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Le Hanneur M, Bouché PA, Vignes JL, Poitevin N, Legagneux J, Fitoussi F. Nonliving versus Living Animal Models for Microvascular Surgery Training: A Randomized Comparative Study. Plast Reconstr Surg 2024; 153:853-860. [PMID: 37256834 DOI: 10.1097/prs.0000000000010755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Ethical and financial considerations have encouraged the use of nonliving models for simulation-based training in microsurgery, such as commercially available chicken thighs. The purpose of this study was to compare the nonliving chicken thigh model to the one currently considered as the standard-namely, the living rat model-in the setting of an initiation microsurgery course. METHODS Applicants to the 3-day basic microsurgery course of the Paris School of Surgery were assigned randomly to either one group that received the regular training of the school (RT group), including four hands-on sessions using only living rat models, or one group that received a modified curriculum in which a nonliving chicken thigh model was used for the first hands-on session (CT group). During the following session, all trainees were evaluated on living rat models, using a global rating scale and two task-specific scales (knot-tying and anastomosis); rates of anastomosis patency, animal survival, and technique completion were recorded. RESULTS Ninety-three residents were enrolled. Global rating scale, knot-tying, and anastomosis task-specific scale scores were significantly higher in the CT group ( n = 51) than in the RT group, with mean differences of 2.6 points ( P = 0.0001), 1.3 points ( P < 0.0001), and 1.4 points ( P < 0.0001), respectively. Patency and survival rates were significantly higher in the CT group than in the RT group, with mean differences of 22% ( P = 0.0020) and 27% ( P < 0.0001), respectively; completion rates were not statistically different. CONCLUSION Subject to the use of validated models, such as the chicken thigh, nonliving animal models are a suitable alternative to the living rat model in microsurgery initial training. CLINICAL RELEVANCE STATEMENT The use of validated non-living models, such as the chicken thigh, is a suitable alternative to the living rat model in microsurgery initial training.
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Affiliation(s)
- Malo Le Hanneur
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
- Hand to Shoulder Mediterranean Center, ELSAN
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Sorbonne University
| | - Pierre-Alban Bouché
- Department of Orthopedics and Traumatology, Lariboisière Hospital, Paris University
| | - Jean-Luc Vignes
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
| | - Nathalie Poitevin
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
| | - Josette Legagneux
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
| | - Franck Fitoussi
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Sorbonne University
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Foppiani J, Stanek K, Alvarez AH, Weidman A, Valentine L, Oh IJ, Albakri K, Choudry U, Rogers-Vizena CR, Lin SJ. Merits of simulation-based education: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 90:227-239. [PMID: 38387420 DOI: 10.1016/j.bjps.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/07/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The drive to improve surgical proficiency through advanced simulation-based training has gained momentum. This meta-analysis systematically evaluated evidence regarding the impact of plastic surgery-related simulation on the performance of residents. METHODS A systematic search of PubMed, Web of Science, and Cochrane Library and review of articles was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. An inverse-variance random-effects model was used to combine study estimates to account for between-study variability. Objective structured assessment of technical skills (OSATS) scores and subjective confidence scores were used to assess the impact of the simulation with positive changes from the baseline indicating better outcomes. RESULTS Eighteen studies pooling 367 trainees who participated in various simulations were included. Completion of simulation training was associated with significant improvement in subjective confidence scores with a mean increase of 1.44 units (95% CI: 0.93 to 1.94, P < 0.001), and in OSATS scores, with a mean increase of 1.24 units (95% CI: 0.87 to 1.62, P < 0.001), both on a 1-5 scale. Participants reported high satisfaction scores (mean = 4.76 units, 95% CI = 4.61 to 4.91, P = 0.006), also on a 1-5 scale. CONCLUSIONS Participation in surgical simulation markedly improved objective and subjective scoring metrics for surgical trainees. Several simulation devices are available for honing surgical skills, with the potential for advancements. The evidence demonstrates the effectiveness of simulations; thus, incorporating simulation into training curricula should be a priority in the field of plastic surgery.
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Affiliation(s)
- Jose Foppiani
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Krystof Stanek
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Allan Weidman
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lauren Valentine
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Irena J Oh
- Georgetown University School of Medicine, Washington, DC, USA
| | - Khaled Albakri
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Umar Choudry
- Department of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA.
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Johnson EA, Johnson RM. Microsurgical Practice with Use of Smartphone Camera as the Microscopic Field. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5651. [PMID: 38435461 PMCID: PMC10906582 DOI: 10.1097/gox.0000000000005651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
Accessibility of microsurgical equipment is a major barrier to proper training of surgeons before live patient free flap surgery. A technique is presented that uses a smartphone camera as the microscopic field, eliminating the need for an expensive operative microscope for surgical practice. A convenient and cost-effective simulation protocol could reduce the time frame of the microsurgery learning curve. Furthermore, the use of the smartphone video function may allow improved feedback by mentors, improving access and communication between microsurgical teachers and learners. The PocketSuture smartphone stand is a commercially available device that allows the smartphone camera to be used as magnification. The proposed education protocol included suture practice, vessel dissection, and free tissue transfer in nonliving animal models, with vessel anastomosis and patency confirmation performed with a smartphone camera for field magnification. Video of the suturing technique allowed feedback from the mentor. A progressive suturing protocol leading to the ability to perform microsurgical anastomosis on nonliving animal models was developed. The basic costs for the stand, instrument set and suture were less than $500. The PocketSuture smartphone stand can be used for microsurgical training with real-time video for plastic surgery learners with limited access to microscopes and local mentors.
