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Tjønnås MS, Muller S, Våpenstad C, Tjønnås J, Ose SO, Das A, Sandsund M. Stress responses in surgical trainees during simulation-based training courses in laparoscopy. BMC Med Educ 2024; 24:407. [PMID: 38610013 PMCID: PMC11010405 DOI: 10.1186/s12909-024-05393-3] [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: 12/14/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Simulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees' stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees' stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting. METHODS We conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants' stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored. RESULTS Twenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05). CONCLUSION Trainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees' stress response during simulation-based skills training courses.
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Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway.
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway.
| | - Sébastien Muller
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
| | - Cecilie Våpenstad
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway
- The National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy (MiDT), St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250, Prinsesse Kristinas Gate 5, Torgarden, Trondheim, NO-7006, Norway
| | - Johannes Tjønnås
- Department of Mathematics and Cybernetics, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO- 7465, Norway
| | - Solveig Osborg Ose
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
| | - Anita Das
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway
| | - Mariann Sandsund
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
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Seymour NE, Nepomnayshy D, De S, Banks E, Breitkopf DM, Campagna R, Gomez-Garibello C, Green I, Jacobsen G, Korndorffer JR, Minasi J, Okrainec A, Matthew Ritter E, Sankaranarayanan G, Schwaitzberg S, Soper NJ, Vassiliou M, Wagner M, Zevin B. What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey. Surg Endosc 2023; 37:7676-7685. [PMID: 37517042 DOI: 10.1007/s00464-023-10238-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: 12/04/2022] [Accepted: 06/12/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests. METHODS A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform. RESULTS Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks. CONCLUSIONS This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.
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Affiliation(s)
- Neal E Seymour
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate Health, 759 Chestnut Street, Springfield, MA, 01199, USA.
| | - Dmitry Nepomnayshy
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Suvranu De
- College of Engineering, Florida A&M University, Tallahassee, FL, USA
| | - Erika Banks
- Department of Obstetrics & Gynecology, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Daniel M Breitkopf
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Ryan Campagna
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Isabel Green
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Garth Jacobsen
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - John Minasi
- Bon Secours Medical Group, Greenville, SC, USA
| | - Allan Okrainec
- Department of Surgery, University of Toronto, Toronto, Canada
| | - E Matthew Ritter
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Steven Schwaitzberg
- Department of Surgery, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA
| | - Nathaniel J Soper
- Department of Surgery, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | | | - Maryam Wagner
- Institute of Health Sciences Education, McGill University, Montreal, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University School of Medicine, Kingston, ON, USA
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Restaino S, Scutiero G, Taliento C, Poli A, Bernardi G, Arcieri M, Santi E, Fanfani F, Chiantera V, Driul L, Scambia G, Greco P, Vizzielli G. Three-dimensional vision versus two-dimensional vision on laparoscopic performance of trainee surgeons: a systematic review and meta-analysis. Updates Surg 2023; 75:455-470. [PMID: 36811183 DOI: 10.1007/s13304-023-01465-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: 11/20/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane's Library and Scopus. The following words and key phrases have been searched: "Two-dimensional vision", "Three-dimensional vision", "2D and 3D laparoscopy", "Trainee surgeons". This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI - 1.17 to - 0.47; p < 0.00001), cutting (MD: - 1.09; 95% CI - 1.50 to - 0.69 p < 0.00001), suturing (MD: - 0.48; 95% CI - 0.83 to - 0.13 p = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI - 13.55 to 30.98; p = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI - 0.72 to - 4.72; p = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.
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Affiliation(s)
- S Restaino
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scutiero
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - Cristina Taliento
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy.
| | - A Poli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Bernardi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - M Arcieri
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98122, Messina, Italy
| | - E Santi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - F Fanfani
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - V Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - L Driul
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - P Greco
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - G Vizzielli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Widder A, Backhaus J, Wierlemann A, Hering I, Flemming S, Hankir M, Germer CT, Wiegering A, Lock JF, König S, Seyfried F. Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students. Surg Endosc 2022; 36:8726-8736. [PMID: 35851816 PMCID: PMC9652220 DOI: 10.1007/s00464-022-09408-2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills. METHODS A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire. RESULTS Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05). CONCLUSION Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.
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Affiliation(s)
- A Widder
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany.
| | - J Backhaus
- Institute of Medical Teaching and Medical Education Research, University Hospital of Wuerzburg, Würzburg, Germany.
