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Hillemans V, Buyne O, de Blaauw I, Botden SM, Verhoeven BH, Joosten M. Self-assessment, and not continuous training, improves basic open suturing skills. MEDICAL EDUCATION ONLINE 2024; 29:2374101. [PMID: 38950187 PMCID: PMC11218580 DOI: 10.1080/10872981.2024.2374101] [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: 12/29/2023] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND To develop and maintain suturing skills, clinical exposure is important. When clinical exposure cannot be guaranteed, an adequate training schedule for suturing skills is required. This study evaluates the effect of continuous training, 'reflection before practice' and self-assessment on basic open suturing skills. METHODS Medical students performed four basic suturing tasks on a simulation set up before ('pre-test') and after their surgical rotation ('after-test'). Participants were divided in three groups; the 'clinical exposure group' (n = 44) had clinical exposure during their rotation only, the 'continuous training group' (n = 16) completed a suturing interval training during their rotation and the 'self-assessment group' (n = 16) also completed a suturing interval training, but with the use of reflection before practice and self-assessment. Parameters measured by a tracking system during the suturing tasks and a calculated 'composite score' were compared between groups and test-moments. RESULTS A significantly better composite score was found at the after-test compared to the pre-test for all groups for all basic suturing tasks (0.001 ≤ p ≤ 0.049). The self-assessment group scored better at the pre-test than the other two groups for all tasks, except for 'knot tying by hand' (0.004 ≤ p ≤ 0.063). However, this group did not score better at the after-test for all tasks, compared to the other two groups. This resulted in a smaller delta of time ('transcutaneous suture', p = 0.013), distance ('Donati suture' and 'intracutaneous suture', 0.005 ≤ p ≤ 0.009) or composite score (all tasks, except for knot tying by hand, 0.007 ≤ p ≤ 0.061) in the self-assessment group. CONCLUSION Reflection before practice and self-assessment during continuous training of basic open suturing tasks, may improve surgical skills at the start of the learning curve.
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Affiliation(s)
- Vera Hillemans
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Otmar Buyne
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc – Amalia Children’s hospital, Nijmegen, The Netherlands
| | | | - Bas H. Verhoeven
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
- Department of Pediatric Surgery, Radboudumc – Amalia Children’s hospital, Nijmegen, The Netherlands
| | - Maja Joosten
- Department of Surgery, Radboudumc, Nijmegen, The Netherlands
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Bellomo TR, Lella SK, Gaston B, Dua A, Eagleton MJ, Zacharias N, Srivastava SD. Pilot Study to Improve Resident Experience on Vascular Surgery by Standardizing Dissemination of Operative Steps. JOURNAL OF SURGICAL EDUCATION 2024; 81:1473-1483. [PMID: 39127532 DOI: 10.1016/j.jsurg.2024.07.003] [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: 02/17/2024] [Revised: 05/27/2024] [Accepted: 07/09/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Many surgical residencies have passed along attendings preferences and procedural knowledge as a highly utilized but informal resource. The objective was to assess the effect of providing operative steps and attending preferences on surgical resident performance. DESIGN This was a prospective observational study with a survey-based design. SETTING We created and shared vascular surgery operative steps including institutional and attending preferences with junior residents at the Massachusetts General Hospital. PARTICIPANTS There were a total of 31 residents who completed a survey to assess self-perception of performance in operative knowledge and Accreditation Council for Graduate Medical Education (ACGME) Milestone criteria. RESULTS Advice from colleagues was the most utilized resource, followed by web-based materials. Of the web-based materials, almost all residents utilized Google searches over other web-based resources designed to specifically help surgical trainees. The vascular surgery resource was used by 90% of residents more than 3 times per week to prepare for operative cases. There was significant improvement in patient positioning, instrument selection, operative field exposure, anatomy, sequence of procedure, procedure choices, and peri-operative care knowledge. CONCLUSIONS Development of institutional resources that specifically capture attending surgeon procedural variations can improve resident performance, encourage resident autonomy, and provide a catalog of approaches to challenging operative situations.
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Affiliation(s)
- Tiffany R Bellomo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA.
| | - Srihari K Lella
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Brandon Gaston
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Nikolaos Zacharias
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Sunita D Srivastava
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA USA
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3
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Qi Z, Corr F, Grimm D, Nimsky C, Bopp MHA. Extended Reality-Based Head-Mounted Displays for Surgical Education: A Ten-Year Systematic Review. Bioengineering (Basel) 2024; 11:741. [PMID: 39199699 PMCID: PMC11351461 DOI: 10.3390/bioengineering11080741] [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: 07/01/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 09/01/2024] Open
Abstract
Surgical education demands extensive knowledge and skill acquisition within limited time frames, often limited by reduced training opportunities and high-pressure environments. This review evaluates the effectiveness of extended reality-based head-mounted display (ExR-HMD) technology in surgical education, examining its impact on educational outcomes and exploring its strengths and limitations. Data from PubMed, Cochrane Library, Web of Science, ScienceDirect, Scopus, ACM Digital Library, IEEE Xplore, WorldCat, and Google Scholar (Year: 2014-2024) were synthesized. After screening, 32 studies comparing ExR-HMD and traditional surgical training methods for medical students or residents were identified. Quality and bias were assessed using the Medical Education Research Study Quality Instrument, Newcastle-Ottawa Scale-Education, and Cochrane Risk of Bias Tools. Results indicate that ExR-HMD offers benefits such as increased immersion, spatial awareness, and interaction and supports motor skill acquisition theory and constructivist educational theories. However, challenges such as system fidelity, operational inconvenience, and physical discomfort were noted. Nearly half the studies reported outcomes comparable or superior to traditional methods, emphasizing the importance of social interaction. Limitations include study heterogeneity and English-only publications. ExR-HMD shows promise but needs educational theory integration and social interaction. Future research should address technical and economic barriers to global accessibility.
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Affiliation(s)
- Ziyu Qi
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.C.); (D.G.); (C.N.)
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Felix Corr
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.C.); (D.G.); (C.N.)
| | - Dustin Grimm
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.C.); (D.G.); (C.N.)
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.C.); (D.G.); (C.N.)
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.C.); (D.G.); (C.N.)
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
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Galvin D, O'Reilly B, Greene R, O'Donoghue K, O'Sullivan OE. A national survey on the impact of the coronavirus pandemic on gynecologic surgical training. Int J Gynaecol Obstet 2024. [PMID: 38958460 DOI: 10.1002/ijgo.15761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 06/04/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE The objective of this study was to assess the impact of the coronavirus pandemic on gynecology surgical training. METHODS A national cross-sectional online survey was distributed to all trainees and trainers in the higher specialist training program for obstetrics and gynecology in Ireland. The survey consisted of questions on topics which included: the volume of surgical procedures performed before and since the pandemic, confidence in performing various gynecologic procedures before and since the pandemic and questions regarding the impact of the pandemic on wellbeing and work practices. RESULTS Trainers and trainees experienced a significant reduction in operative volumes for most procedure types. Analysis showed a significant reduction in the number of minor procedures performed by trainees (z = -2.7, P = 0.007) and a significant reduction in the number of all procedure types performed by trainers (minor procedures z = -3.78, P = <0.001; intermediate procedures z = -4.48, P = < 0.001; major procedures z = -3.69, P = < 0.001). Respondents reported they had less time for research and audit, were less able to attend courses or conferences and worried about the impact of their work on their families. CONCLUSIONS In conclusion, this study has highlighted the current difficulties facing surgical trainees in gynecology because of the COVID-19 pandemic. These challenges have compounded an already challenging training environment for gynecology trainees. Efforts must be made to continue to provide high-quality tailored training to ensure the development of the next generation of gynecologic surgeons.
