Haubruck Patrick
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - Nickel Felix
- Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Walker Tilman
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - Friedrich Mirco
- Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Müller-Stich Beat-Peter
- Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Schmidmaier Gerhard
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - Michael C. Tanner
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
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Liang S, Song C, Zhao X, Ma C, Li X, Liu S. [The design and assessment of a novel simulated training system for cardiac surgery]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2018; 35:779-785. [PMID: 30370719 PMCID: PMC9935252 DOI: 10.7507/1001-5515.201712046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Indexed: 11/03/2022]
Abstract
Simulations can mimic the environment that refers to the surgery operation to improve the technical skills of the trainees. In this paper, we designed a new cardiac surgery simulative training system. The isolated pig heart was selected as the heart model. A mechanical device was designed to achieve the beating of heart model. At the same time, adjusting frequencies of mechanical movement could change the rating of heartbeat. In order to validate the rationality of the system, 12 non-medical specialty students and 12 medical specialty students were divided into two groups, which consecutively accepted seven-days of training for off-pump coronary artery bypass grafting using the cardiac surgery simulative training system. The time for completing bypass grafting before and after training were recorded. And the bridging outcomes of each trainee were assessed by 3 surgery cardiac surgeons using the object structured assessments of technical skill (OSATS) criteria. After training, each trainee could finish the bypass suturing in a shorter time than before training, and the scores of each trainee assessed by OSATS criteria were also improved. The results showed that the cardiac surgery simulative training system had better training effect in improving the surgical techniques, operation skills and proficiency of surgical instruments of trainees.
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Affiliation(s)
- Shichao Liang
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China
| | - Chengli Song
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P. R.
| | - Xuesong Zhao
- Shanghai Shinno-Med Technology Co. Ltd., Shanghai 200093, P. R. China
| | - Chang Ma
- Shanghai Shinno-Med Technology Co. Ltd., Shanghai 200093, P. R. China
| | - Xianda Li
- CCI, Covidien (Shanghai) Management Consulting Co. Ltd, Shanghai 200093, P. R. China
| | - Sha Liu
- CCI, Covidien (Shanghai) Management Consulting Co. Ltd, Shanghai 200093, P. R. China
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Kazan R, Viezel-Mathieu A, Cyr S, Hemmerling TM, Gilardino MS. The Montreal Augmentation Mammaplasty Operation (MAMO) Simulator: An Alternative Method to Train and Assess Competence in Breast Augmentation Procedures. Aesthet Surg J 2018; 38:835-849. [PMID: 29506205 DOI: 10.1093/asj/sjx267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Surgical residents' exposure to aesthetic procedures remains limited in residency training. The development of the Montreal augmentation mammaplasty operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. OBJECTIVES To perform face, content, and construct validations of the MAMO simulator for subpectoral breast augmentation procedures and assess the reliability of the assessment scales used. METHODS Plastic surgery staff and residents were recruited to perform a subpectoral breast augmentation on the simulator. Video recordings of their performance were blindly evaluated using the objective structured assessment of technical skills (OSATS) system consisting of the global rating scale (GRS), mammaplasty objective assessment tool (MOAT), and a surgery-specific Checklist score. RESULTS Fourteen plastic surgery residents and seven expert plastic surgeons were enrolled. Experts' performance was significantly higher than residents' according to each of GRS, MOAT, and Checklist scores. Mean values of residents and experts were 23.4 (2.5) vs 36.9 (3.1) (P < 0.0001) for GRS score, 30.4 (2.2) vs 40 (3.2) (P < 0.0001) for MOAT scores, and 9.7 (1.5) vs 12 (1) (P < 0.001) for Checklist scores, respectively. Face and content validations showed excellent results among parameters evaluated, with an overall mean score of 4.8 (0.3) on 5. Cronbach's alpha was 0.96 and 0.83 for GRS and MOAT scores, respectively. Intraclass correlation coefficients for interrater reliability were excellent at 0.93, 0.92, and 0.89 for the GRS, MOAT, and Checklist scores, respectively. CONCLUSIONS This study proves the construct simulator to be valid and the assessment scales to be reliable.