| | - A Wierlemann
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - I Hering
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - S Flemming
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - M Hankir
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - C-T Germer
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - A Wiegering
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - J F Lock
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - S König
- Institute of Medical Teaching and Medical Education Research, University Hospital of Wuerzburg, Würzburg, Germany
| | - F Seyfried
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
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Vajsbaher T, Schultheis H, Janssen S, Weyhe D, Bektas H, Uslar V, Francis N. The development of visuospatial abilities and their impact on laparoscopic skill acquisition: a clinical longitudinal study. Surg Endosc 2022; 36:8908-8917. [PMID: 35641701 PMCID: PMC9154204 DOI: 10.1007/s00464-022-09328-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/30/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To investigate how visuospatial abilities develop and influence intraoperative laparoscopic performance during surgical residency training programmes. BACKGROUND Laparoscopic surgery is a challenging technique to acquire and master. Visuospatial ability is an important attribute but most prior research have predominantly explored the influence of visuospatial abilities in lab-based settings and/or among inexperienced surgeons. Little is known about the impact of visuospatial profiles on actual laparoscopic performance and its role in shaping competency. METHOD A longitudinal observational cohort study using a pair-matched design over 27 months. At baseline, visuospatial profiles of 43 laparoscopic surgeons of all expertise levels and 19 control subjects were compared. The development of visuospatial abilities and their association with intraoperative performance of 18 residency surgeons were monitored during the course of their laparoscopic training. RESULTS Laparoscopic surgeons significantly outperformed the control group on the measure of spatial visualisation (U = 273.0, p = 0.03, η2 = 0.3). Spatial visualisation was found to be a significant predictor of laparoscopic expertise (R2 = 0.70, F (1.60) = 6.788, p = 0.01) and improved with laparoscopic training (B = 4.01, SE = 1.83, p = 0.02, 95% CI [0.40, 7.63]). From month 6 to 18, a strong positive correlation between spatial visualisation and intraoperative depth perception (r = 0.67, p < 0.01), bimanual dexterity (r = 0.60, p < 0.01), autonomy (r = 0.78, p < 0.01) and the total score (r = 0.70, p < 0.01) were observed but a strong relationship remained only with autonomy (r = 0.89, p < 0.01) and total score (r = 0.80, p < 0.01) at 18 months. CONCLUSION In this longitudinal cohort study, visuospatial abilities associate with laparoscopic skills and improve with training. Spatial visualisation may be characteristic of laparoscopic expertise as it has clear association with competency development during laparoscopy residency training programme.
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Affiliation(s)
- Tina Vajsbaher
- Bremen Spatial Cognition Center, University of Bremen, Enrique-Schmidt-Straße 5, 28359, Bremen, Germany.
- Faculty for Human and Health Sciences, University of Bremen, Bremen, Germany.
| | - Holger Schultheis
- Bremen Spatial Cognition Center, University of Bremen, Enrique-Schmidt-Straße 5, 28359, Bremen, Germany
- Institute for Artificial Intelligence, University of Bremen, Bremen, Germany
| | - Sonja Janssen
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Dirk Weyhe
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Hüseyin Bektas
- Department for General, Visceral-and-Surgical Oncology, Klinikum Bremen-Mitte, Germany
| | - Verena Uslar
- University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Nader Francis
- Division of Surgery and Interventional Science, University College London, London, UK
- The Griffin Institute, Northwick Park and St Mark's Hospital, Y Block, Watford Road, Harrow, HA1 3UJ, Middlesex, UK
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Martín Parra JI, Toledo Martínez E, Martínez Pérez P, Ruiz Gómez JL, Fernández Santiago R, López Useros A, Manuel Palazuelos JC, Rodríguez Sanjuán JC. Analysis of learning styles in a laparoscopic technical skills course. Implications for surgical training. Cir Esp 2021; 99:730-736. [PMID: 34772651 DOI: 10.1016/j.cireng.2021.10.011] [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: 06/02/2020] [Accepted: 11/15/2020] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Learning surgical techniques is a dynamic process. In the 1980s David Kolb described developed a learning model that enabled teaching styles to adapt for better learner outcomes. The aim of this study was to identify the Kolb learning styles of the participants in a laparoscopic technical skills course and to check see if there was any relationship with performance. METHODS An observational descriptive study was conducted with 64 participants in an intensive course in which they performed laparoscopic manual intestinal anastomoses. All completed Kolb's inventory of learning styles. For each anastomosis, join quality was assessed and the performing time recorded. After that, they were analyzed through statistical studies. RESULTS The most frequent learning style was assimilating type (39.1%). No significant differences were observed between different learning styles and gender, professional category, the time taken or the quality of the anastomoses. CONCLUSIONS Assimilating type was the most frequent Kolb learning style, with no differences observed between categories, age or gender. There is no relationship between the learning style of the participants and the results obtained in the course.
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Affiliation(s)
- José Ignacio Martín Parra
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain.
| | - Enrique Toledo Martínez
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - Paula Martínez Pérez
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - José Luis Ruiz Gómez
- Hospital virtual Valdecilla, Santander, Spain; Hospital Comarcal Sierrallana, Torrelavega, Cantabria, Spain
| | - Roberto Fernández Santiago
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - Antonio López Useros
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - José Carlos Manuel Palazuelos
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
| | - Juan Carlos Rodríguez Sanjuán
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Hospital virtual Valdecilla, Santander, Spain
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Kanitra JJ, Khogali-Jakary N, Gambhir SB, Davis AT, Hollis M, Moon C, Gupta R, Haan PS, Anderson C, Collier D, Henry D, Kavuturu S. Transference of skills in robotic vs. laparoscopic simulation: a randomized controlled trial. BMC Surg 2021; 21:379. [PMID: 34711220 PMCID: PMC8554974 DOI: 10.1186/s12893-021-01385-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Elucidating how robotic skills are best obtained will enable surgeons to best develop future robotic training programs. We perform a randomized controlled trial to assess the performance of robotic compared to laparoscopic surgery, transference of pre-existing skills between the two modalities, and to assess the learning curve between the two using novice medical students. METHODS Forty students were randomized into either Group A or B. Students practiced and were tested on a peg transfer task in either a laparoscopic simulator (LS) and robotic simulator (RS) in a pre-defined order. Performance, transference of skills and learning curve were assessed for each modality. Additionally, a fatigue questionnaire was issued. RESULTS There was no significant difference between overall laparoscopic scores (219 ± 19) and robotic scores (227 ± 23) (p = 0.065). Prior laparoscopic skills performed significantly better on robotic testing (236 ± 12) than without laparoscopic skills (216 ± 28) (p = 0.008). There was no significant difference in scores between students with prior robotic skills (223 ± 16) than without robotic skills (215 ± 22) (p = 0.162). Students reported no difference in fatigue between RS and LS. The learning curve plateaus at similar times between both modalities. CONCLUSION Novice medical students with laparoscopic skills performed better on a RS test than students without laparoscopic training, suggesting a transference of skills from laparoscopic to robotic surgery. These results suggest laparoscopic training may be sufficient in general surgery residencies as the skills transfer to robotic if used post-residency.