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Affiliation(s)
- Daniel Galvin
- Department of Obstetrics and Gynecology, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Barry O'Reilly
- Department of Obstetrics and Gynecology, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Richard Greene
- Department of Obstetrics and Gynecology, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynecology, College of Medicine and Health, University College Cork, Cork, Ireland
- INFANT Research Center, University College Cork, Cork, Ireland
| | - Orfhlaith E O'Sullivan
- Department of Obstetrics and Gynecology, College of Medicine and Health, University College Cork, Cork, Ireland
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Izumi D, Nunobe S, Ishizuka N, Yagi T, Hayami M, Makuuchi R, Ohashi M, Watanabe M, Sano T. Identification of the factor affecting learning curves of laparoscopic gastrectomy through the experience at a Japanese high-volume center over the last decade. Ann Gastroenterol Surg 2024; 8:604-610. [PMID: 38957566 PMCID: PMC11216783 DOI: 10.1002/ags3.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/19/2023] [Accepted: 02/06/2024] [Indexed: 07/04/2024] Open
Abstract
Background Though laparoscopic gastrectomy (LG) has become the gold standard for gastric cancer treatment according to the Japanese treatment guidelines, its learning curve remains steep. Decreasing numbers of surgeons and transitions in the work environment have changed LG training recently. We analyzed LG training over the last decade to identify factors affecting the learning curve. Study Design Laparoscopic distal and pylorus-preserving gastrectomies conducted between 2010 and 2020 were included. We assessed learning curves based on the standard operation time (SOT) defined by analysis of covariance. Then we divided the trainees into two groups based on the length of the learning curve and examined the factors affecting the learning curve with linear regression analysis. Results Among 2335 LGs, 960 cases treated by 27 trainees and 1301 cases treated by six attending surgeons were analyzed. The operation time was prolonged (p = 0.009) and postoperative morbidity rates were lower (p = 0.0003) for cases treated by trainees. Trainees experienced 38 (range, 9-81) cases as scopists and nine (range, 0-41) cases as first assistants to the first operator. The learning curve was approximately 30 cases. The SOT was calculated based on gender, body mass index, tumor location, reconstruction, and lymph node dissection. Trainees who had shorter learning curves had more experience (51-100 cases) with any laparoscopic surgery before LG training than the others (11-50 cases, p = 0.017). Conclusion Sufficient experience with laparoscopic surgery before starting LG training might contribute to the efficiency of LG training and shorten the learning curve.
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Affiliation(s)
- Daisuke Izumi
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
- Department of SurgerySaiseikai Kumamoto HospitalKumamotoJapan
- Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Souya Nunobe
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Naoki Ishizuka
- Department of Clinical Trial and ManagementThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Taisuke Yagi
- Department of SurgerySaiseikai Kumamoto HospitalKumamotoJapan
| | - Masaru Hayami
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Rie Makuuchi
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Manabu Ohashi
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Masayuki Watanabe
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
| | - Takeshi Sano
- Department of Gastroenterological SurgeryThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
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Foppiani J, Stanek K, Alvarez AH, Weidman A, Valentine L, Oh IJ, Albakri K, Choudry U, Rogers-Vizena CR, Lin SJ. Merits of simulation-based education: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 90:227-239. [PMID: 38387420 DOI: 10.1016/j.bjps.2024.01.021] [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: 05/06/2023] [Revised: 11/07/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The drive to improve surgical proficiency through advanced simulation-based training has gained momentum. This meta-analysis systematically evaluated evidence regarding the impact of plastic surgery-related simulation on the performance of residents. METHODS A systematic search of PubMed, Web of Science, and Cochrane Library and review of articles was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. An inverse-variance random-effects model was used to combine study estimates to account for between-study variability. Objective structured assessment of technical skills (OSATS) scores and subjective confidence scores were used to assess the impact of the simulation with positive changes from the baseline indicating better outcomes. RESULTS Eighteen studies pooling 367 trainees who participated in various simulations were included. Completion of simulation training was associated with significant improvement in subjective confidence scores with a mean increase of 1.44 units (95% CI: 0.93 to 1.94, P < 0.001), and in OSATS scores, with a mean increase of 1.24 units (95% CI: 0.87 to 1.62, P < 0.001), both on a 1-5 scale. Participants reported high satisfaction scores (mean = 4.76 units, 95% CI = 4.61 to 4.91, P = 0.006), also on a 1-5 scale. CONCLUSIONS Participation in surgical simulation markedly improved objective and subjective scoring metrics for surgical trainees. Several simulation devices are available for honing surgical skills, with the potential for advancements. The evidence demonstrates the effectiveness of simulations; thus, incorporating simulation into training curricula should be a priority in the field of plastic surgery.
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Affiliation(s)
- Jose Foppiani
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Krystof Stanek
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Allan Weidman
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lauren Valentine
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Irena J Oh
- Georgetown University School of Medicine, Washington, DC, USA
| | - Khaled Albakri
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Umar Choudry
- Department of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA.
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Feeley AA, Timon C, Feeley IH, Sheehan E. Extended-Duration Work Shifts in Surgical Specialties: A Systematic Review. J Surg Res 2024; 293:525-538. [PMID: 37827031 DOI: 10.1016/j.jss.2023.08.024] [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: 01/09/2023] [Revised: 07/17/2023] [Accepted: 08/31/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION There has been widespread international implementation of duration-hour restrictions to prevent surgical resident burnout and promote patient safety and wellbeing of doctors. A variety of Extended-Duration Work Shifts (EDWS) have been implemented, with a variety of studies examining the effect of shift systems on both surgical performance and the stress response unestablished in the literature. METHODS This was a systematic review evaluating the impact of extended working hours on surgical performance, cognitive impairment, and physiological stress responses. The review used PubMed, Ovid Medline, Embase, and Google Scholar search engines between September and October 2021 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Filters including studies carried out after 2002 and published in the English language were applied. RESULTS In total, 30 studies were included for analysis. General surgery was the most commonly studied rotation, with Neurosurgical, Orthopedic, and ear, nose and throat specialties also included. The majority of studies found no difference or a significant improvement in post-EDWS on simulated performance. EDWS appeared to have the greatest impact on physiological stress markers in junior surgical trainees. CONCLUSIONS Experience appears to confer a protective element in the postcall period, with preservation of skill demonstrated. More experienced clinicians yielded lower levels of physiological markers of stress, although variability in hierarchical workload should be considered. Heterogeneity of findings across physiological, cognitive, and psychomotor assessments highlights the need for robust research on the optimum shift pattern prevents worker burnout and promotes patient safety. Future research to evaluate correlation between stress, on-call workload, and performance in the postcall period is warranted.
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Affiliation(s)
- Aoife A Feeley
- Department of Plastic Surgery, Connolly Hospital Blanchardstown, Dublin, Ireland; School of Medicine, University College Dublin, Belfield, Dublin, Ireland; School of Medicine, Royal College Surgeons Ireland, Dublin, Ireland.
