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Louridas M, Iancu AM, Grantcharov T, Steele D, Ahmed N, Shore EM. Modeling Technical Skills Learning Curves of Incoming Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2023; 80:51-61. [PMID: 36115788 DOI: 10.1016/j.jsurg.2022.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Not all trainees reach technical competency even after completing surgical training. While assessment of technical skill is not part of the residency interview process, identifying under-performers early on may help identify opportunities for individualized, targeted training. The objectives of this study were to (1) create predictive learning curve (LC) models for each of 3 basic laparoscopic tasks to identify performers versus underperformers and (2) evaluate the use of LCs to identify underperformers during selection into surgical training. DESIGN Predictive LC models were created for laparoscopic pattern cutting (PC), peg transfer (PT) and intra-corporeal knots (IC) over 40 repetitions by 65 novice trainees in 2014. Trainees were categorized as performers and underperformers. Receiver operator characteristic analysis determined the minimum number of repetitions required to predict individual LCs, which were then used to determine the proportion of underperformers. SETTING Technical performance was assessed onsite at the Canadian Residence Matching Service (CaRMS) interviews, after interview completion (January 2015). PARTICIPANTS Applicants to general surgery (GS) and gynecology (OBGYN) participated in a skills assessment during. RESULTS The PC, PT and IC tasks required a minimum of 8, 10, and 5 repetitions respectively, to predict overall performance. Predictive values for each task had excellent sensitivity and specificity: 1.00, 1.00 (PC); 1.00, 1.00 (PT); and 0.94, 1.00 (IC). Eighty applicants completed 8 PC repetitions; 16% were identified as underperformers. CONCLUSIONS Individual LCs for three different laparoscopic tasks can be predicted with excellent sensitivity and specificity based on 10 repetitions or less. This information can be used to identify trainees who may have difficulty with laparoscopic technical skills early on.
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Affiliation(s)
- Marisa Louridas
- Department of Surgery, University of Toronto, Toronto, Ontario,Canada
| | - Ana-Maria Iancu
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Teodor Grantcharov
- Department of Surgery, University of Toronto, Toronto, Ontario,Canada; International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Donna Steele
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Najma Ahmed
- Department of Surgery, University of Toronto, Toronto, Ontario,Canada; Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Eliane M Shore
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; International Centre for Surgical Safety, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada.
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Park SS, Park SC, Kim H, Lee DE, Oh JH, Sohn DK. Assessment of the learning curve for the novel transanal minimally invasive surgery simulator model. Surg Endosc 2022; 36:6260-6270. [PMID: 35467141 DOI: 10.1007/s00464-022-09214-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transanal minimally invasive surgery (TAMIS) is technically demanding and requires extensive training. We developed the TAMIS simulator model by remodeling an existing laparoscopic training system to educate trainees and analyzed their learning curves. METHODS Between March 2020 and June 2020, 12 trainees performed TAMIS simulator training sessions. The total operative time, including specimen removal and wound closure, was recorded. The wound closure and specimen quality, trainee self-confidence, and supervisor evaluation of technical performance were documented. A moving average was used to analyze the number of training sessions required to stabilize the procedure time, while a cumulative sum analysis was performed to identify that required to reach proficiency with each item. RESULTS Each trainee completed 20 TAMIS simulator training sessions. The median total procedure time was 13 min (range, 4-60 min), which stabilized after 15 training sessions. The median times for specimen removal and wound closure were 3 min (range, 1-18 min) and 10 min (range, 2-50 min), respectively, which stabilized after 7 and 15 training sessions, respectively. The mean specimen and wound closure quality scores were 2.9 ± 0.9 (on a scale from 1 to 4) and 2.3 ± 1.1 (on a scale from 1 to 4), respectively, competencies in which were achieved after 16 and 20 training sessions, respectively. The mean trainee self-confidence and supervisor evaluation of technical performance scores were 2.4 ± 1.2 (on a scale from 1 to 5) and 2.7 ± 1.2 (on a scale from 1 to 5), respectively, competencies in which were achieved after 20 and 17 training sessions, respectively. CONCLUSION Trainees required 15 training sessions to stabilize the procedure time and 16-20 training sessions to demonstrate competencies with the TAMIS simulator model. We expect this simulator model may help surgeons more rapidly acquire the skills required for TAMIS.
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Affiliation(s)
- Sung Sil Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi, 10408, South Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi, 10408, South Korea
| | - Hongrae Kim
- Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi, 10408, South Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi, 10408, South Korea.
- Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
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Beattie KL, Hill A, Horswill MS, Grove PM, Stevenson ARL. Aptitude and attitude: predictors of performance during and after basic laparoscopic skills training. Surg Endosc 2021; 36:3467-3479. [PMID: 34370121 PMCID: PMC8351236 DOI: 10.1007/s00464-021-08668-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022]
Abstract
Background Manual dexterity and visual-spatial ability are considered key to the development of superior laparoscopic skills. Nevertheless, these abilities do not reliably explain all the variance found in the technical performance of surgical trainees. Consequently, we must look beyond these abilities to improve our understanding of laparoscopic skills and to better identify/develop surgical potential earlier on. Purpose To assess the individual and collective impact of physical, cognitive, visual, and psychological variables on performance during and after basic simulation-based laparoscopic skills training. Method Thirty-four medical students (laparoscopic novices) completed a proficiency-based laparoscopic skills training program (using either a 2D or 3D viewing mode). This was followed by one testing session, a follow-up testing session with new (yet similar) tasks, and a series of physical, cognitive, visual, and psychological measures. Results The statistical models that best predicted variance in training performance metrics included four variables: viewingmode (2D vs 3D), psychologicalflexibility, perceivedtaskdemands, and manualdexterity (bimanual). In subsequent testing, a model that included viewingmode and manualdexterity (assembly) best predicted performance on the pre-practiced tasks. However, for a highly novel, spatially complex laparoscopic task, performance was best predicted by a model that comprised viewingmode, visual-spatialability, and perceivedtaskdemands. At follow-up, manualdexterity (assembly) alone was the best predictor of performance on new (yet similar) tasks. Conclusion By focussing exclusively on physical/cognitive abilities, we may overlook other important predictors of surgical performance (e.g. psychological variables). The present findings suggest that laparoscopic performance may be more accurately explained through the combined effects of physical, cognitive, visual, and psychological variables. Further, the results suggest that the predictors may change with both task demands and the development of the trainee. This study highlights the key role of psychological skills in overcoming initial training challenges, with far-reaching implications for practice.
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Affiliation(s)
- Kirsty L Beattie
- School of Psychology, The University of Queensland, Brisbane, Australia.
| | - Andrew Hill
- School of Psychology, The University of Queensland, Brisbane, Australia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia
- Minerals Industry Safety and Health Centre, Sustainable Minerals Institute, The University of Queensland, Brisbane, Australia
| | - Mark S Horswill
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Philip M Grove
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Andrew R L Stevenson
- School of Medicine, The University of Queensland, Brisbane, Australia
- Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Abstract
BACKGROUND Surgical training is increasingly supported by the use of simulators. For temporal bone surgery, shown here by means of mastoidectomy, there are other training models besides cadaver specimens, such as artificial temporal bones or computer-based simulators. OBJECTIVES A structured training concept was created which integrates different training methods of mastoidectomy with regard to effectiveness and current learning theory in education. METHOD A selective literature research was conducted to compare learning-theoretical findings and the availability and effectiveness of currently existing training models. RESULTS To acquire surgical skills, a stepwise approach is suggested. Depending on the progress with computer-based simulation, plastic or native temporal bones should be used. To achieve a plateau of the learning curve, approximately 25 semi-autonomous preparations are recommended. Different 'Objective Structured Assessments of Technical Skills' (OSATS) are implemented to assess the learning progress at different levels. DISCUSSION Simulation-based training is recommended until an adequate learning curve plateau is achieved. This is reasonable for patient safety, based on limited accessibility of human cadaveric temporal bones but also by findings of the learning theory. CONCLUSION The curriculum integrates different training models of mastoidectomy and OSATS into an overall concept. The training plan has to be continuously adapted to new findings and technical developments.
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Louridas M, de Montbrun S. Competency-Based Education in Minimally Invasive and Robotic Colorectal Surgery. Clin Colon Rectal Surg 2021; 34:155-162. [PMID: 33814997 DOI: 10.1055/s-0040-1718683] [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: 10/21/2022]
Abstract
Minimally invasive and robotic techniques have become increasingly implemented into surgical practice and are now an essential part of the foundational skills of training colorectal surgeons. Over the past 5 years there has been a shift in the surgical educational paradigm toward competency-based education (CBE). CBE recognizes that trainees learn at different rates but regardless, are required to meet a competent threshold of performance prior to independent practice. Thus, CBE attempts to replace the traditional "time" endpoint of training with "performance." Although conceptually sensible, implementing CBE has proven challenging. This article will define competence, outline appropriate assessment tools to assess technical skill, and review the literature on the number of cases required to achieve competence in colorectal procedures while outlining the barriers to implementing CBE.