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Affiliation(s)
- Elise A Johnson
- From the Ross University School of Medicine, Bridgetown, Barbados
| | - R Michael Johnson
- Division of Plastic & Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
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Shaffrey EC, Zeng W, Nicksic PJ, Eftekari SC, Frank JM, Dingle AM, Poore SO. Perforator Dissection Porcine Abdominal Model: A Novel Simulator to Improve Microsurgical Training. J Reconstr Microsurg 2024. [PMID: 38395058 DOI: 10.1055/s-0044-1779719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND Perforator dissection and flap elevation are routinely performed for microsurgical reconstruction; however, there is a steep learning curve to mastering these technical skills. Though live porcine models have been utilized as microsurgical training models, significant drawbacks limit their use. We recently developed a latex-perfused, nonliving, porcine abdomen perforator dissection simulation and described its anatomic similarity to the human deep inferior epigastric artery flap. The purpose was to assess the change in resident confidence in performing key operative steps of flap elevation and perforator dissection and obtain feedback on model realism and utility. METHODS Seventeen plastic and reconstructive surgery resident physicians (postgraduate years 1-6) at a single institution participated in a perforator dissection session utilizing the simulation model. Each resident completed pre- and postactivity surveys to assess interval change in confidence in operating. The postactivity survey also asked residents to answer questions regarding their perception of the model's anatomic and surgical realism and utility in microsurgical training. RESULTS Following a practice session using the latex-perfused, nonliving porcine abdomen, resident confidence was significantly increased in performing all key operative steps and the procedure overall (p = 0.001). All residents (n = 17, 100%) believed the model would improve "trainees' ability to perform perforator dissection in the operating room." Perforator, fascial, and pedicle anatomy were reported to be "Very" similar to human anatomy, with a median Likert score (MLS) of 4. Additionally, six out of the eight surgical steps were noted to be "Very" realistic, with only "Flap Design" and "Fascial Closure" found to be "Moderately" realistic with an MLS of 3. CONCLUSION The latex-infused porcine abdominal model is a novel, realistic simulation for microsurgical trainee perforator dissection practice. This model offers a suitable substitute for perforator dissection practice, as its implementation within a microsurgery training course improves resident comfort and confidence.
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Affiliation(s)
- Ellen C Shaffrey
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter J Nicksic
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sahand C Eftekari
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jennifer M Frank
- Department of Animal and Dairy Sciences, UW-Madison CALS, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Stefanidis D, Cook D, Kalantar-Motamedi SM, Muret-Wagstaff S, Calhoun AW, Lauridsen KG, Paige JT, Lockey A, Donoghue A, Hall AK, Patocka C, Palaganas J, Gross IT, Kessler D, Vermylen J, Lin Y, Aebersold M, Chang TP, Duff J, Kolbe M, Rutherford-Hemming T, Decker S, Collings A, Toseef Ansari M. Society for Simulation in Healthcare Guidelines for Simulation Training. Simul Healthc 2024; 19:S4-S22. [PMID: 38240614 DOI: 10.1097/sih.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. METHODS Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. OBJECTIVE These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare. RESULTS Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided. CONCLUSIONS The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.
