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Li P, Xu B, Zhang X, Fang D, Zhang J. Design and development of a personalized virtual reality-based training system for vascular intervention surgery. Comput Methods Programs Biomed 2024; 249:108142. [PMID: 38547688 DOI: 10.1016/j.cmpb.2024.108142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/17/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Virtual training has emerged as an exceptionally effective approach for training healthcare practitioners in the field of vascular intervention surgery. By providing a simulated environment and blood vessel model that enables repeated practice, virtual training facilitates the acquisition of surgical skills in a safe and efficient manner for trainees. However, the current state of research in this area is characterized by limitations in the fidelity of blood vessel and guidewire models, which restricts the effectiveness of training. Additionally, existing approaches lack the necessary real-time responsiveness and precision, while the blood vessel models suffer from incompleteness and a lack of scientific rigor. METHODS To address these challenges, this paper integrates position-based dynamics (PBD) and its extensions, shape matching, and Cosserat elastic rods. By combining these approaches within a unified particle framework, accurate and realistic deformation simulation of personalized blood vessel and guidewire models is achieved, thereby enhancing the training experience. Furthermore, a multi-level progressive continuous collision detection method, leveraging spatial hashing, is proposed to improve the accuracy and efficiency of collision detection. RESULTS Our proposed blood vessel model demonstrated acceptable performance with the reduced deformation simulation response times of 7 ms, improving the real-time capability at least of 43.75 %. Experimental validation confirmed that the guidewire model proposed in this paper can dynamically adjust the density of its elastic rods to alter the degree of bending and torsion. It also exhibited a deformation process comparable to that of real guidewires, with an average response time of 6 ms. In the interaction of blood vessel and guidewire models, the simulator blood vessel model used for coronary vascular intervention training exhibited an average response time of 15.42 ms, with a frame rate of approximately 64 FPS. CONCLUSIONS The method presented in this paper achieves deformation simulation of both vascular and guidewire models, demonstrating sufficient real-time performance and accuracy. The interaction efficiency between vascular and guidewire models is enhanced through the unified simulation framework and collision detection. Furthermore, it can be integrated with virtual training scenarios within the system, making it suitable for developing more advanced vascular interventional surgery training systems.
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Affiliation(s)
- Pan Li
- Tianjin Key Lab of Integrated Design and On-line Monitoring for Light Industry & Food Machinery and Equipment, College of Mechanical Engineering, Tianjin University of Science & Technology, Tianjin 300222, China.
| | - Boxuan Xu
- Tianjin Key Lab of Integrated Design and On-line Monitoring for Light Industry & Food Machinery and Equipment, College of Mechanical Engineering, Tianjin University of Science & Technology, Tianjin 300222, China
| | - Xinxin Zhang
- Tianjin Key Lab of Integrated Design and On-line Monitoring for Light Industry & Food Machinery and Equipment, College of Mechanical Engineering, Tianjin University of Science & Technology, Tianjin 300222, China
| | - Delei Fang
- Tianjin Key Lab of Integrated Design and On-line Monitoring for Light Industry & Food Machinery and Equipment, College of Mechanical Engineering, Tianjin University of Science & Technology, Tianjin 300222, China
| | - Junxia Zhang
- Tianjin Key Lab of Integrated Design and On-line Monitoring for Light Industry & Food Machinery and Equipment, College of Mechanical Engineering, Tianjin University of Science & Technology, Tianjin 300222, China
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Baboolal SO, Singaram VS. Implementation and Impact of an Adapted Digital Perioperative Competency-Building Tool to Enhance Teaching, Learning And Feedback in Postgraduate Competency-Based Medical Education. J Surg Educ 2024; 81:722-740. [PMID: 38492984 DOI: 10.1016/j.jsurg.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES The purpose of this educational intervention was to introduce, iteratively adapt, and implement a digital formative assessment tool in a surgical speciality. The study also evaluated the intervention's impact on perioperative teaching, learning, feedback, and surgical competency. DESIGN A participatory action research model with a mixed methods approach. SETTING This study was performed over 10 months in an institutional hospital in South Africa with a general surgery department. PARTICIPANTS Twelve supervising surgical trainers/faculty and 12 surgical trainees/residents consented to participate in the intervention. RESULTS The first 4 months of the intervention focused on relationship building, a multi-stakeholder contextual needs assessment and training sessions to support a shared mindset and shift in the teaching and learning culture. The final adapted perioperative competency-building tool comprised a 23-item assessment with four open-text answers (Table 1). Over the following 6-month period, 48 workplace-based competency-building perioperative evaluations were completed. Most trainees took less than 5 minutes to self-assess (67%) before most trainers (67%) took less than 5 minutes to give oral feedback to the trainee after the perioperative supervised learning encounter. On average, the digital tool took 6 minutes to complete during the bidirectional perioperative teaching and learning encounter with no negative impact on the operational flow. All trainers and trainees reported the training and implementation of the digital tool to be beneficial to teaching, learning, feedback, and the development of surgical competency. Analysis of the completed tools revealed several trainees showing evidence of progression in surgical competency for index procedures within the speciality. The focus groups and interviews also showed a change in the teaching and learning culture: more positively framed, frequent, structured, and specific feedback, improved accountability, and trainee-trainer perioperative readiness for teaching. Highlighted changes included the usefulness of trainee self-assessment before perioperative trainer feedback and the tool's value in improving competency to Kirkpatrick Level 4. CONCLUSION Implementing an adapted digital Workplace-Based Assessment (WBA) tool using a participatory action research model has proven successful in enhancing the effectiveness of supervised perioperative teaching and learning encounters. This approach has improved teaching and feedback practices, facilitated the development of surgical competency, and ultimately impacted the overall culture to Kirkpatrick level 4. Importantly, it has positively influenced the trainee-trainer relationship dynamic. Based on these positive outcomes, we recommend using this effective method and our relationship-centred framework for implementing formative competency-building tools in future studies. By doing so, larger-scale and successful implementation of Competency-Based Medical Education (CBME) could be achieved in various contexts. This approach can potentially enhance teaching and learning encounters, promote competency development, and improve the overall educational experience for surgical trainees and trainers.
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Affiliation(s)
- Sandika O Baboolal
- School of Clinical Medicine College of Health Sciences University of KwaZulu Natal 719 Umbilo Road, Umbilo Durban 4001 South Africa; Ophthalmology Department, Division of Surgery, James Paget University Hospital NHS Foundation Trust, United Kingdom.
| | - Veena S Singaram
- School of Clinical Medicine College of Health Sciences University of KwaZulu Natal 719 Umbilo Road, Umbilo Durban 4001 South Africa
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Sohail AH, Martinez KA, Flesner SL, Martinez C, Nguyen H, Jreisat BH, Ye IB, Goyal A, Rohail A, Pacheco TBS, Williams CE, Askeri A, Levine J. Operative Experience of Esophageal Surgery among General Surgery Residents in the United States: An Analysis of ACGME Operative Case Logs. J Surg Educ 2024; 81:639-646. [PMID: 38556439 DOI: 10.1016/j.jsurg.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Esophageal surgery is an essential component of general surgery training and encompasses several types of cases that are logged by general surgery residents. There is a scarcity of data on the quality and volume of esophageal surgery experience during surgical residency in the United States. We analyzed trends for 9 different esophageal procedure categories logged by residents in the United States, with the aim to identify areas for improvement in training. METHODS We conducted a retrospective analysis of operative case logs of all general surgery residents graduating from programs accredited by the ACGME over a fourteen-year period from 2009 to 2023. Data on mean esophageal cases reported by graduates, including mean in each procedure subcategory were retrieved. Cases were categorized as either surgeon chief or surgeon junior for each procedure category. Mann-Kendall trend test was used to obtain tau statistics and p-value for trends in mean operative surgical volume for the total number of cases in each operative category over the study period. Trends in surgeon chief and surgeon junior cases were also investigated for each operative category. RESULTS The mean number of all esophageal procedures performed per resident during their training increased significantly from 10.5 in 2009 to 16 in 2022 (τ = 0.833, p < 0.001). This trend observed among all esophageal procedures during this 14-year study can be largely attributed to the steady increase in the number and proportion of laparoscopic esophageal antireflux procedures performed (τ = 0.950, p < 0.001). Additionally, esophagectomy procedures had a statistically significant, but modest, increase during the study period (τ = 0.505, p = 0.023), from a mean of 1 case during training in 2009 to a peak of 1.3 in 2020. Although the general trend of esophagus procedures increased during the study period, most categories (7 out of 9) either decreased or did not significantly change. Esophagogastrectomy volume decreased significantly by 30%, from 1 per resident during their training in 2009 to 0.7 in 2022 (τ = -0.510, p = 0.018), esophageal diverticulectomy procedures decreased by 50% from 0.2 to 0.1 (τ = -0.609, p = 0.009), and operations for esophageal stenosis decreased by 75% from 0.4 to 0.1 (τ = -0.734, p = 0.001). Mean number of esophageal bypasses (τ = -0.128, p = 0.584), repair of perforated esophageal disease (τ = -0.333, p = 0.156), and other major esophagus procedures (τ = 0.416, p = 0.063) did not significantly change. CONCLUSION The operative volume of esophageal surgery that general surgery residents in the United States are exposed to has significantly risen over the past 14 years, largely driven by the increase in laparoscopic antireflux procedures. However, given the recent advances and the resultant heterogeneity in both esophageal surgery, the increase in resident operative volume is still inadequate to ensure the training of safe and adept esophageal surgeons, necessitating postresidency specialized training for trainees interested in esophageal surgery.
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Affiliation(s)
- Amir Humza Sohail
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Kevin A Martinez
- University of New Mexico School of Medicine, Albuquerque, New Mexico.
| | - Samuel L Flesner
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Christian Martinez
- University of New Mexico, College of Arts and Sciences, Albuquerque, New Mexico
| | - Hoang Nguyen
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | | | - Ivan B Ye
- Department of Surgery, NYU Langone Health, Long Island School of Medicine, Mineola, NY
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Amal Rohail
- Midwestern University, Chicago College of Osteopathic Medicine, Chicago, Illinois
| | - Tulio B S Pacheco
- Department of Surgery, NYU Langone Health, Long Island School of Medicine, Mineola, NY
| | | | - Aysha Askeri
- Shimoga Institute of Medical Science, Shivamogga, India
| | - Jun Levine
- Department of Surgery, NYU Langone Health, Long Island School of Medicine, Mineola, NY
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Killeen BD, Zhang H, Wang LJ, Liu Z, Kleinbeck C, Rosen M, Taylor RH, Osgood G, Unberath M. Stand in surgeon's shoes: virtual reality cross-training to enhance teamwork in surgery. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03138-7. [PMID: 38642297 DOI: 10.1007/s11548-024-03138-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Teamwork in surgery depends on a shared mental model of success, i.e., a common understanding of objectives in the operating room. A shared model leads to increased engagement among team members and is associated with fewer complications and overall better outcomes for patients. However, clinical training typically focuses on role-specific skills, leaving individuals to acquire a shared model indirectly through on-the-job experience. METHODS We investigate whether virtual reality (VR) cross-training, i.elet@tokeneonedotexposure to other roles, can enhance a shared mental model for non-surgeons more directly. Our study focuses on X-ray guided pelvic trauma surgery, a procedure where successful communication depends on the shared model between the surgeon and a C-arm technologist. We present a VR environment supporting both roles and evaluate a cross-training curriculum in which non-surgeons swap roles with the surgeon. RESULTS Exposure to the surgical task resulted in higher engagement with the C-arm technologist role in VR, as measured by the mental demand and effort expended by participants ( p < 0.001 ). It also has a significant effect on non-surgeon's mental model of the overall task; novice participants' estimation of the mental demand and effort required for the surgeon's task increases after training, while their perception of overall performance decreases ( p < 0.05 ), indicating a gap in understanding based solely on observation. This phenomenon was also present for a professional C-arm technologist. CONCLUSION Until now, VR applications for clinical training have focused on virtualizing existing curricula. We demonstrate how novel approaches which are not possible outside of a virtual environment, such as role swapping, may enhance the shared mental model of surgical teams by contextualizing each individual's role within the overall task in a time- and cost-efficient manner. As workflows grow increasingly sophisticated, we see VR curricula as being able to directly foster a shared model for success, ultimately benefiting patient outcomes through more effective teamwork in surgery.
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Affiliation(s)
| | - Han Zhang
- Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Liam J Wang
- Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Zixuan Liu
- Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Constantin Kleinbeck
- Johns Hopkins University, Baltimore, MD, 21218, USA
- Friedrich-Alexander-Universität, Erlangen, Germany
| | | | | | - Greg Osgood
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, 21218, USA
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von Waldenfels G, Beck MH, Semmler J, Gerber A, Hennigs A, Vochem R, Blohmer JU, Schmalfeldt B, Pietzner K, Sehouli J. Training in obstetrics and gynecology between reality and vision: results of a JAGO-NOGGO survey in 601 physicians (NOGGO-Monitor-12 trial). Arch Gynecol Obstet 2024:10.1007/s00404-024-07508-z. [PMID: 38625545 DOI: 10.1007/s00404-024-07508-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE The primary objective of this study was to establish a benchmark by collecting baseline data on surgical education in obstetrics and gynecology in Germany, including factual number of operations performed. MATERIALS AND METHODS A nationwide anonymous survey was conducted in Germany between January 2019 and July 2019 utilizing a specially designed questionnaire which addressed both residents and senior trainers. RESULTS A total of 601 participants completed the survey, comprising 305 trainees and 296 trainers. The trainees reported performing a median of 125 non-obstetric surgeries (IQR: 41-332) and 75 obstetric procedures (IQR: 27-168) independently. While most last-year residents managed to meet the targeted numbers for minor surgical procedures outlined in the logbook, they fell short of achieving the required numbers for major operations, such as hysterectomies or more complex laparoscopies. Although both trainees and trainers emphasized the significance of surgical training, the overall quality of the training was rated poorly, particularly by trainees. This was attributed to a high proportion of administrative tasks and a deficiency in teaching time within the operating theater. External fellowship and mentoring programs, as well as the implementation of regular, centralized reviews of residency training, were identified as potentially beneficial by both trainees and trainers. CONCLUSION The findings of this survey should serve as a wake-up call both within and outside of Germany, highlighting the importance of comprehensive and structured surgical training to enhance long-term patient care and increase satisfaction among obstetrics and gynecology trainees.