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Affiliation(s)
- Marisa Louridas
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Zhan Y, Wang M, Cheng X, Li Y, Shi X, Liu F. Evaluation of a dynamic navigation system for training students in dental implant placement. J Dent Educ 2020; 85:120-127. [PMID: 32914421 DOI: 10.1002/jdd.12399] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/09/2020] [Accepted: 08/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Computer-guided simulation systems may offer a novel training approach in many surgical fields. This study aimed to compare dental students' learning progress in dental implants placement between a dynamic navigation system and a traditional training method using a simulation model. METHODS Senior dental students with no implant placement experience were randomly assigned to implant placement training using a dynamic navigation system or a traditional freehand protocol. After training, 3-dimensional (3D) deviation at implant platform, 3D deviation at implant apex, and deviation of implant axis between the planned and placed implant positions were measured using superimposed cone beam computed tomography scans. RESULTS Six students were trained in this study. Students showed significantly greater improvement in implant placement after training using the dynamic navigation system than after using the traditional freehand protocol. Overall deviation of implant axis (P < 0.001) and 3D apex deviation (P = 0.014) improved with training using the dynamic navigation system, but differences in 3D platform deviation (P = 0.513) were not statistically significant. CONCLUSIONS A dynamic navigation system may be a useful teaching tool in the early development of clinical skills in implant placement for the novice practitioners. Novice practitioners exhibited significant improvement in angulation deviation across implant placement attempts with dynamic navigation system training.
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Affiliation(s)
- Yalin Zhan
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Miaozhen Wang
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xueyuan Cheng
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yi Li
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xiaorui Shi
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Feng Liu
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Botden SMBI, Bökkerink GM, Leijte E, Antonius T, de Blaauw I. Training the component steps of an extra-corporeal membrane oxygenation (ECMO) cannulation outside the clinical setting. J Artif Organs 2020; 23:328-334. [PMID: 32508004 PMCID: PMC7666290 DOI: 10.1007/s10047-020-01176-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/12/2020] [Indexed: 12/12/2022]
Abstract
Extra-corporeal membrane oxygenation (ECMO) cannulation can be a stressful procedure because a fast cannulation is vital for the patient’s survival. Therefore, it is important to train the steps of cannulation outside the clinical setting. A relatively low budget, easy to use model, was developed to train the most important steps of an ECMO cannulation. Following this, it was evaluated by experts and target group participants. They all completed a questionnaire regarding their experience and opinions on the ECMO model on general aspects and the training of the component steps, rated on a 5-point Likert scale. Twenty-one participants completed the questionnaire. The features and steps of the model were rated with a mean of 3.9 on average. The haptics of the landscape scored least, with a mean of 3.6, although the haptics of the vessels scored highest with 4.0. The rating of the component steps showed that only ‘opening of the vessels’ was scored significantly different between the expertise levels (means experts: 4.0, target group: 3.4, p = 0.032). This low budget model is considered to be a valid tool to train the component steps of the ECMO cannulation, which could reduce the learning curve in the a stressful clinical setting. Level of evidence: II prospective comparative study.
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Affiliation(s)
- Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Guus M Bökkerink
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Pediatric Surgery, Princess Maxima Center, Utrecht, The Netherlands
| | - Erik Leijte
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Tim Antonius
- Department of Neonatology, Radboudumc - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc - Amalia Children's Hospital, Route 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Virtual reality simulator improves the acquisition of basic arthroscopy skills in first-year orthopedic surgery residents. Orthop Traumatol Surg Res 2020; 106:717-724. [PMID: 32284277 DOI: 10.1016/j.otsr.2020.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/02/2020] [Accepted: 03/10/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Arthroscopy training using a virtual reality (VR) simulator is said to improve the training of orthopedic surgery residents, although it has never been evaluated in a large representative population of first-year residents. HYPOTHESIS We hypothesized that first-year residents who train on a VR simulator would improve their basic arthroscopy skills more than residents who use other training methods. The primary aim was to compare various arthroscopy-learning techniques after 6 months of training. POPULATION AND METHODS The study population consisted of 107 first-year residents who were tested twice on a VR arthroscopy simulator (December 2017 and June 2018). The residents were divided into three groups: no specific arthroscopy training (A), non-specific and one-off arthroscopy training (B), 6 months of VR arthroscopy simulator training (C). During the testing, they had to perform the Periscoping exercise (orientation of angled scope) and the Catch the Stars Glenohumeral exercise (extraction of loose bodies). The parameters analyzed were time (s), camera alignment relative to horizontal (%), camera path length (cm) and grasper path length (cm). RESULTS After 6 months, there was a significant difference between groups during the Periscoping exercise in the time (A: 137.8 s; B: 126.7 s; C: 92.2 s) (p<0.0001), camera alignment (A: 93%; B: 98%; C: 97%) (p=0.0028), camera path length (A: 116.9cm; B: 112.5cm; C: 67.3cm) (p<0.0001) and during the Catch the Stars Glenohumeral exercise in the time (A: 112.2 s; B: 103 s; C: 61.4 s) (p<0.0001), camera path length (A: 46.3cm; B: 40.9cm; C: 32.9cm) (p<0.0153) and grasper path length (A: 146.4cm; B: 142.2cm; C: 95.8cm) (p<0.0001). DISCUSSION The residents who participated in the VR arthroscopy simulator training program for 6 months had better results when performing practical exercises and standard arthroscopy tasks than those who did not receive any training or only received only one-off training. Their final performance indicated technical mastery that the other residents had not achieved. LEVEL OF EVIDENCE II, Prospective, comparative, non-randomized study.
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Golob Deeb J, Bencharit S, Carrico CK, Lukic M, Hawkins D, Rener-Sitar K, Deeb GR. Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: A pilot study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:415-423. [PMID: 31141291 DOI: 10.1111/eje.12447] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 05/23/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Recent computer-guided dynamic navigation systems promise a novel training approach for implant surgery. This study aimed to examine learning progress in placement of dental implants among dental students using dynamic navigation on a simulation model. MATERIALS AND METHODS Senior students with no implant placement experience were randomly assigned five implant placement attempts involving either three maxillary or four mandibular implants distributed in the anterior/posterior, and left/right segments. Implant placement was planned using a Navident Dynamic Guidance system. Surgical time was recorded. Horizontal, vertical and angulation discrepancies between the planned and placed implant positions were measured using superimposed CBCT scans. Data were analysed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = 0.05). RESULTS Fourteen students participated, with a mean age of 26.1 years and equal males and females. Mean time for implant placement was associated with attempt number (P < 0.001), implant site (P = 0.010) and marginally related to gender (P = 0.061). Students had a significant reduction in time from their first attempt to their second (10.6 vs 7.6 minutes; adjusted P < 0.001) then plateaued. Overall 3D angulation (P < 0.001) and 2D vertical apex deviation (P = 0.014) improved with each attempt, but changes in lateral 2D (P = 0.513) and overall 3D apex deviations (P = 0.784) were not statistically significant. Implant sites were associated with lateral 2D, 2D vertical and overall 3D apex deviation (P < 0.001). DISCUSSION Males were marginally faster than females, had slightly lower overall 3D angulation, and reported higher proficiency with video games. Novice operators improved significantly in speed and angulation deviation within the first three attempts of placing implants using dynamic navigation. CONCLUSION Computer-aided dynamic implant navigation systems can improve implant surgical training in novice population.
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Affiliation(s)
- Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sompop Bencharit
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caroline K Carrico
- Oral Health Promotion and Community Outreach, Oral Health Research Core, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marija Lukic
- Division for Dental Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel Hawkins
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ksenija Rener-Sitar
- Division for Dental Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Prosthodontics, University Dental Clinics, University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - George R Deeb
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Assessing Technical Performance and Determining the Learning Curve in Cleft Palate Surgery Using a High-Fidelity Cleft Palate Simulator. Plast Reconstr Surg 2018; 141:1485-1500. [DOI: 10.1097/prs.0000000000004426] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Modi HN, Singh H, Yang GZ, Darzi A, Leff DR. A decade of imaging surgeons' brain function (part I): Terminology, techniques, and clinical translation. Surgery 2017; 162:1121-1130. [PMID: 28807409 DOI: 10.1016/j.surg.2017.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/19/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Functional neuroimaging has the potential to deepen our understanding of technical and nontechnical skill acquisition in surgeons, particularly as established assessment tools leave unanswered questions about inter-operator differences in ability that seem independent of experience. METHODS In this first of a 2-part article, we aim to utilize our experience in neuroimaging surgeons to orientate the nonspecialist reader to the principles of brain imaging. Terminology commonly used in brain imaging research is explained, placing emphasis on the "activation response" to an surgical task and its effect on local cortical hemodynamic parameters (neurovascular coupling). RESULTS Skills learning and subsequent consolidation and refinement through practice lead to reorganization of the functional architecture of the brain (known as "neuroplasticity"), evidenced by changes in the strength of regional activation as well as alterations in connectivity between brain regions, culminating in more efficient use of neural resources during task performance. CONCLUSION Currently available neuroimaging techniques that either directly (ie, measure electrical activity) or indirectly (ie, measure tissue hemodynamics) assess brain function are discussed. Finally, we highlight the important practical considerations when conducting brain imaging research in surgeons.
