IMPACT OF A SIMULATED LAPAROSCOPIC TRAINING PROGRAM IN A THREE-YEAR GENERAL SURGERY RESIDENCY

Educational research on medical residency programs in Chile: a scoping review and analysis of the impact of the new accreditation policy

BACKGROUND

Accrediting medical specialties programs are expected to influence and standardize training program quality, align curriculum with population needs, and improve learning environments. Despite global agreement on its necessity, methods vary widely. In the Chilean context, a recent new accreditation criteria includes research productivity in relation to educational research on resident programs, so we aimed to define it. What is the profile of publications in educational research produced by Chilean medical specialty residency programs in the last five years? Based on these results, we intend to analyze the potential impact of the new accreditation policy on medical specialty programs in Chile.

METHODS

We performed a preliminary bibliometric search to identify the use of the term "resident" in literature. After that, we conducted a literature search, using a six-step approach to scoping reviews, including the appraisal of the methodological quality of the articles.

RESULTS

Between 2019 and 2023, an average of 6.2 articles were published yearly (19%). The bibliometric analysis revealed that the dominant thematic area of the journals was clinical, accounting for 78.1%. Most articles focused on residents (84.38%), with only two articles including graduates as participants. One university was responsible for 62.50% of the articles and participated in all multicenter studies (9.38%). Surgical specialties produced 15 research articles focused on procedural training using simulation. Psychiatry was the second most productive specialty, with 5 articles (15.63%) covering standardized patients, well-being, and mental health assessment. The most frequent research focus within residency programs over the five-year period was teaching and learning methodologies, with 19 articles representing almost 60% of the total analyzed.

CONCLUSIONS

Research on medical education in Chile's postgraduate residency programs is limited, with most studies concentrated in a few universities. The new accreditation criteria emphasize educational research, posing challenges for many institutions to meet higher standards. Understanding unexplored areas in educational research and learning from successful programs can enhance research productivity and align efforts with accreditation expectations. Continuous evaluation and new research on residents' satisfaction, skills acquisition, and well-being are needed to ensure training quality and accountability.

Innovations in surgical training: exploring the role of artificial intelligence and large language models (LLM)

The landscape of surgical training is rapidly evolving with the advent of artificial intelligence (AI) and its integration into education and simulation. This manuscript aims to explore the potential applications and benefits of AI-assisted surgical training, particularly the use of large language models (LLMs), in enhancing communication, personalizing feedback, and promoting skill development. We discuss the advancements in simulation-based training, AI-driven assessment tools, video-based assessment systems, virtual reality (VR) and augmented reality (AR) platforms, and the potential role of LLMs in the transcription, translation, and summarization of feedback. Despite the promising opportunities presented by AI integration, several challenges must be addressed, including accuracy and reliability, ethical and privacy concerns, bias in AI models, integration with existing training systems, and training and adoption of AI-assisted tools. By proactively addressing these challenges and harnessing the potential of AI, the future of surgical training may be reshaped to provide a more comprehensive, safe, and effective learning experience for trainees, ultimately leading to better patient outcomes. .

Five-Year Experience Training Surgeons with a Laparoscopic Simulation Training Program for Bariatric Surgery: a Quasi-experimental Design

PURPOSE

Nearly 200,000 laparoscopic Roux-en-Y gastric bypass (LRYGB) are performed yearly. Reported learning curves range between 50 and 150, even 500 cases to decrease the operative risk. Simulation programs could accelerate this learning curve safely; however, trainings for LRYGB are scarce. This study aims to describe and share our 5-year experience of a simulated program designed to achieve proficiency in LRYGB technical skills.

MATERIALS AND METHODS

A quasi-experimental design was used. All recruited participants were previously trained with basic and advanced laparoscopic simulation curriculum completing over 50 h of practical training. Ex vivo animal models were used to practice manual and stapled gastrojejunostomy (GJ) and stapled jejunojejunostomy (JJO) in 10, 3, and 4 sessions, respectively. The main outcome was to assess the manual GJ skill acquisition. Pre- and post-training assessments using a Global Rating Scale (GRS; max 25 pts), Specific Rating Scale (SRS; max 20 pts), performance time, permeability, and leakage rates were analyzed. For the stapled GJ and JJO, execution time was registered. Data analysis was performed using parametric tests.

RESULTS

In 5 years, 68 trainees completed the program. For the manual GJ's pre- vs post-training assessment, GRS and SRS scores increased significantly (from 17 to 24 and from 13 to 19 points respectively, p-value < 0.001). Permeability rate increased while leakage rate and procedural time decreased significantly.