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Affiliation(s)
- John J Kanitra
- Department of Surgery, Ascension St. John Hospital, Detroit, MI, 48236, USA
| | - Nashwa Khogali-Jakary
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Sahil B Gambhir
- Department of General Surgery, University of California, Irvine Medical Center, Orange, CA, 92868, USA
| | - Alan T Davis
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Michael Hollis
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Caroline Moon
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Rama Gupta
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Pamela S Haan
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Cheryl Anderson
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - Deborah Collier
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA
| | - David Henry
- Montefiore Medical Center, Bronx, NY, 10467, USA
| | - Srinivas Kavuturu
- Department of Surgery, Michigan State University College of Human Medicine, 1200 E. Michigan Ave, Suite 655, Lansing, MI, 48912, USA.
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Vitagliano G, Mey L, Rico L, Birkner S, Ringa M, Biancucci M. Construction of a 3D Surgical Model for Minimally Invasive Partial Nephrectomy: the Urotrainer VK-1. Curr Urol Rep 2021; 22:48. [PMID: 34599411 DOI: 10.1007/s11934-021-01060-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Minimally invasive partial nephrectomy (MIPN) is a very challenging technique and complications may occur during its learning curve. It is important to acquire surgical skills to minimize operative risks. Surgical skills may be acquired through simulation devices or mentoring by a mentor. RECENT FINDINGS We designed a 3D operable model with multiple and variant surgical scenarios in order to facilitate surgical training in MIPN. The model delivered a real-life feel and handle. To our knowledge, this is the first minimally invasive partial nephrectomy simulator to encompass a series of scenarios with multiple levels of difficulty while delivering a real-life experience.
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Affiliation(s)
| | - Lucas Mey
- Mirai3D, Mercedes, 3235, Buenos Aires, Argentina
| | - Luis Rico
- Department of Urology, Hospital Alemán, Buenos Aires, Argentina.
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Parente G, De Marziani L, Cordola C, Gargano T, Libri M, Lima M. Training minimally invasive surgery's basic skills: is expensive always better? Pediatr Surg Int 2021; 37:1287-1293. [PMID: 34110478 DOI: 10.1007/s00383-021-04937-8] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Not all hospitals have a MIS training facility because often training is not a main corporate objective and could require lots of money. We tried to build a laparoscopic simulator that was effective and that would allow to carry out an adequate laparoscopic training similar to that obtained with the models normally used in MIS training programs. To construct a box trainer that would achieve the equivalent results than those usually used. A validation study was carried out by evaluating the content validity and construct validity of our simulator in addition a comparison study of our homemade trainer vs Karl Storz box trainer was performed. MATERIAL AND METHODS The HM laparoscopic trainer was assembled using a wood frame. Two LED lights were positioned on the inside roof of the trainer and a webcam was positioned through a special support as operative optic. The webcam was then connected to a PC and the latter was used as a monitor for the operator. Participants were 20 students and a group of 6 surgeons. Students were prospectively randomized to perform 4 of the 5 tasks of the fundamental laparoscopic surgery (FLS) program on both the HM trainer and the KS trainer (pegboard transfer, pattern cut, placement of ligating loop and intracorporeal knot suture). Simple paired t test was performed to compare times between the trainers. Then students performed two more sets of exercises on the HM. The group of surgeons performed three sets of the same exercises performed by the students on the HM. The time taken by surgeons and students to complete the exercises was compared using t test. At the end, all the participants carried out a questionnaire to evaluate their experience with the HM box trainer. For the questionnaire it was chosen to use a Linkert 1-5 scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree). RESULTS HM vs KS BT: Comparing time to complete the 4 tasks performed by students on both the BT, for the first task the p value was 0.30, for the second task 0.48, for the third task 0.80, for the fourth task 0.93, and for the total time 0.86. The comparison between the mean time of the first set of tasks of the participants who started with the HM BT and one of the participants who started on the KS p value was 1 p = 0.09; task 2 p = 0.32; task 3 p = 0.62; task 4 p = 0.32; total time p = 0.81. The comparison between the meantime of the second set of tasks of the participants who switched to the HM BT with the one of those who switched to the KS BT showed a p value of: p = 0.20 tasks 1 p = 0.53 task 2; p = 0.39 task 3; p = 0.30 task 4; p = 0.56 total time. Construct validity: The mean experts and students time of every single task and the total one showed a p value of: p < 0.01 for task 1; p < 0.01 task 2; p < 0.01 task 3; p < 0.01 task 4; p < 0.01 total time. Content validity: Both experts and students indicated the HM BT as a useful training tool and appreciated its easy use. Both groups would use it at home if it were available. CONCLUSION Valid MIS trainer can be easily built at home with few low-cost materials. Our study shows how training programs can be structured even with few resources in a creative and innovative way.