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Affiliation(s)
- Hemel Narendra Modi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Harsimrat Singh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Guang-Zhong Yang
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Daniel Richard Leff
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom.
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Difficult Laparoscopic Cholecystectomy and Trainees: Predictors and Results in an Academic Teaching Hospital. Gastroenterol Res Pract 2017; 2017:6467814. [PMID: 28656045 PMCID: PMC5474555 DOI: 10.1155/2017/6467814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/22/2017] [Indexed: 11/18/2022] Open
Abstract
Laparoscopic cholecystectomy (LC) is one of the first laparoscopic procedures performed by surgical trainees. This study aims to determine preoperative and/or intraoperative predictors of difficult LC and to compare complications of LC performed by trainees with that performed by trained surgeons. A cohort of 180 consecutive patients with cholelithiasis who underwent LC was analyzed. We used univariate and binary logistic regression analyses to predict factors associated with difficult LC. We compared the rate of complications of LCs performed by trainees and that performed by trained surgeons using Pearson's chi-square test. Patients with impacted stone in the neck of the gallbladder (GB) (OR, 5.0; 95% CI, 1.59-15.77), with adhesions in the Triangle of Calot (OR, 2.9; 95% CI, 1.27-6.83), or with GB rupture (OR, 3.4; 95% CI, 1.02-11.41) were more likely to experience difficult LC. There was no difference between trainees and trained surgeons in the rate of cystic artery injury (p = .144) or GB rupture (p = .097). However, operative time of LCs performed by trained surgeons was significantly shorter (median, 45 min; IQR, 30-70 min) compared with the surgical trainees' operative time (60 min; IQR, 50-90 min). Surgical trainees can perform difficult LC safely under supervision with no increase in complications albeit with mild increase in operative time.
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Thomsen ASS. Intraocular surgery - assessment and transfer of skills using a virtual-reality simulator. Acta Ophthalmol 2017. [PMID: 28626885 DOI: 10.1111/aos.13505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ann Sofia Skou Thomsen
- Department of Ophthalmology; Rigshospitalet - Glostrup, University of Copenhagen; Copenhagen Denmark
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Thomsen ASS, Smith P, Subhi Y, Cour ML, Tang L, Saleh GM, Konge L. High correlation between performance on a virtual-reality simulator and real-life cataract surgery. Acta Ophthalmol 2017; 95:307-311. [PMID: 27679989 DOI: 10.1111/aos.13275] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/27/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the correlation in performance of cataract surgery between a virtual-reality simulator and real-life surgery using two objective assessment tools with evidence of validity. METHODS Cataract surgeons with varying levels of experience were included in the study. All participants performed and videorecorded three standard cataract surgeries before completing a proficiency-based test on the EyeSi virtual-reality simulator. Standard cataract surgeries were defined as: (1) surgery performed under local anaesthesia, (2) patient age >60 years, and (3) visual acuity >1/60 preoperatively. A motion-tracking score was calculated by multiplying average path length and average number of movements from the three real-life surgical videos of full procedures. The EyeSi test consisted of five abstract and two procedural modules: intracapsular navigation, antitremor training, intracapsular antitremor training, forceps training, bimanual training, capsulorhexis and phaco divide and conquer. RESULTS Eleven surgeons were enrolled. After a designated warm-up period, the proficiency-based test on the EyeSi simulator was strongly correlated to real-life performance measured by motion-tracking software of cataract surgical videos with a Pearson correlation coefficient of -0.70 (p = 0.017). CONCLUSION Performance on the EyeSi simulator is significantly and highly correlated to real-life surgical performance. However, it is recommended that performance assessments are made using multiple data sources.
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Affiliation(s)
- Ann Sofia Skou Thomsen
- Department of Ophthalmology; Rigshospitalet - Glostrup; Copenhagen Denmark
- Copenhagen Academy for Medical Education and Simulation; Rigshospitalet; Copenhagen Denmark
| | - Phillip Smith
- Department of Computer Science; University of Surrey; Guildford England
| | - Yousif Subhi
- Copenhagen Academy for Medical Education and Simulation; Rigshospitalet; Copenhagen Denmark
| | - Morten la Cour
- Department of Ophthalmology; Rigshospitalet - Glostrup; Copenhagen Denmark
| | - Lilian Tang
- Department of Computer Science; University of Surrey; Guildford England
| | - George M. Saleh
- Department of Computer Science; University of Surrey; Guildford England
- Department of Education; Moorfields Eye Hospital NHS Foundation Trust; London England
- The National Institute for Health Research; Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology; Moorfields Eye Hospital; London England
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation; Rigshospitalet; Copenhagen Denmark
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Dias TR, Alves Junior JDDDC, Abdala N. Learning curve of radiology residents during training in fluoroscopy-guided facet joint injections. Radiol Bras 2017; 50:162-169. [PMID: 28670027 PMCID: PMC5487230 DOI: 10.1590/0100-3984.2015.0176] [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] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To develop a simulator for training in fluoroscopy-guided facet joint injections and to evaluate the learning curve for this procedure among radiology residents. MATERIALS AND METHODS Using a human lumbar spine as a model, we manufactured five lumbar vertebrae made of methacrylate and plaster. These vertebrae were assembled in order to create an anatomical model of the lumbar spine. We used a silicon casing to simulate the paravertebral muscles. The model was placed into the trunk of a plastic mannequin. From a group of radiology residents, we recruited 12 volunteers. During simulation-based training sessions, each student carried out 16 lumbar facet injections. We used three parameters to assess the learning curves: procedure time; fluoroscopy time; and quality of the procedure, as defined by the positioning of the needle. RESULTS During the training, the learning curves of all the students showed improvement in terms of the procedure and fluoroscopy times. The quality of the procedure parameter also showed improvement, as evidenced by a decrease in the number of inappropriate injections. CONCLUSION We present a simple, inexpensive simulation model for training in facet joint injections. The learning curves of our trainees using the simulator showed improvement in all of the parameters assessed.
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Affiliation(s)
- Tiago Rocha Dias
- MD, Radiologist, Research Student in Radiology, Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - João de Deus da Costa Alves Junior
- MD, Interventional Neuroradiologist, Research Student in Radiology, Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Nitamar Abdala
- Full Professor of Radiology, Head of the Department of Diagnostic Imaging, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Louridas M, Szasz P, Fecso AB, Zywiel MG, Lak P, Bener AB, Harris KA, Grantcharov TP. Practice does not always make perfect: need for selection curricula in modern surgical training. Surg Endosc 2017; 31:3718-3727. [PMID: 28451813 DOI: 10.1007/s00464-017-5572-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/16/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is hypothesized that not all surgical trainees are able to reach technical competence despite ongoing practice. The objectives of the study were to assess a trainees' ability to reach technical competence by assessing learning patterns of the acquisition of surgical skills. Furthermore, it aims to determine whether individuals' learning patterns were consistent across a range of open and laparoscopic tasks of variable difficulty. METHODS Sixty-five preclinical medical students participated in a training curriculum with standardized feedback over forty repetitions of the following laparoscopic and open technical tasks: peg transfer (PT), circle cutting (CC), intracorporeal knot tie (IKT), one-handed tie, and simulated laparotomy closure. Data mining techniques were used to analyze the prospectively collected data and stratify the students into four learning clusters. Performance was compared between groups, and learning curve characteristics unique to trainees who have difficulty reaching technical competence were quantified. RESULTS Top performers (22-35%) and high performers (32-42%) reached proficiency in all tasks. Moderate performers (25-37%) reached proficiency for all open tasks but not all laparoscopic tasks. Low performers (8-15%) failed to reach proficiency in four of five tasks including all laparoscopic tasks (PT 7.8%; CC 9.4%; IKT 15.6%). Participants in lower performance clusters demonstrated sustained performance disadvantage across tasks, with widely variable learning curves and no evidence of progression towards a plateau phase. CONCLUSIONS Most students reached proficiency across a range of surgical tasks, but low-performing trainees failed to reach competence in laparoscopic tasks. With increasing use of laparoscopy in surgical practice, screening potential candidates to identify the lowest performers may be beneficial.