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Affiliation(s)
- Dimitrios Stefanidis
- From the Department of Surgery (D.S., S.-M.K.-M.), Indiana University School of Medicine, Indianapolis, IN; Department of Internal Medicine (D.C.), Mayo Clinic, Rochester, MN; Department of Surgery (S.M.-W.), Emory University, Atlanta, GA; Department of Pediatrics (A.W.C.), University of Louisville School of Medicine and Norton Children's Medical Group, Louisville, KY; Department of Medicine (K.G.L.), Randers Regional Hospital, Randers, Denmark; Research Center for Emergency Medicine (K.G.L.), Aarhus University, Aarhus, Denmark; Department of Surgery (J.T.P.), LSU Health New Orleans School of Medicine, New Orleans, LA; Emergency Department (A.L.), Calderdale and Huddersfield NHS Trust, Halifax; School of Human and Health Sciences (A.L.), University of Huddersfield, Huddersfield, UK; Critical Care Medicine and Pediatrics (A.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Emergency Medicine (A.K.H.), University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine (C.P.), Cumming School of Medicine University of Calgary, Calgary, AB, Canada; Department of Health Professions Education (J.P.), School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA; Department of Pediatrics (I.T.G.), Section of Emergency Medicine, Yale University, New Haven, CT; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY,; Department of Medicine and Medical Education (J.V.), Feinberg School of Medicine, Northwestern University, Chicago, IL; KidSIM Simulation Research Program (Y.L.), Alberta Children's Hospital, Calgary, Canada; University of Michigan School of Nursing (M.A.), Ann Arbor, MI; Las Madrinas Simulation Center, Children's Hospital (T.C.), University South California, Los Angeles, CA; Department of Pediatrics (J.D.), University of Alberta, Edmonton, Alberta, Canada; Simulation Center (M.K.), University Hospital Zurich, ETH Zurich, Switzerland; Department of Nursing (T.R.-H.), University of North Carolina, Chapel Hill, NC; Department of Nursing (S.D.), Texas Tech University Health Sciences Center, Lubbock, TX; Department of Surgery (A.C.), University of Louisville, Louisville, KY; and Independent Methodologist (M.T.A.), Ottawa, Ontario, Canada
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Fleurette J, Atlan M, Legagneux J, Fitoussi F. Training in microvascular anastomosis - A randomized comparative study between chicken thigh specimen and live rat. HAND SURGERY & REHABILITATION 2023; 42:499-504. [PMID: 37598858 DOI: 10.1016/j.hansur.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
Training in microsurgical techniques on live rats is the gold standard, but raises ethical issues related to animal welfare and cost. The aim of this study was to compare acquisition of microsurgical techniques with primary training on chicken thigh specimens. Seventy six students were randomly assigned: 23 to exclusive rat training and 53 to primary chicken-leg training. Both groups were then evaluated on aortic suture and jugular aortic bypass surgery in live rats. The primary criterion for successful anastomosis was the patency test. The survival of the rat, the number of severe vascular wounds and the quality of the dissection were also assessed. Aortic anastomoses were of significantly better quality in the chicken group (p = 0.041). There was no significant difference in the number of serious injuries, rat mortality, or quality of dissection (p > 0.05). For jugular aortic bypass surgery, dissection quality (p = 0.02) and patency test (p = 0.05) were better in the chicken-leg group. There was no significant difference in number of severe wounds or rat mortality (p > 0.05). Students who started their microsurgical training on a chicken leg did not perform worse than those with exclusive live rat training. Initial training on chicken thigh specimens seems to be a reliable alternative to training on live models. LEVEL OF EVIDENCE: Level II - Randomized controlled trial.
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Affiliation(s)
- Justine Fleurette
- Université de Versailles Saint-Quentin-en-Yvelines, Service de Chirurgie Orthopédique et Traumatologique, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
| | - Michael Atlan
- Sorbonne Médecine Université, Service de Chirurgie Plastique Reconstructrice et Esthétique, AP-HP, Hôpital Tenon, 75020 Paris, France; Sorbonne Médecine Université, Département de Microchirurgie, AP-HP, 75005 Paris, France
| | - Josette Legagneux
- Sorbonne Médecine Université, Département de Microchirurgie, AP-HP, 75005 Paris, France
| | - Franck Fitoussi
- Sorbonne Médecine Université, Département de Microchirurgie, AP-HP, 75005 Paris, France; Sorbonne Médecine Université, Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, AP-HP, Hôpital Trousseau, 75012 Paris, France.
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Donnelly DT, Nicksic PJ, Zeng W, Dingle AM, Poore SO. Evaluation of a Full-Time Microsurgeon Educator on Resident Training, Research Collaboration, and Grant Funding. J Reconstr Microsurg 2023; 39:648-654. [PMID: 37040796 DOI: 10.1055/s-0043-1767678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND The value of a fully trained microsurgeon dedicated to a laboratory setting at an academic institution is largely unknown. Microsurgery training lacks a national standard despite its highly complicated nature. Our study aims to evaluate the impact of a single laboratory-dedicated microsurgeon on the microsurgical training of integrated plastic surgery residents and collaborative efforts in research. METHOD We devised a three-faceted microsurgical training curriculum, including a collaborative multi-institutional microsurgery course, novel high-fidelity simulator models, and a dedicated microsurgeon. We cataloged grant funding achieved through support to other divisions' protocols. Time, in hours, spent on training and the number of anastomoses completed with the microsurgical educator in a laboratory setting over a 4-year period (2017-2021) were evaluated. Resident independence scores were collected from attending microsurgeons to quantify the translation of microsurgical training. RESULTS Purchasing and maintenance costs of rats in our rodent facility decreased by $16,533.60 as 198 rats were replaced by our models. The residents who participated in our novel microsurgical training program were able to independently perform anastomoses in the OR by their postgraduate year 6. Additionally, the surgical support offered by our laboratory-dedicated microsurgeon led to a total of $24,171,921 in grant funding between 2017 and 2020. CONCLUSION Hiring an expert microsurgical educator to train residents in a laboratory has proved promising in accelerating microsurgical mastery. Novel training modules, alternatives to animal models, save resources in housing and animal costs. The addition of a research-oriented-microsurgeon has improved collaborative efforts to advance a range of surgical fields.