| | - Charlie Timon
- The Walton Centre, Lower Ln, Fazakerley, Liverpool, United Kingdom
| | - Iain H Feeley
- The Walton Centre, Lower Ln, Fazakerley, Liverpool, United Kingdom
| | - Eoin Sheehan
- Department of Surgery, Midland Regional Hospital Tullamore, Tullamore, Co. Offaly, Ireland
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Rogers-Vizena CR, Saldanha FYL, Sideridis GD, Allan CK, Livingston KA, Nussbaum L, Weinstock PH. High-Fidelity Cleft Simulation Maintains Improvements in Performance and Confidence: A Prospective Study. JOURNAL OF SURGICAL EDUCATION 2023; 80:1859-1867. [PMID: 37679288 DOI: 10.1016/j.jsurg.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE High-fidelity simulation has a growing role in plastic surgical education. This study tests the hypothesis that cleft lip repair simulation followed by structured debriefing improves performance and self-confidence and that gains are maintained. DESIGN Prospective, single-blinded interventional study with repeated measures. Trainees performed cleft lip repair on a high-fidelity simulator followed by debriefing, immediately completed a second repair, and returned 3 months later for a third session. Anonymized simulation videos were rated using the modified Objective Structured Assessment of Technical Skills (OSATS) and the Unilateral Cleft Lip Repair competency assessment tool (UCLR). Self-assessed cleft lip knowledge/confidence and procedural self-confidence were surveyed after each simulation. SETTING Boston Children's Hospital, a tertiary care academic hospital in Boston, MA, USA. PARTICIPANTS All trainees rotating through the study setting were eligible. Twenty-six participated; 21 returned for follow-up. RESULTS Significant improvements (p < 0.05) occurred between the first and second simulations for OSATS, UCLR, and procedural self-confidence. Significant improvement occurred between the second and third simulations cleft lip knowledge/confidence. Compared to the first simulation, improvements were maintained at the third simulation for all variables. Training level moderately correlated with score for UCLR for the first simulation (r = 0.55, p < 0.01), deteriorated somewhat with the second (r = 0.35, p = 0.08), and no longer corelated by the third (r = 0.02, p = 0.92). CONCLUSIONS Objective performance and subjective self-assessed knowledge and confidence improve with high-fidelity simulation plus structured debriefing and improvement is maintained. Differences in procedure-specific performance seen with increasing training level are reduced with simulation, suggesting it may accelerate knowledge and skill acquisition.
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Affiliation(s)
- Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Francesca Y L Saldanha
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Georgios D Sideridis
- Harvard Medical School, Boston, Massachusetts; Institutional Centers for Clinical & Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Catherine K Allan
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Katie A Livingston
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts
| | - Lisa Nussbaum
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Peter H Weinstock
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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Zanetto L, Cavallin F, Doglioni N, Bua B, Savino S, Bernardo GD, Pratesi S, Villani PE, Weiner GM, Trevisanuto D. A Simulation Competition on Neonatal Resuscitation as a New Educational Tool for Pediatric Residents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1621. [PMID: 37892284 PMCID: PMC10605553 DOI: 10.3390/children10101621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Training programs on resuscitation have been developed using simulation-based learning to build skills, strengthen cognitive strategies, and improve team performance. This is especially important for residency programs where reduced working hours and high numbers of residents can reduce the educational opportunities during the residency, with lower exposure to practical procedures and prolonged length of training. Within this context, gamification has gained popularity in teaching and learning activities. This report describes the implementation of a competition format in the context of newborn resuscitation and participants' perceptions of the educational experience. METHODS Thirty-one teams of three Italian pediatric residents participated in a 3-day simulation competition on neonatal resuscitation. The event included an introductory lecture, familiarization time, and competition time in a tournament-like structure using high-fidelity simulation stations. Each match was evaluated by experts in neonatal resuscitation and followed by a debriefing. The scenarios and debriefings of simulation station #1 were live broadcasted in the central auditorium where teams not currently competing could observe. At the end of the event, participants received an online survey regarding their perceptions of the educational experience. RESULTS 81/93 (87%) participants completed the survey. Training before the event mostly included reviewing protocols and textbooks. Low-fidelity manikins were the most available simulation tools at the residency programs. Overall, the participants were satisfied with the event and appreciated the live broadcast of scenarios and debriefings in the auditorium. Most participants felt that the event improved their knowledge and self-confidence and stimulated them to be more involved in high-fidelity simulations. Suggested areas of improvement included more time for familiarization and improved communication between judges and participants during the debriefing. CONCLUSIONS Participants appreciated the simulation competition. They self-perceived the educational impact of the event and felt that it improved their knowledge and self-confidence. Our findings suggest areas of improvements for further editions and may serve as an educational model for other institutions.
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Affiliation(s)
- Lorenzo Zanetto
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
| | | | - Nicoletta Doglioni
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
| | - Benedetta Bua
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
| | - Sandro Savino
- Department of Medicine–DIMED, University of Padua, 35121 Padua, Italy;
| | - Giuseppe De Bernardo
- Department of Woman and Child, Ospedale Buon Consiglio Fatebenefratelli, 80122 Naples, Italy;
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital of Florence, 50141 Florence, Italy;
| | | | - Gary M. Weiner
- Department of Pediatrics-Neonatology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Daniele Trevisanuto
- Department of Women’s and Children’s Health, University Hospital of Padua, Via Giustiniani, 3, 35128 Padua, Italy; (L.Z.); (N.D.); (B.B.)
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Shaban L, Mkandawire P, O'Flynn E, Mangaoang D, Mulwafu W, Stanistreet D. Quality Metrics and Indicators for Surgical Training: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:1302-1310. [PMID: 37481412 DOI: 10.1016/j.jsurg.2023.06.023] [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: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Surgical training quality is critical to ensure that trainees receive adequate preparation to perform surgical procedures independently and that patients receive safe, effective, and high-quality care. Numerous surgical training quality indicators have been proposed, investigated and implemented. However, the existing evidence base for these indicators is limited, with most studies originating from English-speaking, high-income countries. OBJECTIVES This scoping review aimed to identify the range of quality indicators that have been proposed and evaluated in the literature, and to critically evaluate the existing evidence base for these indicators. METHODS A systematic literature search was conducted using MEDLINE and Embase databases to identify studies reporting on surgical training quality indicators. A total of 68 articles were included in the review. RESULTS Operative volume is the most commonly cited indicator and has been investigated for its effects on trainee exam performance and career progression. Other indicators include operative diversity, workplace-based assessments, regular evaluation and feedback, academic achievements, formal teaching, and learning agreements, and direct observation of procedural skills. However, these indicators are largely based on qualitative analyses and expert opinions and have not been validated quantitatively using clear outcome measures for trainees and patients. CONCLUSIONS Future research is necessary to establish evidence-based indicators of high-quality surgical training, including in low-resource settings. Quantitative and qualitative studies are required to validate existing indicators and to identify new indicators that are relevant to diverse surgical training environments. Lastly, any approach to surgical training quality must prioritize the benefit to both trainees and patients, ensuring training success, career progression, and patient safety.
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Affiliation(s)
- Lawa Shaban
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland.
| | - Payao Mkandawire
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Eric O'Flynn
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland
| | - Deirdre Mangaoang
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland
| | - Wakisa Mulwafu
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Debbi Stanistreet
- Department of Public Health and Epidemiology, School of Population Health, RCSI, Dublin, Ireland
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Daniel R, McKechnie T, Kruse CC, Levin M, Lee Y, Doumouras AG, Hong D, Eskicioglu C. Video-based coaching for surgical residents: a systematic review and meta-analysis. Surg Endosc 2023; 37:1429-1439. [PMID: 35739431 PMCID: PMC9225812 DOI: 10.1007/s00464-022-09379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Video-based coaching (VBC) is used to supplement current teaching methods in surgical education and may be useful in competency-based frameworks. Whether VBC can effectively improve surgical skill in surgical residents has yet to be fully elucidated. The objective of this study is to compare surgical residents receiving and not receiving VBC in terms of technical surgical skill. METHODS The following databases were searched from database inception to October 2021: Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. Articles were included if they were randomized controlled trials (RCTs) comparing surgical residents receiving and not receiving VBC. The primary outcome, as defined prior to data collection, was change in objective measures of technical surgical skill following implementation of either VBC or control. A pairwise meta-analyses using inverse variance random effects was performed. Standardized mean differences (SMD) were used as the primary outcome measure to account for differences in objective surgical skill evaluation tools. RESULTS From 2734 citations, 11 RCTs with 157 residents receiving VBC and 141 residents receiving standard surgical teaching without VBC were included. There was no significant difference in post-coaching scores on objective surgical skill evaluation tools between groups (SMD 0.53, 95% CI 0.00 to 1.01, p = 0.05, I2 = 74%). The improvement in scores pre- and post-intervention was significantly greater in residents receiving VBC compared to those not receiving VBC (SMD 1.62, 95% CI 0.62 to 2.63, p = 0.002, I2 = 85%). These results were unchanged with leave-one-out sensitivity analysis and subgroup analysis according to operative setting. CONCLUSION VBC can improve objective surgical skills in surgical residents of various levels. The benefit may be most substantial for trainees with lower baseline levels of objective skill. Further studies are required to determine the impact of VBC on competency-based frameworks.