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Affiliation(s)
- Marisa Louridas
- Department of Surgery, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Peter Szasz
- Department of Surgery, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Andras B Fecso
- Department of Surgery, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Michael G Zywiel
- Department of Surgery, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Parisa Lak
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, M5B 2K3, Canada
| | - Ayse B Bener
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, M5B 2K3, Canada
| | - Kenneth A Harris
- Royal College of Physicians and Surgeons of Canada, Ottawa, K1S 5N8, Canada
| | - Teodor P Grantcharov
- Department of Surgery, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
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Burns GT, King BW, Holmes JR, Irwin TA. Evaluating Internal Fixation Skills Using Surgical Simulation. J Bone Joint Surg Am 2017; 99:e21. [PMID: 28244920 DOI: 10.2106/jbjs.16.00653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Open reduction and internal fixation (ORIF) is an essential skill for an orthopaedic surgeon, yet teaching its components to surgical residents poses challenges in both complexity and cost. Surgical simulation has demonstrated efficacy and is now a mandated component of residency programs, but the techniques and resources required for effective simulation vary greatly. We hypothesized that simulation of ORIF skills could be accomplished in a cost-effective, quantifiable, and reproducible manner and that this experience coupled with didactic learning would increase skill proficiency and enhance ORIF performance. METHODS Sixteen postgraduate-year-1 orthopaedic surgery interns were assessed on performance of ORIF simulation tasks before and after attending a module designed to introduce and practice internal fixation techniques. Simulation tasks addressed drilling accuracy via oblique drilling through polyvinyl chloride (PVC) cylinders and bisecting wooden dowels and plunge control via drilling through layered boards of varying densities. Fracture fixation simulation involved fixing oblique fractures on synthetic ulnae. Task performance was assessed at 3 time points: immediately before the module, 1 week after the module, and 3 months after the module. Fracture fixation was assessed before and after the module via load-to-failure testing. Success rates for the tasks were analyzed using a repeated-measures analysis of variance, and mechanical properties of the fixed ulnar constructs were compared using paired t tests. RESULTS In all ORIF simulation tasks, pre-module to post-module improvement in success rates was significant (p < 0.001) and improvements were maintained between the post-module assessment and the 3-month follow-up. The interns also achieved significantly greater strengths in their ulnar fixation constructs, with a mean improvement of 256 N (p = 0.01) after the module. CONCLUSIONS These results indicate that the technical and sensorimotor skills relevant to internal fixation (with emphasis on the specific skill of using a drill) can be significantly augmented and retained in the short term in surgical residents after exposure to faculty-led lecture and hands-on skills practice using low-cost materials. CLINICAL RELEVANCE This study provides evidence for an effective, accessible method of enhancing and assessing surgical skills in training.
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Affiliation(s)
- Geoffrey T Burns
- 1Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Validation of an Arthroscopic Training Device. Arthroscopy 2017; 33:651-658.e1. [PMID: 27923706 DOI: 10.1016/j.arthro.2016.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/08/2016] [Accepted: 08/25/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the usefulness and conduct validation of a simulated arthroscopy training device to train basic arthroscopy skills. METHODS Forty-six participants including 12 novices, 12 intermediates, and 22 experts completed a questionnaire regarding demographics, previous arthroscopic experience, training potential, and statements about the device. Furthermore, participants performed a single task on the arthroscopic training device using the 0° camera and a probe. The task consisted of an attempt to carry a rubber ring across a helix inside a box as fast as possible. Construct validity was evaluated by comparing total task time and portal replacements of the camera and probe between all groups (median values [interquartile range]; Kruskal-Wallis test). RESULTS The median age was 35 (29-44) years. There were 4 female and 42 male participants. A total of 89% of the participants graded the overall training capacity ≥5 (35% graded it as 5, 39% as 6, and 15% as 7), and 83% believed that it is useful to improve any kind of arthroscopy. Ninety-three percent of the participants would recommend the arthroscopic training device to their colleagues. Sixty-one percent of the participants stated that there are certain disadvantages. The median time to complete the task was 108 (58-236) seconds. Novices (259 [123-435] seconds) performed tasks significantly slower than intermediates (169 [67-257] seconds) and experts (75 [49-132] seconds) (P = .005). Furthermore, portal changes were significantly more common in novices and intermediates than experts (P = .019). CONCLUSIONS High scores in training potential were achieved with this arthroscopy simulator box, and most study participants believed that practice with the arthroscopic training device is useful for any kind of arthroscopy. Construct validity was established since novices, intermediates, and experts in real arthroscopy were discriminated with the arthroscopic training device in terms of time to successful completion of a task. However, 61% of the participants stated that there were certain disadvantages. CLINICAL RELEVANCE In every training tool using simulation, it is crucial to pass the first steps in the validation cascade. This study provides this step for further evaluation of this arthroscopic training device.
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Hoffmann H, Oertli D, Mechera R, Dell-Kuster S, Rosenthal R, Reznick R, MacDonald H. Comparison of Canadian and Swiss Surgical Training Curricula: Moving on Toward Competency-Based Surgical Education. JOURNAL OF SURGICAL EDUCATION 2017; 74:37-46. [PMID: 27697404 DOI: 10.1016/j.jsurg.2016.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/23/2016] [Accepted: 07/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Quality of surgical training in the era of resident duty-hour restrictions (RDHR) is part of an ongoing debate. Most training elements are provided during surgical service. As exposure to surgical procedures is important but time-consuming, RDHR may affect quality of surgical training. Providing structured training elements may help to compensate for this shortcoming. DESIGN This binational anonymous questionnaire-based study evaluates frequency, time, and structure of surgical training programs at 2 typical academic teaching hospitals with different RDHR. SETTING Departments of Surgery of University of Basel (Basel, Switzerland) and the Queen's University (Kingston, Ontario, Canada). PARTICIPANTS Surgical consultants and residents of the Queen's University Hospital (Kingston, Ontario, Canada) and the University Hospital Basel (Basel, Switzerland) were eligible for this study. RESULTS Questionnaire response rate was 37% (105/284). Queen's residents work 80 hours per week, receiving 7 hours of formal training (8.8% of workweek). Basel residents work 60 hours per week, including 1 hour of formal training (1.7% of working time). Queen's faculty and residents rated their program as "structured" or "rather structured" in contrast to Basel faculty and residents who rated their programs as "neutral" in structure or "unstructured." Respondents identified specific structured training elements more frequently at Queen's than in Basel. Two-thirds of residents responded that they seek out additional surgical experiences through voluntary extra work. Basel participants articulated a stronger need for improvement of current surgical training. Although Basel residents and consultants in both institutions fear negative influence of RDHR on the training program, this was not the case in Queen's residents. CONCLUSIONS Providing more structured surgical training elements may be advantageous in providing optimal-quality surgical education in an era of work-hour restrictions.
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Affiliation(s)
- Henry Hoffmann
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.
| | - Daniel Oertli
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Robert Mechera
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Salome Dell-Kuster
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Rachel Rosenthal
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Richard Reznick
- Department of Surgery, Queen׳s University, Kingston, Ontario, Canada
| | - Hugh MacDonald
- Department of Surgery, Queen׳s University, Kingston, Ontario, Canada
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Louridas M, Szasz P, Montbrun SD, Harris KA, Grantcharov TP. Optimizing the Selection of General Surgery Residents: A National Consensus. JOURNAL OF SURGICAL EDUCATION 2017; 74:100-107. [PMID: 27476793 DOI: 10.1016/j.jsurg.2016.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/06/2016] [Accepted: 06/20/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Surgical programs strive to recruit trainees who will graduate as competent surgeons; however, selection processes vary between institutions. The purpose of the present study was to (1) solicit program directors' (PDs) opinions on the proportion of trainees who have difficulty achieving competence and (2) establish consensus on the desired attributes of general surgery (GS) candidates and the technical skills that would be most indicative of future performance. METHODS Delphi consensus methodology was used. An open-ended questionnaire, followed by a closed-ended questionnaire, formulated as a 5-point Likert scale, was administered. A Cronbach α ≥ 0.8 with 80% of responses in agreement (4-agree and 5-strongly agree) determined the threshold for consensus. RESULTS The first and second rounds were completed by 14 and 11, of a potential 17, GS PDs, respectively. PDs felt that 5% or less of trainees have difficulty reaching competence in clinical knowledge, 5% to 10% in decision-making, and 5% to 15% in technical skill by the time of completion of training. Consensus was excellent (α = 0.92). The top attributes for success in GS included work ethic and passion for surgery. Technical skills that felt to be most appropriate were open tasks (one-handed tie and subcuticular suture) and laparoscopic tasks (coordination, grasping, and cutting). CONCLUSION PDs indicate that of the 3 domains, the largest proportion of trainees had difficulty reaching competence in technical skill. Consensus among PDs suggests that top personal attributes include work ethic and passion for surgery. Consensus of technical tasks for inclusion into selection was basic open and laparoscopic skills.
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Affiliation(s)
- Marisa Louridas
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Peter Szasz
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandra de Montbrun
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kenneth A Harris
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Teodor P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
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Louridas M, Szasz P, de Montbrun S, Harris KA, Grantcharov TP. Can We Predict Technical Aptitude?: A Systematic Review. Ann Surg 2016; 263:673-91. [PMID: 26079898 DOI: 10.1097/sla.0000000000001283] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To identify background characteristics and cognitive tests that may predict surgical trainees' future technical performance, and therefore be used to supplement existing surgical residency selection criteria. BACKGROUND Assessment of technical skills is not commonly incorporated as part of the selection process for surgical trainees in North America. Emerging evidence, however, suggests that not all trainees are capable of reaching technical competence. Therefore, incorporating technical aptitude into selection processes may prove useful. METHODS A systematic search was carried out of the MEDLINE, PsycINFO, and Embase online databases to identify all studies that assessed associations between surrogate markers of innate technical abilities in surgical trainees, and whether these abilities correlate with technical performance. The quality of each study was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation system. RESULTS A total of 8035 records were identified. After screening by title, abstract, and full text, 52 studies were included. Very few surrogate markers were found to predict technical performance. Significant associations with technical performance were seen for 1 of 23 participant-reported surrogate markers, 2 of 25 visual spatial tests, and 2 of 19 dexterity tests. The assessment of trainee Basic Performance Resources predicted technical performance in 62% and 75% of participants. CONCLUSIONS To date, no single test has been shown to reliably predict the technical performance of surgical trainees. Strategies that rely on assessing multiple innate abilities, their interaction, and their relationship with technical skill may ultimately be more likely to serve as reliable predictors of future surgical performance.