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Affiliation(s)
- Giovanni Parente
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy. .,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy.
| | - Luca De Marziani
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Chiara Cordola
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Tommaso Gargano
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Michele Libri
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Mario Lima
- Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.,Minimally Invasive and Robotic Pediatric Surgery Center (MISCBO), University of Bologna, via Massarenti 9, 40138, Bologna, Italy
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Martín Parra JI, Toledo Martínez E, Martínez Pérez P, Ruiz Gómez JL, Fernández Santiago R, López Useros A, Manuel Palazuelos JC, Rodríguez Sanjuán JC. Analysis of learning styles in a laparoscopic technical skills course. Implications for surgical training. Cir Esp 2020; 99:S0009-739X(20)30380-8. [PMID: 33358409 DOI: 10.1016/j.ciresp.2020.11.006] [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: 06/02/2020] [Revised: 09/28/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Learning surgical techniques is a dynamic process. In the 1980s David Kolb described developed a learning model that enabled teaching styles to adapt for better learner outcomes. The aim of this study was to identify the Kolb learning styles of the participants in a laparoscopic technical skills course and to check see if there was any relationship with performance. METHODS An observational descriptive study was conducted with 64 participants in an intensive course in which they performed laparoscopic manual intestinal anastomoses. All completed Kolb's inventory of learning styles. For each anastomosis, join quality was assessed and the performing time recorded. After that, they were analyzed through statistical studies. RESULTS The most frequent learning style was assimilating type (39.1%). No significant differences were observed between different learning styles and gender, professional category, the time taken or the quality of the anastomoses. CONCLUSIONS Assimilating type was the most frequent Kolb learning style, with no differences observed between categories, age or gender. There is no relationship between the learning style of the participants and the results obtained in the course.
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Affiliation(s)
- José Ignacio Martín Parra
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España.
| | - Enrique Toledo Martínez
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - Paula Martínez Pérez
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - José Luis Ruiz Gómez
- Hospital virtual Valdecilla, Santander, España; Hospital Comarcal Sierrallana, Torrelavega, Cantabria, España
| | - Roberto Fernández Santiago
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - Antonio López Useros
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - José Carlos Manuel Palazuelos
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
| | - Juan Carlos Rodríguez Sanjuán
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Hospital virtual Valdecilla, Santander, España
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Kang ML, Wong CMJ, Tan H, Bohari A, Han TO, Soon Y. A secondary learning curve in 3D versus 2D imaging in laparoscopic training of surgical novices. Surg Endosc 2021; 35:1046-51. [PMID: 32112254 DOI: 10.1007/s00464-020-07466-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Stereoscopic (3D) imaging can be used to facilitate the learning of basic laparoscopic tasks. Its advantages over traditional endoscopic (2D) imaging include better depth perception and spatial orientation. However, the transition between 3D and 2D imaging systems has not been previously studied. This study compares the acquisition of basic laparoscopic skills in a laparoscopic-naïve population using both imaging systems, and explores the possibility of a secondary learning curve in the transition between systems. METHODS 26 novice learners were randomly allocated into two arms and taught to perform two basic laparoscopic tasks adopted from the fundamentals of laparoscopic surgery (FLS) curriculum, peg transfer (T1) and pattern cutting (T2) using either 2D or 3D imaging systems. These tasks were repeated until proficiency was achieved. Participants in each arm then repeated the tasks in the other viewing system (2D/3D vs 3D/2D). The parameters measured were: (a) time taken to complete the task and (b) number of attempts to achieve proficiency. RESULTS There was a significant shortening of time required to achieve proficiency in T2 using a 3D system (mean difference-in-differences = - 65.4, 95% CI - 103.6 to - 27.2, t(24) = - 3.5, p value = 0.002) but no difference between 2D and 3D imaging systems for T1, a simpler task. Sub-group analysis of T1 and T2 between the 2D/3D and 3D/2D arms showed the presence of a secondary learning curve in the 2D/3D arm for both tasks, (T1: β-estimate - 2.68, 95% CI - 3.68 to - 1.68, p value = 0.0003; T2: β-estimate - 2.45, 95% CI - 3.75 to - 1.14, p value 0.004), but in the 3D/2D arm there was a secondary learning curve only for T2. (β-estimate 2.60, 95% CI 1.45-3.76, p value 0.001) CONCLUSION: 3D imaging can be an effective tool to speed the acquisition of proficiency in basic laparoscopic tasks for novice learners, especially in more complex tasks such as pattern cutting. The skills learned in 3D imaging can translate into 2D, albeit with a secondary learning curve.
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Khogali-Jakary N, Kanitra JJ, Haan PS, Anderson CI, Davis AT, Henry D, Gupta R, Moon C, McLeod T, Crockett ET, Kavuturu S. Laparoscopic Simulation in Reverse and Side Alignment Impact on Forward Alignment Performance: A Randomized Controlled Trial. Surg Endosc 2020; 34:298-303. [PMID: 30927126 DOI: 10.1007/s00464-019-06766-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The influence of visual-spatial discordance during training on laparoscopic skills is poorly understood. It has been proposed that training in visual-spatial discordant situations can improve performance in the forward alignment, which was the basis of our hypothesis. Our study's aim was to conduct a randomized control trial to explore the impact of simulated training in visual-spatial discordant situations on forward alignment performance. METHODS The participants were 80 medical students who were randomized into four groups. Group A served as the control and performed all peg transfers in the forward alignment. Groups B, C, and D experienced varied rounds of either increasing or decreasing sensorimotor discordance. The students were trained and tested using the peg transfer task used in the Fundamentals of Laparoscopic Surgery curriculum. Based on the group, each student performed 10 peg transfer practice rounds in their assigned alignment. After each practice session, each student was tested and scored in forward alignment performance. A baseline test, followed by three practice sessions, and three tests were done. RESULTS Group A (control) demonstrated a statistically significant overall increase in scoring of 37.1% from baseline when compared to the final test. Groups B, C, and D showed improvements of 3.7%, 27.1%, and 19.3%, respectively, between baseline and the final test, yet none demonstrated consistent linear improvements. On multi-variate analysis, students who practiced in the side or reverse alignment positions scored 25 and 37 points lower, respectively, than students who practiced in the forward alignment. CONCLUSION Our study suggests that training in visual-spatial discordant conditions does not lead to the development of forward alignment laparoscopic skills. This could have important implications when developing future laparoscopic skills training curriculums. To our knowledge, this is the largest study to date assessing the impacts of training in visual-spatial discordance situations on performance in the forward alignment.
