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Feenstra TM, van der Storm SL, Barsom EZ, Bonjer JH, Nieveen van Dijkum EJ, Schijven MP. Which, how, and what? Using digital tools to train surgical skills; a systematic review and meta-analysis. Surg Open Sci 2023; 16:100-110. [PMID: 37830074 PMCID: PMC10565595 DOI: 10.1016/j.sopen.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
Background Digital tools like digital box trainers and VR seem promising in delivering safe and tailored practice opportunities outside of the surgical clinic, yet understanding their efficacy and limitations is essential. This study investigated Which digital tools are available to train surgical skills, How these tools are used, How effective they are, and What skills they are intended to teach. Methods Medline, Embase, and Cochrane libraries were systematically reviewed for randomized trials, evaluating digital skill-training tools based on objective outcomes (skills scores and completion time) in surgical residents. Digital tools effectiveness were compared against controls, wet/dry lab training, and other digital tools. Tool and training factors subgroups were analysed, and studies were assessed on their primary outcomes: technical and/or non-technical. Results The 33 included studies involved 927 residents and six digital tools; digital box trainers, (immersive) virtual reality (VR) trainers, robot surgery trainers, coaching and feedback, and serious games. Digital tools outperformed controls in skill scores (SMD 1.66 [1.06, 2.25], P < 0.00001, I2 = 83 %) and completion time (SMD -1.05 [-1.72, -0.38], P = 0.0001, I2 = 71 %). There were no significant differences between digital tools and lab training, between tools, or in other subgroups. Only two studies focussed on non-technical skills. Conclusion While the efficacy of digital tools in enhancing technical surgical skills is evident - especially for VR-trainers -, there is a lack of evidence regarding non-technical skills, and need to improve methodological robustness of research on new (digital) tools before they are implemented in curricula. Key message This study provides critical insight into the increasing presence of digital tools in surgical training, demonstrating their usefulness while identifying current challenges, especially regarding methodological robustness and inattention to non-technical skills.
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Affiliation(s)
- Tim M. Feenstra
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Sebastiaan L. van der Storm
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Esther Z. Barsom
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
| | - Jaap H. Bonjer
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Els J.M. Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
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Operative Coaching for General Surgery Residents: Review of Implementation Requirements. J Am Coll Surg 2022; 235:361-369. [PMID: 35839415 DOI: 10.1097/xcs.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Operative coaching offers a unique opportunity to strengthen surgery residents' skill sets and practice readiness. However, institutional organizational capacity may influence the ability to successfully implement and sustain a coaching program. This review concentrates on the implementation requirements as they relate to institutional organizational capacity to help evaluate and determine if adopting such a coaching model is feasible. We searched English-language, peer-reviewed articles concerning operative coaching of general surgery residents between 2000 and 2020 with the MEDLINE database. The abstracts of 267 identified articles were further screened based on the presence of 2 inclusion criteria: general surgery residents and operative coaching. Then we summarized the reported implementation requirements. Findings revealed the implementation requirements (ie people, processes, technology/support resources, physical resources, and organizational systems) of 3 major types of resident operative coaching models were different. Video-assisted coaching faces the most barriers to implementation followed by video-based coaching; in-person coaching encounters the least barriers. Six questions are generated helping residency education leaders assess their readiness for an operative coaching program. Evaluation of the implementation requirements of a desired coaching program using the 5 organizational capacity elements is recommended to ensure the residency's ability to achieve a successful and sustainable program.
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Unsupervised feature disentanglement for video retrieval in minimally invasive surgery. Med Image Anal 2021; 75:102296. [PMID: 34781159 DOI: 10.1016/j.media.2021.102296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022]
Abstract
In this paper, we propose a novel method of Unsupervised Disentanglement of Scene and Motion (UDSM) representations for minimally invasive surgery video retrieval within large databases, which has the potential to advance intelligent and efficient surgical teaching systems. To extract more discriminative video representations, two designed encoders with a triplet ranking loss and an adversarial learning mechanism are established to respectively capture the spatial and temporal information for achieving disentangled features from each frame with promising interpretability. In addition, the long-range temporal dependencies are improved in an integrated video level using a temporal aggregation module and then a set of compact binary codes that carries representative features is yielded to realize fast retrieval. The entire framework is trained in an unsupervised scheme, i.e., purely learning from raw surgical videos without using any annotation. We construct two large-scale minimally invasive surgery video datasets based on the public dataset Cholec80 and our in-house dataset of laparoscopic hysterectomy, to establish the learning process and validate the effectiveness of our proposed method qualitatively and quantitatively on the surgical video retrieval task. Extensive experiments show that our approach significantly outperforms the state-of-the-art video retrieval methods on both datasets, revealing a promising future for injecting intelligence in the next generation of surgical teaching systems.