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Affiliation(s)
- Marisa Louridas
- *Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada †Division of General Surgery, St. Michael's Hospital, Toronto, Canada ‡Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
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Rahm S, Germann M, Hingsammer A, Wieser K, Gerber C. Validation of a virtual reality-based simulator for shoulder arthroscopy. Knee Surg Sports Traumatol Arthrosc 2016; 24:1730-7. [PMID: 26860098 DOI: 10.1007/s00167-016-4022-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 01/21/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE This study was to determine face and construct validity of a new virtual reality-based shoulder arthroscopy simulator which uses passive haptic feedback. METHODS Fifty-one participants including 25 novices (<20 shoulder arthroscopies) and 26 experts (>100 shoulder arthroscopies) completed two tests: for assessment of face validity, a questionnaire was filled out concerning quality of simulated reality and training potential using a 7-point Likert scale (range 1-7). Construct validity was tested by comparing simulator metrics (operation time in seconds, camera and grasper pathway in centimetre and grasper openings) between novices and experts test results. RESULTS Overall simulated reality was rated high with a median value of 5.5 (range 2.8-7) points. Training capacity scored a median value of 5.8 (range 3-7) points. Experts were significantly faster in the diagnostic test with a median of 91 (range 37-208) s than novices with 1177 (range 81-383) s (p < 0.0001) and in the therapeutic test 102 (range 58-283) s versus 229 (range 114-399) s (p < 0.0001). Similar results were seen in the other metric values except in the camera pathway in the therapeutic test. CONCLUSION The tested simulator achieved high scores in terms of realism and training capability. It reliably discriminated between novices and experts. Further improvements of the simulator, especially in the field of therapeutic arthroscopy, might improve its value as training and assessment tool for shoulder arthroscopy skills. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Stefan Rahm
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Marco Germann
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Andreas Hingsammer
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Karl Wieser
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christian Gerber
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Siska VB, Ann L, Gunter DW, Bart N, Willy L, Marlies S, Marc M. Surgical Skill: Trick or Trait? JOURNAL OF SURGICAL EDUCATION 2015; 72:1247-1253. [PMID: 26089161 DOI: 10.1016/j.jsurg.2015.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/30/2015] [Accepted: 05/06/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Among other indispensible qualities, a competent surgeon needs to be technically skilled. With the advent of minimally invasive procedures, technical demands on surgeons also increase. Will it be possible for all individuals to meet these technical demands through motivated practice or is there a trait such as "aptitude" that determines ultimate surgical skill? DESIGN Baseline laparoscopic psychomotor aptitude (on a box trainer), visual-spatial aptitude (Schlauch figures test), and interest in surgery (10-point Likert scale) were measured in our study group. Afterward, study participants attended a 3-hour hands-on laparoscopy training, followed by 2 additional weeks of voluntary practice for those who were motivated to do so. After these 2 weeks, participants were retested using the laparoscopic box trainer. SETTING All research was performed in the Center for Surgical Technologies, Leuven. PARTICIPANTS A total of 68 fifth-year medical students without prior experience in laparoscopy from the University of Leuven. RESULTS Multiple additive regression analysis showed significant effect for psychomotor aptitude (26%), interest in surgery (9%), and voluntary practice (18%) on final box trainer performance. No correlation was found between aptitude and interest in surgery (p = 0.27). No correlation was found between aptitude and amount of voluntary practice. High-aptitude students more frequently applied for surgical disciplines in their final career choice (50% vs 18%, p = 0.01). CONCLUSIONS This study shows that aptitude and motivated practice equally influence final box trainer performance. Students with lower aptitude do not automatically train more. Although the interest in surgery was initially not related to psychomotor aptitude, eventually students with high aptitude apply more frequently for a surgical career.
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Affiliation(s)
- Van Bruwaene Siska
- Center for Surgical Technologies, KU Leuven, Belgium; Department of Urology, University Hospitals Leuven, Belgium.
| | - Lissens Ann
- Center for Surgical Technologies, KU Leuven, Belgium
| | - De Win Gunter
- Center for Surgical Technologies, KU Leuven, Belgium; Department of Urology, University Hospitals Leuven, Belgium; Department of Urology, University Hospitals Antwerp, Belgium
| | - Neyrinck Bart
- Center of Motivational Psychology, KU Leuven, Belgium
| | - Lens Willy
- Center of Motivational Psychology, KU Leuven, Belgium
| | - Schijven Marlies
- Department of Surgery, Academic Medical Center Amsterdam, The Netherlands
| | - Miserez Marc
- Center for Surgical Technologies, KU Leuven, Belgium; Department of Abdominal Surgery, University Hospitals Leuven, Belgium
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Williamson JA, Hecker K, Yvorchuk K, Artemiou E, French H, Fuentealba C. Development and validation of a feline abdominal palpation model and scoring rubric. Vet Rec 2015. [DOI: 10.1136/vr.103212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J. A. Williamson
- Ross University School of Veterinary Medicine, P.O. Box 334, Basseterre, St. Kitts
- Lincoln Memorial University College of Veterinary Medicine; 6965 Cumberland Gap Pkwy Harrogate TN 37752 USA
| | - K. Hecker
- Faculty of Veterinary Medicine; University of Calgary; TRW 2D01, 3280 Hospital Drive NW Calgary Alberta Canada T2N 4Z6
| | - K. Yvorchuk
- Ross University School of Veterinary Medicine, P.O. Box 334, Basseterre, St. Kitts
| | - E. Artemiou
- Ross University School of Veterinary Medicine, P.O. Box 334, Basseterre, St. Kitts
| | - H. French
- Ross University School of Veterinary Medicine, P.O. Box 334, Basseterre, St. Kitts
| | - C. Fuentealba
- Ross University School of Veterinary Medicine, P.O. Box 334, Basseterre, St. Kitts
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Louridas M, Quinn LE, Grantcharov TP. Predictive value of background experiences and visual spatial ability testing on laparoscopic baseline performance among residents entering postgraduate surgical training. Surg Endosc 2015; 30:1126-33. [PMID: 26092028 DOI: 10.1007/s00464-015-4313-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Emerging evidence suggests that despite dedicated practice, not all surgical trainees have the ability to reach technical competency in minimally invasive techniques. While selecting residents that have the ability to reach technical competence is important, evidence to guide the incorporation of technical ability into selection processes is limited. Therefore, the purpose of the present study was to evaluate whether background experiences and 2D-3D visual spatial test results are predictive of baseline laparoscopic skill for the novice surgical trainee. METHODS First-year residents were studied. Demographic data and background surgical and non-surgical experiences were obtained using a questionnaire. Visual spatial ability was evaluated using the PicSOr, cube comparison (CC) and card rotation (CR) tests. Technical skill was assessed using the camera navigation (LCN) task and laparoscopic circle cut (LCC) task. Resident performance on these technical tasks was compared and correlated with the questionnaire and visual spatial findings. RESULTS Previous experience in observing laparoscopic procedures was associated with significantly better LCN performance, and experience in navigating the laparoscopic camera was associated with significantly better LCC task results. Residents who scored higher on the CC test demonstrated a more accurate LCN path length score (r s(PL) = -0.36, p = 0.03) and angle path (r s(AP) = -0.426, p = 0.01) score when completing the LCN task. No other significant correlations were found between the visual spatial tests (PicSOr, CC or CR) and LCC performance. CONCLUSION While identifying selection tests for incoming surgical trainees that predict technical skill performance is appealing, the surrogate markers evaluated correlate with specific metrics of surgical performance related to a single task but do not appear to reliably predict technical performance of different laparoscopic tasks. Predicting the acquisition of technical skills will require the development of a series of evidence-based tests that measure a number of innate abilities as well as their inherent interactions.
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Affiliation(s)
- Marisa Louridas
- University of Toronto, Toronto, ON, Canada. .,St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada.