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Affiliation(s)
- D'Andrea T Donnelly
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter J Nicksic
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Dingle
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Shay A, Zaniletti I, Coffman H, Mehta S, Richter G. Comparing Feedback Techniques in Bilobe Flap Simulation Using 3D-Printed Facial Models. OTO Open 2023; 7:e90. [PMID: 38020044 PMCID: PMC10631012 DOI: 10.1002/oto2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To compare live versus delayed feedback on trainee performance of bilobe flaps using 3-dimensional (3D)-printed facial simulators and determine whether these effects are sustained on repeat performance. Study Design Cohort study. Setting University of Arkansas for Medical Sciences. Methods 3D-printed facial models with a nasal ala defect were provided to 18 subjects. Subjects were stratified and randomized based on their training level into 1 of 3 groups corresponding to live feedback (Group 1), delayed feedback (Group 2), and no feedback (Group 3). Subjects performed a bilobe flap following a structured lecture. Four weeks later, subjects independently repeated the exercise on the contralateral ala. Likert surveys were used to assess subjective parameters. Objective grading was performed by a plastic surgeon, which included a point system and score for the overall appearance. Results Following exercise 1, Group 1 reported a significant improvement in knowledge (P < .001), which was sustained after exercise 2 (P < .001); Group 2 reported a significant improvement after exercise 1 (P = .03) but was not sustained (P = .435). After the second exercise, Group 1 and Group 2 improved their confidence in bilobed repair (P = .001 and P = .003, respectively), but this was greater for Group 1. Group 1 showed a significant improvement in their design time following exercise 2 (P = .007). There were no significant differences between groups on total time for repair, total score, and appearance. Conclusion 3D-printed models are valuable in teaching the bilobe flap for nasal defects, with live feedback providing the greatest level of improvement in self-reported knowledge and confidence.
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Affiliation(s)
- Aryan Shay
- Department of Otolaryngology–Head and Neck Surgery, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | | | - Hannah Coffman
- Department of Otolaryngology–Head and Neck Surgery, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Sagar Mehta
- Department of Surgery–Division of Plastic and Reconstructive Surgery, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Gresham Richter
- Department of Otolaryngology–Head and Neck Surgery, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
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Dowling E, Larson D, Carlson ML, Price DL. Development and Validation of Instrument for Operative Competency Assessment in Selective Neck Dissection. Ann Otol Rhinol Laryngol 2023; 132:173-181. [PMID: 35249359 DOI: 10.1177/00034894221081101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Instruments to assess surgical skills have been validated for several key indicator procedures in otolaryngology. Selective neck dissection is a core procedure for which trainees must integrate knowledge of complex head and neck anatomy with technical surgical skills. An instrument for assessment of surgical performance in selective neck dissection has not been previously developed. The objective of the current study is to develop and validate an instrument for assessing surgical competency for level II-IV selective neck dissection. DESIGN A Delphi working group comprised of 23 fellowship trained head and neck surgeons from 17 institutions was assembled. The modified Delphi method encompassed a 3-step process, including 2 anonymous voting rounds to successively refine individual items and establish levels of consensus. Thresholds for achieving strong consensus, at >80% agreement, were determined a priori. The resulting instrument was subsequently validated in a prospective cohort of 17 resident surgeons, spanning postgraduate year 1 to 5 training experience. Participants were asked to perform a level II-IV selective neck dissection on fresh-frozen cadaveric specimens. Performance was scored by 2 independent, blinded observers using the devised instrument and construct validity was assessed. RESULTS Through the modified Delphi process a final list of 30 items, considered to be the most essential items for achieving the goals of a level II-IV selective neck dissection, was developed. Construct validity was supported by a positive association between instrument scores compared to both resident postgraduate year level and number of head and neck rotations completed. CONCLUSION The development and validation of a novel instrument for assessment of surgical competency in level II-IV selective neck dissection, a key indicator case in otolaryngology, is described. This new instrument may be used to provide objective feedback on overall and task-specific competency to identify surgical deficiencies and offer granular feedback to enhance surgical training.