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Affiliation(s)
- Ryan Daniel
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Tyler McKechnie
- Division of General Surgery, Department of Surgery, St. Joseph’s Healthcare Hamilton, McMaster University, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Colin C. Kruse
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Marc Levin
- Division of Head and Neck, Otolaryngology Surgery, Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, St. Joseph’s Healthcare Hamilton, McMaster University, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Aristithes G. Doumouras
- Division of General Surgery, Department of Surgery, St. Joseph’s Healthcare Hamilton, McMaster University, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada ,Division of General Surgery, Department of Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, St. Joseph’s Healthcare Hamilton, McMaster University, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada ,Division of General Surgery, Department of Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, St. Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. .,Division of General Surgery, Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
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Saleh Y, Piper R, Richard M, Jeyaretna S, Cosker T. Designing a 3D Printed Model of the Skull-Base: A Collaboration Between Clinicians and Industry. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205221080703. [PMID: 35280123 PMCID: PMC8905218 DOI: 10.1177/23821205221080703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The role of three dimensional (3D) printing in neurosurgical education is becoming increasingly common. Notably, 3D printing can simulate complex anatomical pathways that may be difficult to regularly and accurately reproduce in cadavers. One such example is the course of the facial nerve within the temporal bone and its relation to the labyrinth. This can aid pre-surgical planning and minimise surgical complications. Here we aim to develop a novel anatomically accurate model of the skull base which demonstrates key neuro vascular components and the course of the facial nerve within the temporal bone by developing a 3D printed model of the skull-base that can be used for medical education and pre-surgical planning. MATERIALS AND METHODS We utilised a combination of Computed Tomography (CT) and angiography scans to reconstruct the skull base and its vascular contents. Neural components were digitally incorporated under the guidance of the Oxford neurosurgical team and the anatomy department. The model was integrated and printed using polymer jetting. RESULTS The model was successfully printed, with all neurovascular components included. Notably we were able to highlight the intra-temporal course of the facial nerve by creating a bony window within the temporal bone. CONCLUSION Through a collaboration with industry and a multidisciplinary team, we were able to reproduce the base of the skull from patient neuro-imaging. Our model is both cost-effective, reproducible and can aid both medical students and neurosurgical trainees in their training/education.
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Affiliation(s)
- Youssuf Saleh
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Rory Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals, UK
| | - Michael Richard
- 3D Life Prints, Nuffield Orthopaedic Centre, Oxford, United kingdom
| | - Sanjeeva Jeyaretna
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals, UK
| | - Thomas Cosker
- Department of Physiology Anatomy and Genetics, University of Oxford, UK
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Coelho G, Trigo L, Faig F, Vieira EV, da Silva HPG, Acácio G, Zagatto G, Teles S, Gasparetto TPD, Freitas LF, Zanon N, Lapa DA. The Potential Applications of Augmented Reality in Fetoscopic Surgery for Antenatal Treatment of Myelomeningocele. World Neurosurg 2021; 159:27-32. [PMID: 34922026 DOI: 10.1016/j.wneu.2021.11.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To develop a preoperative planning method using augmented reality (AR) of a specific surgical procedure: fetoscopy for myelomeningocele repair. METHODS Imaging data were acquired of a pregnant woman at 27 weeks of gestation whose fetus was diagnosed with myelomeningocele. The patient was identified as a candidate for fetoscopic repair of the spine defect, and an AR application for mobile device simulation was developed. The virtual customized model was created by analysis of the presurgical magnetic resonance imaging. A real-time AR interface was developed by using an application that enhanced the anatomical aspects of both mother and fetus. RESULTS A virtual model for planning fetoscopy repair for myelomeningocele was developed. Preoperative and postoperative procedures were successfully carried out, emphasizing the beneficial role of the AR application. The use of the AR model allowed the multidisciplinary team to engage in discussion to determine the appropriate surgical approach. It also allowed a clearer explanation of the procedure to the parents enabling a better understanding of the parents regarding specifics characteristics of their baby's spine defect. CONCLUSIONS This new preoperative platform using a virtual model represents an important tool to improve patient's comprehension, multidisciplinary discussion, and surgical planning. In addition, it can be used worldwide as a teaching tool in the fetal surgery field.
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Affiliation(s)
- Giselle Coelho
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Scientific Department, EDUCSIM Institute, São Paulo, São Paulo, Brazil; Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil.
| | - Lucas Trigo
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | - Fernanda Faig
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | - Eduardo Varjão Vieira
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil; Department of Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil
| | | | - Gregório Acácio
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil
| | - Gustavo Zagatto
- Scientific Department, EDUCSIM Institute, São Paulo, São Paulo, Brazil
| | - Sylker Teles
- Scientific Department, State University of Amazonas, Manaus, Amazonas, Brazil
| | - Taísa Pallú Davaus Gasparetto
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Radiology, Diagnósticos da América SA, São Paulo, São Paulo, Brazil
| | | | - Nelci Zanon
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Neurosurgery, CENEPE, Centro de Neurocirurgia Pediátrica, São Paulo, São Paulo, Brazil
| | - Denise Araújo Lapa
- Department of Surgery, Sabará Children's Hospital, São Paulo, São Paulo, Brazil; Department of Fetal Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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Letter Regarding: The Multifaceted Concept of Patient Ownership in the Era of Duty Hour Restrictions. J Surg Res 2021; 263:285-286. [DOI: 10.1016/j.jss.2021.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
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Cadieux DC, Mishra A, Goldszmidt MA. Before the scalpel: Exploring surgical residents' preoperative preparatory strategies. MEDICAL EDUCATION 2021; 55:733-740. [PMID: 33423328 DOI: 10.1111/medu.14449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study sought to increase understanding of preoperative preparatory strategies utilised by senior surgical residents and identify how social and material forces come together to shape practice. SUMMARY/BACKGROUND DATA Preoperative preparation can play a powerful role in operative learning. Residents rarely receive guidance, feedback, or explicit expectations on how to prepare for the OR. Understanding current practice and how to support preoperative preparation represents an important gap in our efforts to improve surgical training. METHODS Constructivist grounded theory with sensitizing concepts from sociomateriality guided data collection and analysis. Fifteen senior surgical residents from a range of surgical disciplines were purposefully sampled and participated in an in-depth individual interview. Two return-of-finding focus groups followed with seven residents. Rigor was enhanced through constant comparison, theoretical sampling, pursuit of discrepant data, and investigator triangulation. RESULTS Residents utilised a range of strategies addressing four areas of focus: develop technical skills, improve procedural knowledge, enhance patient-specificity, and know surgical preferences. However, residents also described receiving limited guidance on what it means to 'be prepared' and experience significant challenges in achieving preparedness. A mix of social and material things that enabled or constrained preparatory efforts influenced individual strategies. These included rotation structure, relationships, the OR list, and time. CONCLUSIONS Our findings offer possible solutions by elaborating on preparatory variability and considerations for residents, faculty, and programs to improve practice. As a first step, we suggest programs begin to engage in explicit dialogue and reflection with their residents, faculty, and residency program committees.
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Affiliation(s)
- Danielle C Cadieux
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
- Centre for Education Research and Innovation, Western University, London, ON, Canada
| | - Anuradha Mishra
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Mark A Goldszmidt
- Centre for Education Research and Innovation, Western University, London, ON, Canada
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Guo Z, Tai Y, Du J, Chen Z, Li Q, Shi J. Automatically Addressing System for Ultrasound-Guided Renal Biopsy Training Based on Augmented Reality. IEEE J Biomed Health Inform 2021; 25:1495-1507. [PMID: 33684049 DOI: 10.1109/jbhi.2021.3064308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic kidney disease has become one of the diseases with the highest morbidity and mortality in kidney diseases, and there are still some problems in surgery. During the operation, the surgeon can only operate on two-dimensional ultrasound images and cannot determine the spatial position relationship between the lesion and the medical puncture needle in real-time. The average number of punctures per patient will reach 3 to 4, Increasing the incidence of complications after a puncture. This article starts with ultrasound-guided renal biopsy navigation training, optimizes puncture path planning, and puncture training assistance. The augmented reality technology, combined with renal puncture surgery training was studied. This paper develops a prototype ultrasound-guided renal biopsy surgery training system, which improves the accuracy and reliability of the system training. The system is compared with the VR training system. The results show that the augmented reality training platform is more suitable as a surgical training platform. Because it takes a short time and has a good training effect.
