1
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Li T, Wu H, Dong J. Current status, challenges, and future directions of laparoscopic training in young surgeons: a nationwide survey in China. BMC MEDICAL EDUCATION 2024; 24:1040. [PMID: 39334031 PMCID: PMC11429501 DOI: 10.1186/s12909-024-06031-8] [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: 04/06/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND With the rapid advancement of technology, minimally invasive surgery, particularly laparoscopic surgery, has made significant progress in the field of surgery. Despite the advantages of laparoscopic surgery, a systematic training system for laparoscopic procedures is lacking in Chinese postgraduate medical education. Our study aims to explore the prevalence of laparoscopic training among resident and attending physicians in China and to assess the current state of training programs. METHODS A 10-item questionnaire was distributed to 1,750 resident and attending physicians specializing in surgery across China, with 1,324 valid responses (75.7% response rate). The survey focused on demographics, training curriculum content, and feedback on training effectiveness. Data analysis was conducted using Microsoft Excel and IBM SPSS. RESULTS Among the 1,324 respondents, 30.7% reported receiving laparoscopic training, primarily at the attending physician stage. Only 4% of resident physicians and 14% of attending physicians could independently perform complex laparoscopic surgeries. Most respondents (76.6%) could only assist in surgeries. The majority expressed a desire for more frequent and longer training sessions, with suture training being identified as the most beneficial. CONCLUSIONS This study underscores the critical need for comprehensive laparoscopic training in China. Early, frequent, and structured training programs are essential for developing proficient laparoscopic surgeons. Future initiatives should focus on expanding access to training at all levels of medical education, ensuring continuous skill development and improved surgical care quality.
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Affiliation(s)
- Tianyu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Haikun Wu
- Beijing BoYiTimes Medical Technology Co., Ltd, Beijing, China
| | - Jie Dong
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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2
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Cabello R, Bueno-Serrano G, Arteche AH, Villacampa JM, Castilla C, Carnero C, Garranzo Garcia-Ibarrola M, Gonzalez Enguita C. "Self-Designed Simulation-Based Laparoscopic Training Program for Urology Residents: Results After 6 Years of Experience". ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:451-459. [PMID: 38826693 PMCID: PMC11143445 DOI: 10.2147/amep.s450513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/27/2024] [Indexed: 06/04/2024]
Abstract
Introduction Learning laparoscopy (LAP) is challenging and requires different skills to conventional open surgery. There is a recognized need for a standardized laparoscopic training framework within urology to overcome these difficulties and to shift learning curve from patient to skills laboratory. Simulation-based training has been widely commented, but implementation in real day practice is lacking. We present our "LAP training program for residents". Material Between 2017 and 2022, 11 residents participated in our self-designed program: Theoretical: (Moodle platform) basic knowledge and multimedia content for initiation into LAP. Evaluated through online exam. Practical: exercises for LAP skills acquisition were proposed and encouraged residents' practice in a box trainer available and experimental surgery sessions on a porcine model. On-site E-BLUS (European Basic Laparoscopic Urologic Skills) examination was performed annually. Feedback was obtained through an anonymous online survey. Results All residents positively evaluated the program. Theoretical: 82% passed the online exam. The most valued topics: LAP in special clinical situations, complications, instruments, and configuration of the operating room (OR). Practical: all residents increased dry-lab box practices. A total of 23 experimental surgical sessions were carried out. For 64%, simulation in the experimental OR was a necessary complement to achieve laparoscopic skills and allowed them to feel more confident. Forty-five percent considered it essential to improve their surgical technique. E-BLUS evaluation was valued as a means to achieve dexterity and safer surgery by 90%. Reduction in time and errors were observed through time, although only 2 passed the E-BLUS. Conclusion Our program for learning LAP includes the acquisition of knowledge, training of basic skills and surgical technique in a safe environment, as well as an objective evaluation. Encouraged practice of basic skills and surgical technique simulation and improved objective evaluation. It is structured, reproducible, systematic and has been positively valued, although it requires commitment for success.