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Affiliation(s)
- Gabriel von Waldenfels
- Department of Gynecology, Breast Center, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
| | - Maximilian Heinz Beck
- Department of Gynecology, Breast Center, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany.
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Janina Semmler
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Obstetrics, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annika Gerber
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Fertility Doctors Berlin, Berlin, Germany
| | - André Hennigs
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Ruth Vochem
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- TFP Kinderwunsch Klagenfurt, Klagenfurt, Austria
| | - Jens-Uwe Blohmer
- Department of Gynecology, Breast Center, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Society of Gynecology and Obstetrics (DGGG), Berlin, Germany
| | - Klaus Pietzner
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jalid Sehouli
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Hudelist B, Prebot J, Lecarpentier E, Apra C. A realistic aneurysm clipping simulation combining 3D-printed and placenta-based models-how I do it. Acta Neurochir (Wien) 2024; 166:172. [PMID: 38592539 DOI: 10.1007/s00701-024-06068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Neurovascular surgery, particularly aneurysm clipping, is a critical skill for aspiring neurosurgeons. However, hands-on training opportunities are limited, especially with the growing popularity of endovascular techniques. To address this challenge, we present a novel neurovascular surgical training station that combines synthetic 3D-printed models with placental vascular structures to create a semi-realistic surgical field. METHODS Our model consists of three components: a 3D-printed skull replica with anatomical landmarks, a malleable silicone parenchyma with a Sylvian fissure, and vascular layers (placenta). The placental vascular layer is catheterized and perfused to replicate pulsatile flow, offering a realistic aneurysm simulation. This innovative training station provides a cost-effective solution (approximately 200 USD once) without ethical constraints. Surgeons can practice essential skills such as Sylvian fissure dissection, managing anatomical constraints like bone, and achieving proximal vascular control. The model's realism allows for training in various scenarios, including clipping with different hand orientations and handling ruptures realistically. CONCLUSION Our neurovascular surgical station bridges the gap between existing training models, offering affordability, ecological considerations, and minimal ethical concerns. It empowers neurosurgery residents to refine their skills in handling both emergencies and elective cases under close-to-real surgical conditions, with the potential for independent practice and senior supervision.
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Affiliation(s)
- Benoit Hudelist
- Neurosurgery Department, UMR 955, Université Paris Est Créteil (UPEC)AP-HP, Henri Mondor HospitalUnitéIMRB, INSERM 15, 94000, Créteil, France.
- Department of Neurosurgery, GHU Paris - Psychiatry and Neuroscience, Sainte-Anne Hospital, Paris, France.
| | - Juliette Prebot
- Service de modélisation et d'impression 3D de l'Assistance Publique - Hopitaux de Paris (PRIM3D), Paris, France
| | - Edouard Lecarpentier
- Department of Obstetrics Gynecology and Reproductive Medicine, Centre Hospitalier Inter-Communal de Créteil, Creteil, France
- Faculté de Santé, Univ Paris Est Créteil, Créteil, France
- INSERM, Institut Cochin, Paris, France
| | - Caroline Apra
- Neurosurgery Department, UMR 955, Université Paris Est Créteil (UPEC)AP-HP, Henri Mondor HospitalUnitéIMRB, INSERM 15, 94000, Créteil, France
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Kraus AC, Bui A, Malloy K, Morse J, Young OM. The COVID-19 pandemic and OBGYN residency training: We have a problem and it's not just masks. BMC Med Educ 2024; 24:377. [PMID: 38580978 PMCID: PMC10998311 DOI: 10.1186/s12909-024-05364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The COVID-19 pandemic has left no one untouched. Resident trainees have been driven to reconsider virtually every component of their daily lives. The purpose of this pilot study is to evaluate the impact of the COVID-19 pandemic on Obstetrics and Gynecology (OBGYN) residency training and education. METHODS A cross-sectional pilot study was conducted between 2/2022 and 5/2022. A survey was created and distributed to OBGYN residents. The survey queried the effects of the pandemic on OBGYN residents' procedure skills training and mental health. RESULTS A total of 95 OBGYN residents across programs affiliated with each American College of Obstetricians and Gynecologists (ACOG) district participated in the survey. Among them, just over half (n = 52, 55%) self-identified as under-represented minorities. A significant majority, 80% (n = 81), felt their gynecological training was inadequate, with 70% of fourth-year residents expressing a lack of confidence in their ability to independently practice gynecology after graduation. This lack of confidence among fourth-year residents suggests a notable disparity in readiness for independent gynecological practice, linked to meeting ACGME requirements before completing their residency (p = 0.013). Among the residents who reported a negative impact of the pandemic on their mental health (n = 76, 80%), about 40% (n = 31) had contemplated self-harm or knew a colleague who considered or attempted suicide (p < 0.001). This issue was especially pronounced in residents experiencing burnout (n = 44, 46%), as nearly half (n = 19, 43%) reported suicidal thoughts or knew someone in their program who had such thoughts or engaged in self-harm (p = 0.048). CONCLUSIONS Residents expressed concerns about reduced hands-on gynecological training and doubts about their readiness for independent practice post-residency, highlighting the need for enhanced support through mentorship and revised training curriculums. Additionally, despite the availability of mental health resources to address pandemic-induced burnout, their underuse suggests a need for more accessible time for residents to use at their discretion and flexible training schedules that encourage mental health support resource utilization.
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Affiliation(s)
- Alexandria C Kraus
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, Chapel Hill, NC, 27599, USA.
| | - Anthony Bui
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kimberly Malloy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, Chapel Hill, NC, 27599, USA
| | - Jessica Morse
- Division of Family Planning, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Omar M Young
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, Chapel Hill, NC, 27599, USA
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Dos Santos Almeida Farinha RJ, Piro A, Mottaran A, Paciotti M, Puliatti S, Breda A, Porter J, Van Cleynenbreugel B, Vander Sloten J, Mottrie A, Gallagher AG. Development and validation of metrics for a new RAPN training model. J Robot Surg 2024; 18:153. [PMID: 38563887 DOI: 10.1007/s11701-024-01911-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
Robot-assisted partial nephrectomy (RAPN) is a complex and index procedure that urologists need to learn how to perform safely. No validated performance metrics specifically developed for a RAPN training model (TM) exist. A Core Metrics Group specifically adapted human RAPN metrics to be used in a newly developed RAPN TM, explicitly defining phases, steps, errors, and critical errors. A modified Delphi meeting concurred on the face and content validation of the new metrics. One hundred percent consensus was achieved by the Delphi panel on 8 Phases, 32 Steps, 136 Errors and 64 Critical Errors. Two trained assessors evaluated recorded video performances of novice and expert RAPN surgeons executing an emulated RAPN in the newly developed TM. There were no differences in procedure Steps completed by the two groups. Experienced RAPN surgeons made 34% fewer Total Errors than the Novice group. Performance score for both groups was divided at the median score using Total Error scores, into HiError and LoError subgroups. The LowErrs Expert RAPN surgeons group made 118% fewer Total Errors than the Novice HiErrs group. Furthermore, the LowErrs Expert RAPN surgeons made 77% fewer Total Errors than the HiErrs Expert RAPN surgeons. These results established construct and discriminative validity of the metrics. The authors described a novel RAPN TM and its associated performance metrics with evidence supporting their face, content, construct, and discriminative validation. This report and evidence support the implementation of a simulation-based proficiency-based progression (PBP) training program for RAPN.
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Affiliation(s)
| | - Adele Piro
- Division of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Puliatti
- Division of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Breda
- Department of Urology, Universitat Autonoma de Barcelona, Fundació Puigvert, Barcelona, Spain
| | - James Porter
- Swedish Urology Group, Swedish Medical Center, Seattle, WA, USA
| | - Ben Van Cleynenbreugel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, Section of Biomechanics, KU Leuven, Leuven, Belgium
| | - Alexandre Mottrie
- Orsi Academy, Proefhoevestraat 12, 9090, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium
| | - Anthony G Gallagher
- Orsi Academy, Proefhoevestraat 12, 9090, Ghent, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- Faculty of Life and Health Sciences, Ulster University, Derry, Northern Ireland, UK
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Leng S, Chaudhry N, Pacilli M, Nataraja RM. Evaluation of a novel home-based laparoscopic and core surgical skills programme (Monash Online Surgical Training). Surg Endosc 2024; 38:1813-1822. [PMID: 38302757 PMCID: PMC10978607 DOI: 10.1007/s00464-023-10669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Limitations to surgical education access were exacerbated during the COVID-19 Pandemic. In response, we created a national home-based comprehensive surgical skills course: Monash Online Surgical Training (MOST). Our aim was to evaluate the educational impact of this approach. METHODS A remote, 6-week course was designed with learning objectives aligned to the national surgical training. Participants received a personal laparoscopic bench trainer, instrument tracking software, live webinars, access to an online theoretical learning platform, and individualised feedback by system-generated or expert surgeons' assessments. Mixed method analysis of instrument tracking metrics, pre- and post-course questionnaires (11 core surgical domains) and participant comments was utilised. Data were analysed using the Mann-Whitney U test, and a p-value of < 0.05 was considered statistically significant. RESULTS A total of 54 participants with varied levels of experience (1 to > 6 years post-graduate level) completed MOST. All 11 learning-outcome domains demonstrated statistically significant improvement including core laparoscopic skills (1.4/5 vs 2.8/5, p < 0.0001) and handling laparoscopic instruments (1.5/5 vs 2.8/5, p < 0.0001). A total of 3460 tasks were completed reflecting 158.2 h (9492 min) of practice, 394 were submitted for formal feedback. Participants rated the course (mean 8.5/10, SD 1.6), live webinars (mean 8.9/10, SD 1.6) and instrument tracking software (mean 8.6, SD 1.7) highly. Qualitative analysis revealed a paradigm shift including the benefits of a safe learning environment and self-paced, self-directed learning. CONCLUSION The MOST course demonstrates the successful implementation of a fully remote laparoscopic simulation course which participants found to be an effective tool to acquire core surgical skills.
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Affiliation(s)
- Samantha Leng
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, Melbourne, Australia
| | - Noor Chaudhry
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Science, Monash University, Melbourne, Australia
| | - Ramesh Mark Nataraja
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, Melbourne, Australia.
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Australia.
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Science, Monash University, Melbourne, Australia.
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10
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Mahendran V, Turpin L, Boal M, Francis NK. Assessment and application of non-technical skills in robotic-assisted surgery: a systematic review. Surg Endosc 2024; 38:1758-1774. [PMID: 38467862 PMCID: PMC10978706 DOI: 10.1007/s00464-024-10713-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Undeniably, robotic-assisted surgery (RAS) has become very popular in recent decades, but it has introduced challenges to the workflow of the surgical team. Non-technical skills (NTS) have received less emphasis than technical skills in training and assessment. The systematic review aimed to update the evidence on the role of NTS in robotic surgery, specifically focusing on evaluating assessment tools and their utilisation in training and surgical education in robotic surgery. METHODS A systematic literature search of PubMed, PsycINFO, MEDLINE, and EMBASE was conducted to identify primary articles on NTS in RAS. Messick's validity framework and the Modified Medical Education Research Study Quality Instrument were utilised to evaluate the quality of the validity evidence of the abstracted articles. RESULTS Seventeen studies were eligible for the final analysis. Communication, environmental factors, anticipation and teamwork were key NTS for RAS. Team-related factors such as ambient noise and chatter, inconveniences due to repeated requests during the procedure and constraints due to poor design of the operating room may harm patient safety during RAS. Three novel rater-based scoring systems and one sensor-based method for assessing NTS in RAS were identified. Anticipation by the team to predict and execute the next move before an explicit verbal command improved the surgeon's situational awareness. CONCLUSION This systematic review highlighted the paucity of reporting on non-technical skills in robotic surgery with only three bespoke objective assessment tools being identified. Communication, environmental factors, anticipation, and teamwork are the key non-technical skills reported in robotic surgery, and further research is required to investigate their benefits to improve patient safety during robotic surgery.
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Affiliation(s)
- Vimaladhithan Mahendran
- MSc Patient Safety and Human Clinical Factors, University of Edinburgh, Edinburgh, UK
- Department of General Surgery, Yeovil District Hospital, Yeovil, UK
| | - Laura Turpin
- Division of Medicine, BSc Applied Medical Sciences, University College London, London, UK
| | - Matthew Boal
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
- The Griffin Institute, Northwick Park Hospital, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Charles Bell House, University College London, London, UK
| | - Nader K Francis
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK.
- The Griffin Institute, Northwick Park Hospital, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK.
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11
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Matassa-Patrone J, Agras-Menghi G, Espil P, Maccagno J, Navarrete P, Verdier E, Petre C, Acuña M, Saravia-Toledo A. Training in Skull Base Endonasal Endoscopic Surgery: Development and Validation of a Novel Low-Cost Simulation with Animal Cadaveric Model. World Neurosurg 2024; 184:74-85. [PMID: 38218436 DOI: 10.1016/j.wneu.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Endoscopic skull base surgery is constantly evolving and its scope has expanded. The acquisition of surgical skills involves a long learning curve with significant risks for the patient. Therefore, training in the laboratory has become essential to achieve appropriate proficiency and reduce the morbidity and mortality associated with these procedures. The objective of our work is to develop and validate a cost-effective and easily replicable simulator for endonasal endoscopy training using a swine cadaveric model. METHODS We used fresh Pietrain swine heads. Training exercises of increasing complexity were performed. A Specific Technical Skills and Knowledge Scale was created considering the objectives to be assessed in each task. After the simulation, the trainees were required to answer a satisfaction survey. RESULTS Ten participants were recruited (5 neurosurgery residents and 5 neurosurgeons). The simulator assessment showed statistically significant differences between groups. Performance was better among the group with endoscopic surgery experience. Face validity was assessed through a postsimulation questionnaire showing an overall mean score of 28.7 out of 30, indicating a highly positive overall assessment of the simulator. Furthermore, 100% of the trainees believe that including endoscopy training in their education would be beneficial. CONCLUSIONS The endonasal endoscopy training simulator using a swine cadaveric model is a useful and accessible tool for enhancing surgical skills in this field. It provides an opportunity for training outside the operating room, reducing the potential risks associated with patient practice, and improving the training of residents.