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Bisgaard CH, Rodt SA, Musaeus P, Petersen JAK, Rubak SLM. Early procedural training increases anesthesiology residents' clinical production: a comparative pre-post study of the payoff in clinical training. BMC MEDICAL EDUCATION 2021; 21:262. [PMID: 33957915 PMCID: PMC8103582 DOI: 10.1186/s12909-021-02693-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Competency-based education has been shown to enhance clinical skills, improve patient care, and reduce number of complications resulting in a better return on investments. Residents constitute an important workforce at many hospitals. Yet, the effect of training on residents' contribution to production in patient care is scarcely studied. This study evaluated the effects of early competency-based procedural training on residents' contribution to patient care in central venous catheterization and spinal and epidural anesthesia. METHODS The design was a non-randomized cohort study of first-year anesthesiology residents. The intervention group received additional early focused skills training while three control groups received traditional competency-based education. The residents' contributions to patient care were compared between the intervention group (n = 20), a historical control group (n = 19), and between a contemporary control group (n = 7) and a historical control group (n = 7) from different departments. The residents' vs specialists' procedural production share was compared between years within each study group. We calculated specialist time saved compared to the time spent providing additional skills training in the intervention group. RESULTS We found statistically significant increases in residents' vs specialists' share of total production after the intervention for epidural anesthesia: 2015: 0.51 (0.23, 0.70) to 2017: 0.94 (0.78, 1.05), p = 0.011 and central venous catheterization: 2015: 0.30 (0.23, 0.36) to 2016: 0.46 (0.35, 0.55), p = .008; and to 2017: 0.64 (0.50, 0.79), p = 0.008. Comparison between residents and specialists on production of the three procedures before and after the intervention showed a surplus of 21 h of freed specialist time per year. CONCLUSIONS Early procedural training results in more productive residents and freed specialist time for additional supervision, other clinical tasks or research. This provides empirical support for a positive correlation between early focused training and increased independent production among residents.
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Affiliation(s)
- Claus Hedebo Bisgaard
- Centre for Health Sciences Education, Faculty of Health, Aarhus University, Palle Juul Jensens Boulevard 82, Building B, DK-8200 Aarhus N, Denmark
| | - Svein Aage Rodt
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Peter Musaeus
- Centre for Educational Development, Aarhus University, Palle Juul Jensens Boulevard 82, Building B, DK-8200 Aarhus N, Denmark
| | - Jens Aage Kølsen Petersen
- Department of Anaesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Sune Leisgaard Mørck Rubak
- Department of Paediatrics and Adolescent Medicine, Center of Paediatric Pulmonology and Allergology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Keni S, Ilin R, Partridge R, Hughes MA, Brennan PM. Using Automated Continuous Instrument Tracking to Benchmark Simulated Laparoscopic Performance and Personalize Training. JOURNAL OF SURGICAL EDUCATION 2021; 78:998-1006. [PMID: 33077417 DOI: 10.1016/j.jsurg.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/29/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Laparoscopic simulation is widely used in surgical training. However, the impact of training on performance is difficult to assess. Observation is time-intensive and subjective. SurgTrac laparoscopic box-trainer instrument tracking software provides continuous, automated, real-time, objective performance feedback. We used this data to assess the relationship between task attempts and performance. We assessed whether improvement in performance with repetition could be modeled in learning curves that might be used for benchmarking. DESIGN Anonymized SurgTrac data for performances undertaken between 10/2016 and 05/2019 were retrospectively extracted. The thread transfer task, a basic instrument handling task, was assessed. Task duration and instrument-based metrics were analyzed; total distance travelled by instrument tips, average speed, average acceleration, and the ratio of movements between the left and right hands. Curve estimation regression was used to assess the relationship between attempt number and metrics for pooled data across the entire cohort of users and amongst individual users with ≥50 attempts. Threshold for significance p = 0.05. SETTING SurgTrac has generated the largest available database of performances in box trainer simulated tasks with 64,000 activities performed by over 1450 users in 77 countries to date. PARTICIPANTS Data was derived from the unselected world-wide cohort of SurgTrac users. No participants were excluded. RESULTS Five hundred seventy-eight users performed 13,027 attempts in the thread transfer task. Across the entire cohort, SurgTrac performance metrics were significantly associated with attempt number. Task duration and total distance decreased with attempt number. This benefit persisted across 100 attempts. Ambidexterity increased with attempt number. Individual candidate performance improved in line with predicted learning curves for better performing candidates. CONCLUSIONS We analyzed the largest database of simulated laparoscopic task performances. Performance improves with practice. Using learning curves derived from peer-group performances as benchmarks, users may be regularly and objectively assessed to support personalization of training.
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Affiliation(s)
| | | | | | | | - Paul M Brennan
- Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
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Ederer IA, Reutzsch FL, Schäfer RC, Wahler T, Daigeler A, Rieger UM, Rothenberger J. A Training Model for Local Flaps Using Fresh Human Skin Excised During Body Contouring Procedures. J Surg Res 2021; 262:190-196. [PMID: 33607413 DOI: 10.1016/j.jss.2021.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/27/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The safe execution of local flaps tends to be challenging for surgical residents. Thus, the purpose of the study was to evaluate a training model of local flaps based on fresh human skin excised from body contouring procedures. MATERIALS AND METHODS A questionnaire and surgical skills evaluation-analyzing the theoretical and procedural knowledge about local flaps-were held both before and after the surgical skills training. All surgical procedures were executed on a simulation model based on fresh human skin. Skills evaluation was done according to a modified version of the Objective Structured Assessment of Technical Skills Score. Results before and after the training were compared using SPSS, version 21. RESULTS In pretraining evaluation, residents showed great difficulty regarding the accuracy of flap design and sufficiency of wound coverage indicating the need for surgical training outside the operating theater. After training, the procedural skills significantly improved as depicted by the modified Objective Structured Assessment of Technical Skills score with a mean cumulative pretraining score of 26.81 ± 5.41 and posttraining score of 43.59 ± 5.72 (P = 0.008). Also, theoretical knowledge significantly improved in the posttraining evaluation with exception to the indication of a Z-plasty (P = 0.257). The training model itself was generally regarded as highly useful and thus recommendable to others. CONCLUSIONS Surgical handling and the understanding of tissue rotation clearly improved by the presented model which mimics very realistic conditions. The simulation model based on fresh human skin shows cost-effectiveness and allows a broad range for flap procedures wherefore its use should be further promoted.