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Affiliation(s)
- Eric Dowling
- Mayo Clinic - Otorhinolaryngology, Rochester, MN, USA
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Patel A, Massand S, Ingraham J. The state of remote learning in plastic surgery: A systematic review of modalities. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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New, Innovative, Three-Dimensional In Vivo Model for High-Level Microsurgical and Supermicrosurgical Training: A Replacement for Animal Models. Plast Reconstr Surg 2022; 150:432-436. [PMID: 35674658 DOI: 10.1097/prs.0000000000009330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY Microsurgery and supermicrosurgery are surgical subdomains necessary for a large variety of surgical disciplines. So far, there is no training model for lymphatic surgery or perforator flap surgery, and the most commonly used microsurgical training models are living animals. However, the ethical principles of replacement, refinement, and reduction (the three Rs) of living animals for training purposes were implemented, highlighting the necessity of an animal-sparing microsurgical training model. Formed during embryogenesis, the chick chorioallantoic membrane resembles a highly vascularized, noninnervated membrane within fertilized chicken eggs. The aim of this study was to utilize the chorioallantoic membrane model as an innovative and versatile training model for supermicrosurgery and microsurgery that can reduce the number of animals used for these purposes. The variety of different sized vessels for the implementation of an anastomosis proved the chorioallantoic membrane model as a well-functioning supermicrosurgical and microsurgical training model. The circulatory system is resilient enough to withstand the mechanical stress applied to the tissue, and the patency of the implemented anastomosis can be tested for the verification of the procedures. In summary, the integration of the chorioallantoic membrane model into a surgical training program can benefit its quality by representing a realistic anatomical and physiological model with a high variety of vascular structures. Moreover, the chorioallantoic membrane model satisfies the principles of replacement, refinement, and reduction as an animal-sparing model, indicating the potential of this model as an innovative microsurgical training model for the improvement of surgical skills.
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Gavira N, Benayoun M, Hamel Q, Fournier HD, Bigorre N. Learning, teaching, and training in microsurgery: A systematic review. HAND SURGERY & REHABILITATION 2022; 41:296-304. [DOI: 10.1016/j.hansur.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
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Mind the Gap: a Competency-Based Scoping Review of Aesthetic and Reconstructive Reported Simulation Training Models. Aesthetic Plast Surg 2021; 45:2483-2490. [PMID: 33483780 DOI: 10.1007/s00266-020-02089-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Simulation training has become an integral part of plastic surgery postgraduate curricula. It facilitates the acquisition of skills in a safe environment that can be later transferred to real-life settings. A variety of models have been described covering some aspects of the specialty better than others. The aim of this study was to identify and classify all the previously reported plastic surgery simulation models and the possible gaps having the Accreditation Council for Graduate Medical Education (ACGME) list of competencies as a guide. METHODS Through a Delphi process, the complete list of ACGME minimum requirements for certification was analyzed to identify domains amenable for simulation training. A systematic search was conducted in Pubmed looking for all previously reported simulation models in plastic surgery. Predefined inclusion and exclusion criteria and parallel blind review were used to identify eligible models. RESULTS A total of 81 ACGME competencies were identified. Following a 3-round Delphi process, consensus was reached on 19 reconstructive and 15 aesthetic surgery domains suitable for simulation training. 1667 articles were initially retrieved from Pubmed, of which 66 articles were eligible for inclusion. Descriptive (65%), quasi-experimental (24%) and experimental studies (11%) were found. For the 34 identified ACGME competencies, there were simulation models described for 58.8% of these, mostly covering reconstructive surgery (84.2%) while for aesthetic surgery it was 13.3%. CONCLUSIONS This scoping review has identified that there are still gaps in ACGME competencies that could benefit from new simulation training models, especially in those related to aesthetic surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Dave A, Singhal M, Tiwari R, Chauhan S, De M. Effectiveness of a microsurgery training program using a chicken wing model. J Plast Surg Hand Surg 2021; 56:191-197. [PMID: 34339351 DOI: 10.1080/2000656x.2021.1953043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Microsurgical skills are essential for plastic surgeons in the modern times. Chicken wing model for microsurgery training offers an easy and cost-effective alternative to the traditional live rat model. A prospective study was conducted over a period of 6 months. Fifteen resident doctors in the department of plastic surgery were enrolled. Each of them underwent one session of microsurgery training on chicken wings (ulnar artery) every week for 15 weeks. The pre-training and post-training microvascular anastomosis were recorded and analyzed by two blinded investigators using a modification of the Structured Assessment of Microsurgery Skills (SAMS) tool. The pre- and post-training scores were compared. Twelve residents completed the requisite number of training sessions and were included in the final analysis. The mean diameter of the chicken wing ulnar artery was 1.04 mm (SD:0.11). All trainees demonstrated an improvement in the total scores. There was significant improvement in the mean scores (Pre-training: 33.46 vs. post-training: 41.42, p = 0.002). There was also a significant decrease in the total number of errors (Pre-training: 6.75 vs. post-training: 4.79, p = 0.012). However, there was no significant improvement in the average time taken to perform anastomosis (Pre-training: 58.03 mins vs. post-training: 52.51 mins, p = 0.182). We concluded that chicken wing is a useful training model for microsurgery. It helps in improving the overall microsurgical skill as well as reducing the average number of errors. This model is cost-effective, easily available, and easy to set-up. The wide assortment of vessels with varying diameters provides opportunities for training of microsurgeons of different skill levels.