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Affiliation(s)
- Jerónimo Matassa-Patrone
- Department of Neurosurgery, Sanatorio Güemes, University of Buenos Aires, Buenos Aires, Argentina; Neuroanatomy Laboratory of the Institute of Applied Sciences, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
| | - Giuliana Agras-Menghi
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Pablo Espil
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Juan Maccagno
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Paulina Navarrete
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Exequiel Verdier
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Cesar Petre
- Department of Neurosurgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Marcelo Acuña
- Neuroanatomy Laboratory of the Institute of Applied Sciences, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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12
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Hancock AJ, Pepper T, Messiha A, Millwaters M. Use of online educational resources before and during the COVID-19 era in oral and maxillofacial surgery. J Craniomaxillofac Surg 2024; 52:406-412. [PMID: 38448336 DOI: 10.1016/j.jcms.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/27/2023] [Accepted: 12/30/2023] [Indexed: 03/08/2024] Open
Abstract
Restrictions to traditional face-to-face meetings were mandated by many government authorities during the COVID-19 pandemic, impacting the delivery of educational training sessions for maxillofacial surgery trainees in the traditional group manner. An online survey was designed to review what effect the pandemic had on the use and uptake of online educational sources amongst a representative cohort of maxillofacial surgery trainees in higher specialist training. Their attitudes and satisfaction with online resources were considered. The use of live sources such as webinars and pre-recorded materials (e.g. YouTube videos) was investigated. Engagement with online sources was considered prior to, and then during the pandemic. Alterations in the behaviour of trainees were demonstrated, with increasing online resource use seen once the COVID-19 pandemic took hold. Online pre-recorded resource use increased by 26% during the pandemic, with the median number of hours watched per month increasing from 1-5 h to 5-10 h (p < 0.001). Engagement with live online sources (webinars) increased by 52% and median time watched increased from 15 h per month to 10-20 h per month (p < 0.001). Trainees expressed satisfaction with the quality and flexibility of the resources. There was a firmly positive response to live webinars with regard to teaching quality, audio and video quality, ease of access and relevance to training needs. Pre-recorded and live online resources may prove a useful alternative or adjunct to face-to-face teaching when regulations limit or restrict social interactions.
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Affiliation(s)
- Angela J Hancock
- King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom.
| | - Thomas Pepper
- Institute of Naval Medicine, Defence Medical Services, Crescent Road, Gosport, PO12 2DL, United Kingdom.
| | - Ashraf Messiha
- St. George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, United Kingdom.
| | - Michael Millwaters
- The Royal London Hospital, Whitechapel Road, E1 1BB, London, United Kingdom.
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13
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Sánchez A, Rodríguez O, Medina M, Vegas L, Couto F, Mogollon I, Inchausti C, Galvis L. Is YouTube a reliable tool for approaching robotic assisted transabdominal preperitoneal surgery? A critical review of the available resources. Cir Esp 2024; 102:188-193. [PMID: 38224772 DOI: 10.1016/j.cireng.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/08/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review videos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed videos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met. METHODS Identify and evaluate the 10 videos with the highest number of views related to rTAPP. Three experienced Surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable. RESULTS The average overall evaluation was 3.63 with a range of 2.6 to 4.9. The scores related to compliance with the rules 1, 2, 9, 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98. CONCLUSIONS The lack of compliance with the 10 golden rules in most of the videos demonstrates that the use of videos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure.
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Affiliation(s)
- Alexis Sánchez
- Director Programa de Cirugía Robótica. Orlando Health, Orlando, USA
| | - Omaira Rodríguez
- Programa de Cirugía Robótica, Hospital de Clínicas Caracas. Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Manuel Medina
- Departamento de Cirugía, Hospital Universitario del Henares, Madrid, Spain
| | - Liumariel Vegas
- Departamento de Cirugía, Hospital de Linares, Linares, Chile
| | - Francisco Couto
- Cirujano General, Grupo de Cirugía General. Orlando Health, Orlando, USA
| | - Ivan Mogollon
- Research Fellow, Programa de Cirugía Robótica ORMC, Orlando Health, Orlando, EE.UU
| | - Cristina Inchausti
- Research Fellow, Programa de Cirugía Robótica ORMC, Orlando Health, Orlando, EE.UU.
| | - Luz Galvis
- Unidad de Cirugía Robótica e Invasión minima, Caracas, Venezuela
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Shakir M, Irshad HA, Khowaja AH, Altaf A, Enam SA. Exploring the neurosurgery training landscape in Pakistan: A trainee's perspective in resource-limited settings. World Neurosurg X 2024; 22:100346. [PMID: 38444865 PMCID: PMC10914589 DOI: 10.1016/j.wnsx.2024.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
Background Shortage of neurosurgeons in Pakistan, one per 720,000 people, stems from a lack of trainees. Therefore, it is vital to assess the training experience, career opportunities, and satisfaction levels of neurosurgical trainees in Pakistan. Methods A nationwide survey was conducted, covering 22 CPSP-accredited neurosurgery training programs in Pakistan. Convenience sampling was utilized with a pilot tested questionnaire and responses were analyzed using STATA 15. Results The response rate was 98% (120/122) with 70.8% male and mean age of 30.4 ± 4.1 years. Training programs included teaching courses (79%) and journal club (66%); however, there was a lack of cadaver workshops (14%) and cranial model-based stimulation (22%). 67% of trainees lacked publications in indexed journals. 69% worked 50-100 h weekly, with 62% experiencing burnout due to workload and hours and a third reporting poor work-life balance. Trainees dedicated more to operating rooms (37%, 10-24 h/week) and clinics (34%, 24-48 h/week) compared to study (42%, <5 h/week) and research (64%, <5 h/week). Gender equality was rated poorly by 50%. Disparities emerged in subspecialty exposure, with over half of trainees lacking exposure to deep brain stimulation (67%), and epilepsy (75%). 52.5% of the training institutes did not offer fellowships and 64.1% of trainees planned to pursue fellowships abroad. Conclusions Steps need to be taken to improve working hours, gender equity, and increase simulation courses, diversify subspecialty exposure, and promote research initiatives.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, 74800, Pakistan
| | | | | | - Ahmed Altaf
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, 74800, Pakistan
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, 74800, Pakistan
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Romero-Marcos JM, Sampson-Dávila JG, Cuenca-Gómez C, Altet-Torné J, González-Abós S, Ojeda-Jiménez I, Galaviz-Sosa ML, Delgado-Rivilla S. Colorectal procedures with the novel Hugo™ RAS system: training process and case series report from a non-robotic surgical team. Surg Endosc 2024; 38:2160-2168. [PMID: 38448626 DOI: 10.1007/s00464-024-10760-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/16/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The landscape of robotic surgery is evolving with the emergence of new platforms. However, reports on their applicability in different surgical fields are still limited and come from teams with robotics experience. This study aims to describe the training process for colorectal surgery with the Hugo™ RAS system of a robotics-inexperienced surgical team and present the initial patient series. METHODS The training process is depicted, and data from the first 10 consecutive patients operated on for colorectal conditions with the Hugo™ RAS system by a surgical team with no prior experience in robotic surgery were prospectively recorded and analysed. RESULTS The team received intensive training in robotic surgery and specifically in the Hugo™ RAS system previously to the first case. Between May 2023 and December 2023, 10 patients underwent colorectal procedures: 5 right colectomies, 3 sigmoid resections, 1 high rectal resection and 1 ventral mesh rectopexy. The first case was proctored by an expert. Median docking time was 14 min and median total operative time was 185 min. The only technical difficulty during the procedures was occasional clashing of robotic arms. None had to be converted, and no intraoperative or postoperative morbidity was recorded. Hospital stays ranged from 2 to 4 days. A median of 21 lymph nodes were yielded in the operations for malignant conditions. CONCLUSIONS Common colorectal procedures can be safely performed using the Hugo™ RAS platform. Prior experience in robotic surgery is not a necessary requirement, but following a structured training program is essential.
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Affiliation(s)
- Juan-Manuel Romero-Marcos
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain.
- , Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
| | | | - Carlota Cuenca-Gómez
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Juan Altet-Torné
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Sandra González-Abós
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Iris Ojeda-Jiménez
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
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Nestler T, Hircin E, Siech C, Moharam N, Mattigk A, Borgmann H, Kuru TH, Salem J. [Evaluation of the GeSRU-Steps educational video concept (German Society of Residents in Urology e. V.)]. Urologie 2024; 63:373-378. [PMID: 38153428 PMCID: PMC10991055 DOI: 10.1007/s00120-023-02248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Surgical educational videos represent a contemporary, multimedia supplement to surgical education and training. The German Society of Residents in Urology e. V. (GeSRU) developed an educational video platform (steps.GeSRU.de) with free, quality-assured educational videos for urologists, especially for residents. OBJECTIVES The purpose of this study was to evaluate the GeSRU Steps teaching videos. MATERIALS AND METHODS Prospectively, 29 GeSRU Steps training videos were made available (03/2019-05/2023) via amboss.com, and an online questionnaire was inserted following the videos. This comprised 12 items on medical, technical, and didactic quality, usefulness for own knowledge acquisition, and sociodemographic data of respondents. Aspects of video quality were assessed with the Acceptability E‑scale and the Global Quality Score. RESULTS During the survey period, the GeSRU Steps videos implemented on the amboss.com website were viewed 49,698 times. A total of 474 questionnaires were answered (rate 0.25%). The collective of respondents consisted of 419 (88%) students, 47 (10%) physicians in training, and 5 (1%) specialists; 351 (74%) were female, 107 (23%) were male, and 4 (1%) were diverse. Each educational video was rated a median of 10 times (range 5-65). The six questions of the Acceptability E‑scale and the Global Quality Score were rated good and very good (81.6-95.8%), respectively. CONCLUSIONS GeSRU teaching videos achieved a very good rating with high user satisfaction. By specific promotion of these teaching videos, which are quality-assured through supervision, the portfolio of surgical videos available at a low threshold can be expanded and can serve as a contemporary education tool.
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Affiliation(s)
- Tim Nestler
- Klinik für Urologie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstr. 170, 56072, Koblenz, Deutschland.
- Klinik für Urologie, Uniklinik Köln, Köln, Deutschland.
| | | | - Carolin Siech
- Universitätsklinik, Klinik für Urologie, Goethe Universität Frankfurt, Frankfurt, Deutschland
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Kanada
| | - Nadim Moharam
- Klinik für Urologie, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Angelika Mattigk
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Hendrik Borgmann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Timur H Kuru
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Neuruppin, Deutschland
- CUROS urologisches Zentrum, Klinik Links vom Rhein, Köln, Deutschland
| | - Johannes Salem
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Neuruppin, Deutschland
- CUROS urologisches Zentrum, Klinik Links vom Rhein, Köln, Deutschland
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Li W, Ma S, Zhou L, Konge L, Pan J, Hui J. The bibliometric analysis of extended reality in surgical training: Global and Chinese perspective. Heliyon 2024; 10:e27340. [PMID: 38495188 PMCID: PMC10943385 DOI: 10.1016/j.heliyon.2024.e27340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Objectives The prospect of extended reality (XR) being integrated with surgical training curriculum has attracted scholars. However, there is a lack of bibliometric analysis to help them better understand this field. Our aim is to analyze relevant literature focusing on development trajectory and research directions since the 21st century to provide valuable insights. Methods Papers were retrieved from the Web of Science Core Collection. Microsoft Excel, VOSviewer, and CiteSpace were used for bibliometric analysis. Results Of the 3337 papers published worldwide, China contributed 204, ranking fifth. The world's enthusiasm for this field has been growing since 2000, whereas China has been gradually entering since 2001. Although China had a late start, its growth has accelerated since around 2016 due to the reform of the medical postgraduate education system and the rapid development of Chinese information technology, despite no research explosive period has been yet noted. International institutions, notably the University of Toronto, worked closely with others, while Chinese institutions lacked of international and domestic cooperation. Sixteen stable cooperation clusters of international scholars were formed, while the collaboration between Chinese scholars was not yet stable. XR has been primarily applied in orthopedic surgery, cataract surgery, laparoscopic training and intraoperative use in neurosurgery worldwide. Conclusions There is strong enthusiasm and cooperation in the international research on the XR-based surgical training. Chinese scholars are making steady progress and have great potential in this area. There has not been noted an explosive research phase yet in the Chinese pace. The research on several surgical specialties has been summarized at the very first time. AR will gradually to be more involved and take important role of the research.
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Affiliation(s)
- Wei Li
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyuan Ma
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Zhou
- School of Postgraduate Education, Southern Medical University, Guangzhou, China
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark
| | - Junjun Pan
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
- PENG CHENG Laboratory, Shenzhen, China
| | - Jialiang Hui
- Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou City, China
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Gazit N, Ben-Gal G, Eliashar R. Development and validation of an objective virtual reality tool for assessing technical aptitude among potential candidates for surgical training. BMC Med Educ 2024; 24:286. [PMID: 38486166 PMCID: PMC10941473 DOI: 10.1186/s12909-024-05228-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Good technical skills are crucial for surgeons. Yet although surgical training programs strive to assess technical aptitude when selecting surgical residents, valid assessments of such aptitude are still lacking. Surgical simulators have been proposed as a potentially effective tool for this purpose. The current study aims to develop a technical aptitude test using a virtual reality surgical simulator, and to validate its use for the selection of surgical residents. METHODS The study had three phases. In Phase 1, we developed an initial version of the technical aptitude test using the Lap-X-VR laparoscopic simulator. In Phases 2 and 3 we refined the test and collected empirical data to evaluate four main sources of validity evidence (content, response process, internal structure, and relationships with other variables), and to evaluate the feasibility and acceptability of the test. Specifically, Phase 2 comprised a review of the test by 30 senior surgeons, and in Phase 3 a revised version of the test was administered to 152 interns to determine its psychometric properties. RESULTS Both the surgeons and interns rated the test as highly relevant for selecting surgical residents. Analyses of the data obtained from the trial administration of the test supported the appropriateness of the score calculation process and showed good psychometric properties, including reliability (α = 0.83) and task discrimination (mean discrimination = 0.5, SD = 0.1). The correlations between test scores and background variables revealed significant correlations with gender, surgical simulator experience, and video game experience (ps < 0.001). These variables, however, explained together only 10% of the variance in test scores. CONCLUSIONS We describe the systematic development of an innovative virtual reality test for assessing technical aptitude in candidates for surgical training, and present evidence for its validity, feasibility and acceptability. Further validation is required to support the application of the test for selection, as well as to discern the impact of gender, surgical simulator experience, and video game experience on the fairness of test results. However, the test appears to be a promising tool that may help training programs assess the suitability of candidates for surgical training.