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Affiliation(s)
- Ines Ana Ederer
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt, Germany; Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany.
| | - Franziska Leandra Reutzsch
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany; Department of Hand, Plastic and Aesthetic Surgery, Medius Hospital Nuertingen, Nuertingen, Germany
| | - Ruth Christine Schäfer
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Theodora Wahler
- Department of Hand, Plastic and Aesthetic Surgery, Medius Hospital Nuertingen, Nuertingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ulrich Michael Rieger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Jens Rothenberger
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt, Germany
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Moeckli B, Burgermeister LC, Siegrist M, Clavien PA, Käser SA. Evolution of the Surgical Residency System in Switzerland: An In-Depth Analysis Over 15 Years. World J Surg 2020; 44:2850-2856. [PMID: 32367397 DOI: 10.1007/s00268-020-05552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The landscape of surgical training has been subject to many changes over the past 15 years. This study examines resident satisfaction, determinants of satisfaction, demographics, working hours and the teaching rate of common operations in a longitudinal fashion with the aim to identify trends, shortcomings and possible ways to improve the current training system. METHODS The Swiss Medical Association administers an annual survey to all Swiss residents to evaluate the quality of postgraduate medical training (yearly respondents: 687-825, response rate: 68-72%). Teaching rates for general surgical procedures were obtained from the Swiss association for quality management in surgery. RESULTS During the study period (2003-2018), the number of surgical residents (408-655 (+61%)) and graduates in general surgery per year (42-63 (+50%)) increased disproportionately to the Swiss population. While the 52 working hour restriction was introduced in 2005 reported average weekly working hours did not decline (59.9-58.4 h (-3%)). Workplace satisfaction (6 being highest) rose from 4.3 to 4.6 (+7%). Working climate and leadership culture were the main determinants for resident satisfaction. The proportion of taught basic surgical procedures fell from 24.6 to 18.9% (-23%). CONCLUSIONS The number of residents and graduates in general surgery has risen markedly. At the same time, the proportion of taught operations is diminishing. Despite the introduction of working hour restrictions, the self-reported hours never reached the limit. The low teaching rate combined with the increasing resident number represents a major challenge to the maintenance of the current training quality.
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Affiliation(s)
- Beat Moeckli
- Department of Visceral- and Transplantation Surgery, Zurich University Hospital, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Lea C Burgermeister
- Department of Health Sciences and Technology (HEST), ETH Zurich, Zürich, Switzerland
| | - Michael Siegrist
- Department of Health Sciences and Technology (HEST), ETH Zurich, Zürich, Switzerland
| | - Pierre A Clavien
- Department of Visceral- and Transplantation Surgery, Zurich University Hospital, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Samuel A Käser
- Department of Visceral- and Transplantation Surgery, Zurich University Hospital, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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Kantar RS, Alfonso AR, Ramly EP, Diaz-Siso JR, Breugem CC, Flores RL. Simulation in Cleft Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2438. [PMID: 31942398 PMCID: PMC6908384 DOI: 10.1097/gox.0000000000002438] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022]
Abstract
A number of digital and haptic simulators have been developed to address challenges facing cleft surgery education. However, to date, a comprehensive review of available simulators has yet to be performed. Our goal is to appraise cleft surgery simulators that have been described to date, their role within a simulation-based educational strategy, the costs associated with their use, and data supporting or refuting their utility.
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Affiliation(s)
- Rami S Kantar
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Allyson R Alfonso
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Elie P Ramly
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - J Rodrigo Diaz-Siso
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Corstiaan C Breugem
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roberto L Flores
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
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Abstract
While adrenal tumors are common, adrenalectomy is rather uncommon. This is one reason for the many challenges regarding the training of adrenal surgery. Here we focus on issues that are most pertinent regarding training of the young surgeons performing adrenalectomy. Due to the very limited literature, what is presented is mainly based on personal experience and/or from the literature published for other surgical operations and subspecialties. The discussed challenges include indications for surgery, surgical approaches and extent, and intraoperative complications. With advances in adrenal surgery, we expect some old challenges to be resolved, and some new challenges to arise. These challenges will be faced in order to continue to help our younger trainee acquire the knowledge and skills to best care for our patients with adrenal diseases.
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Affiliation(s)
- Oliver Gimm
- Department of Surgery and Department of Clinical and Experimental Medicine, Medical Faculty, Linköping University, Linköping, Sweden
| | - Quan-Yang Duh
- Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco, CA, USA
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Playing the Surgical Technologist Role by Surgery Residents Improves Their Technical and Nontechnical Skills. J Surg Res 2019; 238:57-63. [DOI: 10.1016/j.jss.2019.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/29/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022]
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Jung S, Lee J, Biocca F, Kim JW. Augmented Reality in the Health Domain: Projecting Spatial Augmented Reality Visualizations on a Perceiver's Body for Health Communication Effects. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 22:142-150. [PMID: 30668138 DOI: 10.1089/cyber.2018.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An experiment is reported that studied the effects of spatial embodiment in augmented reality on medical attitudes about the self. College students (N = 90) viewed public service announcements (PSAs) with overlaid virtual fetuses and X-rayed images of lungs on various interfaces representing embodiment-a two-dimensional screen, a three-dimensional (3D) mannequin, and the participants' bodies (3D). Results indicated that PSA messages with richer embodied interfaces increase the sense of "being there," also known as spatial presence (SP), in sequential order; this leads to increased negative emotion regarding smoking cigarettes and an increased willingness to engage with a cigarette cessation campaign. When the SP mediates the dual model process, only affective attitudes increase the behavioral intention to engage with the campaign.
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Affiliation(s)
- Soyoung Jung
- 1 S.I. School of Newhouse Public Communications, Syracuse University, Syracuse, New York.,2 M.I.N.D. Lab, Digital Design, School of Art & Design College of Architecture & Design, New Jersey Institute of Technology. Newark, New Jersey
| | - Jiyoung Lee
- 1 S.I. School of Newhouse Public Communications, Syracuse University, Syracuse, New York
| | - Frank Biocca
- 3 Department of Informatics, Ying Wu College of Computing, New Jersey Institute of Technology, Newark, New Jersey
| | - Ji Won Kim
- 1 S.I. School of Newhouse Public Communications, Syracuse University, Syracuse, New York
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Resident satisfaction regarding surgical training programme in Eastern Saudi Arabia: A cross-sectional study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ingrassia PL, Franc JM, Carenzo L. A novel simulation competition format as an effective instructional tool in post-graduate medical education. Adv Simul (Lond) 2018; 3:17. [PMID: 30116591 PMCID: PMC6085625 DOI: 10.1186/s41077-018-0075-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/11/2018] [Indexed: 05/07/2023] Open
Abstract
Objective Medical simulation competitions are a growing reality. This study aims at exploring if a novel format of simulation competition (SIMCUP) can be an effective educational format in post-graduate education. Design We designed a 2-day event that included scientific educational lectures, an orientation to the competition, familiarization with the simulation lab, and competition time. Day 1 was devoted to preliminary rounds and was structured using an Objective Structured Clinical Examination (OSCE)-like system. On day 2, the first four teams advanced to semi-finals and then to finals, which were held using a classical SimWars style. Setting and subjects A total of 14 four-participant teams participated in the event over two editions (Ed.1 in 2015 and Ed.2 in 2016). Interventions External referees evaluated both technical and non-technical skills for each simulated scenario. Each participant was also administered pre- and post-test questionnaires covering self-perception about the confidence in managing simulated clinical cases, educational effectiveness, satisfaction with the simulation experience, and previous simulation training. Main results Overall participants found SIMCUP a useful learning experience, rating it 10 [9, 10] and 10 [7.75–10] out of 10 for Ed.1 and Ed.2, respectively. Participants reported, using a 10-point semantic differential scale ranging from “1 - strongly disagree.” to “10 - strongly agree,” finding both days to be educationally effective: day 1 was rated 9 [7–10] and 9 [8–10] as day 2 was rated 8 [7–10] and 8 [7–10] for Ed. 1 and Ed. 2, respectively. Participants’ self-perception regarding the confidence of managing the specific scenarios significantly improved immediately after the event as measured by pre- and post-questionnaires for all stations and during both editions. Conclusion This study suggests that simulation competition can serve as an effective instructional format in residency training. Electronic supplementary material The online version of this article (10.1186/s41077-018-0075-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pier Luigi Ingrassia
- 1SIMNOVA - Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie, Università del Piemonte Orientale, Via Lanino 1, 28100 Novara, Italy.,3SIMNOVA - Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie, Università del Piemonte Orientale, Via Lanino 1, 28100 Novara, Italy
| | - Jeffrey Michael Franc
- 2Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB T6G 2T4 Canada
| | - Luca Carenzo
- 1SIMNOVA - Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie, Università del Piemonte Orientale, Via Lanino 1, 28100 Novara, Italy
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Maliha SG, Diaz-Siso JR, Plana NM, Torroni A, Flores RL. Haptic, Physical, and Web-Based Simulators: Are They Underused in Maxillofacial Surgery Training? J Oral Maxillofac Surg 2018; 76:2424.e1-2424.e11. [PMID: 30081008 DOI: 10.1016/j.joms.2018.06.177] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/30/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Surgical residencies have increasingly incorporated both digital and mannequin simulation into their training programs. The aim of our review was to identify all digital and mannequin maxillofacial simulators available for education and training, highlight their benefit, and critically assess the evidence in support of these educational resources. MATERIALS AND METHODS We performed a comprehensive literature review of all peer-reviewed publications of digital and mannequin simulators that met the inclusion criteria, defined as any simulator used in education or training. All simulators used in surgical planning were excluded. Before the query, it was hypothesized that most studies would be descriptive in nature and supported by low levels of evidence. Literature search strategies included the use of multiple combinations of key search terms, review of titles and abstracts, and precise identification of the use of the simulator described. All statistics were descriptive. RESULTS The primary search yielded 259 results, from which 22 total simulators published on from 2001 to 2016 were identified using the inclusion and exclusion criteria: 10 virtual reality haptic-based simulators, 6 physical model simulators, and 6 Web-based simulators used for a variety of procedures such as dental skills, instrument handling, orthognathic surgery (Le Fort I osteotomy, vertical ramus osteotomy, bilateral sagittal split ramus osteotomy), genioplasty, bone grafting, sinus surgery, cleft lip repair, orbital floor repair, and oral biopsy. Only 9 formalized studies were completed; these were classified as low-level evidence-based cohort studies (Levels IV and V). All other simulator reports were descriptive in nature. There were no studies with high levels of evidence completed (Level I to III). CONCLUSIONS The results of this review suggest that, although seemingly beneficial to the trainee in maxillofacial surgery, simulation in education in this field is an underused commodity because of the significant lack of scientific and validated study designs reported on in the literature thus far. The maxillofacial and simulation communities would benefit from studies on utility and efficacy with higher levels of evidence.
