Comparison of 2 training programs for basic laparoscopic skills and simulated surgery performance in veterinary students

Approaches to Laparoscopic Training in Veterinary Medicine: A Review of Personalized Simulators

Veterinary minimally invasive surgery (MIS) has experienced notable growth in recent years, yet the availability of specialized training tools remains limited and not readily accessible to practitioners worldwide. While borrowing simulators from human medicine practices suffices for acquiring fundamental laparoscopic skills, it proves inadequate when addressing procedure-specific nuances. Veterinary professionals are now taking steps to create simulators tailored to their patients, although the validation process can be time-consuming. Consequently, the availability of advanced laparoscopic simulators for veterinary training remains scarce. The present study aims to highlight custom-made simulators. A comprehensive search across five databases was conducted to uncover the simulators documented from 2010 to 2022. A total of five simulators emerged from this search, with four grounded in a canine model and only one in an equine model. These models underwent validation and were found to be effective in training surgeons for their designated tasks. The findings underscore a limited array of simulators, predominantly catering to two species (horses and dogs). Considering these findings, it is evident that further research is imperative to create laparoscopic simulators capable of facilitating advanced veterinary training. This would enable the continued evolution of surgical techniques across diverse species, including ruminants, small mammals, and non-mammalian animals.

Comparison of Attempts Needed for Veterinary Students to Reach Proficiency in a Basic and Advanced Robotic Simulator Task

Surgical training of students is one of the most difficult aspects of veterinary medical education. Competing interests of house officers, owner's wishes, and ethical concerns have led to increasing use of inanimate models for basic surgical skills training. Robotic simulators have benefits for psychomotor training but have not been previously investigated in veterinary medicine. Understanding the necessary practice time for new training devices is important when determining their potential value. The aim of this study was to compare the number of attempts needed for veterinary students to reach proficiency in both a basic and advanced robotic simulator task, and to assess the predictive nature of performance variables. Each student performed a basic and advanced tasks on the Mimic dV-Trainer™ until proficiency was reached. Students required a median of eight attempts (95% CI = 7-8, range: 6-11) to reach proficiency for the basic task versus 22 attempts (95% CI = 20-26, range: 11-62) for the advanced task. The median time required to complete training for the basic and advanced task was 13.5 minutes (range: 8-24 minutes) and 26.5 minutes (range: 11-82 minutes) respectively. The difference in task attempts supports the training protocol and confirms proficiency can be attained in a short period of time. The number of attempts to reach proficiency correlated with specific performance variables which can be used by educators to aid in training students on a robotic simulator. Continued investigations on robotic simulators should be performed to investigate their use in improving psychomotor skills in veterinary students.

The Use of Simulators for Teaching Practical Clinical Skills to Veterinary Students - A Review

In the context of veterinary education, simulators are devices or sets of conditions aiming to imitate real patients and enable students to practice skills without the need for live animal use. Simulator use in veterinary education has increased significantly in recent years, allowing consistent practical teaching without reliance on clinical cases. This review examines the available literature regarding the use of simulation and simulators for teaching practical day one competences to veterinary students. Scientific databases were searched and 73 relevant articles were reviewed. The reviewed articles revealed that there are a number of simulators currently available to veterinary educators, that simulators can enhance student skills and provide an alternative learning environment without the need for live animal and/or cadaver use, and that they usually receive positive feedback from the students who use them. There appears to be a bias towards small animal simulators - however, some skills that are developed through the use of small animal or table-top models will be transferrable to other species. The majority of large animal simulators focus on bovine rectal palpation and/or pregnancy diagnosis. Further research is required to increase the repertoire of available simulators for use in veterinary education, in order to improve the practical skills of veterinary students and reduce the use of live animals and cadaver material for teaching purposes.

Evaluating validity evidence for 2 instruments developed to assess students' surgical skills in a simulated environment

Objective

To gather and evaluate validity evidence in the form of content and reliability of scores produced by 2 surgical skills assessment instruments, 1) a checklist, and 2) a modified form of the Objective Structured Assessment of Technical Skills (OSATS) global rating scale (GRS).