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Affiliation(s)
- Noa Gazit
- Department of Prosthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Otolaryngology/HNS, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Gilad Ben-Gal
- Department of Prosthodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ron Eliashar
- Department of Otolaryngology/HNS, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Gerk A, Naus A, Carroll M, Ponte L, Salgado LS, Marrazzo E, Secanho M, Botelho F, Mooney D, Ferreira R, Ferreira JL. Perceived Impact of Coronavirus Disease 2019 on Surgical Training: A Brazilian Survey. J Surg Res 2024; 295:619-630. [PMID: 38101108 DOI: 10.1016/j.jss.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/22/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Recent studies revealed that coronavirus disease 2019 (COVID-19) negatively impacted residency programs worldwide, particularly procedure-based programs. However, most studies are from high-income countries, with scarce data from low- and middle-income countries. Pandemic effects on surgical training were likely worse in strictly apprenticeship models relying heavily on surgical volume as opposed to competency-based programs. Notably, training programs in Brazil and other low- and middle-income countries follow these strict apprenticeship style frameworks. In this study, we aimed to evaluate the trainees' perceptions of the impact of COVID-19 on their Brazilian surgical programs. METHODS A cross-sectional study was performed using an anonymous survey in Portuguese, distributed via social media platforms to surgical residents enrolled in Brazilian surgery programs. Data collection took place from August 2021 to May 2022. The survey contained 30 questions on the perception of the impact of COVID-19 on surgical training. RESULTS One-hundred sixty-two residents from 17 different surgical specialties and all five regions of Brazil responded to the survey. Of 162 residents, 145 (89%) believed the pandemic negatively impacted their surgical training. Furthermore, of 162 residents, 153 (94%) reported that elective surgical volume decreased during the pandemic and 91 (56%) were redeployed to assist with COVID-19 management. As a result, 102 of 162 (63%) residents believed their surgical skills were negatively impacted by COVID-19. Yet, 95 of 162 (59%) residents reported their residency programs did not offer resources to mitigate the pandemic's impact on training. Of 162 residents, 57 (35%) reported they did not feel on track for graduation, with no statistical difference between responses by year of residency (P = 0.083). Additionally, 124 of 162 (77%) residents reported that the pandemic negatively affected their mental health, most commonly related to stress at work, stress about transmitting COVID-19, and loss in surgical training. CONCLUSIONS Most of the surveyed Brazilian surgical residents felt the COVID-19 pandemic negatively impacted their training. This leads to believe that the detrimental impacts of the pandemic exposed preexisting weaknesses in the Brazilian surgical training model's dependence on a strict apprenticeship model. Our findings suggest a crucial need to redesign surgical education programs to make residency programs more prepared for changes in surgical volume, evolve the apprenticeship model to competency-based approaches, and unify surgical training standards in low- and middle-income countries.
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Affiliation(s)
- Ayla Gerk
- Universidad Católica Argentina, Buenos Aires, Argentina; Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Abbie Naus
- Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts; Boston Children's Hospital, Boston, Massachusetts
| | - Madeleine Carroll
- Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts
| | - Lucas Ponte
- School of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil
| | | | - Enzzo Marrazzo
- Faculty of Medicine, Institute of Biological Sciences, Pontifícia Universidade Católica de Minas Gerais Poços de Caldas, Poços de Caldas, Minas Gerais, Brazil
| | - Murilo Secanho
- Faculty of Medical Sciences of Botucatu, UNESP Botucatu, Botucatu, São Paulo, Brazil
| | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Childrens' Hospital, McGill University, Montreal, Quebec, Canada
| | - David Mooney
- Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts; Boston Children's Hospital, Boston, Massachusetts
| | - Roseanne Ferreira
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Júlia Loyola Ferreira
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Childrens' Hospital, McGill University, Montreal, Quebec, Canada.
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Nikolian VC, Camacho D, Earle D, Lehmann R, Nau P, Ramshaw B, Stulberg J. Development and preliminary validation of a new task-based objective procedure-specific assessment of inguinal hernia repair procedural safety. Surg Endosc 2024; 38:1583-1591. [PMID: 38332173 DOI: 10.1007/s00464-024-10677-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/30/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Surgical videos coupled with structured assessments enable surgical training programs to provide independent competency evaluations and align with the American Board of Surgery's entrustable professional activities initiative. Existing assessment instruments for minimally invasive inguinal hernia repair (IHR) have limitations with regards to reliability, validity, and usability. A cross-sectional study of six surgeons using a novel objective, procedure-specific, 8-item competency assessment for minimally invasive inguinal hernia repair (IHR-OPSA) was performed to assess inter-rater reliability using a "safe" vs. "unsafe" scoring rubric. METHODS The IHR-OPSA was developed by three expert IHR surgeons, field tested with five IHR surgeons, and revised based upon feedback. The final instrument included: (1) incision/port placement; (2) dissection of peritoneal flap (TAPP) or dissection of peritoneal flap (TEP); (3) exposure; (4) reducing the sac; (5) full dissection of the myopectineal orifice; (6) mesh insertion; (7) mesh fixation; and (8) operation flow. The IHR-OPSA was applied by six expert IHR surgeons to 20 IHR surgical videos selected to include a spectrum of hernia procedures (15 laparoscopic, 5 robotic), anatomy (14 indirect, 5 direct, 1 femoral), and Global Case Difficulty (easy, average, hard). Inter-rater reliability was assessed against Gwet's AC2. RESULTS The IHR-OPSA inter-rater reliability was good to excellent, ranging from 0.65 to 0.97 across the eight items. Assessments of robotic procedures had higher reliability with near perfect agreement for 7 of 8 items. In general, assessments of easier cases had higher levels of agreement than harder cases. CONCLUSIONS A novel 8-item minimally invasive IHR assessment tool was developed and tested for inter-rater reliability using a "safe" vs. "unsafe" rating system with promising results. To promote instrument validity the IHR-OPSA was designed and evaluated within the context of intended use with iterative engagement with experts and testing of constructs against real-world operative videos.
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Affiliation(s)
- Vahagn C Nikolian
- Department of Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Diego Camacho
- Minimally Invasive and Endoscopic Surgery at Montefiore Medical Center, New York, NY, USA
| | - David Earle
- New England Hernia Center, Lowell, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Ryan Lehmann
- Department of Surgery, Section of Bariatric Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Peter Nau
- Department of Surgery, Section of Bariatric Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, MA, USA
| | - Jonah Stulberg
- Department of Surgery, McGovern Medical School University of Texas Health Science Center at Houston, Houston, TX, USA
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Checcucci E, Puliatti S, Pecoraro A, Piramide F, Campi R, Carrion DM, Esperto F, Afferi L, Veneziano D, Somani B, Vásquez JL, Fiori C, Mottrie A, Amato M, N'Dow J, Porpiglia F, Liatsikos E, Rivas JG, Cacciamani GE. ESRU-ESU-YAU_UROTECH Survey on Urology Residents Surgical Training: Are We Ready for Simulation and a Standardized Program? EUR UROL SUPPL 2024; 61:18-28. [PMID: 38384440 PMCID: PMC10879935 DOI: 10.1016/j.euros.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/23/2024] Open
Abstract
Background Currently, the landscape of surgical training is undergoing rapid evolution, marked by the initial implementation of standardized surgical training programs, which are further facilitated by the emergence of new technologies. However, this proliferation is uneven across various countries and hospitals. Objective To offer a comprehensive overview of the existing surgical training programs throughout Europe, with a specific focus on the accessibility of simulation resources and standardized surgical programs. Design setting and participants A dedicated survey was designed and spread in May 2022 via the European Association of Urology (EAU) mail list, to Young Urologist Office (YUO), Junior membership, European Urology Residents Education Program participants between 2014 and 2022, and other urologists under 40 yr, and via the EAU Newsletter. Intervention A 64-item, online-based survey in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) using the platform of Survey Monkey (Portland, OR, USA) was realized. Outcome measurements and statistical analysis The study involved an assessment of the demographic characteristics. Additionally, it explored the type of center, availability of various surgical approaches, presence of training infrastructure, participation in courses, organization of training, and participants' satisfaction with the training program. The level of satisfaction was evaluated using a Likert-5 scale. The subsequent sections delved into surgical training within the realms of open, laparoscopic, robotic, and endoscopic surgery, each explored separately. Finally, the investigation encompassed the presence of a structured training course and the availability of a duly validated final evaluation process. Results and limitations There were 375 responders with a completion rate of 82%. Among them, 75% were identified as male, 50.6% were young urologists, 31.7% were senior residents, and 17.6% were junior residents. A significant majority of participants (69.6%) were affiliated with academic centers. Regarding the presence of dry lab training facilities, only 50.3% of respondents indicated its availability. Among these centers, 46.7% were primarily focused on laparoscopy training. The availability of virtual and wet lab training centers was even more limited, with rates of 31.5% and 16.2%, respectively. Direct patient involvement was reported in 80.5% of cases for open surgery, 58.8% for laparoscopy, 25.0% for robotics, and 78.6% for endourology. It is worth noting that in <25% of instances, training followed a well-defined standardized program comprising both preclinical and clinical modular phases. Finally, the analysis of participant feedback showed that 49.7% of respondents expressed a satisfaction rating of either 4 or 5 points with respect to the training program. The limitations of our study include the low response rate, predominance of participants from academic centers, and absence of responses from individuals not affiliated with the EAU network. Conclusions The current distribution of surgical training centers falls short of ensuring widespread access to standardized training programs. Although dry lab facilities are relatively well spread, the availability of wet lab resources remains restricted. Additionally, it appears that many trainees' initial exposure to surgery occurs directly with patients. There is a pressing need for continued endeavors to establish uniform training routes and assessment techniques across various surgical methodologies. Patient summary Nowadays, the surgical training landscape is heterogeneous across different countries. The implementation of a standardized training methodology to enhance the overall quality of surgical training and thereby improving patient outcomes is needed.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Federico Piramide
- Department of Urology, AOU San Luigi Gonzaga – University of Turin, Orbassano (To), Piemonte, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Diego M. Carrion
- Torrejon University Hospital, Madrid, Spain
- Universidad Francisco de Vitoria, Madrid, Spain
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Cristian Fiori
- Department of Urology, AOU San Luigi Gonzaga – University of Turin, Orbassano (To), Piemonte, Italy
| | - Alex Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Francesco Porpiglia
- Department of Urology, AOU San Luigi Gonzaga – University of Turin, Orbassano (To), Piemonte, Italy
| | | | - Juan Gomez Rivas
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
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Bartier S, Fieux M, Carsuzaa F, Coste A, Legré M, Alexandru M, Favier V, Fath L. Perception of endoscopic endonasal surgery training by French otolaryngology residents: A STROBE analysis of expectations. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:61-67. [PMID: 38081760 DOI: 10.1016/j.anorl.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To analyze the perception of endoscopic endonasal surgery training by French otolaryngology residents. MATERIAL AND METHODS A multicenter retrospective observational study was conducted from March to April 2023. Otolaryngology residents from 7 French regions filled out a 27-item questionnaire on their training in endoscopic endonasal surgery. RESULTS Out of 283 residents contacted, 126 (45%) filled out the questionnaire. Seventy-four (59%) had already partially or completely performed the surgeries specified in their diploma course. The level of mastery of the main steps of endonasal surgery and the level of autonomy were higher in the consolidation stage group than in the basic and advanced stages. Seventy residents (56%) felt they had gaps in their level of training. To improve training, 94 (75%) wished for more dissection sessions, surgical skills assessments each semester and simulation sessions. Eighty-nine (71%) felt they needed to find their own teaching aids and other methods to complete their training. One hundred and thirteen (90%) felt that the lack of funding available for congresses and training courses was detrimental. CONCLUSION This study highlighted the overall satisfaction of residents with their training in endoscopic endonasal surgery. They expressed a desire for more dissection, simulation and evaluation.
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Affiliation(s)
- S Bartier
- Service d'ORL, de chirurgie cervico-faciale, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France, université Paris Est Créteil, Inserm, IMRB, CNRS EMR 7000, 94010 Créteil, France.
| | - M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 69310 Pierre-Bénite cedex, France; Université de Lyon, université Lyon 1, 69003 Lyon, France
| | - F Carsuzaa
- Service ORL, chirurgie cervico-maxillo-faciale et audiophonologie, centre hospitalier universitaire de Poitiers, laboratoire inflammation tissus épithéliaux et cytokines (LITEC), UR15560, université de Poitiers, 86000 Poitiers, France
| | - A Coste
- Service d'ORL, de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, université Paris Est Créteil, Inserm, IMRB, CNRS EMR 7000, 94010 Créteil, France
| | - M Legré
- Service ORL et chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - M Alexandru
- Service d'Orl et chirurgie cervico-faciale, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Institut national de la santé et de la recherche médicale, France Sorbonne université,UMR_S933, hôpital Armand-Trousseau, 75012 Paris, France
| | - V Favier
- Département d'ORL, chirurgie cervico-faciale et maxillo-faciale, centre hospitalier universitaire de Montpellier, hôpital Gui-de-Chauliac, ICAR Research Team, Laboratory of Computer Science, Robotics, Microelectronics of Montpellier (LIRMM), University of Montpellier, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - L Fath
- Service d'ORL, de chirurgie cervico-faciale, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France; Unité Inserm 1121, biomatériaux et bioingénierie, 1, rue Eugène-Boeckel, Strasbourg, France
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23
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Wang C, Karl R, Sharan L, Grizelj A, Fischer S, Karck M, De Simone R, Romano G, Engelhardt S. Surgical training of minimally invasive mitral valve repair on a patient-specific simulator improves surgical skills. Eur J Cardiothorac Surg 2024; 65:ezad387. [PMID: 37988128 DOI: 10.1093/ejcts/ezad387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/05/2023] [Accepted: 11/20/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES Minimally invasive mitral valve repair (MVR) is considered one of the most challenging operations in cardiac surgery and requires much practice and experience. Simulation-based surgical training might be a method to support the learning process and help to flatten the steep learning curve of novices. The purpose of this study was to show the possible effects on learning of surgical training using a high-fidelity simulator with patient-specific mitral valve replicas. METHODS Twenty-five participants were recruited to perform MVR on anatomically realistic valve models during different training sessions. After every session their performance was evaluated by a surgical expert regarding accuracy and duration for each step. A second blinded rater similarly assessed the performance after the study. Through repeated documentation of those parameters, their progress in learning was analysed, and gains in proficiency were evaluated. RESULTS Participants showed significant performance enhancements in terms of both accuracy and time. Their surgical skills showed sizeable improvements after only 1 session. For example, the time to implant neo-chordae decreased by 24.64% (354 s-264 s, P < 0.001) and the time for annuloplasty by 4.01% (54 s-50 s, P = 0.165), whereas the number of irregular stitches for annuloplasty decreased from 52% to 24%.The significance of simulation-based surgical training as a tool for acquiring and training surgical skills was reviewed positively. CONCLUSIONS The results of this study indicate that simulation-based surgical training is a valuable and effective method for learning reconstructive techniques of minimally invasive MVR and overall general dexterity.The novel learning and training options should be implemented in the surgical traineeship for systematic teaching of various surgical skills.