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Serdinšek T, Andrić BŽ, But I. A new affordable and easy-to-make pelvic model for training in complex urogynecological laparoscopic procedures. Int Urogynecol J 2018; 30:1497-1501. [PMID: 30411215 DOI: 10.1007/s00192-018-3803-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/21/2018] [Accepted: 10/19/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to introduce a new affordable and easy-to-make pelvic model for training in complex urogynecological laparoscopic procedures. METHODS We modified a commercial female pelvic model consisting of sacrum, coccyx, two hip bones, the pubic symphysis, the fifth lumbar vertebra with intervertebral disc, and certain pelvic ligaments. We used sponge foam paper, felt fabric pieces, chenille stems, foam, plastic ties, fabric glue, and a thick, coated wire to create pelvic floor, uterus/vaginal cuff, bladder, both ureters, and anterior longitudinal and pectineal ligaments. RESULTS We created two different pelvic models: one with the uterus and one with the vaginal cuff. They enable training for laparoscopic pectopexy and hysteropexy/sacrocolpopexy. Trainees can practice proper mesh placement and suture the mesh to the corresponding anatomical structures. Because of the wire inserted in the uterus/vaginal cuff, it is possible to move the uterus/vaginal cuff in the anterior-posterior direction, thus mimicking the use of the manipulator during surgery. Besides the basic pelvis, all other parts of the model can be easily replaced when necessary. CONCLUSIONS We believe that our pelvic model could provide a valuable tool for training complex urogynecological laparoscopic procedures and help to reduce the long learning curve of these procedures.
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Affiliation(s)
- Tamara Serdinšek
- Department of General Gynecology and Urogynecology, Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Branka Žegura Andrić
- Department of General Gynecology and Urogynecology, Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
| | - Igor But
- Department of General Gynecology and Urogynecology, Clinic for Gynecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia
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14
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Abstract
Background and Objectives: Virtual simulators have played a vital role in preparing surgeons for laparoscopic and robotic procedures in gynecologic surgery. The efficacy of the simulator was evaluated to improve basic (trainee) laparoscopic skills and assess training levels. Methods: This prospective, comparative study was conducted in volunteer residents in the obstetrics and gynecology training program of Université Laval. Study participants performed 9 laparoscopic simulator tasks on 2 different occasions. Skills improvement between sessions and differences between junior and senior residents were examined. Results: Thirteen junior and 11 senior residents participated in the study. Junior trainees significantly improved their speed of execution, accuracy, and maintenance of horizontal view. Senior trainees mainly accelerated their rapidity in completing different tasks. They performed better than junior trainees, with economy of movements, and tended toward greater precision, speed of execution, and safe retraction in various tasks. Conclusion: Virtual simulators are useful pedagogic tools that could benefit both junior and senior residents. Integration into the residency curricula should be considered.
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Affiliation(s)
- Joalee Paquette
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Québec, QC, Canada
| | - Madeleine Lemyre
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Québec, QC, Canada
| | - Chantale Vachon-Marceau
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Québec, QC, Canada
| | - Emmanuel Bujold
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Québec, QC, Canada
| | - Sarah Maheux-Lacroix
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Québec, QC, Canada
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15
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Ganni S, Botden SMBI, Chmarra M, Goossens RHM, Jakimowicz JJ. A software-based tool for video motion tracking in the surgical skills assessment landscape. Surg Endosc 2018; 32:2994-2999. [PMID: 29340824 PMCID: PMC5956097 DOI: 10.1007/s00464-018-6023-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 09/05/2017] [Accepted: 01/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of motion tracking has been proved to provide an objective assessment in surgical skills training. Current systems, however, require the use of additional equipment or specialised laparoscopic instruments and cameras to extract the data. The aim of this study was to determine the possibility of using a software-based solution to extract the data. METHODS 6 expert and 23 novice participants performed a basic laparoscopic cholecystectomy procedure in the operating room. The recorded videos were analysed using Kinovea 0.8.15 and the following parameters calculated the path length, average instrument movement and number of sudden or extreme movements. RESULTS The analysed data showed that experts had significantly shorter path length (median 127 cm vs. 187 cm, p = 0.01), smaller average movements (median 0.40 cm vs. 0.32 cm, p = 0.002) and fewer sudden movements (median 14.00 vs. 21.61, p = 0.001) than their novice counterparts. CONCLUSION The use of software-based video motion tracking of laparoscopic cholecystectomy is a simple and viable method enabling objective assessment of surgical performance. It provides clear discrimination between expert and novice performance.