CONCLUSION

This simulated training program showed effectiveness in improving laparoscopic skills for manual GJ and JJO in a simulated scenario. This new training program could optimize the clinical learning curve. Further studies are needed to assess the transfer of skills to the operating room.

LATIN AMERICAN RESIDENTS' SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA?

BACKGROUND

The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice.

AIMS

This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America.

METHOD

A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world.

RESULTS

In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested.

CONCLUSIONS

Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.

Lessons learned during the COVID-19 pandemic using virtual basic laparoscopic training in Santa Cruz de la Sierra, Bolivia: effects on confidence, knowledge, and skill

BACKGROUND

An international surgical team implemented a virtual basic laparoscopic surgery course for Bolivian general and pediatric surgeons and residents during the COVID-19 pandemic. This simulation course aimed to enhance training in a lower-resource environment despite the challenges of decreased operative volume and lack of in-person instruction.

METHODS

The course was developed by surgeons from Bolivian and U.S.-based institutions and offered twice between July-December 2020. Didactic content and skill techniques were taught via weekly live videoconferences. Additional mentorship was provided through small group sessions. Participants were evaluated by pre- and post-course tests of didactic content as well as by video task review.

RESULTS

Of the 24 enrolled participants, 13 were practicing surgeons and 10 were surgery residents (one unspecified). Fifty percent (n = 12) indicated "almost never" performing laparoscopic surgeries pre-course. Confidence significantly increased for five laparoscopic tasks. Test scores also increased significantly (68.2% ± 12.5%, n = 21; vs 76.6% ± 12.6%, n = 19; p = 0.040). While challenges impeded objective evaluation for the first course iteration, adjustments permitted video scoring in the second iteration. This group demonstrated significant improvements in precision cutting (11.6% ± 16.7%, n = 9; vs 62.5% ± 18.6%, n = 6; p < 0.001), intracorporeal knot tying (36.4% ± 38.1%, n = 9; vs 79.2% ± 17.2%, n = 7; p = 0.012), and combined skill (40.3% ± 17.7%; n = 8 vs 77.2% ± 13.6%, n = 4; p = 0.042). Collectively, combined skill scores improved by 66.3% ± 10.4%.

CONCLUSION

Virtual international collaboration can improve confidence, knowledge, and basic laparoscopic skills, even in resource-limited settings during a global pandemic. Future efforts should focus on standardizing resources for participants and enhancing access to live feedback resources between classes.

Ten years of IRCAD, Barretos, SP, Brazil

Minimally invasive surgery represented a significant milestone in modern surgery; however, continuous innovation and the emergence of new technologies pose new challenges in terms of surgical learning curves since new interventions are associated with increased surgical complexity and a higher risk of complications. For this reason, surgeons are aware of the beneficial effects of "learning before doing" and the importance of safely implementing new surgical procedures in order to obtain better patient outcomes. Considered the largest Latin American training center in minimally invasive surgery, IRCAD Barretos, São Paulo, Brazil, makes it possible to acquire surgical skills through training in different and the most complex areas of medicine, providing the experience of real and simulated situations, with focus on innovation. The center possesses state-of-the-art infrastructure and technology, with a very high-level teaching staff and an affectionate and hospitable reception. Since its inauguration, in 2011, the center has already qualified numerous professionals and has placed the country in a privileged position in terms of surgical knowledge. The present article describes the activities developed over these ten years of the institute in Brazil as the largest training center for surgeons of the continent in order to address the importance of surgical skills training.

Surgical training through simulation dedicated to French Ob-gyn residents. Evaluation and satisfaction

OBJECTIVE

In order to be able to develop surgical training of residents through simulation, we carried out a descriptive study, evaluating the satisfaction of participating residents and the benefit of the workshops offered during the 4 th Junior Master Class, free annual training organized in 2017 in Lille University Hospital. It is dedicated to ob-gyn residents in France, overseas departments and territories.

MATERIAL AND METHODS

During two days, plenary sessions and practical workshops on animal models or simulators were organized in laparoscopy, diagnostic and operative hysteroscopy, vaginal surgery and robotic surgery. A questionnaire was given anonymously to each student, collecting on the one hand their surgical curriculum, on the other hand, the evaluations of the theoretical contribution and the quality of the interventions and materials offered during the plenary sessions. The last part was subdivided into a questionnaire specific to each workshop.

RESULTS

The 48 residents who voluntarily followed this training were overwhelmingly satisfied with the quality of the training offered. The practical benefits outweighed the theoretical benefits. These workshops improved their practical skills from 63 % to 84 % depending on the workshops offered. In addition, 100 % of students would recommend this training to other residents and consider it useful for their future practice.

CONCLUSION

These very satisfactory results encourage us to organize new surgical training. Simulation is the key point for an appropriate surgical learning.