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Affiliation(s)
- Christina Wang
- University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
| | - Roger Karl
- University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
- University Hospital Heidelberg, Department of Internal Medicine III, Heidelberg, Germany
| | - Lalith Sharan
- University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
- University Hospital Heidelberg, Department of Internal Medicine III, Heidelberg, Germany
| | - Andela Grizelj
- University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
| | - Samantha Fischer
- University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
| | - Matthias Karck
- University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
| | - Raffaele De Simone
- University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
| | - Gabriele Romano
- University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
| | - Sandy Engelhardt
- University Hospital Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
- University Hospital Heidelberg, Department of Internal Medicine III, Heidelberg, Germany
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Wczysla K, Sparn M, Schmied B, Hahnloser D, Bischofberger S. There is a need for a paradigm shift in laparoscopic surgical training: results of a nationwide survey among teaching hospitals in Switzerland. BMC Med Educ 2024; 24:205. [PMID: 38413927 PMCID: PMC10900659 DOI: 10.1186/s12909-024-05209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Surgical training curricula have changed little over the past decades. Current advances in surgical techniques, especially in minimally invasive surgery, as well as the rapidly changing socioeconomic environment pose a major challenge for the training of young surgeons. The aim of this survey was to provide a representative overview of the surgical training landscape in Switzerland focusing on laparoscopic surgical training: How do department chairs of teaching hospitals deal with the above challenges, and what should a future training curriculum look like? METHODS This is a prospective, questionnaire-based, cross-sectional study among the heads of departments of all certified surgical teaching hospitals in Switzerland. RESULTS The overall response rate was 56% (48/86) and 86% (19/22) for tertiary centers. Two-thirds of the centers (32) organize themselves in training networks. Laparoscopic training courses are offered in 25 (52%) hospitals, mainly in tertiary centers. Self-training opportunities exist in 40 (83%) hospitals. In addition to commercial (27) and self-built (7) box trainers, high-fidelity trainers are available in 16 (33%) hospitals. A mandatory training curriculum exists in 7 (15%) facilities, and a training assessment is performed in 15 (31%) institutions. Thirty-two (65%) heads of departments indicated that residents have sufficient practical exposure in the operating room, but the ability to work independently with obtaining the specialist title is seen critically (71%). They state that the surgical catalog does not adequately reflect the manual skills of the resident (64%). The desire is for training to be restructured from a numbers-based to a performance-based curriculum (53%) and for tools to assess residents' manual skills (56%) to be introduced. CONCLUSIONS Department chairs stated that the existing curriculum in Switzerland does not meet the requirements of a modern training curriculum. This study highlights the need to create an improved, competency-based curriculum that ensures the training of a new generation of surgeons, taking into account the growing evidence of the effectiveness of state-of-the-art training modalities such as simulation or proficiency-based training.
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Affiliation(s)
- Karolina Wczysla
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland
| | - Moritz Sparn
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland
| | - Bruno Schmied
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland
| | - Dieter Hahnloser
- Department of Surgery, Centre Hôpitalier Universitaire Vaudois, CH-1011, Lausanne, Switzerland
| | - Stephan Bischofberger
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland.
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Roche AF, Kavanagh D, McCawley N, O'Riordan JM, Cahir C, Toale C, O'Keeffe D, Lawler T, Condron CM. Collating evidence to support the validation of a simulated laparotomy incision and closure-training model. Am J Surg 2024:S0002-9610(24)00110-7. [PMID: 38402084 DOI: 10.1016/j.amjsurg.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND It is essential to evaluate the functionality of surgical simulation models, in order to determine whether they perform as intended. In this study, we assessed the use of a simulated laparotomy incision and closure-training model by collating validity evidence to determine its utility as well as pre and post-test interval data. METHOD This was a quantitative study design, informed by Messick's unified validity framework. In total, 93 participants (surgical trainees = 80, experts = 13) participated in this study. Evaluation of content validity and the models' relationships with other variables was conducted, along with a pre and post-test confidence assessment. RESULTS The model was deemed realistic and useful as a teaching tool, providing strong content validity evidence. In assessment of relationships with other variables, the expert group out-performed the novice group conclusively. Pre and post-test evaluation reported a statistically significant increase in confidence levels. CONCLUSION We present strong validity evidence of a novel laparotomy incision and closure simulation-training model.
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Affiliation(s)
- Adam F Roche
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Dara Kavanagh
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh McCawley
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - J M O'Riordan
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Caitriona Cahir
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Conor Toale
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Dara O'Keeffe
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tim Lawler
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire M Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Constable MD, Shum HPH, Clark S. Enhancing surgical performance in cardiothoracic surgery with innovations from computer vision and artificial intelligence: a narrative review. J Cardiothorac Surg 2024; 19:94. [PMID: 38355499 PMCID: PMC10865515 DOI: 10.1186/s13019-024-02558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
When technical requirements are high, and patient outcomes are critical, opportunities for monitoring and improving surgical skills via objective motion analysis feedback may be particularly beneficial. This narrative review synthesises work on technical and non-technical surgical skills, collaborative task performance, and pose estimation to illustrate new opportunities to advance cardiothoracic surgical performance with innovations from computer vision and artificial intelligence. These technological innovations are critically evaluated in terms of the benefits they could offer the cardiothoracic surgical community, and any barriers to the uptake of the technology are elaborated upon. Like some other specialities, cardiothoracic surgery has relatively few opportunities to benefit from tools with data capture technology embedded within them (as is possible with robotic-assisted laparoscopic surgery, for example). In such cases, pose estimation techniques that allow for movement tracking across a conventional operating field without using specialist equipment or markers offer considerable potential. With video data from either simulated or real surgical procedures, these tools can (1) provide insight into the development of expertise and surgical performance over a surgeon's career, (2) provide feedback to trainee surgeons regarding areas for improvement, (3) provide the opportunity to investigate what aspects of skill may be linked to patient outcomes which can (4) inform the aspects of surgical skill which should be focused on within training or mentoring programmes. Classifier or assessment algorithms that use artificial intelligence to 'learn' what expertise is from expert surgical evaluators could further assist educators in determining if trainees meet competency thresholds. With collaborative efforts between surgical teams, medical institutions, computer scientists and researchers to ensure this technology is developed with usability and ethics in mind, the developed feedback tools could improve cardiothoracic surgical practice in a data-driven way.
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Affiliation(s)
- Merryn D Constable
- Department of Psychology, Northumbria University, Newcastle-upon-Tyne, UK.
| | - Hubert P H Shum
- Department of Computer Science, Durham University, Durham, UK
| | - Stephen Clark
- Department of Applied Sciences, Northumbria University, Newcastle-upon-Tyne, UK
- Consultant Cardiothoracic and Transplant Surgeon, Freeman Hospital, Newcastle upon Tyne, UK
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Yannamani P, Gale NK. The ebbs and flows of empathy: a qualitative study of surgical trainees in the UK. BMC Med Educ 2024; 24:131. [PMID: 38336765 PMCID: PMC10858458 DOI: 10.1186/s12909-024-05105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Empathy is widely recognised as an important element of medical practice contributing to patient outcomes and satisfaction. It is also an important element of collaborative work in a healthcare team. However, there is evidence to suggest that empathy towards patients declines over time, particularly in surgical specialities. There is little qualitative research on this decline in surgical trainees, particularly in the UK. Therefore, the aim of this study was to explore how trainee surgeons experience empathy over the course of their career, both towards patients and colleagues and how they perceive it in others. METHODS 10 semi-structured interviews were carried out with surgical trainees of different grades and specialties in January and February 2022. Framework analysis was used to interpret the data. RESULTS Participants experienced an evolution in empathy over their career as their personal and professional experience was added to. They drew a distinction between desensitisation and actual decline in empathy and identified more with experiencing the former in their careers. Participants also felt interprofessional relationships require empathy, and this could be improved upon. Finally, they highlighted specific impacts of the COVID-19 pandemic upon their training, including reduced theatre time. CONCLUSIONS Participants felt training could be improved in regard to accessing training opportunities and relationships with colleagues, although many felt empathy between colleagues is better than it has been in the past. This project highlighted areas for future research, such as with surgeons in later stages of their careers, or mixed-methods projects.
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Affiliation(s)
| | - Nicola Kay Gale
- Health Policy and Sociology, Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
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Kitic N, Bourges JL. Preclinical training of future ocular surgeons: a French opinion-based study. BMC Med Educ 2024; 24:129. [PMID: 38336776 PMCID: PMC10858601 DOI: 10.1186/s12909-024-05124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To assess ophthalmology residents satisfaction regarding surgical training during residency in France. METHODS A questionnaire consisting of 28 questions was designed and sent to residents of ophthalmology across the 27 French regions. RESULTS A total of 30.3% ophthalmology residents in France completed our questionnaire. All French regions participated. They rated 5,27 ± 2.42/10 the global surgical training during residency. They had performed at least one step of any type of ocular surgery for 93.4% of them, while 80.7% had completed at least one full cataract surgery, by the beginning of their second year of residency on average (Paris: 2.59 ± 1.36 semesters; regions: 4.05 ± 1.96 semesters, p < 0.0001). Only 48.9% identified a surgical mentor during their residency, but 82.2% did not clearly identify surgical goals & objectives during their training. Simulation was available for any type of ocular surgery to all residents in the Paris (Île-de-France) region and to 78.1% in other regions (p < 0.005). Residents who accessed drylabs and wetlabs gave a satisfaction score of 7.31 ± 1.89/10 and 6.39 ± 2.15/10 to it respectively. Simulation was a mandatory part of the curriculum for 35.2% of the resident. They commented on on reduced access to subspecialized surgery. They were willing for more access to simulation and surgery on real patients, as well for closer mentoring and clearly defined surgical goals within the curriculum. CONCLUSION Ophthalmology residents seemed globally satisfied with their surgical training nationwide, although we observed disparities across region. They largely acknowledged a lack of standard procedures nationwide. They acclaimed simulation during the initial phase of residency, progressively switching towards surgery on real patients. An "operating license" during residency could be a viable way for the resident to demonstrate that they have acquired enough surgical abilities to perform surgery on real patients.
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Affiliation(s)
- Nicolas Kitic
- Rothschild Foundation Hospital, Paris, France.
- Sorbonne Université, Paris, France.
| | - Jean-Louis Bourges
- INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Centre de Recherche des Cordeliers, Université Paris Cité, Paris, France
- Department of Ophthalmology, Cochin Hospital, AP-HP, Paris, France
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McLeod K, Woodward-Kron R, Rashid P, Archer J, Nestel D. "I'm on an island": A qualitative study of underperforming surgical trainee perspectives on remediation. Am J Surg 2024:S0002-9610(24)00035-7. [PMID: 38350749 DOI: 10.1016/j.amjsurg.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/14/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND There is a significant gap in the literature regarding trainees' perceptions of remediation. This study aims to explore surgical trainees' experiences and perspectives of remediation. METHODS This qualitative study used semi-structured interviews with 11 doctors who have experienced formal remediation as a surgical trainee. Reflexive thematic analysis was used for data analysis. RESULTS In this study, trainees perceived remediation as a harrowing and isolating experience, with long-lasting emotions. There was a perceived lack of clarity regarding explanations of underperformance and subjective goals. Remediation was viewed as a 'performance' and tick-box exercise with superficial plans, with challenging trainee/supervisor dynamics. CONCLUSIONS These findings about trainees' perspectives on remediation show a need for trainees to be better emotionally supported during remediation and that remediation plans must be improved to address deficits. Integrating the perspectives and experiences of surgical trainees who have undergone remediation should help improve remediation outcomes and patient care.
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Affiliation(s)
- Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia; Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia.
| | - Robyn Woodward-Kron
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, Australia
| | - Julian Archer
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Debra Nestel
- Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia
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Thaventhiran A, McKnight G, Clements JM, Barlow E, Pegna V, Dovell G, Nally D, Burke J. The Association of Surgeons in Training (ASiT) Consensus Statement on Major Trauma Training in the UK. Ann R Coll Surg Engl 2024; 106:123-130. [PMID: 36748795 PMCID: PMC10830340 DOI: 10.1308/rcsann.2022.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Since the establishment of the Major Trauma Networks in 2012, it is estimated that an extra 1,600 lives have been saved across England. Although the delivery of trauma care has improved significantly, the provision of trauma training has not and remains fragmented. The Association of Surgeons in Training (ASiT), an independent organisation run by trainees, is dedicated to excellence in surgical training within the United Kingdom (UK) and Republic of Ireland (ROI). The aim of this study was to develop a consensus statement representing the views of the ASiT on the future of trauma surgery training. METHODS A modified nominal group technique was used in five stages: 1, scoping exercise; 2, virtual consultation; 3, nominal group consensus meeting; 4, virtual feedback from stakeholders; and 5, virtual confirmation by the ASiT Council. The design and reporting of the consensus followed best practice methodology for consensus research. RESULTS Overall, 62 participants gave 90 statements across stages 1-3. Eleven key themes were identified, all of which met the consensus of the ASiT Council. The key findings were widespread support for increased exposure to trauma for medical students and early surgical trainees as well as an increased use of simulation methods and improved focus on non-technical skills within trauma surgery. CONCLUSIONS This study sets out the position of the ASiT on the future of trauma surgery training and how training in major trauma surgery in the UK and ROI could be improved.