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Kaulfuss JC, Kluth LA, Marks P, Grange P, Fisch M, Chun FKH, Meyer CP. Long-Term Effects of Mental Training on Manual and Cognitive Skills in Surgical Education - A Prospective Study. JOURNAL OF SURGICAL EDUCATION 2021; 78:1216-1226. [PMID: 33257297 DOI: 10.1016/j.jsurg.2020.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/24/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Limited training opportunities and expanding requirements are challenging surgical education, calling for alternative training methods like simulation or mental training. The aim of this study is to evaluate short- and long-term effects of a structured mental training on surgical performance. DESIGN Medical students without laparoscopic experience were randomly assigned to 3 groups: (1) control (2) video training, and (3) video plus mental training performing 2 E-BLUS (European Training in Basic Laparoscopic Urological Skills) exercises, "peg transfer" (PT) and "cutting a circle" (CC). Group 3 performed a structured mental training course (identification of procedural key steps, relaxation, mental vocalization, and imaging). Longitudinal assessment including binominal checklists, global rating scales (GRS), procedural times, and Test of Performance Strategies (TOPS) were performed at baseline, day 2, 14, and after 16 months. Statistical analysis included ANOVA and general linear models with repeated measures. SETTING The study was conducted in "Olympus Training and Education Center Hamburg West" and "Endo Club Academy" at the University Medical Center Hamburg-Eppendorf. PARTICIPANTS Participants were eligible if they were medical students with no experience in laparoscopy. 24 participants were recruited and finished the study. RESULTS The mental training group maintained significantly better GRS scores at 16 months for PT (mean score 24.6 [95% CI: 21-28.25]) and CC (mean score 22.5 [18.4-26.6]) (both p < 0.01) and performed faster in the latter (261 seconds [Std. Dev 116] vs. 427 seconds [SD 132] vs. 368 seconds [SD 78]) compared to the other groups (p = 0.004). Longitudinally, mental training had a significant effect on TOPS scores and procedural times (p < 0.001 and p = 0.005, respectively). CONCLUSION In addition to short time efficacy, our study is the first to ascertain a positive long-term effect of mental training on manual and cognitive skills and might be a useful and cost-effective tool in surgical education.
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Affiliation(s)
- Julia C Kaulfuss
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Luis A Kluth
- Department of Urology, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K H Chun
- Department of Urology, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Al-Zain AO, Al-Osaimi TM. Effectiveness of Using an Instructional Video in Teaching Light-Curing Technique. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:289-302. [PMID: 33824613 PMCID: PMC8018569 DOI: 10.2147/amep.s298556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 05/14/2023]
Abstract
PURPOSE To investigate dental students' ability to deliver satisfactory amounts of irradiance and radiant exposure to simulated cavities by teaching the light-curing technique using instructional video compared to verbal instructions. METHODS Students attended the didactic light-curing lecture explaining the light-curing technique. Participants were divided into two groups (n=60). Each participant light-cured a class III and a class I simulated cavities with sensors built-in a Managing Accurate Resin Curing-Patient Simulator (MARC-PS) system, using a multiple-emission-peak light-emitting-diode unit. Each student either 1) watched an instructional video (V) showing the light-curing technique, or 2) received individual verbal instruction (I). The light-curing performance, in terms of the mean irradiance and radiant exposure, was recorded. Each student performed light-curing again on the simulated cavities. Students' feedback for the corresponding teaching method was collected. Comparisons between before and after each instructional method were analyzed using the Wilcoxon signed-rank test. Comparisons between both instructional methods were analyzed using a Mann-Whitney U-test (α=0.05). RESULTS The students' light-curing performance improved after both methods, as observed on the MARC-PS laptop monitor. The mean irradiance values were anterior-V=1280.6 (183.2), anterior-I=1318.0 (143.5), posterior-V=1337.5 (181.1), posterior-I=1317.6 (248.2) mW/cm2. The mean radiant exposure values were for anterior-V=13.5 (2.7), anterior-I=13.3 (1.6), posterior-V=13.7 (1.9), posterior-I=13.7 (2.5) J/cm2. No significant difference was found between both instruction methods. Students reported that each method was effective. CONCLUSION Using V was comparable to I and an effective tool for teaching the light-curing technique per the students' ability to deliver sufficient amounts of irradiance and radiant exposure to simulated cavities.
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Affiliation(s)
- Afnan O Al-Zain
- Restorative Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Correspondence: Afnan O Al-Zain Restorative Dentistry Department, King Abdulaziz University Faculty of Dentistry, P.O. Box 80209, Jeddah, 21589, Saudi ArabiaTel +966539116467Fax +9666403316 Email
| | - Tasneem M Al-Osaimi
- Restorative Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Vaidya A, Aydin A, Ridgley J, Raison N, Dasgupta P, Ahmed K. Current Status of Technical Skills Assessment Tools in Surgery: A Systematic Review. J Surg Res 2020; 246:342-378. [DOI: 10.1016/j.jss.2019.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/29/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022]
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Augestad KM, Butt K, Ignjatovic D, Keller DS, Kiran R. Video-based coaching in surgical education: a systematic review and meta-analysis. Surg Endosc 2019; 34:521-535. [PMID: 31748927 DOI: 10.1007/s00464-019-07265-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/12/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the era of competency-based surgical education, VBC has gained increased attention and may enhance the efficacy of surgical education. The objective of this systematic review was to summarize the existing evidence of video-based coaching (VBC) and compare VBC to traditional master-apprentice-based surgical education. METHODS We performed a systematic review and meta-analysis of randomized controlled trials (RCT) assessing VBC according to the PRISMA and Cochrane guidelines. The MEDLINE, EMBASE, and COCHRANE and Researchgate databases were searched for eligible manuscripts. Standard mean difference (SMD) of performance scoring scales was used to assess the effect of VBC versus traditional training without VBC (control). RESULTS Of 627 studies identified, 24 RCTs were eligible and evaluated. The studies included 778 surgical trainees (n = 386 VBC vs. n = 392 control). 13 performance scoring scales were used to assess technical competence; OSATS-GRS was the most common (n = 15). VBC was provided preoperative (n = 11), intraoperative (n = 1), postoperative (n = 10), and perioperative (n = 2). The majority of studies were unstructured, where identified coaching frameworks were PRACTICE (n = 1), GROW (n = 2) and Wisconsin Coaching Framework (n = 1). There was an effect on performance scoring scales in favor of VBC coaching (SMD 0.87, p < 0.001). In subgroup analyses, the residents had a larger relative effect (SMD 1.13; 0.61-1.65, p < 0.001) of VBC compared to medical students (SMD 0.43, 0.06-0.81, p < 0.001). The greatest source of potential bias was absence of blinding of the participants and personnel (n = 20). CONCLUSION Video-based coaching increases technical performance of medical students and surgical residents. There exist significant study and intervention heterogeneity that warrants further exploration, showing the need to structure and standardize video-based coaching tools.