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Affiliation(s)
- Ramiro Cabello
- Department Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - José Miguel Villacampa
- Department Otorhinolaryngology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Castilla
- Experimental Surgery Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Carnero
- Experimental Surgery Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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3
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Ackermann J, Pape J, Vogler F, Pahls J, Baumann J, Holthaus B, Noé GK, Anapolski M, Ruchay Z, Westermann A, Günther V, Andresen K, Allahqoli L, Moawad G, Neymeyer J, Brügge S, Maass N, Mettler L, Alkatout I. The Feasibility of Practical Training in Minimally Invasive Surgery at Medical School-A Prospective Study on the Pelvitrainer. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:159. [PMID: 38256419 PMCID: PMC10819215 DOI: 10.3390/medicina60010159] [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: 11/30/2023] [Revised: 12/21/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The acquisition of practical skills at medical school is an important part of the multidimensional education program of future physicians. However, medical schools throughout the world have been slow in incorporating practical skills in their curriculum. Therefore, the aims of the present prospective study were (a) to demonstrate the feasibility of such surgical training, (b) to objectify its benefit in medical education, and (c) to investigate the impact of such training on subsequent career choices. Material and Methods: We introduced a two-day laparoscopy course on the pelvitrainer as part of the curriculum of the gynecological internship of fifth year medical students from 2019 to 2020. The results of the students' training were matched to those of surgeons who completed the same curriculum in a professional postgraduate laparoscopy course from 2017 to 2020 in a comparative study design. Additionally, we performed a questionnaire-based evaluation of the impact of the course on medical education and subsequent career choices directly before and after completing the course. Results: A total of 261 medical students and 206 physicians completed the training program. At baseline, the students performed significantly more poorly than physicians in a median of three of four exercises (p < 0.001). However, this evened out in the final runs, during which students performed more poorly than physicians only in one exercise and even better than physicians in one. The general integration of surgical training in medical school curricula was rated very low (12.4% on the VAS, IQR 3-16%) despite the high demand for such training. In the survey, the course was deemed very beneficial for medical education (median VAS 80.7%, IQR 73-98%), but did not appear to influence the students' subsequent career preferences. Conclusions: The acquisition of practical surgical skills during medical school is significantly under-represented in many medical faculties. The benefits of such training, as demonstrated in our study, would improve the education of future physicians.
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Affiliation(s)
- Johannes Ackermann
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Julian Pape
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Felix Vogler
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Julia Pahls
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Jorun Baumann
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Bernd Holthaus
- Clinic of Obstetrics and Gynecology, St. Elisabeth Hospital, 49401 Damme, Germany;
| | - Günter Karl Noé
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dr.-Geldmacher-Straße 20, 41540 Dormagen, Germany; (G.K.N.)
| | - Michael Anapolski
- Department of Obstetrics and Gynecology, University Witten/Herdecke, Rheinland Klinikum Dormagen, Dr.-Geldmacher-Straße 20, 41540 Dormagen, Germany; (G.K.N.)
| | - Zino Ruchay
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Anna Westermann
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Veronika Günther
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Kristin Andresen
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran 1467664961, Iran;
| | - Gaby Moawad
- Department of Obstetrics and Gynaecology, The George Washington University Hospital, Washington, DC 20037, USA;
| | - Jörg Neymeyer
- Clinic of Urology, Charité—Universitätsmedizin Berlin, Hindenburgdamm 30, 12200 Berlin, Germany;
| | - Sandra Brügge
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Nicolai Maass
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Liselotte Mettler
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
| | - Ibrahim Alkatout
- Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (House C), 24105 Kiel, Germany; (J.P.); (F.V.); (J.P.); (J.B.); (A.W.); (V.G.); (K.A.); (S.B.); (N.M.); (L.M.)