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Affiliation(s)
- Aniket Dave
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India.,Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Maneesh Singhal
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Tiwari
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Chauhan
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Moumita De
- Department of Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India.,Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, India
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Gasteratos K, Paladino JR, Akelina Y, Mayer HF. Superiority of living animal models in microsurgical training: beyond technical expertise. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:167-176. [PMID: 33589852 PMCID: PMC7875764 DOI: 10.1007/s00238-021-01798-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
Background Many studies are investigating the role of living and nonliving models to train microsurgeons. There is controversy around which modalities account for the best microsurgical training. In this study, we aim to provide a systematic literature review of the practical modalities in microsurgery training and compare the living and nonliving models, emphasizing the superiority of the former. We introduce the concept of non-technical skill acquisition in microsurgical training with the use of living laboratory animals in the context of a novel proposed curriculum. Methods A literature search was conducted on PubMed/Medline and Scopus within the past 11 years based on a combination of the following keywords: “microsurgery,” “training,” “skills,” and “models.” The online screening process was performed by two independent reviewers with the Covidence tool. A total of 101 papers was identified as relevant to our study. The protocol was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Living models offer the chance to develop both technical and non-technical competencies (i.e., leadership, situation awareness, decision-making, communication, and teamwork). Prior experience with ex vivo tissues helps residents consolidate basic skills prior to performing more advanced techniques in the living tissues. Trainees reported a higher satisfaction rate with the living models. Conclusions The combination of living and nonliving training microsurgical models leads to superior results; however, the gold standard remains the living model. The validity of the hypothesis that living models enhance non-technical skills remains to be confirmed. Level of evidence: Not ratable.
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Affiliation(s)
- Konstantinos Gasteratos
- Department of Plastic and Reconstructive Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Yelena Akelina
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY USA
| | - Horacio F Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Hospital Italiano de Buenos Aires University Institute, Buenos Aires, Argentina
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Albano NJ, Zeng W, Lin C, Uselmann AJ, Eliceiri KW, Poore SO. Augmentation of Chicken Thigh Model with Fluorescence Imaging Allows for Real-Time, High Fidelity Assessment in Supermicrosurgery Training. J Reconstr Microsurg 2020; 37:514-518. [PMID: 33378772 DOI: 10.1055/s-0040-1722184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The skills required for supermicrosurgery are hard-earned and difficult to master. The University of Wisconsin "blue-blood" chicken thigh model incorporates perfusion of the thigh vessels with a blue liquid solution, allowing users to visualize flow across their anastomoses. This model has proven to be an excellent source of small vessels (down to 0.3 mm) but assessing the quality of anastomoses at this spatial scale has proven difficult. We evaluated whether fluorescent imaging with indocyanine green (ICG) in this realistic training model would enhance the assessment of supermicrosurgical anastomoses, and therefore improve real-time feedback to trainees. METHODS Anastomoses of vessels ranging from 0.35 to 0.55mm in diameter were performed followed by the capture of white light with and without fluorescence imaging overlay during infusion of "blue-blood" and ICG. Videos were randomized and shown to seven fellowship-trained microsurgeons at the University of Wisconsin-Madison who rated each anastomosis as "patent," "not patent," or "unsure." Surgeon accuracy, uncertainty, and inter-rater agreement were measured for each imaging modality. RESULTS Use of fluorescence significantly increased surgeon accuracy to 91% compared with 47% with white light alone (p = 0.015), decreased surgeon uncertainty to 4% compared with 41% with white light alone (p = 0.011), and improved inter-rater agreement from 53.1% with white light alone to 91.8% (p = 0.016). CONCLUSION Augmentation of the University of Wisconsin "blue-blood" chicken thigh model with ICG fluorescence improves accuracy, decreases uncertainty, and improves inter-rater agreement when assessing supermicrosurgical anastomoses in a training setting. This improved, real-time feedback enhances this model's value as a supermicrosurgical training tool.
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Affiliation(s)
- Nicholas J Albano
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Weifeng Zeng
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christie Lin
- OnLume Inc., Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | | | - Kevin W Eliceiri
- OnLume Inc., Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - Samuel O Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Del Maestro M, Rampini AD, Mauramati S, Giotta Lucifero A, Bertino G, Occhini A, Benazzo M, Galzio R, Luzzi S. Dye-Perfused Human Placenta for Vascular Microneurosurgery Training: Preparation Protocol and Validation Testing. World Neurosurg 2020; 146:e854-e864. [PMID: 33197635 DOI: 10.1016/j.wneu.2020.11.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Human placenta is recognized as a valuable vascular microneurosurgery training model because of its abundant availability, ethical acceptance, and analogous vasculature with other vessels of the human body; however, human placenta laboratory preparation techniques are not well described in the literature. This study outlines a detailed and standardized laboratory protocol for preparation of a color-perfused human placenta model. Survey-based validation of the model is also reported herein. METHODS The protocol involved cleaning and cannulation of the umbilical vein and arteries, irrigation with heparin, and storage at 3°C or freezing at -18°C. Before use, arteries were perfused with carmine/cochineal, and veins were perfused with methylthioninium chloride. A questionnaire with 5 questions was administered to 40 participants among attending or resident neurosurgeons, otolaryngologists, and maxillofacial surgeons on 4 consecutive microsurgical courses to assess the reliability of the placenta model. Trainees were divided into 3 groups based on their experience. A χ2 test was used to identify differences between groups. RESULTS Forty-two placentas were considered appropriate for training and were successfully perfused with dyes. Thirty-three participants completed the questionnaire, of which most, especially advanced and intermediate participants, indicated the placenta as a valuable, accurate, and reproducible model. No differences were observed among the groups. CONCLUSIONS The human placenta is an excellent tool for vascular microneurosurgery laboratory training. Color perfusion enhances the reliability of this model, which was validated by most surgeons, regardless of their experience.