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Affiliation(s)
| | | | - JM Clements
- The Association of Surgeons in Training, Royal College of Surgeons of England, UK
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Adrales G, Ardito F, Chowbey P, Morales-Conde S, Ferreres AR, Hensman C, Martin D, Matthaei H, Ramshaw B, Roberts JK, Schrem H, Sharma A, Tabiri S, Vibert E, Woods MS. A multi-national, video-based qualitative study to refine training guidelines for assigning an "unsafe" score in laparoscopic cholecystectomy critical view of safety. Surg Endosc 2024; 38:983-991. [PMID: 37973638 DOI: 10.1007/s00464-023-10528-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The critical view of safety (CVS) was incorporated into a novel 6-item objective procedure-specific assessment for laparoscopic cholecystectomy (LC-CVS OPSA) to enhance focus on safe completion of surgical tasks and advance the American Board of Surgery's entrustable professional activities (EPAs) initiative. To enhance instrument development, a feasibility study was performed to elucidate expert surgeon perspectives regarding "safe" vs. "unsafe" practice. METHODS A multi-national consortium of 11 expert LC surgeons were asked to apply the LC-CVS OPSA to ten LC videos of varying surgical difficulty using a "safe" vs. "unsafe" scale. Raters were asked to provide written rationale for all "unsafe" ratings and invited to provide additional feedback regarding instrument clarity. A qualitative analysis was performed on written responses to extract major themes. RESULTS Of the 660 ratings, 238 were scored as "unsafe" with substantial variation in distribution across tasks and raters. Analysis of the comments revealed three major categories of "unsafe" ratings: (a) inability to achieve the critical view of safety (intended outcome), (b) safe task completion but less than optimal surgical technique, and (c) safe task completion but risk for potential future complication. Analysis of reviewer comments also identified the potential for safe surgical practice even when CVS was not achieved, either due to unusual anatomy or severe pathology preventing safe visualization. Based upon findings, modifications to the instructions to raters for the LC-CVS OPSA were incorporated to enhance instrument reliability. CONCLUSIONS A safety-based LC-CVS OPSA has the potential to significantly improve surgical training by incorporating CVS formally into learner assessment. This study documents the perspectives of expert biliary tract surgeons regarding clear identification and documentation of unsafe surgical practice for LC-CVS and enables the development of training materials to improve instrument reliability. Learnings from the study have been incorporated into rater instructions to enhance instrument reliability.
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Affiliation(s)
- Gina Adrales
- Division of Minimally Invasive Surgery, Minimally Invasive Surgical Training and Innovation Center (MISTIC), Johns Hopkins Hospital, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Pradeep Chowbey
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - Alberto R Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | - Chrys Hensman
- Monash University Department of Surgery & Lap Surgery, Melbourne, Australia
| | - David Martin
- Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, USA
| | - Hanno Matthaei
- Department of Surgery, University Medical Center Bonn, Bonn, Germany
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, USA
| | - J Keith Roberts
- Liver Transplant and HPB Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Stephen Tabiri
- Tamale Teaching Hospital, University for Development Studies-School of Medicine and Health Sciences, Tamale, Ghana
| | - Eric Vibert
- Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France
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Gajjar A, Gandhi J, Prajapati R, Mahadar R, Shrivastava R, Chaudhari S, Shinde P, Takalkar Y, Thakur B. Impact of cadaver training for learning abdominal wall reconstruction: our early experience. Hernia 2024; 28:85-95. [PMID: 37857931 DOI: 10.1007/s10029-023-02907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Assess the utility of a hands-on cadaver workshop for teaching abdominal wall reconstruction (AWR) using components separation technique. METHODS Over a year, from June 2022 to July 2023, 112 surgeons participated in seven training courses focused on the eTEP technique for inguinal and ventral hernias. The workshops covered theoretical learning sessions followed by hands-on training using frozen human cadavers. An online survey was used to know the influence of our workshop on the clinical practice of the attendees. RESULTS Out of 112 total participants, 70% (78) participants completed the survey. Among them, 58% (45) surgeons had over 10 years of experience. The workshop resulted in approximately 85% (66) of participants successfully adapting to eTEP. Confidence levels significantly increased for all steps of the technique after the workshop (p < 0.001, Rank-Biserial Correlation = -1.000). Participants expressed high satisfaction with the course. CONCLUSION The cadaver model training program was found to be effective in reducing the learning curve and being replicable. This suggests its potential for widespread implementation as an introductory training model for learning the anatomy of abdominal wall and adapting this for treating hernias requiring AWR.
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Affiliation(s)
- Aarsh Gajjar
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, India.
| | - Jignesh Gandhi
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, India
| | - Ram Prajapati
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, India
| | - Rahul Mahadar
- Department of General Surgery, Jeevanshree Hospital, Mumbai, India
| | | | | | - Pravin Shinde
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, India
| | - Yogesh Takalkar
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, India
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Guo W, Forte V, Davies JC, Kahrs LA. An interactive augmented reality software for facial reconstructive surgeries. Comput Methods Programs Biomed 2024; 244:107970. [PMID: 38101087 DOI: 10.1016/j.cmpb.2023.107970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/03/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Surgical trainees need a lot of training and practice before being able to operate independently. The current approach of surgical education mainly involves didactic teaching and psychomotor training through physical models or real tissue. Due to the unavailability of physical resources and lack of objective ways of evaluation, there is a demand for developing alternative training methods for surgeons. In this paper, we present an application that provides additional training opportunities to surgical trainees in the field of facial reconstructive surgeries. METHODS We built a mobile augmented reality application that helps the user to visualize important concepts and experiment with different surgical plans for facial reconstructive surgeries. The application can overlay relaxed skin tension lines on a live video input or a patient's photo, which serve as bases for aligning a skin flap. A surgical trainee can interactively compare different skin flap design choices with estimated final scars on a photo of a patient. Data collection capability is also added to the application, and we performed a Monte Carlo experiment with simulated users (five classes of 100 users each) as an example of objectively measuring user performance. RESULTS The application can overlay relaxed skin tension lines on a patient's face in real time on a modern mobile device. Accurate overlays were achieved in over 91% as well as 84% and 88% out of 263 generated face images, depending on the method. Visual comparisons of the three overlay methods are presented on sample faces from different population groups. From the Monte Carlo experiment, we see that user actions in each class follow a normal distribution with a distinct set of parameters. CONCLUSIONS This application can serve as a basis for teaching surgical trainees the fundamentals of different facial reconstructive procedures, especially concepts related to relaxed skin tension lines and skin flaps. It can objectively evaluate the performance of surgical trainees in a course. This setup focuses on illustrating the relationship between the orientation of skin flaps and relaxed skin tension lines, which is a prerequisite of minimizing scarring in patients in addition to good surgical techniques.
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Affiliation(s)
- Wenzhangzhi Guo
- Department of Computer Science, University of Toronto, Toronto, ON, Canada; Wilfred and Joyce Posluns Centre for Image Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Vito Forte
- Wilfred and Joyce Posluns Centre for Image Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Joel C Davies
- Department of Otolaryngology - Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Lueder A Kahrs
- Department of Computer Science, University of Toronto, Toronto, ON, Canada; Department of Mathematical and Computational Sciences, University of Toronto Mississauga, Mississauga, ON, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Ortenzi M, Corallino D, Botteri E, Balla A, Arezzo A, Sartori A, Reddavid R, Montori G, Guerrieri M, Williams S, Podda M. Safety of laparoscopic cholecystectomy performed by trainee surgeons with different cholangiographic techniques (SCOTCH): a prospective non-randomized trial on the impact of fluorescent cholangiography during laparoscopic cholecystectomy performed by trainees. Surg Endosc 2024; 38:1045-1058. [PMID: 38135732 DOI: 10.1007/s00464-023-10613-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
AIMS The identification of the anatomical components of the Calot's Triangle during laparoscopic cholecystectomy (LC) might be challenging and its difficulty may increase when a surgical trainee (ST) is in charge, ultimately allegedly affecting also the incidence of common bile duct injuries (CBDIs). There are various methods to help reach the critical view of safety (CVS): intraoperative cholangiogram (IOC), critical view of safety in white light (CVS-WL) and near-infrared fluorescent cholangiography (NIRF-C). The primary objective was to compare the use of these techniques to obtain the CVS during elective LC performed by ST. METHODS This was a multicentre prospective observational study (Clinicalstrials.gov Registration number: NCT04863482). The impact of three different visualization techniques (IOC, CVS-WL, NIRF-C) on LC was analyzed. Operative time and time to achieve the CVS were considered. All the participating surgeons were also required to fill in three questionnaires at the end of the operation focusing on anatomical identification of the general task and their satisfaction. RESULTS Twenty-nine centers participated for a total of 338 patients: 260 CVS-WL, 10 IOC and 68 NIRF-C groups. The groups did not differ in the baseline characteristics. CVS was considered achieved in all the included case. Rates were statistically higher in the NIR-C group for common hepatic and common bile duct visualization (p = 0.046; p < 0.005, respectively). There were no statistically significant differences in operative time (p = 0.089) nor in the time to achieve the CVS (p = 0.626). Three biliary duct injuries were reported: 2 in the CVS-WL and 1 in the NIR-C. Surgical workload scores were statistically lower in every domain in the NIR-C group. Subjective satisfaction was higher in the NIR-C group. There were no other statistically significant differences. CONCLUSIONS These data showed that using NIRF-C did not prolong operative time but positively influenced the surgeon's satisfaction of the performance of LC.
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Affiliation(s)
- Monica Ortenzi
- Department of General and Emergency Surgery, Università Politecnica delle Marche, Ancona, Italy.
| | - Diletta Corallino
- Department of General Surgery and Surgical Specialties, Sapienza University of Rome, Rome, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili di Brescia PO Montichiari, Montichiari, Brescia, Italy
| | - Andrea Balla
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Alberto Arezzo
- Department of General Surgery, Ospedale Di Montebelluna, Montebelluna, Treviso, Italy
| | - Alberto Sartori
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | | | | | - Mario Guerrieri
- Department of General and Emergency Surgery, Università Politecnica delle Marche, Ancona, Italy
| | | | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
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Adrales G, Ardito F, Chowbey P, Morales-Conde S, Ferreres AR, Hensman C, Martin D, Matthaei H, Ramshaw B, Roberts JK, Schrem H, Sharma A, Tabiri S, Vibert E, Woods MS. Laparoscopic cholecystectomy critical view of safety (LC-CVS): a multi-national validation study of an objective, procedure-specific assessment using video-based assessment (VBA). Surg Endosc 2024; 38:922-930. [PMID: 37891369 DOI: 10.1007/s00464-023-10479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND A novel 6-item objective, procedure-specific assessment for laparoscopic cholecystectomy incorporating the critical view of safety (LC-CVS OPSA) was developed to support trainee formative and summative assessments. The LC-CVS OPSA included two retraction items (fundus and infundibulum retraction) and four CVS items (hepatocystic triangle visualization, gallbladder-liver separation, cystic artery identification, and cystic duct identification). The scoring rubric for retraction consisted of poor (frequently outside of defined range), adequate (minimally outside of defined range) and excellent (consistently inside defined range) and for CVS items were "poor-unsafe", "adequate-safe", or "excellent-safe". METHODS A multi-national consortium of 12 expert LC surgeons applied the OPSA-LC CVS to 35 unique LC videos and one duplicate video. Primary outcome measure was inter-rater reliability as measured by Gwet's AC2, a weighted measure that adjusts for scales with high probability of random agreement. Analysis of the inter-rater reliability was conducted on a collapsed dichotomous scoring rubric of "poor-unsafe" vs. "adequate/excellent-safe". RESULTS Inter-rater reliability was high for all six items ranging from 0.76 (hepatocystic triangle visualization) to 0.86 (cystic duct identification). Intra-rater reliability for the single duplicate video was substantially higher across the six items ranging from 0.91 to 1.00. CONCLUSIONS The novel 6-item OPSA LC CVS demonstrated high inter-rater reliability when tested with a multi-national consortium of LC expert surgeons. This brief instrument focused on safe surgical practice was designed to support the implementation of entrustable professional activities into busy surgical training programs. Instrument use coupled with video-based assessments creates novel datasets with the potential for artificial intelligence development including computer vision to drive assessment automation.
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Affiliation(s)
- Gina Adrales
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Pradeep Chowbey
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Sevilla, Spain
| | - Alberto R Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | - Chrys Hensman
- Department of Surgery & LapSurgery, Monash University, Melbourne, Australia
| | - David Martin
- Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Hanno Matthaei
- Department of Surgery, University Medical Center, Bonn, Germany
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, MA, USA
| | - J Keith Roberts
- Liver Transplant and HPB Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Stephen Tabiri
- University for Development Studies-School of Medicine and Health Sciences, Tamale Teaching Hospital, Tamales, Ghana
| | - Eric Vibert
- Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France
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Behera K, McKenna M, Smith L, McKnight G, Horwood J, Davies MM, Torkington J, Ansell J. Transferring laparoscopic skills to robotic-assisted surgery: a systematic review. J Robot Surg 2024; 18:11. [PMID: 38214801 DOI: 10.1007/s11701-023-01757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024]
Abstract
Robotic-Assisted Surgery (RAS) is experiencing rapid expansion, prompting the integration of robotic technical skills training into surgical education programs. As access to robotic training platforms remains limited, it is important to investigate the transferability of laparoscopic skills to RAS. This could potentially support the inclusion of early years laparoscopic training to mitigate the learning curve associated with robotic surgery. This study aims to assess the transferability of laparoscopic skills to robotic surgery. A systematic search was conducted using the PRISMA checklist to identify relevant articles. PubMed, MEDLINE, Embase, and Cochrane databases were searched, and inclusion and exclusion criteria were applied to collate eligible articles. Included were original articles comparing the performance of comparable tasks on both laparoscopic and robotic platforms written in English. Non-peer reviewed papers, conference abstracts, reviews, and case series were excluded. Seventeen articles met the inclusion criteria. Among these, 10 studies (59%) demonstrated skill transferability from laparoscopic surgery (LS) to robotic surgery (RS); while one study (5.8%) showed no significant transferability. Four studies highlighted the positive impact of prior laparoscopic training on robotic skill, whereas six papers suggested no significant difference between laparoscopic novices and experienced laparoscopists when utilizing a robotic simulator. Five studies evaluated advanced surgical skills such as intracorporeal knot tying and suturing, revealing superior robotic performance among experienced laparoscopists compared to novice learners. Laparoscopic skills appear to be transferrable to robotic surgery, particularly in complex surgical techniques. Robotic simulators demonstrate a significant reduction in the learning curve for surgical novices, albeit to a lesser extent for experienced laparoscopists.