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Affiliation(s)
- Knut Magne Augestad
- Department of Postgraduate Surgical Education, University Hospital North Norway, Tromsö, Norway. .,Department of GI Surgery, Sandnessjøen Regional Hospital, Sandnessjøen, Norway. .,Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA.
| | - Khayam Butt
- Department of GI Surgery, Nordlandssykehuset, Bodø, Norway
| | - Dejan Ignjatovic
- Department of GI Surgery, Akershus University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Deborah S Keller
- Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ravi Kiran
- Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
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What Is a Good Teaching Video? Results of an Online International Survey. J Minim Invasive Gynecol 2019; 27:738-747. [PMID: 31233782 DOI: 10.1016/j.jmig.2019.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/18/2019] [Accepted: 05/22/2019] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To analyze surgeon views on criteria for a good teaching video with the aim of determining guidelines. DESIGN An online international survey using a self-developed questionnaire. SETTING A French university tertiary care hospital. PATIENTS Three hundred eighty-eight participants answered an online questionnaire (154 women [40.53%] and 226 men [59.47%]). INTERVENTIONS A questionnaire on the criteria for a good quality teaching surgery video was developed by our team and communicated via an online link. MEASUREMENTS AND MAIN RESULTS The responses of 388 respondents were analyzed and highlighted the pedagogical benefits of teaching videos. The video duration may vary according to the type of media or surgical procedure but should not exceed 10 to 15 minutes for complex procedures. Providing information on the surgical setup (body mass index of the patient, Trendelenburg position degree, pressure of pneumoperitoneum, etc.) is essential. Surgical videos should be reviewed and divided into clearly defined steps with continued access to the entire nonmodified video for reviewers and be accessible on both educational and open platforms. Patient consent and relevant information should be made available. Reviews should include "bad procedure" videos, which are highly appreciated, especially by young surgeons. CONCLUSION The many advantages of the video format, including availability and rising popularity, provide an opportunity to reinforce and complement current surgical teaching. To optimize use of this surgical teaching tool, standardization, updating, and ease of access of surgical videos should be promoted.
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Shi G, Lee S, Yuen Y, Liu J, Rothman Z, Milaire P, Gillis S, Henri-Bhargava A. 12 Tips for Creating High Impact Clinical Encounter Videos - with Technical Pointers. MEDEDPUBLISH 2019; 8:92. [PMID: 38089391 PMCID: PMC10712636 DOI: 10.15694/mep.2019.000092.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Videos are increasingly used in medical education. They are effective for teaching difficult-to-grasp concepts that rely heavily on visuospatial processing ability such as anatomy, surgical procedures, and physical exam maneuvers. Common pitfalls of existing videos include lackluster audiovisual quality, poor camera angles, absence of formal teaching as narration, or excessive length. This article serves to assist educators who wish to produce educational clinical encounter videos that maximize student learning. We detail 12 tips focused on improving the quality of clinical educational videos, mitigating cognitive load within a video, and understanding the technicalities of video production. These tips are based on review of existing literature on neurocognitive learning theories and the succeeding Cognitive Theory of Multimedia Learning (CTML), as well as our experience in producing educational videos.
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Affiliation(s)
- Ge Shi
- University of British Columbia
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Miller KA, Monuteaux MC, Aftab S, Lynn A, Hillier D, Nagler J. A Randomized Controlled Trial of a Video-Enhanced Advanced Airway Curriculum for Pediatric Residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1858-1864. [PMID: 30095451 DOI: 10.1097/acm.0000000000002392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Pediatric advanced airway management is a low-frequency but critical procedure, making it challenging for trainees to learn. This study examined the impact of a curriculum integrating prerecorded videos of patient endotracheal intubations on performance related to simulated pediatric intubation. METHOD The authors conducted a randomized controlled educational trial for pediatric residents between January 2015 and June 2016 at Boston Children's Hospital. Investigators collecting data were blinded to the intervention. The control group received a standard didactic curriculum including still images, followed by simulation on airway trainers. The intervention group received a video-enhanced didactic curriculum including deidentified intubation clips recorded using a videolaryngoscope, followed by simulation. The study assessed intubation skills on simulated infant and pediatric airway scenarios of varying difficulty immediately after instruction and at three months. RESULTS Forty-nine trainees completed the curriculum: 23 received the video-enhanced curriculum and 26 received the standard curriculum. Median time to successful intubation was 18.5 and 22 seconds in the video-enhanced and standard groups, respectively. Controlling for mannequin age and difficulty, residents receiving the video-enhanced curriculum successfully intubated faster (hazard ratio [95% confidence interval]: 1.65 [1.25, 2.19]). Video-enhanced curriculum participants also demonstrated decreased odds of requiring multiple attempts and of esophageal intubation. At three-month follow-up, residents who received the video-enhanced curriculum remained faster at intubation (hazard ratio [95% confidence interval]: 1.93 [1.23, 3.02]). CONCLUSIONS Integrating videos of patient intubations into an airway management curriculum improved participating pediatric residents' intubation performance on airway trainers with sustained improvement at three months.