Study design

Prospective randomized blinded study.

Sample population

Veterinary surgical skills educators (n =10) evaluated content validity. Scores from students in their third preclinical year of veterinary school (n = 16) were used to assess reliability.

Methods

Content validity was assessed using Lawshe's method to calculate the Content Validity Index (CVI) for the checklist and modified OSATS GRS. The importance and relevance of each item was determined in relation to skills needed to successfully perform supervised surgical procedures. The reliability of scores produced by both instruments was determined using generalizability (G) theory.

Results

Based on the results of the content validation, 39 of 40 checklist items were included. The 39‐item checklist CVI was 0.81. One of the 6 OSATS GRS items was included. The 1‐item GRS CVI was 0.80. The G‐coefficients for the 40‐item checklist and 6‐item GRS were 0.85 and 0.79, respectively.

Conclusion

Content validity was very good for the 39‐item checklist and good for the 1‐item OSATS GRS. The reliability of scores from both instruments was acceptable for a moderate stakes examination.

Impact

These results provide evidence to support the use of the checklist described and a modified 1‐item OSAT GRS in moderate stakes examinations when evaluating preclinical third‐year veterinary students' technical surgical skills on low‐fidelity models.

Comparison between intracorporeal and extracorporeal ligations in a laparoscopic ovariectomy model in dogs

OBJECTIVE

To compare the influence of extracorporeal and intracorporeal ligations on the duration of and complications associated with laparoscopic ovariectomy in dogs.

STUDY DESIGN

Prospective randomized experimental study.

ANIMALS

Healthy intact female dogs (n = 18).

METHODS

The left and right ovarian pedicles of dogs undergoing laparoscopic ovariectomy were randomly assigned to intracorporeal (n = 18) or extracorporeal (n = 18) ligation groups. Surgeries were performed by two American College of Veterinary Surgeons (ACVS) diplomates and two ACVS residents. The time required to place extracorporeal and intracorporeal ligations, duration of surgery, and intraoperative complications were compared between ligation techniques. Postoperative complications were recorded.

RESULTS

The time required for intracorporeal ligation (17.3 ± 8.7 minutes) did not differ from that required for extracorporeal ligation (15.1 ± 6.1 minutes; P = .38). The total duration of surgery was 102.7 ± 28.7 minutes including portal placement and veterinary student closure of incisions. Ligation of the ovarian pedicle was successful in 16 of 17 dogs. Intraoperative hemorrhage occurred in three dogs, and postoperative complications were noted in three dogs, without apparent difference between ligation techniques.

CONCLUSION

No difference was identified between extracorporeal and intracorporeal ligations of ovarian pedicles.

CLINICAL SIGNIFICANCE

This study does not provide evidence to support one ligation technique rather than the other.

Evaluation of a laparoscopic abdominal simulator assessment to test readiness for laparoscopic ovariectomy in live dogs

OBJECTIVE

To predict readiness for laparoscopic ovariectomy of live dogs on the basis of performance on a high-fidelity laparoscopic abdominal simulator and to determine interrater reliability of the assessment.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Seventeen fourth-year veterinary students.

METHODS

After a standardized laparoscopic training course, each participant performed a laparoscopic ovariectomy with a simulator. This performance was scored in real time by two evaluators using a rubric. Participants achieving a score of 112 of 160 performed a laparoscopic ovariectomy in a live dog, supervised by an instructor in the room. Two evaluators scored video recordings of each procedure using the rubric. Participants' opinions about the simulator were collected with a survey.

RESULTS

All participants scored above the threshold (range, 126-151) and successfully completed laparoscopic ovariectomy in a live dog, with an average of 10 of 17 participants requiring verbal guidance and 5 of 17 participants requiring intervention from the instructor. Interrater concordance was excellent for the rubrics used to score performance on the simulator (R = 0.91) and in vivo (R = 0.81). All participants agreed that the simulator should be used to assess trainee readiness prior to surgery in a live dog.

CONCLUSION

Participants achieving a score of at least 126 of 160 on the simulator were able to perform a laparoscopic ovariectomy in a live dog under supervision. The scoring system for the simulator had excellent interrater concordance.