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Affiliation(s)
- Karishma Behera
- NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG, UK
| | - Matthew McKenna
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - Laurie Smith
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - Gerard McKnight
- Health Education and Improvement Wales (HEIW), Cardiff, Wales, UK
| | - James Horwood
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - Michael M Davies
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - Jared Torkington
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - James Ansell
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK.
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Takami H, Kodera Y, Eguchi H, Kitago M, Murotani K, Hirano S, Kitagawa Y, Ikeda N, Mori M. The shortage of surgeons in Japan: Results of an online survey of qualified teaching hospitals that take part in the surgical training programs for board certification by the Japan Surgical Society. Surg Today 2024; 54:41-52. [PMID: 37193795 PMCID: PMC10764368 DOI: 10.1007/s00595-023-02697-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE A collapse in regional healthcare through the maldistribution of physicians has been a long-debated issue in Japan and amidst this situation, a new system of board certification was initiated. The Japan Surgical Society (JSS) conducted a nation-wide survey to grasp the current distribution of surgeons in Japan, and their roles. METHODS All 1976 JSS-certified teaching hospitals were invited to respond to a web-based questionnaire. The responses were analyzed to seek a solution to the current issues. RESULTS Responses to the questionnaire were received from 1335 hospitals. The surgical departments of medical universities serve as an internal labor market and were the source of surgeons for most hospitals. More than 50% of teaching hospitals throughout the country claimed a shortage of surgeons even in well-populated prefectures such as Tokyo and Osaka. Hospitals rely on surgeons to cover the deficits in medical oncology, anesthesiology, and emergency medicine. These additional responsibilities were identified as significant predictors of a shortage of surgeons. CONCLUSIONS Surgeon shortage is a serious issue throughout Japan. Given the limited number of surgeons and surgical trainees, hospitals should make every effort to recruit specialists in the additional fields where surgeons are filling the gaps and allow surgeons to engage more in surgery.
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Affiliation(s)
- Hideki Takami
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kenta Murotani
- Biostatics Center, Kurume University, Kurume, 830-0011, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Kita-Ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 860-8556, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023, Japan
- The Japan Surgical Society, Tokyo, Japan
| | - Masaki Mori
- School of Medicine, Tokai University, 143, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Gorard J, Boal M, Swamynathan V, Ghamrawi W, Francis N. The application of objective clinical human reliability analysis (OCHRA) in the assessment of basic robotic surgical skills. Surg Endosc 2024; 38:116-128. [PMID: 37932602 PMCID: PMC10776495 DOI: 10.1007/s00464-023-10510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Using a validated, objective, and standardised assessment tool to assess progression and competency is essential for basic robotic surgical training programmes. Objective clinical human reliability analysis (OCHRA) is an error-based assessment tool that provides in-depth analysis of individual technical errors. We conducted a feasibility study to assess the concurrent validity and reliability of OCHRA when applied to basic, generic robotic technical skills assessment. METHODS Selected basic robotic surgical skill tasks, in virtual reality (VR) and dry lab equivalent, were performed by novice robotic surgeons during an intensive 5-day robotic surgical skills course on da Vinci® X and Xi surgical systems. For each task, we described a hierarchical task analysis. Our developed robotic surgical-specific OCHRA methodology was applied to error events in recorded videos with a standardised definition. Statistical analysis to assess concurrent validity with existing tools and inter-rater reliability were performed. RESULTS OCHRA methodology was applied to 272 basic robotic surgical skills tasks performed by 20 novice robotic surgeons. Performance scores improved from the start of the course to the end using all three assessment tools; Global Evaluative Assessment of Robotic Skills (GEARS) [VR: t(19) = - 9.33, p < 0.001] [dry lab: t(19) = - 10.17, p < 0.001], OCHRA [VR: t(19) = 6.33, p < 0.001] [dry lab: t(19) = 10.69, p < 0.001] and automated VR [VR: t(19) = - 8.26, p < 0.001]. Correlation analysis, for OCHRA compared to GEARS and automated VR scores, shows a significant and strong inverse correlation in every VR and dry lab task; OCHRA vs GEARS [VR: mean r = - 0.78, p < 0.001] [dry lab: mean r = - 0.82, p < 0.001] and OCHRA vs automated VR [VR: mean r = - 0.77, p < 0.001]. There is very strong and significant inter-rater reliability between two independent reviewers (r = 0.926, p < 0.001). CONCLUSION OCHRA methodology provides a detailed error analysis tool in basic robotic surgical skills with high reliability and concurrent validity with existing tools. OCHRA requires further evaluation in more advanced robotic surgical procedures.
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Affiliation(s)
- Jack Gorard
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
| | - Matthew Boal
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
- The Griffin Institute, Northwick Park and St Mark's Hospital, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Charles Bell House, University College London, London, UK
| | - Vishaal Swamynathan
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
| | - Walaa Ghamrawi
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK
- The Griffin Institute, Northwick Park and St Mark's Hospital, London, UK
| | - Nader Francis
- Division of Surgery & Interventional Science, Royal Free Hospital Campus, University College London, London, UK.
- The Griffin Institute, Northwick Park and St Mark's Hospital, London, UK.
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Halperin L, Sroka G, Zuckerman I, Laufer S. Automatic performance evaluation of the intracorporeal suture exercise. Int J Comput Assist Radiol Surg 2024; 19:83-86. [PMID: 37278834 DOI: 10.1007/s11548-023-02963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/16/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE This work uses deep learning algorithms to provide automated feedback on the suture with intracorporeal knot exercise in the fundamentals of laparoscopic surgery simulator. Different metrics were designed to provide informative feedback to the user on how to complete the task more efficiently. The automation of the feedback will allow students to practice at any time without the supervision of experts. METHODS Five residents and five senior surgeons participated in the study. Object detection, image classification, and semantic segmentation deep learning algorithms were used to collect statistics on the practitioner's performance. Three task-specific metrics were defined. The metrics refer to the way the practitioner holds the needle before the insertion to the Penrose drain, and the amount of movement of the Penrose drain during the needle's insertion. RESULTS Good agreement between the human labeling and the different algorithms' performance and metric values was achieved. The difference between the scores of the senior surgeons and the surgical residents was statistically significant for one of the metrics. CONCLUSION We developed a system that provides performance metrics of the intracorporeal suture exercise. These metrics can help surgical residents practice independently and receive informative feedback on how they entered the needle into the Penrose.
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Affiliation(s)
- Liran Halperin
- Faculty of Data and Decision Sciences, Technion - Israel Institute of Technology, 3200003, Haifa, Israel.
| | - Gideon Sroka
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Ido Zuckerman
- Faculty of Data and Decision Sciences, Technion - Israel Institute of Technology, 3200003, Haifa, Israel
| | - Shlomi Laufer
- Faculty of Data and Decision Sciences, Technion - Israel Institute of Technology, 3200003, Haifa, Israel
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Keuning MC, Lambert B, Nieboer P, Huiskes M, Diemers AD. Perceptions and Guiding Strategies to Regulate Entrusted Autonomy of Residents in the Operating Room: A Systematic Literature Review. Journal of Surgical Education 2024; 81:93-105. [PMID: 37838573 DOI: 10.1016/j.jsurg.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/24/2022] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE To provide a systematic literature review of intraoperative entrusted autonomy for surgical residents. Specifically, perceptions from residents and supervising surgeons, supervising behavior and influencing factors on intraoperative teaching and learning are analyzed. BACKGROUND Increasing demands on surgical training and the need for effective development of technical skills, amplify the importance of making the most of intraoperative teaching and learning opportunities in the operating room. It is critical for residents to gain the greatest benefit from every surgical case and to achieve operative competence. METHODS A systematic literature search identified 921 articles from 2000 to 2022 that addressed surgical education/training, intraoperative supervision/teaching, autonomy and entrustment. 40 studies with heterogeneous designs and methodologies were included. RESULTS Four themes were established in the analysis: patient safety, learner, learning environment and supervising surgeon. The patient is identified as the primary responsibility during intraoperative teaching and learning. Supervisors continuously guard patient safety as well as the resident's learning process. Ideal intraoperative learning occurs when the resident has optimal entrusted autonomy during the procedure matching with the current surgical skills level. A safe learning environment with dedicated time for learning are prerequisites for both supervising surgeons and residents. Supervising surgeons' own preferences and confidence levels also play an important role. CONCLUSIONS This systematic literature review identifies patient safety as the overriding principle for supervising surgeons when regulating residents' entrusted autonomy. When the supervisor's responsibility toward the patient has been met, there is room for intraoperative teaching and learning. In this process the learner, the learning environment and the supervising surgeon's own preferences all intertwine, creating a triangular responsibility. This review outlines the challenge of establishing an equilibrium in this triangle and the broad arsenal of strategies supervising surgeons use to keep it in balance.
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Affiliation(s)
- Martine C Keuning
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands.
| | - Bart Lambert
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Patrick Nieboer
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike Huiskes
- Center for Language and Cognition Groningen, University of Groningen, Groningen, The Netherlands
| | - Agnes D Diemers
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, The Netherlands
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Munawar A, Li Z, Nagururu N, Trakimas D, Kazanzides P, Taylor RH, Creighton FX. Fully immersive virtual reality for skull-base surgery: surgical training and beyond. Int J Comput Assist Radiol Surg 2024; 19:51-59. [PMID: 37347346 DOI: 10.1007/s11548-023-02956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE A virtual reality (VR) system, where surgeons can practice procedures on virtual anatomies, is a scalable and cost-effective alternative to cadaveric training. The fully digitized virtual surgeries can also be used to assess the surgeon's skills using measurements that are otherwise hard to collect in reality. Thus, we present the Fully Immersive Virtual Reality System (FIVRS) for skull-base surgery, which combines surgical simulation software with a high-fidelity hardware setup. METHODS FIVRS allows surgeons to follow normal clinical workflows inside the VR environment. FIVRS uses advanced rendering designs and drilling algorithms for realistic bone ablation. A head-mounted display with ergonomics similar to that of surgical microscopes is used to improve immersiveness. Extensive multi-modal data are recorded for post-analysis, including eye gaze, motion, force, and video of the surgery. A user-friendly interface is also designed to ease the learning curve of using FIVRS. RESULTS We present results from a user study involving surgeons with various levels of expertise. The preliminary data recorded by FIVRS differentiate between participants with different levels of expertise, promising future research on automatic skill assessment. Furthermore, informal feedback from the study participants about the system's intuitiveness and immersiveness was positive. CONCLUSION We present FIVRS, a fully immersive VR system for skull-base surgery. FIVRS features a realistic software simulation coupled with modern hardware for improved realism. The system is completely open source and provides feature-rich data in an industry-standard format.
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Affiliation(s)
- Adnan Munawar
- Johns Hopkins University, Baltimore, MD, 21218, USA.
| | - Zhaoshuo Li
- Johns Hopkins University, Baltimore, MD, 21218, USA
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Nwokedi U, Graviss EA, Nguyen DT, Pei KY. Work relative value units undervalue the clinical effort associated with teaching cases: An ACS-NSQIP analysis. Am J Surg 2024; 227:117-122. [PMID: 37806890 DOI: 10.1016/j.amjsurg.2023.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Work-relative-value-units (wRVUs) are a core metric of faculty effort but do not account for the additional work associated with intraoperative teaching. This study introduces and assesses an indexed effort, wRVU per minute (wRVU index). We hypothesize that there is a significant decrease in the calculated wRVU index among teaching cases. METHODS We queried the ACS-NSQIP database for 7 core Emergency General Surgery procedures and records were stratified into teaching vs non-teaching, and emergent vs non-emergent procedures. We utilized multivariable generalized linear models to determine factors associated with increased operative time and decreased wRVU index. RESULTS Data were available for 953,967 cases from 2005 to 2010. For all cases, teaching vs non-teaching, the median wRVU index was 0.16 vs 0.21 (p < 0.001). There was a positive association between teaching cases and decreased wRVU index for all cases. CONCLUSION The wRVU index was 24% lower for teaching cases when compared to non-teaching cases despite controlling for patient-specific factors. This finding highlights the need for further evaluation of the current wRVU framework.
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Affiliation(s)
- Ugoeze Nwokedi
- Department of Graduate Medical Education, Parkview Health, Fort Wayne, Indiana, USA.
| | - Edward A Graviss
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA; Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Duc T Nguyen
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kevin Y Pei
- Department of Graduate Medical Education, Parkview Health, Fort Wayne, Indiana, USA
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Travers HC, Beamish AJ, McCarthy M, Lewis DR. Defining quality assessment in vascular surgery training: an expert Delphi process. Ann R Coll Surg Engl 2024; 106:70-77. [PMID: 36779452 PMCID: PMC10765177 DOI: 10.1308/rcsann.2022.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION A robust and reproducible way of assessing training should optimise and standardise vascular surgical training. This study describes the methodology supporting the Vascular Surgery Specialty Advisory Committee regional quality assurance reports for vascular surgery training programmes in the UK. METHODS A Delphi consensus exercise was performed to establish the domains of training that most appropriately assess the quality of a vascular surgery training programme. A total of 54 stakeholders were invited to participate, including trainees, training programme directors and members of the vascular speciality advisory committee (SAC), vascular society executive and education committees. RESULTS A total of 39 stakeholders successfully completed the three-stage Delphi process over 15 weeks. The domains identified as most appropriate to assess the quality of a vascular training programme were: Joint Committee on Surgical Training (JCST) survey results, clinical experience, regional education programmes, radiology support, timetable, regional support for trainees, trainer support for trainees, opportunities for professional development, trainee-rated quality of consultant teaching and training, and trainee recommendation of the post. CONCLUSIONS This study describes a method to identify and prioritise domains that are appropriate to assess the quality of a vascular training programme. The domains that were identified as appropriate to assess quality are transferable internationally and the Delphi methodology could be used by other training schemes to 'fine-tune' their own domains to review and optimise the quality of their own training programmes.