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Affiliation(s)
- Kelsey A Miller
- K.A. Miller is a fellow, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts. M.C. Monuteaux is senior epidemiologist and biostatistician, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts. S. Aftab is director, Fetal Care Center, Nicklaus Children's Hospital, Miami, Florida. A. Lynn is a medical student, Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona. D. Hillier is staff physician, Intermediate Care Program, Boston Children's Hospital, Boston, Massachusetts. J. Nagler is associate physician, Division of Emergency Medicine, and director, Pediatric Emergency Medicine Fellowship, Boston Children's Hospital, Boston, Massachusetts
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Green JL, Suresh V, Bittar P, Ledbetter L, Mithani SK, Allori A. The Utilization of Video Technology in Surgical Education: A Systematic Review. J Surg Res 2018; 235:171-180. [PMID: 30691792 DOI: 10.1016/j.jss.2018.09.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/05/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of surgical video has great potential to enhance surgical education, but there exists limited information about how to effectively use surgical videos. We performed a systematic review of video technology in surgical training and provided evidence-based recommendations for its effective use. MATERIALS AND METHODS A systematic review of literature on surgical video in residency education was conducted. All articles meeting inclusion criteria were evaluated for technical characteristics pertaining to video usage. Included studies were critically appraised using a quality-scoring system. Recommendations were provided for the effective implementation of video in surgical education based on associations with improved training outcomes. RESULTS Twenty articles met inclusion criteria. In these studies, the source of video acquisition was primarily laparoscopy (40.0% of papers), and the main perspective of video was endoscopy (45.0%). Features of videos included supplementation with other educational tools (55.0%), schematic diagrams or images (50.0%), audio (40.0%), and narration (25.0%). Videos were primarily viewed preoperatively (60.0%) or postoperatively (50.0%). The intended viewer for videos was usually residents (70.0%) but also included attendings/faculty (30.0%). When compared with a nonvideo training group, video training was associated with improved resident knowledge (100%), improved operative performance (81.3%), and greater participant satisfaction (100%). CONCLUSIONS Based on this review, we recommend that surgical training programs incorporate schematics and imaging into video, supplement video with other education tools, and utilize audio in video. For video review, we recommend that residents review video preoperatively and postoperatively for learning and that attendings review video postoperatively for assessment.
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Affiliation(s)
- Jason L Green
- Duke University School of Medicine, Durham, North Carolina.
| | - Visakha Suresh
- Duke University School of Medicine, Durham, North Carolina
| | - Peter Bittar
- Duke University School of Medicine, Durham, North Carolina
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina
| | - Suhail K Mithani
- Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alexander Allori
- Pediatric Plastic & Craniofacial Surgery, Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Ahmet A, Gamze K, Rustem M, Sezen KA. Is Video-Based Education an Effective Method in Surgical Education? A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2018; 75:1150-1158. [PMID: 29449162 DOI: 10.1016/j.jsurg.2018.01.014] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/21/2017] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Visual signs draw more attention during the learning process. Video is one of the most effective tool including a lot of visual cues. This systematic review set out to explore the influence of video in surgical education. We reviewed the current evidence for the video-based surgical education methods, discuss the advantages and disadvantages on the teaching of technical and nontechnical surgical skills. METHODS This systematic review was conducted according to the guidelines defined in the preferred reporting items for systematic reviews and meta-analyses statement. The electronic databases: the Cochrane Library, Medline (PubMED), and ProQuest were searched from their inception to the 30 January 2016. The Medical Subject Headings (MeSH) terms and keywords used were "video," "education," and "surgery." We analyzed all full-texts, randomised and nonrandomised clinical trials and observational studies including video-based education methods about any surgery. "Education" means a medical resident's or student's training and teaching process; not patients' education. We did not impose restrictions about language or publication date. RESULTS A total of nine articles which met inclusion criteria were included. These trials enrolled 507 participants and the total number of participants per trial ranged from 10 to 172. Nearly all of the studies reviewed report significant knowledge gain from video-based education techniques. The findings of this systematic review provide fair to good quality studies to demonstrate significant gains in knowledge compared with traditional teaching. Additional video to simulator exercise or 3D animations has beneficial effects on training time, learning duration, acquisition of surgical skills, and trainee's satisfaction. CONCLUSION Video-based education has potential for use in surgical education as trainees face significant barriers in their practice. This method is effective according to the recent literature. Video should be used in addition to standard techniques in the surgical education.