CLINICAL SIGNIFICANCE

This simulator and scoring system can be used in laparoscopic training programs to assess readiness for progression to the operative setting.

Veterinary Student Self-Assessment of Basic Surgical Skills as an Experiential Learning Tool

Mastery of basic skills is critical for surgical training. Such training is best obtained by experiential learning, which requires an element of self-reflection. Self-reflection is not always an automatic process, however; guidance may be required. This article sought to determine whether guided self-assessment would help facilitate student mastery of learned skills in a veterinary basic surgery course. The course consisted of 18 lectures and eight laboratories. Students were provided with written notes and presentation slides before the course. At the end of each lab, students completed a self-assessment of their skills. Skills were practiced in multiple labs; at the end of the course, each student was given a graded, practical examination to evaluate skills mastery. Statistical analysis was performed to compare students' mean self-assessment over the eight labs and to determine whether self-assessment scores correlated with examination grades. Results from 80 students were included. Students' overall self-assessments improved significantly from lab 1 to lab 8, and their self-assessment of two specific skills (closed gloving and simple continuous suture pattern) also improved. Students' self-assessments after the eighth lab were predictive of their practical exam scores. These results suggest guided reflection in the form of self-assessment could help facilitate student mastery of basic surgery skills. Correlation between self-assessment and practical examination results suggests instructors may use these self-assessments to detect students who need extra practice or instruction.

Cognitive training for robotic surgery: a chance to optimize surgical training? A pilot study

The rapid rise of robotic-assisted surgery (RAS) has necessitated an efficient and standardized training curriculum. Cognitive training (CT) can significantly improve skills, such as attention, working memory and problem solving, and can enhance surgical capacity and support RAS training. This pilot study was carried out between 02/2019 and 04/2019. The participants included 33 student volunteers, randomized into 3 groups: group 1 received training using the da Vinci training simulator, group 2 received computer-based cognitive training, and group 3 was the control group without training. Before (T1) and after-training (T2), performance was measured. Additionally, expert ratings and self-evaluations were collected. Subjective evaluations of performance were supplemented by evaluations based on three scales from the revised NEO Personality Inventory (NEO PI-R). In total, 25 probands remained with complete data for further analyses: n = 8 (group 1), n = 7 (group 2) and n = 10 (group 3). There were no significant differences in T1 and T2 among all three groups. The average training gain of group 1 and 2 was 15.87% and 24.6%, respectively, (a restricting condition is the loss of the last training session in group 2). Analyses of semi-structured psychological interviews (SPIs) revealed no significant differences for T1, but in T2, significance occurred at ‘self-reflection’ for group 2 (F(2.22) = 8.56; p < .005). The efficacy of CT in training highly complex and difficult procedures, such as RAS, is a proven and accepted fact. Further investigation involving higher numbers of training trials (while also being cost effective) should be performed.

Validation of Training and Acquisition of Surgical Skills in Veterinary Laparoscopic Surgery: A Review

At present, veterinary laparoscopic surgery training is lacking in experiences that provide a controlled and safe environment where surgeons can practice specific techniques while receiving experts' feedback. Surgical skills acquired using simulators must be certified and transferable to the operating room. Most models for practicing laparoscopic skills in veterinary minimally invasive surgery are general task trainers and consist of boxes (simulators) designed for training human surgery. These simulators exhibit several limitations, including anatomic species and procedural differences, as well as general psychomotor training rather than in vivo skill recreation. In this paper, we review the existing methods of training, evaluation, and validation of technical skills in veterinary laparoscopic surgery. Content includes global and specific scales, and the conditions a structured curriculum should meet for improving the performance of novice surgeons during and after training. A focus on trainee-specific assessment and tailored-technical instruction should influence training programs. We provide a comprehensive analysis of current theories and concepts related to the evaluation and validation of simulators for training laparoscopic surgery in small animal surgery. We also highlight the need to develop new training models and complementary evaluation scales for the validation of training and acquisition of basic and advanced skills in veterinary laparoscopic surgery.