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Affiliation(s)
- Sandeep Ganni
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands. .,Department of Surgery, GSL Medical College, Rajahmundry, India. .,Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Magdalena Chmarra
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Richard H M Goossens
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jack J Jakimowicz
- Medisign, Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.,Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
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Hazboun R, Rodriguez S, Thirumoorthi A, Baerg J, Moores D, Tagge EP. Laparoscopic skills assessment: an additional modality for pediatric surgery fellowship selection. J Pediatr Surg 2017; 52:1904-1908. [PMID: 28947326 DOI: 10.1016/j.jpedsurg.2017.08.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/06/2017] [Accepted: 08/28/2017] [Indexed: 11/16/2022]
Abstract
AIM The Pediatric Surgery fellow selection is a multi-layered process which has not included assessment of surgical dexterity. MATERIALS AND METHODS Data was collected prospectively as part of the 2016 Pediatric Surgery Match interview process. Applicants completed a questionnaire to document laparoscopic experience and fine motor skills activities. Actual laparoscopic skills were assessed using a simulator. Time to complete an intracorporeal knot was tabulated. An initial rank list was formulated based only on the ERAS application and interview scores. The rank list was re-formulated following the laparoscopic assessment. Un-paired T-test and regression were utilized to analyze the data. RESULTS Forty applicants were interviewed with 18 matched (45%). The mean knot tying time was 201.31s for matched and 202.35s for unmatched applicants. Playing a musical instrument correlated with faster knot tying (p=0.03). No correlation was identified between knot tying time and either video game experience (p=0.4) or passing the FLS exam (p=0.78). Laparoscopic skills assessment lead to significant reordering of rank list (p=0.01). CONCLUSIONS Laparoscopic skills performance significantly impacted ranking. Playing a musical instrument correlated with faster knot tying. No correlation was identified between laparoscopic performance and passing the FLS exam or other activities traditionally believed to improve technical ability. TYPE OF STUDY Prospective study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Rajaie Hazboun
- Division of Pediatric Surgery, Loma Linda University School of Medicine, Coleman Pavilion, Loma Linda, CA, USA
| | - Samuel Rodriguez
- Department of General Surgery, Loma Linda University School of Medicine, Coleman Pavilion, Loma Linda, CA, USA
| | - Arul Thirumoorthi
- Division of Pediatric Surgery, Loma Linda University School of Medicine, Coleman Pavilion, Loma Linda, CA, USA
| | - Joanne Baerg
- Division of Pediatric Surgery, Loma Linda University School of Medicine, Coleman Pavilion, Loma Linda, CA, USA
| | - Donald Moores
- Division of Pediatric Surgery, Loma Linda University School of Medicine, Coleman Pavilion, Loma Linda, CA, USA
| | - Edward P Tagge
- Division of Pediatric Surgery, Loma Linda University School of Medicine, Coleman Pavilion, Loma Linda, CA, USA.
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Panel P, Niro J, Neveu ME, Compan C, Botchorishvili R, Celhay O. Assessing technical competence in laparoscopic surgery in France: Ratification of the GOALS rating scale. J Gynecol Obstet Hum Reprod 2017; 46:551-557. [PMID: 28684105 DOI: 10.1016/j.jogoh.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/25/2017] [Revised: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The question of assessing surgical competence is the focus of mainly Anglo-Saxon studies. The GOALS questionnaire (Global Operative Assessment of Laparoscopic Skills) specific to laparoscopic surgery assessment has been developed since 2005. The aim of the study was to assess the metrological qualities of the GOALS questionnaire after ratification in French language. METHODS To produce a French version of the GOALS surgical competence assessing tool according to an established method (translation - backward translation - retranslation) and to check the metrological qualities (user satisfaction, acceptability, reliability and validity) of this questionnaire through observing residents while in training program on 22 residents in Gynaecology Obstetrics during the laparoscopy training, with the performance of a nephrectomy on a porcine model. RESULTS The discrepancies in the initial translations were mainly due literal translations. Only synonymous differences were observed in the two backward translations. Comparison with original version led to 8 minor changes. No changes occurred between the 2 French versions. Satisfaction surveys when using the GOALS questionnaire by both examiners and students are similar. Face and content validity seemed good and there is no significant discrepancy between the examiners and the students (11.5 [9-15]; 12.4 [9-15]; P=0.40). Assessment by examiners showed an median value of 17.8 [9-26] with good correlation (α=0.80). By contrast, self-assessment, although there is no significant discrepancy, showed heterogeneity. GOALS French version was able to prove a significant progression both in self-assessment and external evaluation between the act performed on the first nephrectomy on the first day of the first session of the training and the fourth nephrectomy performed on the first day of the second session of the training. CONCLUSION Our work allowed obtaining a GOALS French version with acceptable validity, good consistency between the assessments and ability to measure progress.
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Affiliation(s)
- P Panel
- Service de gynécologie-obstétrique, centre hospitalier de Versailles 155, route de Versailles 78150 Le Chesnay, France
| | - J Niro
- Service de gynécologie-obstétrique, centre hospitalier de Versailles 155, route de Versailles 78150 Le Chesnay, France.