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Affiliation(s)
- Akgul Ahmet
- Department of Gerontology, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey.
| | - Kus Gamze
- Division of Physiotherapy and Rehabilitation, Institute of Health Science, Istanbul University, Istanbul, Turkey; Department of Physiotherapy and Rehabilitation, Mustafa Kemal University, Hatay, Turkey
| | - Mustafaoglu Rustem
- Department of Neurological Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Karaborklu Argut Sezen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey.
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Brady SL, Rao N, Gibbons PJ, Williams L, Hakel M, Pape T. Face-to-face versus online training for the interpretation of findings in the fiberoptic endoscopic exam of the swallow procedure. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2018; 9:433-441. [PMID: 29928150 PMCID: PMC6003290 DOI: 10.2147/amep.s142947] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the comparative effectiveness of an online, interdisciplinary, interactive course designed to increase the ability to accurately interpret the fiberoptic endoscopic exam of the swallow (FEES) procedure to traditional, face-to-face (F2F) lectures for both graduate medical education (GME) and graduate speech language pathology (GSLP) programs. DESIGN This was a prospective, quantitative, nonrandomized study. Participants were medical residents in physical medicine and rehabilitation from two affiliated programs and graduate students in speech language pathology from two instructional cohorts at a single institution. Group 1, traditional group (n=51), participated in F2F lectures using an audience response system, whereas Group 2, online group (n=57), participated in an online, interactive course. The main outcome measure was pre- and post-course FEES knowledge test scores. RESULTS For Group 1, the mean pre-course score was 26.94 (SD=3.24) and the post-course score was 34.96 (SD=2.51). Differences between pre- and post-course scores for Group 1 were significant (t=-16.38, P≤0.0001). For Group 2, the mean pre-course score was 27.05 (SD=2.74) and the post-course score was 34.05 (SD=2.84). Differences between pre- and post-course scores for Group 2 were significant (t=-13.5, P≤0.0001). The mean knowledge change score for Group 1 and Group 2 was 8.01 (SD=3.50) and 7.04 (SD=3.91), respectively (nonsignificant, t=1.372, P=0.173), suggesting groups made similar gains. CONCLUSION Incorporating technology into GME and GSLP programs yielded comparable gains to traditional lectures. Findings support the use of online education as a viable alternative to the traditional F2F classroom format for the instruction of the cognitive component of the FEES procedure.
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Affiliation(s)
- Susan L Brady
- Quality and Research Department, Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
| | - Noel Rao
- Medical Residency Department, Marianjoy Rehabilitation Hospital, Wheaton, IL, USA
| | - Patricia J Gibbons
- Department of Speech Language Pathology, Midwestern University, Downers Grove, IL, USA
| | - Letha Williams
- Health Administration, College of Graduate Health Studies, A.T. Still Medical University, Kirksville, MO, USA
| | - Mark Hakel
- Education and Staff Development, Madonna Rehabilitation Hospital, Lincoln, NE, USA
| | - Theresa Pape
- Hines Veterans Administration Hospital, Hines, IL, USA
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Training for laparoscopic pancreaticoduodenectomy. Surg Today 2018; 49:103-107. [DOI: 10.1007/s00595-018-1668-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/27/2018] [Indexed: 12/16/2022]
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Kaijser M, van Ramshorst G, van Wagensveld B, Pierie JP. Current Techniques of Teaching and Learning in Bariatric Surgical Procedures: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2018; 75:730-738. [PMID: 29033273 DOI: 10.1016/j.jsurg.2017.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/26/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The gastric sleeve resection and gastric bypass are the 2 most commonly performed bariatric procedures. This article provides an overview of current teaching and learning methods of those techniques in resident and fellow training. DESIGN A database search was performed on Pubmed, Embase, and the Education Resources Information Center (ERIC) to identify the methods used to provide training in bariatric surgery worldwide. After exclusion based on titles and abstracts, full texts of the selected articles were assessed. Included articles were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS In total, 2442 titles were identified and 14 full text articles met inclusion criteria. Four publications described an ex vivo training course, and 6 focused on at least 1 step of the gastric bypass procedure. Two randomized controlled trials (RCT) provided high-quality evidence on training aspects. Surgical coaching caused significant improvement of Bariatric Objective Structured Assessment of Technical Skills (BOSATS) scores (3.60 vs. 3.90, p = 0.017) and reduction of technical errors (18 vs. 10, p = 0.003). A preoperative warm-up increased global rating scales (GRS) scores on depth perception (p = 0.02), bimanual dexterity (p = 0.01), and efficiency of movements (p = 0.03). CONCLUSION Stepwise education, surgical coaching, warming up, Internet-based knowledge modules, and ex vivo training courses are effective in relation to bariatric surgical training of residents and fellows, possibly shortening their learning curves.