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Affiliation(s)
- Samantha G Maliha
- Medical Student and Research Fellow, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, and New York University School of Medicine, New York, NY.
| | - J Rodrigo Diaz-Siso
- Research Fellow, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Natalie M Plana
- Medical Student and Research Fellow, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, and New York University School of Medicine, New York, NY
| | - Andrea Torroni
- Associate Professor, New York University School of Medicine, New York, NY, and Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, NY
| | - Roberto L Flores
- Joseph G. McCarthy Associate Professor of Reconstructive Plastic Surgery, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
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Liu BJ, Ordon M, Bodley J, Liu G, Kroft J. Impact of Resident Overnight Duty Hour Changes on Obstetrical Outcomes: A Population-Based Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1586-1591. [PMID: 30025868 DOI: 10.1016/j.jogc.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether obstetrical patient outcomes have changed following the introduction of restricted resident work hours. METHODS A population-based retrospective cohort study of the effects of restricted duty hours for residents in July 2013 at three academic hospitals in Toronto, ON using linked health care databases. The study included 6763 deliveries in the 2 years pre-exposure and 5548 deliveries in the 2 years post-exposure. RESULTS The primary outcome, planned prior to data collection, was a composite index of 29 maternal/fetal outcomes including maternal transfusion/postpartum hemorrhage, maternal infection, fetal mortality, NICU admissions, and surgical/obstetrical complications. There were seven secondary outcomes analysed: NICU admissions; neonatal death; maternal transfusion or postpartum hemorrhage; maternal infection; and three composite measures. A generalized estimating equation model, clustered by institution, was utilized to assess for differences post-intervention. We found no significant differences in baseline demographics between groups. After the implementation of duty hour restrictions, no significant difference was seen in the primary outcome. However, an increased incidence of composite maternal surgical/obstetrical outcomes (OR 1.191; 95% CI 1.037-1.367, P = 0.013) and transfusion/postpartum hemorrhage (OR 1.232; 95% CI 1.074-1.413, P = 0.003) was found. There were no significant differences in other secondary outcomes. CONCLUSION Since the implementation of resident duty hour restrictions, there was no overall change in patient outcomes. However, there was an increase in surgical/obstetrical complications and transfusion/postpartum hemorrhage. This suggests that duty hour restrictions may not be beneficial to patient outcomes. It highlights the need to further investigate the clinical impact of a change in resident duty hours.
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Affiliation(s)
- Brian J Liu
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Michael Ordon
- Division of Urology, Department of Surgery, St. Michael's Hospital, Toronto, ON; The Institute for Clinical Evaluative Sciences, Toronto, ON
| | - Janet Bodley
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Grace Liu
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Jamie Kroft
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON.
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Abstract
OBJECTIVES As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change. DESIGN Prospective cohort study. SETTING Twenty-five PICUs at various children's hospitals across the United States. PATIENTS Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children). INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Prospective cohort study in which all primary tracheal intubations occurring in the United States from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children) were analyzed. Participating PICU leaders were also asked to describe their local airway management training for residents. Resident participation trends over time, stratified by presence of a Pediatric Critical Care Medicine fellowship and airway training curriculum for residents, were described. A total of 9,203 tracheal intubations from 25 PICUs were reported. Pediatric residents participated in 16% of tracheal intubations as first laryngoscopists: 14% in PICUs with a Pediatric Critical Care Medicine fellowship and 34% in PICUs without one (p < 0.001). Resident participation decreased significantly over time (3.4% per year; p < 0.001). The decrease was significant in ICUs with a Pediatric Critical Care Medicine fellowship (p < 0.001) but not in ICUs without one (p = 0.73). After adjusting for site-level clustering, patient characteristics, and Pediatric Critical Care Medicine fellowship presence, the Accreditation Council for Graduate Medical Education guideline change was not associated with lower participation by residents (odds ratio, 0.86; 95% CI, 0.59-1.24; p = 0.43). The downward trend of resident participation was similar regardless of the presence of an airway curriculum for residents. CONCLUSION Laryngoscopy by pediatric residents has substantially decreased over time. This downward trend was not associated with the 2013 Accreditation Council for Graduate Medical Education change in residency requirements.
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Mehaffey JH, Michaels AD, Mullen MG, Yount KW, Meneveau MO, Smith PW, Friel CM, Schirmer BD. Adoption of robotics in a general surgery residency program: at what cost? J Surg Res 2017; 213:269-273. [DOI: 10.1016/j.jss.2017.02.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/30/2017] [Accepted: 02/24/2017] [Indexed: 12/25/2022]
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Coverdill JE, Alseidi A, Borgstrom DC, Dent DL, Dumire RD, Fryer J, Hartranft TH, Holsten SB, Nelson MT, Shabahang M, Sherman S, Termuhlen PM, Woods RJ, Mellinger JD. Professionalism in the Twilight Zone: A Multicenter, Mixed-Methods Study of Shift Transition Dynamics in Surgical Residencies. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:S31-S36. [PMID: 27779507 DOI: 10.1097/acm.0000000000001358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism. METHOD Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015. The response rate was 76% (N = 291). The 18 items focused on end-of-shift behaviors and the frequency and source of delayed departures. Follow-up interviews (N = 39) examined motives for delayed departures. The results include means, percentages, and representative quotations from the interviews. RESULTS A minority (33%) agreed that it is routine and acceptable to pass work to night teams, whereas a strong majority (81%) believed that residents exceed work hours in the name of professionalism. Delayed departures were ubiquitous: Only 2 of 291 residents were not delayed for any of 13 reasons during a typical week. The single most common source of delay involved a desire to avoid the appearance of dumping work on fellow residents. In the interviews, residents expressed a strong reluctance to pass work to an on-call resident or night team because of sparse night staffing, patient ownership, an aversion to dumping, and the fear of being seen as inefficient. CONCLUSIONS Resident behavior is shaped by organizational and cultural contexts that require attention and reform. The evidence points to the stunted development of a new professionalism, little role for shift-work mentalities, and uneven expression of traditional professionalism in resident behavior.