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Fucentese SF, Rahm S, Wieser K, Spillmann J, Harders M, Koch PP. Evaluation of a virtual-reality-based simulator using passive haptic feedback for knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 2015; 23:1077-85. [PMID: 24519617 DOI: 10.1007/s00167-014-2888-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this work is to determine face validity and construct validity of a new virtual-reality-based simulator for diagnostic and therapeutic knee arthroscopy. METHODS The study tests a novel arthroscopic simulator based on passive haptics. Sixty-eight participants were grouped into novices, intermediates, and experts. All participants completed two exercises. In order to establish face validity, all participants filled out a questionnaire concerning different aspects of simulator realism, training capacity, and different statements using a seven-point Likert scale (range 1-7). Construct validity was tested by comparing various simulator metric values between novices and experts. RESULTS Face validity could be established: overall realism was rated with a mean value of 5.5 points. Global training capacity scored a mean value of 5.9. Participants considered the simulator as useful for procedural training of diagnostic and therapeutic arthroscopy. In the foreign body removal exercise, experts were overall significantly faster in the whole procedure (6 min 24 s vs. 8 min 24 s, p < 0.001), took less time to complete the diagnostic tour (2 min 49 s vs. 3 min 32 s, p = 0.027), and had a shorter camera path length (186 vs. 246 cm, p = 0.006). CONCLUSION The simulator achieved high scores in terms of realism. It was regarded as a useful training tool, which is also capable of differentiating between varying levels of arthroscopic experience. Nevertheless, further improvements of the simulator especially in the field of therapeutic arthroscopy are desirable. In general, the findings support that virtual-reality-based simulation using passive haptics has the potential to complement conventional training of knee arthroscopy skills. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sandro F Fucentese
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Immersive training: breaking the bubble and measuring the heat. Surg Endosc 2014; 28:1545-54. [PMID: 24399519 DOI: 10.1007/s00464-013-3350-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Minimal access surgery and, lately, single-incision laparoscopic procedures are challenging and demanding with regard to the skills of the surgeon performing the procedures. This article presents the results of an investigation of the performance and attention focus of 21 medical interns and surgical residents training in an immersive context. That is, training 'in situation', representing more realistically the demands imposed on the surgeons during minimal access surgery. METHODS Twenty-one medical interns and surgical residents participated in simulation trainings in an integrated operating room for laparoscopic surgery. Various physiological measures of body heat expenditure were gathered as indicators of mental strain and attention focus. RESULTS The results of the Mann-Whitney test indicated that participants with a poor performance in the two laparoscopic cholecystectomy cases had a significantly (U = 3, p = 0.038) higher heat flux at the start of the procedure (mean 107.08, standard deviation [SD] 24.34) than those who excelled in the two cases (mean 62.64, SD 23.41). Also, the average frontal head temperature of the participants who failed at the task was significantly lower (mean 33.27, SD 0.52) than those who performed well (mean 33.92, SD 0.27). CONCLUSIONS Surgeons cannot operate in a bubble; thus, they should not be trained in one. Combining heat flux and frontal head temperature could be a good measure of deep involvement and attentional focus during performance of simulated surgical tasks.
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Abboudi H, Khan MS, Guru KA, Froghi S, de Win G, Van Poppel H, Dasgupta P, Ahmed K. Learning curves for urological procedures: a systematic review. BJU Int 2013; 114:617-29. [PMID: 24053179 DOI: 10.1111/bju.12315] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures. PATIENT AND METHODS The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011. Studies pertaining to learning curves of urological procedures were included. Two reviewers independently identified potentially relevant articles. Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed. RESULTS Forty-four studies described the learning curve for different urological procedures. The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases. The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number. Robot-assisted radical cystectomy has a documented learning curve of 16-30 cases, depending on which outcome variable is measured. Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs. CONCLUSIONS The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency. The complexities associated with defining procedural competence are vast. The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures.
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Affiliation(s)
- Hamid Abboudi
- MRC Centre for Transplantation, King's College London, King's Health Partners, Department of Urology, Guy's Hospital, London, UK
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Abstract
The introduction of minimally invasive surgery has demonstrated the need for training surgical skills outside the operating room using animal models or simulators. As laparoscopic surgery involves displaying images on a screen, virtual reality simulation of the surgical tasks is feasible. Different types of simulators have become available. The existing trainers can be divided into three groups: mechanical, hybrid, and virtual reality. This article aims at giving an overview of the different simulators available and the potential of simulators in the education of surgeons with focus on virtual reality simulators. All simulators aim at training psychomotoric skills and some simulators also allow training in decision-making and anatomical orientation. In the future virtual reality simulators may become a tool for training and validation of surgical skills and monitoring the training progress.
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Våpenstad C, Buzink SN. Procedural virtual reality simulation in minimally invasive surgery. Surg Endosc 2012; 27:364-77. [DOI: 10.1007/s00464-012-2503-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/19/2012] [Indexed: 12/16/2022]
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Selvander M, Åsman P. Virtual reality cataract surgery training: learning curves and concurrent validity. Acta Ophthalmol 2012; 90:412-7. [PMID: 21054818 DOI: 10.1111/j.1755-3768.2010.02028.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To investigate initial learning curves on a virtual reality (VR) eye surgery simulator and whether achieved skills are transferable between tasks. METHODS Thirty-five medical students were randomized to complete ten iterations on either the VR Caspulorhexis module (group A) or the Cataract navigation training module (group B) and then two iterations on the other module. Learning curves were compared between groups. The second Capsulorhexis video was saved and evaluated with the performance rating tool Objective Structured Assessment of Cataract Surgical Skill (OSACSS). The students' stereoacuity was examined. RESULTS Both groups demonstrated significant improvements in performance over the 10 iterations: group A for all parameters analysed including score (p < 0.0001), time (p < 0.0001) and corneal damage (p = 0.0003), group B for time (p < 0.0001), corneal damage (p < 0.0001) but not for score (p = 0.752). Training on one module did not improve performance on the other. Capsulorhexis score correlated significantly with evaluation of the videos using the OSACSS performance rating tool. For stereoacuity < and ≥120 seconds of arc, sum of both modules' second iteration score was 73.5 and 41.0, respectively (p = 0.062). CONCLUSION An initial rapid improvement in performance on a simulator with repeated practice was shown. For capsulorhexis, 10 iterations with only simulator feedback are not enough to reach a plateau for overall score. Skills transfer between modules was not found suggesting benefits from training on both modules. Stereoacuity may be of importance in the recruitment and training of new cataract surgeons. Additional studies are needed to investigate this further. Concurrent validity was found for Capsulorhexis module.
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Affiliation(s)
- Madeleine Selvander
- Department of Clinical Sciences, Lund University, Malmö: Ophthalmology, Sweden.
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Sadideen H, Kneebone R. Practical skills teaching in contemporary surgical education: how can educational theory be applied to promote effective learning? Am J Surg 2012; 204:396-401. [PMID: 22688108 DOI: 10.1016/j.amjsurg.2011.12.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/16/2011] [Accepted: 12/16/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND Teaching practical skills is a core component of undergraduate and postgraduate surgical education. It is crucial to optimize our current learning and teaching models, particularly in a climate of decreased clinical exposure. This review explores the role of educational theory in promoting effective learning in practical skills teaching. METHODS Peer-reviewed publications, books, and online resources from national bodies (eg, the UK General Medical Council) were reviewed. RESULTS This review highlights several aspects of surgical education, modeling them on current educational theory. These include the following: (1) acquisition and retention of motor skills (Miller's triangle; Fitts' and Posner's theory), (2) development of expertise after repeated practice and regular reinforcement (Ericsson's theory), (3) importance of the availability of expert assistance (Vygotsky's theory), (4) learning within communities of practice (Lave and Wenger's theory), (5) importance of feedback in learning practical skills (Boud, Schon, and Endes' theories), and (6) affective component of learning. CONCLUSIONS It is hoped that new approaches to practical skills teaching are designed in light of our understanding of educational theory.
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Affiliation(s)
- Hazim Sadideen
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, Praed St., Second Floor QEQM Wing, London W2 1NY, UK.
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Debes AJ, Aggarwal R, Balasundaram I, Jacobsen MB. Construction of an evidence-based, graduated training curriculum for D-box, a webcam-based laparoscopic basic skills trainer box. Am J Surg 2012; 203:768-75. [DOI: 10.1016/j.amjsurg.2011.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 07/18/2011] [Accepted: 07/18/2011] [Indexed: 01/22/2023]
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Pollard TCB, Khan T, Price AJ, Gill HS, Glyn-Jones S, Rees JL. Simulated hip arthroscopy skills: learning curves with the lateral and supine patient positions: a randomized trial. J Bone Joint Surg Am 2012; 94:e68. [PMID: 22617934 DOI: 10.2106/jbjs.k.00690] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hip arthroscopy can be performed with the patient in the lateral or supine position, but it remains technically demanding. We aimed to objectively quantify and compare learning curves between two groups of orthopaedic trainees randomized to learn simulated hip arthroscopy with the patient in either a lateral or a supine position. We also compared learning curves between senior and junior trainees. METHODS A hip arthroscopy simulator with anterolateral and anterior portals, a 70° arthroscope, and fixed distraction was used. Rotation of the simulator by 90° enabled arthroscopy with the patient in a supine or lateral position. Twenty orthopaedic trainees with minimal hip arthroscopy experience were randomized into lateral and supine position groups, and were asked to perform a diagnostic hip arthroscopy of the central compartment on twelve occasions. Each episode involved a change in the portal and repetition of the diagnostic round. A validated motion analysis system objectively measured surgical performance by recording time taken, total path-length of the hands, and number of hand movements. RESULTS Both groups demonstrated learning with objective improvement in all parameters (p < 0.001). Initially, the lateral group was significantly slower and more variable in their performance during the second diagnostic round, after portal exchange (p = 0.006). However, they achieved parity with the supine group in all parameters by nine episodes. During the first three episodes, the junior trainees performed significantly worse for the first diagnostic round (p = 0.005) but not for the second diagnostic round (p = 0.200), and they rapidly achieved parity with the senior trainees, performing at a similar level by the end of the study period. CONCLUSIONS Trainees with minimal experience with hip arthroscopy progressively learn and objectively improve their performance when using a hip simulator. Orientation after portal exchange is difficult for all trainees but particularly for those learning with a simulated patient lateral position. Trainees are likely to benefit from simulator training to learn orientation and basic competence prior to performing hip arthroscopy on patients.