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Affiliation(s)
- Mirjam Kaijser
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands; Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; Heelkunde Friesland Groep, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Gabrielle van Ramshorst
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Bart van Wagensveld
- Department of Surgery, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands
| | - Jean-Pierre Pierie
- University of Groningen, University Medical Centre Groningen, Post Graduate School of Medicine, Groningen, The Netherlands; Heelkunde Friesland Groep, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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van Ramshorst GH, Kaijser MA, Pierie JPEN, van Wagensveld BA. Resident Training in Bariatric Surgery-A National Survey in the Netherlands. Obes Surg 2018; 27:2974-2980. [PMID: 28560526 PMCID: PMC5651706 DOI: 10.1007/s11695-017-2729-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose Surgical procedures for morbid obesity, including laparoscopic Roux-en-Y gastric bypass (LRYGB), are considered standardized laparoscopic procedures. Our goal was to determine how bariatric surgery is trained in the Netherlands. Materials and Methods Questionnaires were sent to lead surgeons from all 19 bariatric centers in the Netherlands. At least two residents or fellows were surveyed for each center. Dutch residents are required to collect at least 20 electronic Objective Standard Assessment of Technical Skills (OSATS) observations per year, which include the level of supervision needed for specific procedures. Centers without resident accreditation were excluded. Results All 19 surgeons responded (100%). Answers from respondents who worked at teaching hospitals with residency accreditation (12/19, 63%) were analyzed. The average number of trained residents or fellows was 14 (range 3–33). Preferred procedures were LRYGB (n = 10), laparoscopic gastric sleeve (LGS) resection (n = 1), or no preference (n = 1). Three groups could be discerned for the order in which procedural steps were trained: unstructured, in order of increasing difficulty, or in order of chronology. Questionnaire response was 79% (19/24) for residents and 73% (8/11) for fellows. On average, residents started training in bariatric surgery in postgraduate year (PGY) 4 (range 0–5). The median number of bariatric procedures performed was 40 for residents (range 0–148) and 220 during fellowships (range 5–306). Conclusions Training in bariatric surgery differs considerably among centers. A structured program incorporating background knowledge, step-wise technical skills training, and life-long learning should enhance efficient training in bariatric teaching centers without affecting quality or patient safety.
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Affiliation(s)
- Gabrielle H van Ramshorst
- VU University Medical Center, Amsterdam, the Netherlands. .,The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, the Netherlands.
| | - Mirjam A Kaijser
- Department of Surgery, MCL Leeuwarden, Leeuwarden, the Netherlands.,PGSOM, UMCG/RU Groningen, Groningen, the Netherlands
| | - Jean-Pierre E N Pierie
- Department of Surgery, MCL Leeuwarden, Leeuwarden, the Netherlands.,PGSOM, UMCG/RU Groningen, Groningen, the Netherlands
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Russell KA, Brook CD, Platt MP, Grillone GA, Aliphas A, Noordzij JP. The Benefits and Limitations of Targeted Training in Flexible Transnasal Laryngoscopy Diagnosis. JAMA Otolaryngol Head Neck Surg 2017; 143:707-711. [PMID: 28472351 DOI: 10.1001/jamaoto.2017.0120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Targeted laryngoscopy training can be used successfully in de novo learners. Objective To determine the value of targeted laryngoscopy education in interns. Design, Setting, and Participants This prospective study of fiberoptic laryngoscopy interpretations enrolled 13 participants in an academic hospital setting from August 1 to December 31, 2015. Participants included 10 postgraduate year 1 emergency and otolaryngology interns and 3 board-certified otolaryngology attending physicians. Interventions Participants viewed 25 selected and digitally recorded fiberoptic laryngoscopies and were asked to rate 13 items relating to abnormalities in the pharynx, hypopharynx, larynx, and subglottis; the level of concern; and confidence with the diagnosis. A laryngoscopy teaching video was then administered to the interns before rating a second set of 25 videos. Improvement in diagnosis and intraclass correlation coefficients (ICC) were calculated for each question and compared between the first and second administration. Main Outcomes and Measures Improvement in correct diagnosis of abnormalities in recorded laryngoscopies. Results All 13 participants completed the interventions. The ICCs for all questions were generally low for the intern groups and higher for the attending group. For vocal cord mobility, a preintervention ICC of 0.25 (95% CI, 0.16-0.37) improved to 0.47 (95% CI, 0.36-0.59) among interns after the intervention. The ICCs for vocal cord mobility were higher among attendings for the preintervention (0.89; 95% CI, 0.84-0.93) and postintervention (0.89; 95% CI, 0.83-0.93) assessments. Minimal improvement was observed in intern scores for base of tongue abnormalities, subglottic stenosis, vocal cord abnormalities, level of comfort, level of concern, pharyngeal abnormalities, or laryngeal, pharyngeal, and hypopharyngeal masses. Conclusions and Relevance Learning of flexible laryngoscopy can be improved with the use of a teaching video; however, additional interventions are needed to attain competence in accurately diagnosing upper airway lesions. Clinicians who seek to perform flexible laryngoscopy require robust training.
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Affiliation(s)
- Kimberly A Russell
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Christopher D Brook
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Michael P Platt
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Gregory A Grillone
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Avner Aliphas
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts
| | - J Pieter Noordzij
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts
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Development and Assessment of an Advanced Pediatric Airway Management Curriculum With Integrated Intubation Videos. Pediatr Emerg Care 2017; 33:239-244. [PMID: 27383403 DOI: 10.1097/pec.0000000000000777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Opportunities to learn advanced airway management skills on pediatric patients in the emergency department are limited. Current strategies have focused largely on traditional didactics coupled with procedural skills training using simulation. However, these approaches are limited in their exposure to anatomic variation and realism. Here, we describe the development and assessment of an advanced airway curriculum that integrates videolaryngoscopic recordings obtained during actual patient intubations into a series of interactive educational sessions. METHODS Trainees and attending physicians were surveyed anonymously to assess the impact of participation in the curriculum. A mixed methods approach to statistical analysis was used. Rating questions were used to evaluate the relative impact of this approach over other traditional strategies and recurrent themes within open-ended questions were identified. RESULTS Participants reported this to be a highly effective means of learning about pediatric laryngoscopy and endotracheal intubation and regarded it more highly than other traditional educational approaches. Identified benefits included repetitive exposure, approaches to laryngoscopy, the realism of teaching using real and varied anatomy, and the opportunities to identify and troubleshoot difficulty in a learning environment. CONCLUSIONS An advanced pediatric airway curriculum that integrates intubation videos obtained during videolaryngoscopy was highly regarded by pediatric emergency medicine providers. Content emphasis can be shifted to meet the needs of pediatric emergency medicine providers with all levels of skill and experience.