| | - M-E Neveu
- Service de gynécologie-obstétrique, centre hospitalier de Versailles 155, route de Versailles 78150 Le Chesnay, France
| | - C Compan
- CICE, faculté de médecine, Bat 3C, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - R Botchorishvili
- CICE, faculté de médecine, Bat 3C, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - O Celhay
- Service d'urologie, CHU de Poitiers, 86000 Poitiers, France
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18
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Ganni S, Chmarra MK, Goossens RHM, Jakimowicz JJ. Self-assessment in laparoscopic surgical skills training: Is it reliable? Surg Endosc 2017; 31:2451-2456. [PMID: 27655377 PMCID: PMC5443853 DOI: 10.1007/s00464-016-5246-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 09/12/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The concept of self-assessment has been widely acclaimed for its role in the professional development cycle and self-regulation. In the field of medical education, self-assessment has been most used to evaluate the cognitive knowledge of students. The complexity of training and evaluation in laparoscopic surgery has previously acted as a barrier in determining the benefits self-assessment has to offer in comparison with other fields of medical education. METHODS Thirty-five surgical residents who attended the 2-day Laparoscopic Surgical Skills Grade 1 Level 1 curriculum were invited to participate from The Netherlands, India and Romania. The competency assessment tool (CAT) for laparoscopic cholecystectomy was used for self- and expert-assessment and the resulting distributions assessed. RESULTS A comparison between the expert- and self-assessed aggregates of scores from the CAT agreed with previous studies. Uniquely to this study, the aggregates of individual sub-categories-'use of instruments'; 'tissue handling'; and errors 'within the component tasks' and the 'end product' from both self- and expert-assessments-were investigated. There was strong positive correlation (r s > 0.5; p < 0.001) between the expert- and self-assessment in all categories with only the 'tissue handling' having a weaker correlation (r s = 0.3; p = 0.04). The distribution of the mean of the differences between self-assessment and expert-assessment suggested no significant difference between the scores of experts and the residents in all categories except the 'end product' evaluation where the difference was significant (W = 119, p = 0.03). CONCLUSION Self-assessment using the CAT form gives results that are consistently not different from expert-assessment when assessing one's proficiency in surgical skills. Areas where there was less agreement could be explained by variations in the level of training and understanding of the assessment criteria.
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Affiliation(s)
- Sandeep Ganni
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands.
- Department of Surgery, GSL Medical College, Rajahmundry, India.
- Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands.
| | - Magdalena K Chmarra
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Richard H M Goossens
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
| | - Jack J Jakimowicz
- Delft University of Technology, Industrial Design Engineering, Medisign, Delft, The Netherlands
- Research and Education, Catharina Hospital, Michelangelolaan 2, 5653 EJ, Eindhoven, The Netherlands
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19
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Lahanas V, Loukas C, Georgiou K, Lababidi H, Al-Jaroudi D. Virtual reality-based assessment of basic laparoscopic skills using the Leap Motion controller. Surg Endosc 2017; 31:5012-5023. [PMID: 28466361 DOI: 10.1007/s00464-017-5503-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 07/19/2016] [Accepted: 03/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The majority of the current surgical simulators employ specialized sensory equipment for instrument tracking. The Leap Motion controller is a new device able to track linear objects with sub-millimeter accuracy. The aim of this study was to investigate the potential of a virtual reality (VR) simulator for assessment of basic laparoscopic skills, based on the low-cost Leap Motion controller. METHODS A simple interface was constructed to simulate the insertion point of the instruments into the abdominal cavity. The controller provided information about the position and orientation of the instruments. Custom tools were constructed to simulate the laparoscopic setup. Three basic VR tasks were developed: camera navigation (CN), instrument navigation (IN), and bimanual operation (BO). The experiments were carried out in two simulation centers: MPLSC (Athens, Greece) and CRESENT (Riyadh, Kingdom of Saudi Arabia). Two groups of surgeons (28 experts and 21 novices) participated in the study by performing the VR tasks. Skills assessment metrics included time, pathlength, and two task-specific errors. The face validity of the training scenarios was also investigated via a questionnaire completed by the participants. RESULTS Expert surgeons significantly outperformed novices in all assessment metrics for IN and BO (p < 0.05). For CN, a significant difference was found in one error metric (p < 0.05). The greatest difference between the performances of the two groups occurred for BO. Qualitative analysis of the instrument trajectory revealed that experts performed more delicate movements compared to novices. Subjects' ratings on the feedback questionnaire highlighted the training value of the system. CONCLUSIONS This study provides evidence regarding the potential use of the Leap Motion controller for assessment of basic laparoscopic skills. The proposed system allowed the evaluation of dexterity of the hand movements. Future work will involve comparison studies with validated simulators and development of advanced training scenarios on current Leap Motion controller.
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Affiliation(s)
- Vasileios Lahanas
- Medical Physics Lab-Simulation Center, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75 Str., 11527, Athens, Greece
| | - Constantinos Loukas
- Medical Physics Lab-Simulation Center, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75 Str., 11527, Athens, Greece.
| | - Konstantinos Georgiou
- Medical Physics Lab-Simulation Center, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75 Str., 11527, Athens, Greece
| | - Hani Lababidi
- Center for Research, Education & Simulation Enhanced Training, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dania Al-Jaroudi
- Center for Research, Education & Simulation Enhanced Training, King Fahad Medical City, Riyadh, Saudi Arabia
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20
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Law KE, Jenewein CG, Gannon SJ, DiMarco SM, Maulson LJ, Laufer S, Pugh CM. Exploring hand coordination as a measure of surgical skill. J Surg Res 2016; 205:192-7. [PMID: 27621018 DOI: 10.1016/j.jss.2016.06.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 02/05/2016] [Revised: 05/03/2016] [Accepted: 06/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The study aim was to identify residents' coordination between dominant and nondominant hands while grasping for sutures in a laparoscopic ventral hernia repair procedure simulation. We hypothesize residents will rely on their dominant and nondominant hands unequally while grasping for suture. METHODS Surgical residents had 15 min to complete the mesh securing and mesh tacking steps of a laparoscopic ventral hernia repair procedure. Procedure videos were coded for manual coordination events during the active suture grasping phase. Manual coordination events were defined as: active motion of dominant, nondominant, or both hands; and bimanual or unimanual manipulation of hands. A chi-square test was used to discriminate between coordination choices. RESULTS Thirty-six residents (postgraduate year, 1-5) participated in the study. Residents changed manual coordination types during active suture grasping 500 times, ranging between 5 and 24 events (M = 13.9 events, standard deviation [SD] = 4.4). Bimanual coordination was used most (40%) and required the most time on average (M = 20.6 s, SD = 27.2), while unimanual nondominant coordination was used least (2.2%; M = 7.9 s, SD = 6.9). Residents relied on their dominant and nondominant hands unequally (P < 0.001). During 24% of events, residents depended on their nondominant hand (n = 120), which was predominantly used to operate the suture passer device. CONCLUSIONS Residents appeared to actively coordinate both dominant and nondominant hands almost half of the time to complete suture grasping. Bimanual task durations took longer than other tasks on average suggesting these tasks were characteristically longer or switching hands required a greater degree of coordination. Future work is necessary to understand how task completion time and overall performance are affected by residents' hand utilization and switching between dominant and nondominant hands in surgical tasks.