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Affiliation(s)
- Thomas C B Pollard
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford and Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom.
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Palter VN, Graafland M, Schijven MP, Grantcharov TP. Designing a proficiency-based, content validated virtual reality curriculum for laparoscopic colorectal surgery: A Delphi approach. Surgery 2012; 151:391-7. [PMID: 22019340 DOI: 10.1016/j.surg.2011.08.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 08/04/2011] [Indexed: 11/24/2022]
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Intégration de la simulation dans la formation des internes en chirurgie. Programme pédagogique du centre de simulation médicale de la faculté de médecine de Nice. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.jchirv.2011.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bréaud J, Chevallier D, Benizri E, Fournier JP, Carles M, Delotte J, Venissac N, Myx A, Ianelli A, Levraut J, Jones D, Benchimol D. The place of simulation in the surgical resident curriculum. The pedagogic program of the Nice Medical School Simulation Center. J Visc Surg 2012; 149:e52-60. [PMID: 22285517 DOI: 10.1016/j.jviscsurg.2011.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Surgical training relies on medical school lectures, practical training in patient care and in the operating room including instruction in anatomy and experimental surgery. Training with different techniques of simulators can complete this. Simulator-based training, widely used in North America, can be applied to several aspects of surgical training without any risk for patients: technical skills in both open and laparoscopic surgery, the notion of teamwork and the multidisciplinary management of acute medicosurgical situations. METHOD We present the curriculum developed in the Simulation Center of the Medical School of Nice Sophia-Antipolis. All residents in training at the Medical School participate in this curriculum. RESULTS Each medical student is required to pursue theoretical training (familiarization with the operating room check-list), training in patient management using a high fidelity mannequin for various medical and surgical scenarios and training in technical gestures in open and laparoscopic surgery over a 2-year period, followed by an examination to validate all technical aptitudes. This curriculum has been approved and accredited by the prestigious American College of Surgeons, making this the first of its kind in France. CONCLUSION As such, it should be considered as a model and, in accordance to the wishes of the French Surgical Academy, the first step toward the creation of true schools of surgery.
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Affiliation(s)
- J Bréaud
- Centre de simulation médicale, faculté de médecine de Nice, université de Nice Sophia-Antipolis, France.
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van Empel PJ, van der Veer WM, van Rijssen LB, Cuesta MA, Scheele F, Bonjer HJ, Meijerink WJ. Mapping the maze of minimally invasive surgery simulators. J Laparoendosc Adv Surg Tech A 2011; 22:51-60. [PMID: 22145607 DOI: 10.1089/lap.2010.0467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Conforming to, among other considerations, legal and ethical concerns for patient safety, there is an increasing demand to assess a surgeon's skills prior to performance in the operating room in pursuit of higher-quality treatment. Training in minimally invasive surgery (MIS) must therefore be intensified, including team training. New methods to train and assess minimally invasive surgical skills are gaining interest. The goal of this review is to provide instructors with an overview of available MIS training tools. In this review, we discuss currently available simulators for MIS training. Applicability, validity, and construction of simulators are reviewed. Also, some of the leading training programs and assessment methods in MIS are reviewed. METHODS A literature search was performed on studies evaluating surgical task performance on a simulator, reviewing satisfaction with laparoscopic training programs, or validating simulators or assessment methods. RESULTS Simulators may be divided into simple box trainers and computer-based systems, such as virtual and augmented simulators. All have advantages and disadvantages. An overview is provided of currently available training systems, validity, trainee assessment, and the importance of training programs in MIS. CONCLUSIONS No simulator yet provides the ability to train the entire set of required psychomotor skills or procedures for MIS. A multiyear training program combining various simulators for multiple-level training, including team training, should be constructed.
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Affiliation(s)
- Pieter J van Empel
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
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Alvand A, Auplish S, Khan T, Gill HS, Rees JL. Identifying orthopaedic surgeons of the future. ACTA ACUST UNITED AC 2011; 93:1586-91. [DOI: 10.1302/0301-620x.93b12.27946] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this study was to investigate the effect of training on the arthroscopic performance of a group of medical students and to determine whether all students could be trained to competence. Thirty-three medical students with no previous experience of arthroscopy were randomised to a ‘Trained’ or an ‘Untrained’ cohort. They were required to carry out 30 episodes of two simulated arthroscopic tasks (one shoulder and one knee). The primary outcome variable was task success at each episode. Individuals achieved competence when their learning curve stabilised. The secondary outcome was technical dexterity, assessed objectively using a validated motion analysis system. Six subjects in the ‘Untrained’ cohort failed to achieve competence in the shoulder task, compared with one in the ‘Trained’ cohort. During the knee task, two subjects in each cohort failed to achieve competence. Based on the objective motion analysis parameters, the ‘Trained’ cohort performed better on the shoulder task (p < 0.05) but there was no significant difference for the knee task (p > 0.05). Although specific training improved the arthroscopic performance of novices, there were individuals who could not achieve competence despite focused training.These findings may have an impact on the selection process for trainees and influence individual career choices.
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Affiliation(s)
- A. Alvand
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, NIHR Biomedical
Research Unit, University of Oxford, Windmill
Road, Oxford OX3 7LD, UK
| | - S. Auplish
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, NIHR Biomedical
Research Unit, University of Oxford, Windmill
Road, Oxford OX3 7LD, UK
| | - T. Khan
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, NIHR Biomedical
Research Unit, University of Oxford, Windmill
Road, Oxford OX3 7LD, UK
| | - H. S. Gill
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, NIHR Biomedical
Research Unit, University of Oxford, Windmill
Road, Oxford OX3 7LD, UK
| | - J. L. Rees
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, NIHR Biomedical
Research Unit, University of Oxford, Windmill
Road, Oxford OX3 7LD, UK
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Performance curve of basic skills in single-incision laparoscopy versus conventional laparoscopy: is it really more difficult for the novice? Surg Endosc 2011; 26:1231-7. [PMID: 22101419 PMCID: PMC3327835 DOI: 10.1007/s00464-011-2041-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 10/20/2011] [Indexed: 10/25/2022]
Abstract
BACKGROUND Single-incision laparoscopy is a step forward toward nearly scarless surgery. Concern has been raised that single-incision laparoscopy is technically more challenging than conventional laparoscopy. This study researched the performance curves of novice trainees for single-incision laparoscopy (SILS) versus conventional laparoscopy for performing two basic tasks on a box trainer. METHODS In this study, 20 novice participants performed two tasks (peg transfer and a dissection task) on a standard box trainer. All the participants practiced each task 11 times and were randomized in two groups. The first group performed the tasks on a box trainer through three incisions. The second group used a single-incision access with the same box trainer. The assessment scores for errors and time were recorded. The 2nd, 8th, and 11th runs of both tasks in both settings were assessed to objectify the gain in basic laparoscopic skills. RESULTS The performance curves for both groups improved significantly in terms of both time and errors in performing the two tasks [P < 0.01, analysis of variance (ANOVA)]. For the first task, no significant difference in time between the two groups was observed at the top of the performance curve (mean, 212 ± 64 vs. 182 ± 48 s), but the SILS group performed with fewer errors (1.3 ± 1.5 vs. 2.7 ± 2.11). However, the difference was not significant (P = 0.10). The dissection task was performed faster in the SILS group (mean, 205 ± 78 vs. 243 ± 40 s; P = 0, 18) with fewer errors (0.7 ± 1.05 vs. 1.9 ± 2.1; P = 0. 12), but the difference was not significant. CONCLUSION This study showed a significant improvement in basic skills for both the SILS and conventional laparoscopy settings after 11 repetitions. These data suggest that box training shows no significant difference between conventional laparoscopic and single-incision laparoscopic settings in terms of error or time in performing basic tasks at a low complexity level for the novice. These data also show significant improvement in basic skills over a relatively short period.