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Law Forsyth K, DiMarco SM, Jenewein CG, Ray RD, D'Angelo ALD, Cohen ER, Wiegmann DA, Pugh CM. Do errors and critical events relate to hernia repair outcomes? Am J Surg 2017; 213:652-655. [DOI: 10.1016/j.amjsurg.2016.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022]
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Lorch AC, Kloek CE. An evidence-based approach to surgical teaching in ophthalmology. Surv Ophthalmol 2017; 62:371-377. [PMID: 28104385 DOI: 10.1016/j.survophthal.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 01/22/2023]
Abstract
An apprenticeship model has traditionally been used in procedural and surgical teaching. As the pressures of work hours and patient outcome monitoring increase, surgical teachers need a more flexible plan for teaching procedural skills. We attempt to delineate a program of preprocedural, intraprocedural, and postprocedural teaching that can be used in the field of ophthalmology to maximize a resident's skill acquisition in a constructive learning environment. We review the literature on surgical teaching from within ophthalmology as well as other surgical fields and combine this with teaching experience in an ophthalmic surgical training program to produce a collection of procedural teaching guidelines. These guidelines are structured to serve in both individual teaching settings and in curriculum design.
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Affiliation(s)
- Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
| | - Carolyn E Kloek
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Broekema TH, Talsma AK, Wevers KP, Pierie JPEN. Laparoscopy Instructional Videos: The Effect of Preoperative Compared With Intraoperative Use on Learning Curves. JOURNAL OF SURGICAL EDUCATION 2017; 74:91-99. [PMID: 27553762 DOI: 10.1016/j.jsurg.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Previous studies have shown that the use of intraoperative instructional videos has a positive effect on learning laparoscopic procedures. This study investigated the effect of the timing of the instructional videos on learning curves in laparoscopic skills training. DESIGN After completing a basic skills course on a virtual reality simulator, medical students and residents with less than 1 hour experience using laparoscopic instruments were randomized into 2 groups. Using an instructional video either preoperatively or intraoperatively, both groups then performed 4 repetitions of a standardized task on the TrEndo augmented reality. With the TrEndo, 9 motion analysis parameters (MAPs) were recorded for each session (4 MAPs for each hand and time). These were the primary outcome measurements for performance. The time spent watching the instructional video was also recorded. Improvement in performance was studied within and between groups. SETTING Medical Center Leeuwarden, a secondary care hospital located in Leeuwarden, The Netherlands. PARTICIPANTS Right-hand dominant medical student and residents with more than 1 hour experience operating any kind of laparoscopic instruments were participated. A total of 23 persons entered the study, of which 21 completed the study course. RESULTS In both groups, at least 5 of 9 MAPs showed significant improvements between repetition 1 and 4. When both groups were compared after completion of repetition 4, no significant differences in improvement were detected. The intraoperative group showed significant improvement in 3 MAPs of the left-nondominant-hand, compared with one MAP for the preoperative group. CONCLUSION No significant differences in learning curves could be detected between the subjects who used intraoperative instructional videos and those who used preoperative instructional videos. Intraoperative video instruction may result in improved dexterity of the nondominant hand.
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Affiliation(s)
- Theo H Broekema
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
| | - Aaldert K Talsma
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Postgraduate School of Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Kevin P Wevers
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Jean-Pierre E N Pierie
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Postgraduate School of Medicine, University Medical Center Groningen, Groningen, The Netherlands; University Groningen, Groningen, The Netherlands
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Kramp KH, van Det MJ, Veeger NJGM, Pierie JPEN. The Pareto Analysis for Establishing Content Criteria in Surgical Training. JOURNAL OF SURGICAL EDUCATION 2016; 73:892-901. [PMID: 27267561 DOI: 10.1016/j.jsurg.2016.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Current surgical training is still highly dependent on expensive operating room (OR) experience. Although there have been many attempts to transfer more training to the skills laboratory, little research is focused on which technical behaviors can lead to the highest profit when they are trained outside the OR. The Pareto principle states that in any population that contributes to a common effect, a few account for the bulk of the effect. This principle has been widely used in business management to increase company profits. This study uses the Pareto principle for establishing content criteria for more efficient surgical training. METHOD A retrospective study was conducted to assess verbal guidance provided by 9 supervising surgeons to 12 trainees performing 64 laparoscopic cholecystectomies in the OR. The verbal corrections were documented, tallied, and clustered according to the aimed change in novice behavior. The corrections were rank ordered, and a cumulative distribution curve was used to calculate which corrections accounted for 80% of the total number of verbal corrections. RESULTS In total, 253 different verbal corrections were uttered 1587 times and were categorized into 40 different clusters of aimed changes in novice behaviors. The 35 highest-ranking verbal corrections (14%) and the 11 highest-ranking clusters (28%) accounted for 80% of the total number of given verbal corrections. CONCLUSIONS Following the Pareto principle, we were able to identify the aspects of trainee behavior that account for most corrections given by supervisors during a laparoscopic cholecystectomy on humans. This strategy can be used for the development of new training programs to prepare the trainee in advance for the challenges encountered in the clinical setting in an OR.