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Affiliation(s)
- James E Coverdill
- J.E. Coverdill is associate professor, Department of Sociology, University of Georgia, Athens, Georgia. A. Alseidi is associate director, General Surgery Residency Program, and director, HPB Fellowship, HPB and Endocrine Surgery, Virginia Mason Medical Center, Seattle, Washington. D.C. Borgstrom is associate professor, Department of Surgery, West Virginia University, Morgantown, West Virginia. D.L. Dent is professor of surgery, Division of Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas. R.D. Dumire is general surgery residency program director and medical director of trauma services, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania. J. Fryer is professor of surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. T.H. Hartranft is clinical professor of surgery, Ohio University, and general surgery residency program director, Mount Carmel Health System, Columbus, Ohio. S.B. Holsten is associate professor and general surgery residency program director, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia. T. Nelson is chief of general surgery and executive physician, Health System Surgical Services, University of New Mexico, Albuquerque, New Mexico. M. Shabahang is director, Department of General Surgery, and general surgery residency program director, Geisinger Medical Center, Danville, Pennsylvania. S. Sherman is associate clinical professor and associate director, General Surgery Residency Program, Michigan State University / Grand Rapids Medical Education Partners, Wyoming, Michigan. P.M. Termuhlen is regional campus dean, University of Minnesota Medical School, Duluth, Minnesota. R.J. Woods is associate professor and general surgery residency program director, Wright State University Boonshoft School of Medicine, Dayton, Ohio. J.D. Mellinger is professor, chair of general surgery, and general surgery residency program director, Southern Illinois University School of Medicine, Springfield, Illinois
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Mullen MG, Salerno EP, Michaels AD, Hedrick TL, Sohn MW, Smith PW, Schirmer BD, Friel CM. Declining Operative Experience for Junior-Level Residents: Is This an Unintended Consequence of Minimally Invasive Surgery? JOURNAL OF SURGICAL EDUCATION 2016; 73:609-615. [PMID: 27066854 PMCID: PMC4985608 DOI: 10.1016/j.jsurg.2016.02.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/21/2016] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. METHODS A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried for these procedures between 2005 and 2012. Cases were stratified by participating resident post-graduate year with "junior resident" defined as post-graduate year1-3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. RESULTS A total of 185,335 cases were included in the study. For 3 of the operations we considered, the prevalence of laparoscopic surgery increased from 2005-2012 (all p < 0.001). Cholecystectomy was an exception, which showed an unchanged proportion of cases performed laparoscopically across the study period (p = 0.119). Junior resident participation decreased by 4.5%/y (p < 0.001) for laparoscopic procedures and by 6.2%/y (p < 0.001) for open procedures. The proportion of laparoscopic surgeries performed by junior-level residents decreased for appendectomy by 2.6%/y (p < 0.001) and cholecystectomy by 6.1%/y (p < 0.001), whereas it was unchanged for inguinal herniorrhaphy (p = 0.75) and increased for partial colectomy by 3.9%/y (p = 0.003). A decline in junior resident participation was seen for all open surgeries, with appendectomy decreasing by 9.4%/y (p < 0.001), cholecystectomy by 4.1%/y (p < 0.002), inguinal herniorrhaphy by 10%/y (p < 0.001) and partial colectomy by 2.9%/y (p < 0.004). CONCLUSIONS Along with the proliferation of laparoscopy for common general surgical procedures there has been a concomitant reduction in the participation of junior-level residents. As previously thought, familiarity with laparoscopy has not translated to redistribution of basic operations from senior to junior residents. This trend has significant implications for general surgery resident education.
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Affiliation(s)
- Matthew G Mullen
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Elise P Salerno
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alex D Michaels
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Traci L Hedrick
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Min-Woong Sohn
- Department of Public Health Sciences, Health System Old Medical School, University of Virginia, Charlottesville, Virginia
| | - Philip W Smith
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Bruce D Schirmer
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Charles M Friel
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Barsom EZ, Graafland M, Schijven MP. Systematic review on the effectiveness of augmented reality applications in medical training. Surg Endosc 2016; 30:4174-83. [PMID: 26905573 PMCID: PMC5009168 DOI: 10.1007/s00464-016-4800-6] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 02/03/2016] [Indexed: 12/16/2022]
Abstract
Background Computer-based applications are increasingly used to support the training of medical professionals. Augmented reality applications (ARAs) render an interactive virtual layer on top of reality. The use of ARAs is of real interest to medical education because they blend digital elements with the physical learning environment. This will result in new educational opportunities. The aim of this systematic review is to investigate to which extent augmented reality applications are currently used to validly support medical professionals training. Methods PubMed, Embase, INSPEC and PsychInfo were searched using predefined inclusion criteria for relevant articles up to August 2015. All study types were considered eligible. Articles concerning AR applications used to train or educate medical professionals were evaluated. Results Twenty-seven studies were found relevant, describing a total of seven augmented reality applications. Applications were assigned to three different categories. The first category is directed toward laparoscopic surgical training, the second category toward mixed reality training of neurosurgical procedures and the third category toward training echocardiography. Statistical pooling of data could not be performed due to heterogeneity of study designs. Face-, construct- and concurrent validity was proven for two applications directed at laparoscopic training, face- and construct validity for neurosurgical procedures and face-, content- and construct validity in echocardiography training. In the literature, none of the ARAs completed a full validation process for the purpose of use. Conclusion Augmented reality applications that support blended learning in medical training have gained public and scientific interest. In order to be of value, applications must be able to transfer information to the user. Although promising, the literature to date is lacking to support such evidence.
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Affiliation(s)
- E Z Barsom
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M Graafland
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.,Department of Surgery, Flevo Hospital, Almere, The Netherlands
| | - M P Schijven
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Review of 3-Dimensional Printing on Cranial Neurosurgery Simulation Training. World Neurosurg 2015; 88:188-198. [PMID: 26724615 DOI: 10.1016/j.wneu.2015.12.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Shorter working times, reduced operative exposure to complex procedures, and increased subspecialization have resulted in training constraints within most surgical fields. Simulation has been suggested as a possible means of acquiring new surgical skills without exposing patients to the surgeon's operative "learning curve." Here we review the potential impact of 3-dimensional printing on simulation and training within cranial neurosurgery and its implications for the future. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of PubMed, OVID MEDLINE, Embase, and the Cochrane Database of Systematic Reviews was performed. RESULTS In total, 31 studies relating to the use of 3-dimensional (3D) printing within neurosurgery, of which 16 were specifically related to simulation and training, were identified. The main impact of 3D printing on neurosurgical simulation training was within vascular surgery, where patient-specific replication of vascular anatomy and pathologies can aid surgeons in operative planning and clip placement for reconstruction of vascular anatomy. Models containing replicas of brain tumors have also been reconstructed and used for training purposes, with some providing realistic representations of skin, subcutaneous tissue, bone, dura, normal brain, and tumor tissue. CONCLUSION 3D printing provides a unique means of directly replicating patient-specific pathologies. It can identify anatomic variation and provide a medium in which training models can be generated rapidly, allowing the trainee and experienced neurosurgeon to practice parts of operations preoperatively. Future studies are required to validate this technology in comparison with current simulators and show improved patient outcomes.
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Imrie KR, Frank JR, Parshuram CS. Resident duty hours: past, present, and future. BMC MEDICAL EDUCATION 2014; 14 Suppl 1:S1. [PMID: 25559868 PMCID: PMC4304261 DOI: 10.1186/1472-6920-14-s1-s1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Kevin R Imrie
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- The University of Toronto, Toronto, Ontario, Canada
| | - Jason R Frank
- The Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- The Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher S Parshuram
- The University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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