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Schreuder HWR, Oei G, Maas M, Borleffs JCC, Schijven MP. Implementation of simulation in surgical practice: minimally invasive surgery has taken the lead: the Dutch experience. MEDICAL TEACHER 2011; 33:105-115. [PMID: 21275542 DOI: 10.3109/0142159x.2011.550967] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Minimal invasive techniques are rapidly becoming standard surgical techniques for many surgical procedures. To develop the skills necessary to apply these techniques, box trainers and/or inanimate models may be used, but these trainers lack the possibility of inherent objective classification of results. In the past decade, virtual reality (VR) trainers were introduced for training minimal invasive techniques. Minimally invasive surgery (MIS) is, by nature, very suitable for this type of training. The specific psychomotor skills and eye-hand coordination needed for MIS can be mastered largely using VR simulation techniques. It is also possible to transfer skills learned on a simulator to real operations, resulting in error reduction and shortening of procedural operating time. The authors aim to enlighten the process of gaining acceptance in the Netherlands for novel training techniques. The Dutch Societies of Surgery, Obstetrics and Gynecology, and Urology each developed individual training curricula for MIS using simulation techniques, to be implemented in daily practice. The ultimate goal is to improve patient safety. The authors outline the opinions of actors involved, such as different simulators, surgical trainees, surgeons, surgical societies, hospital boards, government, and the public. The actual implementation of nationwide training curricula for MIS is, however, a challenging step.
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Affiliation(s)
- Henk W R Schreuder
- ivision of Women and Baby, Department of Gynecologic Surgery and Oncology, University Medical Centre Utrecht, PO Box 85500, Room F05-126, 3508 GA, Utrecht, The Netherlands.
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European consensus on a competency-based virtual reality training program for basic endoscopic surgical psychomotor skills. Surg Endosc 2010; 25:166-71. [PMID: 20574856 DOI: 10.1007/s00464-010-1151-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 05/18/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Virtual reality (VR) simulators have been demonstrated to improve basic psychomotor skills in endoscopic surgery. The exercise configuration settings used for validation in studies published so far are default settings or are based on the personal choice of the tutors. The purpose of this study was to establish consensus on exercise configurations and on a validated training program for a virtual reality simulator, based on the experience of international experts to set criterion levels to construct a proficiency-based training program. METHODS A consensus meeting was held with eight European teams, all extensively experienced in using the VR simulator. Construct validity of the training program was tested by 20 experts and 60 novices. The data were analyzed by using the t test for equality of means. RESULTS Consensus was achieved on training designs, exercise configuration, and examination. Almost all exercises (7/8) showed construct validity. In total, 50 of 94 parameters (53%) showed significant difference. CONCLUSIONS A European, multicenter, validated, training program was constructed according to the general consensus of a large international team with extended experience in virtual reality simulation. Therefore, a proficiency-based training program can be offered to training centers that use this simulator for training in basic psychomotor skills in endoscopic surgery.
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Cromwell J, McCall N, Dalton K, Braun P. Missing Productivity Gains in the Medicare Physician Fee Schedule: Where Are They? Med Care Res Rev 2010; 67:676-93. [DOI: 10.1177/1077558710371115] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Medicare Fee Schedule with payments for thousands of visits and procedures is updated periodically for the work component of changes in physician relative work. Three 5-year reviews of physician work by Medicare have been biased against finding productivity gains and reductions in physician work relative values. The authors present four studies showing shorter physician times with patients in their offices and in the operating room, increases in surgeons’ self-reported total work in spite of declining operating room times, and growing numbers of costly handoffs to nonsurgeons, while surgeons receive full payment for postoperative follow-up with patients. Substantial savings exist in the fee schedule if productivity gains from greater delegation to ancillary staff and specialists, reengineering of services, and rapid learning by experience with new technologies were integrated into the periodic reviews.
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Affiliation(s)
- Jerry Cromwell
- Research Triangle Institute, Research Triangle Park, NC,
| | - Nancy McCall
- Research Triangle Institute, Research Triangle Park, NC
| | | | - Peter Braun
- Research Triangle Institute, Research Triangle Park, NC
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Schout BM, Muijtjens AM, Hendrikx AJ, Ananias HJ, Dolmans VE, Scherpbier AJ, Bemelmans BL. Acquisition of flexible cystoscopy skills on a virtual reality simulator by experts and novices. BJU Int 2010; 105:234-9. [DOI: 10.1111/j.1464-410x.2009.08733.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Do absorption and realistic distraction influence performance of component task surgical procedure? Surg Endosc 2009; 24:902-7. [PMID: 19789922 PMCID: PMC2846274 DOI: 10.1007/s00464-009-0689-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 08/10/2009] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgeons perform complex tasks while exposed to multiple distracting sources that may increase stress in the operating room (e.g., music, conversation, and unadapted use of sophisticated technologies). This study aimed to examine whether such realistic social and technological distracting conditions may influence surgical performance. METHODS Twelve medical interns performed a laparoscopic cholecystectomy task with the Xitact LC 3.0 virtual reality simulator under distracting conditions (exposure to music, conversation, and nonoptimal handling of the laparoscope) versus nondistracting conditions (control condition) as part of a 2 x 2 within-subject experimental design. RESULTS Under distracting conditions, the medical interns showed a significant decline in task performance (overall task score, task errors, and operating time) and significantly increased levels of irritation toward both the assistant handling the laparoscope in a nonoptimal way and the sources of social distraction. Furthermore, individual differences in cognitive style (i.e., cognitive absorption and need for cognition) significantly influenced the levels of irritation experienced by the medical interns. CONCLUSION The results suggest careful evaluation of the social and technological sources of distraction in the operation room to reduce irritation for the surgeon and provision of proper preclinical laparoscope navigation training to increase security for the patient.
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Schout BMA, Hendrikx AJM, Scheele F, Bemelmans BLH, Scherpbier AJJA. Validation and implementation of surgical simulators: a critical review of present, past, and future. Surg Endosc 2009; 24:536-46. [PMID: 19633886 PMCID: PMC2821618 DOI: 10.1007/s00464-009-0634-9] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 05/31/2009] [Accepted: 06/26/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the past 20 years the surgical simulator market has seen substantial growth. Simulators are useful for teaching surgical skills effectively and with minimal harm and discomfort to patients. Before a simulator can be integrated into an educational program, it is recommended that its validity be determined. This study aims to provide a critical review of the literature and the main experiences and efforts relating to the validation of simulators during the last two decades. METHODS Subjective and objective validity studies between 1980 and 2008 were identified by searches in Pubmed, Cochrane, and Web of Science. RESULTS Although several papers have described definitions of various subjective types of validity, the literature does not offer any general guidelines concerning methods, settings, and data interpretation. Objective validation studies on endourological simulators were mainly characterized by a large variety of methods and parameters used to assess validity and in the definition and identification of expert and novice levels of performance. CONCLUSION Validity research is hampered by a paucity of widely accepted definitions and measurement methods of validity. It would be helpful to those considering the use of simulators in training programs if there were consensus on guidelines for validating surgical simulators and the development of training programs. Before undertaking a study to validate a simulator, researchers would be well advised to conduct a training needs analysis (TNA) to evaluate the existing need for training and to determine program requirements in a training program design (TPD), methods that are also used by designers of military simulation programs. Development and validation of training models should be based on a multidisciplinary approach involving specialists (teachers), residents (learners), educationalists (teaching the teachers), and industrial designers (providers of teaching facilities). In addition to technical skills, attention should be paid to contextual, interpersonal, and task-related factors.
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Affiliation(s)
- B M A Schout
- Department of Urology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.
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Establishing construct validity of a virtual-reality training simulator for hysteroscopy via a multimetric scoring system. Surg Endosc 2009; 24:79-88. [DOI: 10.1007/s00464-009-0582-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 04/25/2009] [Indexed: 01/22/2023]
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Howells NR, Auplish S, Hand GC, Gill HS, Carr AJ, Rees JL. Retention of arthroscopic shoulder skills learned with use of a simulator. Demonstration of a learning curve and loss of performance level after a time delay. J Bone Joint Surg Am 2009; 91:1207-13. [PMID: 19411470 DOI: 10.2106/jbjs.h.00509] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In orthopaedic surgery, arthroscopy is an irreplaceable diagnostic and interventional tool, and its breadth of use is increasing. The aim of this study was to investigate the surgeon's capacity for retention of an unfamiliar arthroscopic skill. METHODS Six fellowship-trained lower-limb surgeons were given standardized instruction regarding the performance of an arthroscopic Bankart suture on a laboratory-based simulator. They performed three single Bankart sutures on each of four occasions, one to two weeks apart. Six months later, the same surgeons repeated the study. They received no further instruction or guidance. Their performance was objectively assessed with use of validated motion-analysis equipment to record the total path length of the surgeon's hands, number of hand movements, and time taken to perform the sutures. RESULTS A learning curve showing significant and objective improvement in performance was demonstrated for all outcome parameters in both experiments (p < 0.005). The learning curve at six months was a repeated learning curve showing no significant difference from the initial learning curve. CONCLUSIONS This study objectively demonstrated a loss of all of the initial improvement in the performance of an arthroscopic Bankart suture following a six-month interval in which the surgeons did not do the procedure.
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Affiliation(s)
- N R Howells
- Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom
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Grantcharov TP, Reznick RK. Training tomorrow’s surgeons: what are we looking for and how can we achieve it? ANZ J Surg 2009; 79:104-7. [DOI: 10.1111/j.1445-2197.2008.04823.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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