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Malanowska-Jarema E, Osnytska Y, Starczewski A, Balzarro M, Rubilotta E. A comparative study in learning curves of laparoscopic lateral suspension vs. laparoscopic sacrocolpopexy: preliminary results. Front Surg 2023; 10:1274178. [PMID: 38125583 PMCID: PMC10731022 DOI: 10.3389/fsurg.2023.1274178] [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: 08/07/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Background Determination of the learning curve of new techniques is essential to improve safety and efficiency. Limited information is available regarding learning curves of different techniques in laparoscopic pelvic floor surgery. Objective The aim of this study was to compare the learning curve of two operative techniques, laparoscopic lateral suspension (LLS) and laparoscopic sacrocolpopexy (LSC). Material and methods We conducted a prospective study to assess the learning curve of LLS and LSC by implementing a structured urogynecologic surgical training program with the use of pelvic trainers for our urogynecology fellow. The fellow was an experienced urogynecologic surgeon, but was laparoscopic suturing and dissection naive at the beginning of the study. She was required to assist in 20 laparoscopic urogynecologic surgeries and undertake laparoscopic suturing and knot tying training with mesh positioning on a laparoscopic trainer for 4 h/week during the trial period. After the completion of this structured training program, the fellow performed LLS and LSC under the supervision of an experienced subspecialist as the primary surgeon. Linear regression analysis was used to compare the data of LLS and LSC learning curves. Subjective pre- and post-operative evaluation of pelvic organ prolapse (POP) and pelvic floor disorders was undertaken preoperatively and 12 months postoperatively using the PFDI-20-Quality of Life validated questionnaire. Follow-up was scheduled 12 months after the surgery and performed by a skilled urogynecologist. Objective cure was defined as Pelvic Organ Prolapse-Qualification (POP-Q) stage Results The mean operative times of laparoscopic sacrocolpopexy and lateral suspension were 168.26 and 160.33 min, respectively. According to linear regression analysis after 43 procedures, the learning curve for laparoscopic lateral suspension was shorter than for laparoscopic sacrocolpopexy (OPTime 134.69 min). In both groups, there was a significant reduction in bothersome POP symptoms (p ≤ 0.005). Bladder injuries in two cases and lumbar pain in one case were recorded during the study. Overall objective success at 12 months was 90.7% for LSC and 89.1% for LLS. Conclusion Laparoscopic lateral suspension could be an alternative to laparoscopic sacrocolpopexy in the treatment of POP with its good objective and subjective outcomes. Lateral suspension has a shorter learning curve, and it is technically less demanding than LSC. Procedure-dedicated training can accelerate the move from a novice to a master laparoscopic surgeon.
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Affiliation(s)
- Ewelina Malanowska-Jarema
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Yana Osnytska
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Starczewski
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Charondo LB, Brian R, Syed S, Chern H, Lager J, Alseidi A, O'Sullivan P, Bayne D. Confronting new challenges: Faculty perceptions of gaps in current laparoscopic curricula in a changing training landscape. Surg Open Sci 2023; 16:1-7. [PMID: 37731731 PMCID: PMC10507640 DOI: 10.1016/j.sopen.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
Background Opportunities for residents to develop laparoscopic skills have decreased with the rise in robotic operations and the development of complex, subspecialized laparoscopic operations. Given the changing training landscape, this study aimed to identify laparoscopic surgeons' perceptions of gaps in current laparoscopic skills in general surgery, obstetrics-gynecology, and urology residency programs. Methods Laparoscopic surgeons who operate with residents participated in semi-structured interviews. Questions addressed expectations for resident proficiency, deficits in laparoscopic surgical skills, and barriers to learning and teaching. Two authors independently coded de-identified transcripts followed by a conventional content analysis. Results Fourteen faculty members from thirteen subspecialties participated. Faculty identified three main areas to improve laparoscopic training across specialties: foundational knowledge, technical skills, and cognitive skills. They also recognized an overarching opportunity to address faculty development. Conclusions This qualitative study highlighted key deficiencies in laparoscopic training that have emerged in the current, changing era of minimally invasive surgery. Key message This qualitative study identified laparoscopic educators' perceptions of deficiencies in laparoscopic training. Findings emphasized the importance of incorporating high quality educational practices to optimize training in the current changing landscape of laparoscopic surgery.