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Affiliation(s)
- Roy Kazan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Viezel-Mathieu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Shantale Cyr
- Intelligence Technologies of Anesthesia Group Laboratory, Department of Anesthesia, McGill University
| | | | - Mirko S Gilardino
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
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Neumann E, Mayer J, Russo GI, Amend B, Rausch S, Deininger S, Harland N, da Costa IA, Hennenlotter J, Stenzl A, Kruck S, Bedke J. Transurethral Resection of Bladder Tumors: Next-generation Virtual Reality Training for Surgeons. Eur Urol Focus 2018; 5:906-911. [PMID: 29802051 DOI: 10.1016/j.euf.2018.04.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The number of virtual reality (VR) simulators is increasing. The aim of this prospective trial was to determine the benefit of VR cystoscopy (UC) and transurethral bladder tumor resection (TURBT) training in students. DESIGN, SETTING, AND PARTICIPANTS Medical students without endoscopic experience (n=51, median age=25 yr, median 4th academic year) were prospectively randomized into groups A and B. After an initial VR-UC and VR-TURBT task, group A (n=25) underwent a video-based tutorial by a skilled expert. Group B (n=26) was trained using a VR training program (Uro-Trainer). Following the training, every participant performed a final VR-UC and VR-TURBT task. Performance indicators were recorded via the simulator. Data was analyzed by Mann-Whitney U test. INTERVENTION VR cystoscopy and TURBT. RESULTS AND LIMITATIONS No baseline and post-training differences were found for VR-UC between groups. During baseline, VR-TURBT group A showed higher inspected bladder surface than group B (56% vs 73%, p=0.03). Subgroup analysis detected differences related to sex before training (male: 31.2% decreased procedure time; 38.1% decreased resectoscope movement; p=0.02). After training, significant differences in procedure time (3.9min vs 2.7min, p=0.007), resectoscope movement (857mm vs 529mm, p=0.005), and accidental bladder injury (n=3.0 vs n=0.88, p=0.003) were found. Male participants showed reduced blood loss (males: 3.92ml vs females: 10.12ml; p=0.03) after training. CONCLUSIONS Measuring endoscopic skills within a virtual environment can be done easily. Short training improved efficacy and safety of VR-TURBT. Nevertheless, transfer of improved VR performance into real world surgery needs further clarification. PATIENT SUMMARY We investigated how students without endoscopic experience profit from simulation-based training. The safe environment and repeated simulations can improve the surgical training. It may be possible to enhance patient's safety and the training of surgeons in long term.
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Affiliation(s)
- Eva Neumann
- University Tuebingen, Dept. of Urology, Tuebingen, Germany
| | - Julian Mayer
- University Tuebingen, Dept. of Urology, Tuebingen, Germany
| | - Giorgio Ivan Russo
- University Tuebingen, Dept. of Urology, Tuebingen, Germany; University of Catania, Urology Section, Catania, Italy
| | - Bastian Amend
- University Tuebingen, Dept. of Urology, Tuebingen, Germany
| | - Steffen Rausch
- University Tuebingen, Dept. of Urology, Tuebingen, Germany
| | | | - Niklas Harland
- University Tuebingen, Dept. of Urology, Tuebingen, Germany
| | | | | | - Arnulf Stenzl
- University Tuebingen, Dept. of Urology, Tuebingen, Germany
| | - Stephan Kruck
- University Tuebingen, Dept. of Urology, Tuebingen, Germany
| | - Jens Bedke
- University Tuebingen, Dept. of Urology, Tuebingen, Germany.
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Cheng HC, de Costa C, Woods C. Medical students and midwives - How do they view each other? Aust N Z J Obstet Gynaecol 2018; 58:586-589. [PMID: 29569707 DOI: 10.1111/ajo.12803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
Medical students from James Cook University who had completed their rotation in obstetrics, and midwives working in Cairns Hospital who had undertaken supervision of medical students in the birth suite, were invited to complete anonymous questionnaires on their views of their respective roles in the birth suite. Several issues were identified including increased medical and midwifery student numbers, and lack of communication between midwives and medical students. Increased cooperation and communication between medical and midwifery education providers is urgently needed to improve both student groups' learning experiences.
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Affiliation(s)
- Hon C Cheng
- Cairns Clinical School, School of Medicine & Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Caroline de Costa
- Cairns Clinical School, School of Medicine & Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Cindy Woods
- School of Health, University of New England, Armidale, New South Wales, Australia
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Chisthi MM. Brief Commentary on the article "A Novel Clinical-Simulated Suture Education for Basic Surgical Skill: Suture on the Biological Tissue Fixed on Standardized Patient Evaluated with Objective Structured Assessment of Technical Skill (OSATS) Tools". J INVEST SURG 2017; 31:340-341. [PMID: 28525290 DOI: 10.1080/08941939.2017.1325544] [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]
Affiliation(s)
- Meer M Chisthi
- a Department of General Surgery , Government Medical College , Trivandrum 695011 , Kerala , India
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