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Affiliation(s)
- HC Travers
- Russell’s Hall Hospital, UK
- Vascular Surgery Specialty Advisory Committee,UK
| | - AJ Beamish
- Swansea University Medical School, Swansea University, UK
| | - M McCarthy
- Vascular Surgery Specialty Advisory Committee,UK
- University Hospitals of Leicester, UK
| | - DR Lewis
- Vascular Surgery Specialty Advisory Committee,UK
- Aneurin Bevan University Health Board, UK
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Leng A, Zeng B, Chen Y, Tu P, Tao B, Chen X. Development of a virtual reality-based zygomatic implant surgery training system with global collision detection and optimized finite element method model. Comput Methods Programs Biomed 2024; 243:107940. [PMID: 38006686 DOI: 10.1016/j.cmpb.2023.107940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Zygomatic implant surgery is challenging due to the complex structure of the zygomatic bone, limited visual range during surgery, and lengthy implant path. Moreover, traditional training methods are costly, and experimental subjects are scarce. METHODS To overcome these challenges, we propose a novel training system that integrates visual, haptic, and auditory feedback to create a more immersive surgical experience. The system uses dynamic bounding volume hierarchy (BVH) and Symplectic Euler to detect global collisions between surgical tools and models, while an optimized finite element method (FEM) model simulates soft tissue and detects collisions. Compared to previous works, our system achieves global rigid-body collisions between surgical tools and patient models, while also providing stable and realistic simulation and collisions of soft tissues. This advancement offers a more realistic simulation for zygomatic implant surgery. RESULTS We conducted three experiments and evaluations. The first experiment measured the axial force generated during the zygomatic implant simulation process and compared it with actual surgery, demonstrating the realistic force rendering feedback of our system. The second evaluation involved 15 novice surgeons who experienced the system and completed a questionnaire survey focusing on five aspects. The results showed satisfactory evaluations. The third experiment involved six surgeons who underwent in-depth training for two hours daily and were tested on the first, third, and fifth days. We collected data and combined it with the doctors' feedback to prove that our system can improve surgeons' proficiency in zygomatic implant surgery and provide a novel training solution for this procedure. CONCLUSION We have innovatively integrated global collision detection and optimized soft tissue simulation into our system. Furthermore, we have conducted experimental validation to demonstrate the effectiveness of this implementation. We present a novel solution for zygomatic implant surgery training.
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Affiliation(s)
- Ao Leng
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, China
| | - Bolun Zeng
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, China
| | - Yizhou Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, China
| | - Puxun Tu
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, China
| | - Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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Tronchot A, Casy T, Vallee N, Common H, Thomazeau H, Jannin P, Huaulmé A. Virtual reality simulation training improve diagnostic knee arthroscopy and meniscectomy skills: a prospective transfer validity study. J Exp Orthop 2023; 10:138. [PMID: 38095746 PMCID: PMC10721743 DOI: 10.1186/s40634-023-00688-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE Limited data exist on the actual transfer of skills learned using a virtual reality (VR) simulator for arthroscopy training because studies mainly focused on VR performance improvement and not on transfer to real word (transfer validity). The purpose of this single-blinded, controlled trial was to objectively investigate transfer validity in the context of initial knee arthroscopy training. METHODS For this study, 36 junior resident orthopaedic surgeons (postgraduate year one and year two) without prior experience in arthroscopic surgery were enrolled to receive standard knee arthroscopy surgery training (NON-VR group) or standard training plus training on a hybrid virtual reality knee arthroscopy simulator (1 h/month) (VR group). At inclusion, all participants completed a questionnaire on their current arthroscopic technical skills. After 6 months of training, both groups performed three exercises that were evaluated independently by two blinded trainers: i) arthroscopic partial meniscectomy on a bench-top knee simulator; ii) supervised diagnostic knee arthroscopy on a cadaveric knee; and iii) supervised knee partial meniscectomy on a cadaveric knee. Training level was determined with the Arthroscopic Surgical Skill Evaluation Tool (ASSET) score. RESULTS Overall, performance (ASSET scores) was better in the VR group than NON-VR group (difference in the global scores: p < 0.001, in bench-top meniscectomy scores: p = 0.03, in diagnostic knee arthroscopy on a cadaveric knee scores: p = 0.04, and in partial meniscectomy on a cadaveric knee scores: p = 0.02). Subgroup analysis by postgraduate year showed that the year-one NON-VR subgroup performed worse than the other subgroups, regardless of the exercise. CONCLUSION This study showed the transferability of the technical skills acquired by novice residents on a hybrid virtual reality simulator to the bench-top and cadaveric models. Surgical skill acquired with a VR arthroscopy surgical simulator might safely improve arthroscopy competences in the operating room, also helping to standardise resident training and follow their progress. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Alexandre Tronchot
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France.
- Orthopaedics and Trauma Department, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000, Rennes, France.
| | - Tiphaine Casy
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
| | - Nicolas Vallee
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
- Orthopaedics and Trauma Department, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Harold Common
- Orthopaedics and Trauma Department, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Hervé Thomazeau
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
- Orthopaedics and Trauma Department, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Pierre Jannin
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
| | - Arnaud Huaulmé
- University Rennes, CHU Rennes, Inserm, LTSI, Equipe MediCIS- UMR 1099, 35000, Rennes, France
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Crihfield EG, Uppalapati P, Abittan B, Laibangyang A, Brahmbhatt S, Burlingame M, Goldberg GL, Rabin JM. Development of laparoscopic skills in skills-naïve trainees using self-directed learning with take-home laparoscopic trainer boxes. Surg Open Sci 2023; 16:82-93. [PMID: 37789947 PMCID: PMC10542196 DOI: 10.1016/j.sopen.2023.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/09/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023] Open
Abstract
Background To determine if take home laparoscopic trainer boxes with only self-directed learning can develop laparoscopic skills in surgically naive learners. Methods 74 starting PGY1 OB/Gyn residents and OB/Gyn clerkship medical students volunteered for the study. Learners performed a laparoscopic peg transfer task with only task instructions and no additional training. Initial tasks were recorded and scored. The participants took home a laparoscopic trainer box for 3 weeks to practice without guidance and returned to perform the same task for a second/final score. Initial and final scores were compared for improvement. This improvement was compared to practice and variables such as demographics, surgical interest, comfort with laparoscopy, and past experiences. Results Mean peg transfer task scores improved from 287 (SD = 136) seconds to 193 (SD = 79) seconds (p < 0.001). Score improvement showed a positive correlation with number of home practice sessions with a linear regression R2 of 0.134 (p = 0.001). More practice resulted in larger increases in comfort levels, and higher comfort levels correlated with better final task scores with a linear regression R2 of 0.152 (p < 0.001). Interest in a surgical specialty had no impact on final scores or improvement. Playing a musical instrument and having two or more dexterity-based hobbies was associated with a better baseline score (p = 0.032 and p = 0.033 respectively), but no difference in the final scores or score improvement. No other past experiences impacted scores. Conclusions Our study demonstrates that the use of home laparoscopic box trainers can develop laparoscopic skills in surgical novices even without formal guidance or curriculum.
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Affiliation(s)
- Eric G. Crihfield
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Pooja Uppalapati
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Baruch Abittan
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Anya Laibangyang
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Sonam Brahmbhatt
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Madeleine Burlingame
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Gary L. Goldberg
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
| | - Jill M. Rabin
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY, USA
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Fitzgerald TN, Zambeli-Ljepović A, Olatunji BT, Saleh A, Ameh EA. Gaps and priorities in innovation for children's surgery. Semin Pediatr Surg 2023; 32:151352. [PMID: 37976896 DOI: 10.1016/j.sempedsurg.2023.151352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Lack of access to pediatric medical devices and innovative technology contributes to global disparities in children's surgical care. There are currently many barriers that prevent access to these technologies in low- and middle-income countries (LMICs). Technologies that were designed for the needs of high-income countries (HICs) may not fit the resources available in LMICs. Likewise, obtaining these devices are costly and require supply chain infrastructure. Once these technologies have reached the LMIC, there are many issues with sustainability and maintenance of the devices. Ideally, devices would be created for the needs and resources of LMICs, but there are many obstacles to innovation that are imposed by institutions in both HICs and LMICs. Fortunately, there is a growing interest for development of this space, and there are many examples of current technologies that are paving the way for future innovations. Innovations in simulation-based training with incorporated learner self-assessment are needed to fast-track skills acquisition for both specialist trainees and non-specialist children's surgery providers, to scale up access for the larger population of children. Pediatric laparoscopy and imaging are some of the innovations that could make a major impact in children's surgery worldwide.
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Affiliation(s)
- Tamara N Fitzgerald
- Department of Surgery, Duke University, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA
| | - Alan Zambeli-Ljepović
- Philip R. Lee Institute for Health Policy Studies, University of California San Fransisco, USA
| | | | | | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria.
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Hogan D, Geary S, Hennessey DB. The impact of a novel surgical forum, 'Virtual Surgical Speed Dating', on career perception for medical students: a pilot study. Ir J Med Sci 2023; 192:2987-2992. [PMID: 37055703 PMCID: PMC10101731 DOI: 10.1007/s11845-023-03361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic limited medical student's exposure to surgical specialities, potentially affecting their understanding of specialties and limiting access to mentorship. AIMS To develop a novel online 'round table' session to increase medical student's exposure to surgical careers, and to assess the value of the event as an educational tool. METHOD A virtual education session was held, with questionnaires being completed before and after the virtual event. The event began with an introduction to surgical training. Participants rotated every 10 min in groups, with two specialties represented by a specialist registrar at each station. Data were analysed using a 5-point Likert scale, and a Student Evaluation of Educational Quality (SEEQ) questionnaire was completed. RESULTS Of the 19 students involved, 14 (73.7%) were female, and 16 (84.2%) were undergraduate. The specialty attendees were most interested in before and after the event were neurosurgery (21.1%, n = 4) and cardiothoracic surgery (26.3%, n = 5), respectively. Five (26.3%) students changed the subspecialty they were most interested in after the event. Attendees' knowledge of surgical training in Ireland improved from 52.6% prior to the educational session to 69.5% after (p < 0.001). The session resulted in an increase in the perceived importance of research (4 [IQR 2-4] versus 4 [IQR 4-5], p = 0.0021). CONCLUSIONS This 'Virtual Surgical Speed Dating' event offered medical students an opportunity to interact with various surgical specialties despite the SARS-CoV-2 pandemic. The novel approach increased medical students' exposure to surgical trainees, improved knowledge of training pathways and altered student values influencing career decision-making.
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Affiliation(s)
- Donnacha Hogan
- Department of Urology, Mercy University Hospital, Grenville Place, Cork, Ireland.
| | - Sharon Geary
- School of Medicine and Health, University College Cork, College Road, Cork, Ireland
| | - Derek B Hennessey
- Department of Urology, Mercy University Hospital, Grenville Place, Cork, Ireland
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Rocchi C, Martel A. [Current status of French oculoplastics in France and in Europe]. J Fr Ophtalmol 2023; 46:1232-1243. [PMID: 37845142 DOI: 10.1016/j.jfo.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/07/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION In 2023, oculoplastics in France is experiencing a paradox with an imbalance between demand and supply of trainees. The goal of this study is to establish a factual overview of oculoplastics in France, with its limitations, and make proposals to optimize this sector. METHODS An observational study was conducted by compiling epidemiological data related to oculoplastics. This included full-time hospital practitioners (HPs) in French university hospitals (FUH), data from the distributed computerized system for health assessment (SIDES), the specialized cross-disciplinary training (FST) in oculoplastics, the interuniversity diploma (DIU) in oculoplastics, the French University Ophthalmologists College (COUF), and the French Society of Reconstructive and Aesthetic Ophthalmology (SOPREF). RESULTS Of the 32 FUH, only 11 full-time HPs (among them 5 academic) are specialized in oculoplastics. Several "priority" regions are underrepresented in oculoplastic surgeons. The number of ophthalmology residency coordinators and residents participating in the oculoplastics FST are decreasing over time and favoring other subspecialties. On the SIDES platform dedicated to residents, 26 (11.5%) of the 226 courses are devoted to oculoplastics. The role of women in oculoplastics is also discussed. CONCLUSION Despite offering quality theoretical training, the future of French oculoplastics is clouded by a lack of practical training. Corrective measures include increasing oculoplastic surgeons in the FUH, developing private practice fellowships, prioritizing residents from "priority" regions for the oculoplastics DIU, optimizing the inter-CHU network, creating innovative teaching resources, and organizing specific congresses for the residents.
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Affiliation(s)
- C Rocchi
- Ophthalmology Department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France
| | - A Martel
- University Hospital of Nice, 30 voie romaine, 06000 Nice, France.
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Forsbacka N, Kolari T, Talme M, Bister V. Surgical Residents´ Results Seem to be Non-Inferior Comparing to More Experienced Surgeons in Femoral Neck Fracture Osteosynthesis. Indian J Orthop 2023; 57:2018-2023. [PMID: 38026839 PMCID: PMC10673761 DOI: 10.1007/s43465-023-00992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023]
Abstract
Purpose of the Study Femoral neck fracture osteosynthesis is usually performed by using dynamic hip screw (DHS) or multiple parallel cannulated screws (MCS). In orthopedic surgery training, certain hip fractures are one of the most common operations performed by residents. It has been questioned, whether residents can provide as safe treatment and patient outcomes as those of more experienced surgeons. The aim of this study was to evaluate the effect of surgical experience on risk of complications by comparing the surgical performance and clinical outcomes in femoral neck osteosyntheses between surgical residents and orthopaedic surgeons. Methods All patients with femoral neck fracture admitted to Helsinki and Uusimaa Hospital District (HUS) Hyvinkää Hospital from 2011 to 2016 were collected as research material. 88 hip fractures (87 patients) treated with DHS or MCS osteosyntheses were included in this study. The patients were divided into 2 groups, based on the surgeon's experience: an orthopedic surgeon group (n = 68) and a surgical resident group (n = 20). All data from complications, reoperations, and the duration of operations were collected. Results There was no significant difference in characteristics of operated patients between orthopaedics and residents group. There was no significant difference in complications or re-operations between groups (p = 0.4, p = 0.2). Surgical residents had statistically longer surgical time (mean 76 min, 95% CI 62.92 min, mean 46 min, 95% Cl 42.51 min; p-value < 0.001). Still surgical time was not a risk factor for complication (p-value 0.5). Conclusion Our results show that surgical residents´ outcomes in femoral neck fracture osteosynthesis seem to be as favorable as those of orthopedic surgeons; the operations just last slightly longer.
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Affiliation(s)
- Nora Forsbacka
- Turku University Hospital Trauma Unit, Turku University Hospital, Turku, Finland
| | - Terhi Kolari
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Marjo Talme
- Helsinki University Hospital, Hyvinkää Hospital, Hyvinkää, Finland
| | - Ville Bister
- Helsinki University Hospital Trauma Unit, Töölö Hospital, Helsinki, Finland
- Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Peijas Hospital, Vantaa, Finland
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