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Affiliation(s)
| | - Riley Brian
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Shareef Syed
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Hueylan Chern
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Jeannette Lager
- University of California, San Francisco, Department of Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, CA, USA
| | - Adnan Alseidi
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Patricia O'Sullivan
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - David Bayne
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
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6
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Karadza E, Haney CM, Limen EF, Müller PC, Kowalewski KF, Sandini M, Wennberg E, Schmidt MW, Felinska EA, Lang F, Salg G, Kenngott HG, Rangelova E, Mieog S, Vissers F, Korrel M, Zwart M, Sauvanet A, Loos M, Mehrabi A, de Santibanes M, Shrikhande SV, Abu Hilal M, Besselink MG, Müller-Stich BP, Hackert T, Nickel F. Development of biotissue training models for anastomotic suturing in pancreatic surgery. HPB (Oxford) 2023:S1365-182X(23)00041-2. [PMID: 36828741 DOI: 10.1016/j.hpb.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/11/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Anastomotic suturing is the Achilles heel of pancreatic surgery. Especially in laparoscopic and robotically assisted surgery, the pancreatic anastomosis should first be trained outside the operating room. Realistic training models are therefore needed. METHODS Models of the pancreas, small bowel, stomach, bile duct, and a realistic training torso were developed for training of anastomoses in pancreatic surgery. Pancreas models with soft and hard textures, small and large ducts were incrementally developed and evaluated. Experienced pancreatic surgeons (n = 44) evaluated haptic realism, rigidity, fragility of tissues, and realism of suturing and knot tying. RESULTS In the iterative development process the pancreas models showed high haptic realism and highest realism in suturing (4.6 ± 0.7 and 4.9 ± 0.5 on 1-5 Likert scale, soft pancreas). The small bowel model showed highest haptic realism (4.8 ± 0.4) and optimal wall thickness (0.1 ± 0.4 on -2 to +2 Likert scale) and suturing behavior (0.1 ± 0.4). The bile duct models showed optimal wall thickness (0.3 ± 0.8 and 0.4 ± 0.8 on -2 to +2 Likert scale) and optimal tissue fragility (0 ± 0.9 and 0.3 ± 0.7). CONCLUSION The biotissue training models showed high haptic realism and realistic suturing behavior. They are suitable for realistic training of anastomoses in pancreatic surgery which may improve patient outcomes.
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Affiliation(s)
- Emir Karadza
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Caelan M Haney
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Eldridge F Limen
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Philip C Müller
- Department of Surgery and Transplantation, Swiss HPB and Transplantation Center, University Hospital Zürich, Zürich, Switzerland
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urooncological Surgery, University Medical Center Mannheim, Mannheim, Germany
| | - Marta Sandini
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Erica Wennberg
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Mona W Schmidt
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany
| | - Eleni A Felinska
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Franziska Lang
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Gabriel Salg
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Hannes G Kenngott
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Elena Rangelova
- Section for Upper Abdominal Surgery at Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederique Vissers
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Maarten Korrel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Maurice Zwart
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Alain Sauvanet
- Department of HPB Surgery, Hôpital Beaujon, Clichy-Paris, France
| | - Martin Loos
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Martin de Santibanes
- Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Mohammad Abu Hilal
- Department of Surgery, Instituto Fondazione Poliambulanza, Brescia, Italy
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery at Heidelberg University Hospital, Heidelberg, Germany.
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Greenberg A, Samueli B, Fahoum I, Farkash S, Greenberg O, Zemser-Werner V, Sabo E, Hagege RR, Hershkovitz D. Short Training Significantly Improves Ganglion Cell Detection Using an Algorithm-Assisted Approach. Arch Pathol Lab Med 2023; 147:215-221. [PMID: 35738006 DOI: 10.5858/arpa.2021-0481-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Medical education in pathology relies on the accumulation of experience gained through inspection of numerous samples from each entity. Acquiring sufficient teaching material for rare diseases, such as Hirschsprung disease (HSCR), may be difficult, especially in smaller institutes. The current study makes use of a previously developed decision support system using a decision support algorithm meant to aid pathologists in the diagnosis of HSCR. OBJECTIVE.— To assess the effect of a short training session on algorithm-assisted HSCR diagnosis. DESIGN.— Five pathologists reviewed a data set of 568 image sets (1704 images in total) selected from 50 cases by the decision support algorithm and were tasked with scoring the images for the presence or absence of ganglion cells. The task was repeated a total of 3 times. Each pathologist had to complete a short educational presentation between the second and third iterations. RESULTS.— The training resulted in a significantly increased rate of correct diagnoses (true positive/negative) and a decreased need for referrals for expert consultation. No statistically significant changes in the rate of false positives/negatives were detected. CONCLUSIONS.— A very short (<10 minutes) training session can greatly improve the pathologist's performance in the algorithm-assisted diagnosis of HSCR. The same approach may be feasible in training for the diagnosis of other rare diseases.