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Affiliation(s)
- Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Angela Dele Rampini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Simone Mauramati
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Otorhinolaryngology Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giulia Bertino
- Otorhinolaryngology Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Occhini
- Otorhinolaryngology Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Benazzo
- Otorhinolaryngology Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Otorhinolaryngology Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Chai A, Crank S, Mizen K, Philip J. Low-cost model using a digital microscope for learning, practicing, and maintaining microvascular surgical skills. Br J Oral Maxillofac Surg 2020; 59:247-248. [PMID: 33160731 PMCID: PMC7438998 DOI: 10.1016/j.bjoms.2020.08.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022]
Affiliation(s)
- A Chai
- Oral and Maxillofacial Department, Hull Royal Infirmary.
| | - S Crank
- Oral and Maxillofacial Department, Hull Royal Infirmary.
| | - K Mizen
- Oral and Maxillofacial Department, Hull Royal Infirmary.
| | - J Philip
- Oral and Maxillofacial Department, Hull Royal Infirmary.
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Microsurgery Training in Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2898. [PMID: 32802641 PMCID: PMC7413759 DOI: 10.1097/gox.0000000000002898] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/09/2020] [Indexed: 12/25/2022]
Abstract
Advances in surgical instruments, magnification technology, perforator dissection techniques, and vascular imaging over the past decades have facilitated exponential growth in the field of microsurgery. With wide application potential including but not limited to limb salvage, breast reconstruction, lymphedema treatment, and sex affirmation surgery, microsurgery represents a critical skill set that powerfully augments the reconstructive armamentarium of plastic surgeons. Accordingly, microsurgical training is now a critical component of the plastic surgery residency education curriculum. Trainees must meet minimum microsurgery case requirements in addition to the core competencies outlined by the Accreditation Council for Graduate Medical Education. Through the use of simulation models, residency programs increasingly incorporate early skills development and assessment in microsurgery in the laboratory. Beyond residency, microsurgery fellowships offer additional exposure and refinement by offering volume, complexity, autonomy, and possible focused specialization. With continued refinement in technology and advances in knowledge, new types of simulation training models will continue to be developed and incorporated into microsurgery training curricula.
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20
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Versteeg M, Hendriks RA, Thomas A, Ommering BWC, Steendijk P. Conceptualising spaced learning in health professions education: A scoping review. MEDICAL EDUCATION 2020; 54:205-216. [PMID: 31860936 PMCID: PMC7064953 DOI: 10.1111/medu.14025] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/05/2019] [Accepted: 10/21/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To investigate the definitions and applications of 'spaced learning' and to propose future directions for advancing its study and practice in health professions education. METHOD The authors searched five online databases for articles published on spaced learning in health professions education prior to February 2018. Two researchers independently screened articles for eligibility with set inclusion criteria. They extracted and analysed key data using both quantitative and qualitative methods. RESULTS Of the 2972 records retrieved, 120 articles were included in the review. More than 90% of these articles were published in the last 10 years. The definition of spaced learning varied widely and was often not theoretically grounded. Spaced learning was applied in distinct contexts, including online learning, simulation training and classroom settings. There was a large variety of spacing formats, ranging from dispersion of information or practice on a single day, to intervals lasting several months. Generally, spaced learning was implemented in practice or testing phases and rarely during teaching. CONCLUSIONS Spaced learning is infrequently and poorly defined in the health professions education literature. We propose a comprehensive definition of spaced learning and emphasise that detailed descriptions of spacing formats are needed in future research to facilitate the operationalisation of spaced learning research and practice in health professions education.