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Affiliation(s)
- Katherine E Law
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Caitlin G Jenewein
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Samantha J Gannon
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shannon M DiMarco
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lakita J Maulson
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shlomi Laufer
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carla M Pugh
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
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21
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Herrera-Almario GE, Kirk K, Guerrero VT, Jeong K, Kim S, Hamad GG. The effect of video review of resident laparoscopic surgical skills measured by self- and external assessment. Am J Surg 2015; 211:315-20. [PMID: 26590043 DOI: 10.1016/j.amjsurg.2015.05.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 02/18/2015] [Revised: 04/10/2015] [Accepted: 05/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Video review of surgical skills is an educational modality that allows trainees to reflect on self-performance. The purpose of this study was to determine whether resident and attending assessments of a resident's laparoscopic performance differ and whether video review changes assessments. METHODS Third-year surgery residents were invited to participate. Elective laparoscopic procedures were video recorded. The Global Operative Assessment of Laparoscopic Skills evaluation was completed immediately after the procedure and again 7 to 10 days later by both resident and attending. Scores were compared using t tests. RESULTS Nine residents participated and 76 video reviews were completed. Residents scored themselves significantly lower than the faculty scores both before and after video review. Resident scores did not change significantly after video review. CONCLUSIONS Attending and resident self-assessment of laparoscopic skills differs and subsequent video review does not significantly affect Global Operative Assessment of Laparoscopic Skills scores. Further studies should evaluate the impact of video review combined with verbal feedback on skill acquisition and assessment.
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Affiliation(s)
| | - Katherine Kirk
- Department of Surgery, University of Pittsburgh Medical Center, 3380 Boulevard of the Allies Suite 390, Pittsburgh, PA, 15213, USA
| | - Veronica T Guerrero
- Department of Surgery, University of Pittsburgh Medical Center, 3380 Boulevard of the Allies Suite 390, Pittsburgh, PA, 15213, USA
| | - Kwonho Jeong
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sara Kim
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Giselle G Hamad
- Department of Surgery, University of Pittsburgh Medical Center, 3380 Boulevard of the Allies Suite 390, Pittsburgh, PA, 15213, USA.
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Abbas P, Holder-Haynes J, Taylor DJ, Scott BG, Brandt ML, Naik-Mathuria B. More than a camera holder: teaching surgical skills to medical students. J Surg Res 2015; 195:385-9. [PMID: 25777824 DOI: 10.1016/j.jss.2015.01.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 12/09/2014] [Revised: 01/13/2015] [Accepted: 01/21/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Students often experience passive learning in their surgical rotations as they are delegated to holding the camera during laparoscopic cases. We introduced a laparoscopic skills course to medical students to provide hands-on experience. We hypothesized that the course will improve basic laparoscopic skills and increase interest in a surgical career. MATERIALS AND METHODS All students on the core surgery rotation attended two sessions in the surgical simulation laboratory lead by Department of Surgery faculty members. Surveys were used before and after the course to assess video game (VG) use and interest in a surgical career. Course effectiveness was assessed with a laparoscopic peg transfer exercise. RESULTS One hundred one students participated with 82 students documenting preinstruction and postinstruction peg transfer times. There was an overall improvement in median transfer times after instruction (before 63 s [interquartile range {IQR} 46-84.5] versus after 50.5 s [IQR 39-65.2], P < 0.001). When stratified by gender, men (n = 40) had faster median preintervention peg transfer times than women (n = 61; 65 s [IQR 51-88]) versus 81 s [IQR 65-98] (P = 0.030). However, both genders had equivalent postinstruction transfer times (men 48 s [IQR 36-61] versus women 51.3 s [IQR 43.2-68.3], P = 0.478). A similar trend was observed between students with and without prior VG use. Of the 50 students who completed both surveys, there was no significant increase (pre-24% versus post-34%, P = 0.29) or decrease (pre-32% versus post-22%, P = 0.13) in interest in a surgical career after the course. CONCLUSIONS A laparoscopic course for medical students is effective in improving laparoscopic skills. Although male gender and VG use may be associated with better intrinsic skills, instruction and practice allow female students and non-VG users to "catch up." A longer follow-up study is warranted to determine true interest in a surgical career.
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Affiliation(s)
- Paulette Abbas
- Texas Children's Hospital, Division of Pediatric Surgery, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Juliet Holder-Haynes
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Deborah J Taylor
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bradford G Scott
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Mary L Brandt
- Texas Children's Hospital, Division of Pediatric Surgery, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bindi Naik-Mathuria
- Texas Children's Hospital, Division of Pediatric Surgery, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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