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Affiliation(s)
- Ariel Greenberg
- From Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (A Greenberg, Fahoum, O Greenberg, Zemser-Werner, Hagege, Hershkovitz)
| | - Benzion Samueli
- From the Department of Pathology, Soroka University Medical Center, Be'er Sheva, Israel (Samueli)
| | - Ibrahim Fahoum
- From Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (A Greenberg, Fahoum, O Greenberg, Zemser-Werner, Hagege, Hershkovitz)
| | - Shai Farkash
- From the Institute of Pathology, Emek Medical Center, Afula, Israel (Farkash)
| | - Orli Greenberg
- From Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (A Greenberg, Fahoum, O Greenberg, Zemser-Werner, Hagege, Hershkovitz)
| | - Valentina Zemser-Werner
- From Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (A Greenberg, Fahoum, O Greenberg, Zemser-Werner, Hagege, Hershkovitz)
| | - Edmond Sabo
- From the Institute of Pathology, Carmel Medical Center, Haifa, Israel (Sabo).,From the Rappaport Faculty of Medicine, Technion, Haifa, Israel (Sabo)
| | - Rami R Hagege
- From Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (A Greenberg, Fahoum, O Greenberg, Zemser-Werner, Hagege, Hershkovitz).,Hagege and Hershkovitz contributed equally to the research
| | - Dov Hershkovitz
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Hershkovitz).,Hagege and Hershkovitz contributed equally to the research
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Ackermann J, Pahls J, Baumann J, Spüntrup C, Holthaus B, Noé G, Anapolski M, Meinhold-Heerlein I, Laganà AS, Peters G, Pape J, Willer D, Westermann AM, Günther V, Maass N, Mettler L, Alkatout I. The pelvitrainer for training in laparoscopic surgery – A prospective, multicenter, interdisciplinary study: Experimental research. Int J Surg 2022; 101:106604. [DOI: 10.1016/j.ijsu.2022.106604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
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Lavi A, Tzemah S, Hussein A, Bishara I, Shcherbakov N, Zelichenko G, Mashiah A, Gross M, Cohen M. The Urology Residency Program in Israel-Results of a Residents Survey and Insights for the Future. Rambam Maimonides Med J 2017; 8:RMMJ.10317. [PMID: 29059043 PMCID: PMC5652930 DOI: 10.5041/rmmj.10317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Urology practice has undergone several changes in recent years mainly related to novel technologies introduced. We aimed to get the residents' perspective on the current residency program in Israel and propose changes in it. METHODS A web-based survey was distributed among urology residents. RESULTS 61 residents completed the survey out of 95 to whom it was sent (64% compliance). A total of 30% replied that the 9 months of mandatory general surgery rotation contributed to their training, 48% replied it should be shortened/canceled, and 43% replied that the Step A exam (a mandatory written certifying exam) in general surgery was relevant to their training. A total of 37% thought that surgical exposure during the residency was adequate, and 28% considered their training "hands-on." Most non-junior residents (post-graduate year 3 and beyond) reported being able to perform simple procedures such as circumcision and transurethral resections but not complex procedures such as radical and laparoscopic procedures. A total of 41% of non-junior residents practice at a urology clinic. A total of 62% of residents from centers with no robotics replied its absence harmed their training, and 85% replied they would benefit from a robotics rotation. A total of 61% of residents from centers with robotics replied its presence harmed their training, and 72% replied they would benefit from an open surgery rotation. A total of 82% of the residents participated in post-graduate courses, and 81% replied they would engage in a clinical fellowship. CONCLUSION Given the survey results we propose some changes to be considered in the residency program. These include changes in the general surgery rotation and exam, better surgical training, possible exchange rotations to expose residents to robotic and open surgery (depending on the availability of robotics in their center), greater out-patient urology clinic exposure, and possible changes in the basic science period.
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Affiliation(s)
- Arnon Lavi
- Department of Urology, Haamek Medical Center, Afula, Israel
| | - Sharon Tzemah
- Department of Urology, Haamek Medical Center, Afula, Israel
| | - Anan Hussein
- Department of Urology, Haamek Medical Center, Afula, Israel
| | | | | | | | - Alon Mashiah
- Department of Urology, Haamek Medical Center, Afula, Israel
| | - Michael Gross
- Department of Urology, Haamek Medical Center, Afula, Israel
| | - Michael Cohen
- Department of Urology, Haamek Medical Center, Afula, Israel
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Sleiman Z, Atallah E, Rassi E, Sarkis R, Khazzaka A. Validation Study of a Portable Home Trainer Using a Pad for Laparoscopic Practice. Surg Innov 2017; 24:284-288. [PMID: 28178872 DOI: 10.1177/1553350617692481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The aim of this study was to describe and validate a homemade laparoscopic trainer. The abdominal cavity is simulated within a 3-mm-thick stainless steel model. Thirty-four participants were evaluated in a pilot study to validate our model. Participants were divided into experts (n = 19) and novices (n = 15) to perform basic and complex laparoscopic skills. The comparison between the homemade trainer (HT) and the standard laparoscopic trainer showed no significant differences for the 2 tasks performed for each group ( P > .05). The experts' performance of the 2 tasks was statistically different from the novices ( P < .05) on both trainers. Both experts (84%) and novices (87%) approved the HT as an effective home trainer. Our HT seems to fulfill the conditions of performing the basic and complex laparoscopic psychomotor skills at a low cost and similar efficiency.