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Affiliation(s)
- Marjolein Versteeg
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Center for Innovation In Medical EducationLeiden University Medical CenterLeidenthe Netherlands
| | - Renée A. Hendriks
- Center for Innovation In Medical EducationLeiden University Medical CenterLeidenthe Netherlands
| | - Aliki Thomas
- School of Physical and Occupational TherapyMontrealQuébecCanada
- Faculty of MedicineInstitute for Health Sciences EducationMcGill UniversityMontrealQuébecCanada
- Centre for Interdisciplinary Research in RehabilitationMontrealQuébecCanada
| | - Belinda W. C. Ommering
- Center for Innovation In Medical EducationLeiden University Medical CenterLeidenthe Netherlands
| | - Paul Steendijk
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Center for Innovation In Medical EducationLeiden University Medical CenterLeidenthe Netherlands
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21
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Reel it in: A readily available and high-fidelity model for microvascular training. J Plast Reconstr Aesthet Surg 2019; 72:2064-2094. [PMID: 31623985 DOI: 10.1016/j.bjps.2019.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/21/2019] [Indexed: 11/24/2022]
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Javid P, Aydın A, Mohanna P, Dasgupta P, Ahmed K. Current status of simulation and training models in microsurgery: A systematic review. Microsurgery 2019; 39:655-668. [DOI: 10.1002/micr.30513] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/25/2019] [Accepted: 08/30/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Pernia Javid
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Abdullatif Aydın
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Pari‐Naz Mohanna
- Department of Plastic SurgeryGuy's and St. Thomas' NHS Foundation Trust London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
- Department of UrologyKing's College Hospital NHS Foundation Trust London UK
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23
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Brown J, Rapaport B. Role of live animals in the training of microvascular surgery: a systematic review. Br J Oral Maxillofac Surg 2019; 57:616-619. [DOI: 10.1016/j.bjoms.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
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24
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Alessa MA, Kwak SH, Lee YW, Kang ML, Sung HJ, Ahn SH, Choi EC, Kim WS. Porcine As a Training Module for Head and Neck Microvascular Reconstruction. J Vis Exp 2018. [PMID: 30320742 DOI: 10.3791/58104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Live models that resemble surgical conditions of humans are needed for training free-flap harvesting and anastomosis. Animal models for training purposes have been available for years in many surgical fields. We used the female (because they are easy to handle for the procedure) Yorkshire pigs for the head and neck reconstruction by harvesting the deep inferior epigastric artery perforator or the superior epigastric artery perforator flap. The anastomosis site (neck skin defect or tracheal wall defect) was prepared via the dissection of the common carotid artery and the internal jugular vein, in which 3.5× loupe magnification was used for anastomosis as we use on human cases in real life. This procedure demonstrates a new training method using a reliable learning model and provides a detailed anatomy in a live scenario. We focused on the ischemia time, harvesting, vessel anastomosis, and designing the flap to fit the defect site. This model improves tissue handling and with the use of proper instruments can be repeated many times so that the surgeon is fully confident before starting the surgery on humans.
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Affiliation(s)
- Mohammad Ali Alessa
- Department of Otolaryngology, Head and Neck Surgery, King Abdullah Medical City; Department of Otorhinolaryngology, Yonsei University, College of Medicine
| | - Sang Hyun Kwak
- Department of Otorhinolaryngology, Yonsei University, College of Medicine
| | - Young Woo Lee
- Department of Otorhinolaryngology, Yonsei University, College of Medicine
| | - Mi-Lan Kang
- Severance Biomedical Science Institute, Yonsei University, College of Medicine
| | - Hak-Joon Sung
- Severance Biomedical Science Institute, Yonsei University, College of Medicine; The George W.Woodruff School of Mechanical Engineering, Georgia Institute of Technology
| | - Soon Hyun Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University, College of Medicine
| | - Won Shik Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine;
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Creighton FX, Feng AL, Goyal N, Emerick K, Deschler D. Chicken thigh microvascular training model improves resident surgical skills. Laryngoscope Investig Otolaryngol 2017; 2:471-474. [PMID: 29299526 PMCID: PMC5743170 DOI: 10.1002/lio2.94] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives Microsurgical techniques are essential for vessel anastomosis in free flap reconstructive surgery. However, teaching these skills intraoperatively is difficult. The chicken thigh microvascular model is a high‐fidelity model that has been previously validated to differentiate between skill levels of surgeons. This study aims to determine if this model objectively improves microsurgical skills. Study Design Validation study Methods Thirteen residents were given a tutorial on microvascular anastomosis and asked to perform anastomoses on the microvascular model. Anastomoses were video‐recorded and the time required for trainees to complete the first stitch of their first anastomosis was compared to the time required for the first stitch of their last anastomosis. Comparison of first and last stitch times was completed using a paired student t‐test. All participants completed a survey regarding their experience with the simulator. Results There was a statistically significant decrease between the time required for the first stitch (235 s, 95%CI 198–272 s) compared to last stitch (120 s, 95%CI 92–149 s), and an average 48.7% (115 s) decrease in time (p < 0.001). Junior (PGY 2/3) and senior (PGY 4/5) residents had similar decreases in time, 49.1% and 48.21%, respectively. One hundred percent of residents felt they improved during the session and 92% of residents agreed or strongly agreed that their final stitch was better than their last stitch. All residents agreed or strongly agreed that the simulation is realistic, effective in teaching the procedure, and would translate to improved intraoperative performance. Conclusions The chicken thigh model demonstrates objective improvements in resident microvascular surgical skills. Level of Evidence NA
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Affiliation(s)
- Francis X Creighton
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Allen L Feng
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Neerav Goyal
- Department of Otolaryngology Penn State Medical School Hershey Pennsylvania U.S.A
| | - Kevin Emerick
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Daniel Deschler
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
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