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Affiliation(s)
- Zaki Sleiman
- 1 Saint Joseph University, Beirut, Lebanon.,2 Lebanese American University, Beirut, Lebanon
| | - Elie Atallah
- 1 Saint Joseph University, Beirut, Lebanon.,3 Hotel Dieu de France University Hospital, Beirut, Lebanon
| | - Elie Rassi
- 1 Saint Joseph University, Beirut, Lebanon.,3 Hotel Dieu de France University Hospital, Beirut, Lebanon
| | - Riad Sarkis
- 1 Saint Joseph University, Beirut, Lebanon.,3 Hotel Dieu de France University Hospital, Beirut, Lebanon
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Development and validation of a sensor- and expert model-based training system for laparoscopic surgery: the iSurgeon. Surg Endosc 2016; 31:2155-2165. [DOI: 10.1007/s00464-016-5213-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
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Ekenze SO, Ugwu JO, Onumaegbu OO. Evaluation of neonatal circumcision training for resident doctors in a developing country. J Pediatr Urol 2015; 11:263.e1-6. [PMID: 26036169 DOI: 10.1016/j.jpurol.2015.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 03/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a high prevalence of neonatal circumcision (NC) in Sub-Saharan Africa. However, when providers do not have adequate training on the procedure, neonatal circumcision can result in complications. There are indications that the reported high complication rate of NC in the current setting might be a reflection of inadequate training of the providers. In order to establish a framework for better training of providers of NC, it may be necessary to evaluate the providers' opinions of their training and competence of the procedure. OBJECTIVE The opinions of surgical, paediatric, and obstetrics-gynaecology resident doctors were evaluated for their exposure to, training on and perceived competence of neonatal circumcision. STUDY DESIGN The resident doctors in surgery, paediatrics and obstetrics-gynaecology (OBGYN) at two teaching hospitals in southeastern Nigeria were surveyed using a self-developed questionnaire. The self-assessment survey evaluated the residents' exposure and training on NC, and their perceived competence of the procedure. The responses from the different specialties were compared. Data were analysed using Statistical package for Social Sciences (SPSS). RESULTS The summary of findings is shown in Table below: The confidence in the ability to perform the NC did not significantly differ between the sexes (male 53/87 vs female 6/15; P = 0.22) and the level of training (SHO, Senior house officer 7/17, Registrar 24/42, senior registrar 28/43; P = 0.24). DISCUSSION A substantial proportion of residents who encountered neonatal circumcision considered their training in NC to be sub-optimal, despite their perceived exposure to the procedure. Notwithstanding this deficiency of training, the majority of the residents planned to perform NC and this presaged an expectedly higher rate of complications. Well-thought-out and structured training, comprising lectures, workshops and hands-on training, for the resident doctors and the other providers of NC might address these shortcomings and minimise complications. This may further be strengthened with a government policy on circumcision. The limitations of the study included: (1) It was a self-assessment survey and this introduced bias in the assessment of competency; (2) There were no outcome measures in the survey for those who had practical exposure vs those who did not. CONCLUSION The resident doctors perceived that their exposure, training and competence in NC might be sub-optimal. Curriculum modification that incorporates appropriate hands-on training in NC might address these deficiencies.
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Affiliation(s)
- S O Ekenze
- Sub Department of Paediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
| | - J O Ugwu
- Sub Department of Paediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
| | - O O Onumaegbu
- Plastic Surgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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Aslam A, Nason GJ, Giri SK. Homemade laparoscopic surgical simulator: a cost-effective solution to the challenge of acquiring laparoscopic skills? Ir J Med Sci 2015; 185:791-796. [DOI: 10.1007/s11845-015-1357-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/05/2015] [Indexed: 11/29/2022]
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