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Affiliation(s)
- Kelvin H Kramp
- Department of Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands.
| | - Marc J van Det
- Department of Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - Nic J G M Veeger
- Department of Epidemiology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Jean-Pierre E N Pierie
- Department of Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; Post Graduate School of Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Sánchez-Fernández J, Bachiller-Burgos J, Serrano-Pascual Á, Cózar-Olmo J, Martín-Portugués IDG, Pérez-Duarte F, Hernández-Hurtado L, Álvarez-Ossorio J, Sánchez-Margallo F. The assessment of surgical skills as a complement to the training method. Revision. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.acuroe.2015.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sánchez-Fernández J, Bachiller-Burgos J, Serrano-Pascual Á, Cózar-Olmo JM, Díaz-Güemes Martín-Portugués I, Pérez-Duarte FJ, Hernández-Hurtado L, Álvarez-Ossorio JL, Sánchez-Margallo FM. The assessment of surgical skills as a complement to the training method. Revision. Actas Urol Esp 2016; 40:55-63. [PMID: 26321191 DOI: 10.1016/j.acuro.2015.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT AND OBJECTIVE The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. ACQUISITION OF EVIDENCE Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. SUMMARY OF THE EVIDENCE After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. CONCLUSIONS We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons.
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Affiliation(s)
| | - J Bachiller-Burgos
- Servicio de Urología, Hospital San Juan de Dios del Aljarafe, Sevilla, España
| | | | - J M Cózar-Olmo
- Servicio de Urología, Complejo Hospitalario Universitario de Granada, Granada, España
| | | | - F J Pérez-Duarte
- Centro de Cirugía de Mínima Invasión Jesús Usón, Cáceres, España
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Abdelsattar JM, Pandian TK, Finnesgard EJ, El Khatib MM, Rowse PG, Buckarma ENH, Gas BL, Heller SF, Farley DR. Do You See What I See? How We Use Video as an Adjunct to General Surgery Resident Education. JOURNAL OF SURGICAL EDUCATION 2015; 72:e145-50. [PMID: 26454723 DOI: 10.1016/j.jsurg.2015.07.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Preparation of learners for surgical operations varies by institution, surgeon staff, and the trainees themselves. Often the operative environment is overwhelming for surgical trainees and the educational experience is substandard due to inadequate preparation. We sought to develop a simple, quick, and interactive tool that might assess each individual trainee's knowledge baseline before participating in minimally invasive surgery (MIS). DESIGN A 4-minute video with 5 separate muted clips from laparoscopic procedures (splenectomy, gastric band removal, cholecystectomy, adrenalectomy, and inguinal hernia repair) was created and shown to medical students (MS), general surgery residents, and staff surgeons. Participants were asked to watch the video and commentate (provide facts) on the operation, body region, instruments, anatomy, pathology, and surgical technique. Comments were scored using a 100-point grading scale (100 facts agreed upon by 8 surgical staff and trainees) with points deducted for incorrect answers. All participants were video recorded. Performance was scored by 2 separate raters. SETTING An academic medical center. PARTICIPANTS MS = 10, interns (n = 8), postgraduate year 2 residents (PGY)2s (n = 11), PGY3s (n = 10), PGY4s (n = 9), PGY5s (n = 7), and general surgery staff surgeons (n = 5). RESULTS Scores ranged from -5 to 76 total facts offered during the 4-minute video examination. MS scored the lowest (mean, range; 5, -5 to 8); interns were better (17, 4-29), followed by PGY2s (31, 21-34), PGY3s (33, 10-44), PGY4s (44, 19-47), PGY5s (48, 28-49), and staff (48, 17-76), p < 0.001. Rater concordance was 0.98-measured using a concordance correlation coefficient (95% CI: 0.96-0.99). Only 2 of 8 interns acknowledged the critical view during the laparoscopic cholecystectomy video clip vs 10 of 11 PGY2 residents (p < 0.003). Of 8 interns, 7 misperceived the spleen as the liver in the splenectomy clip vs 2 of 7 chief residents (p = 0.02). CONCLUSIONS Not surprisingly, more experienced surgeons were able to relay a larger number of laparoscopic facts during a 4-minute video clip of 5 MIS operations than inexperienced trainees. However, even tenured staff surgeons relayed very few facts on procedures they were unfamiliar with. The potential differentiating capabilities of such a quick and inexpensive effort has pushed us to generate better online learning tools (operative modules) and hands-on simulation resources for our learners. We aim to repeat this and other studies to see if our learners are better prepared for video assessment and ultimately, MIS operations.
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Affiliation(s)
- Jad M Abdelsattar
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - T K Pandian
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Eric J Finnesgard
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Phillip G Rowse
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - EeeL N H Buckarma
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Becca L Gas
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Stephanie F Heller
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David R Farley
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
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Watanabe Y, Bilgic E, Lebedeva E, McKendy KM, Feldman LS, Fried GM, Vassiliou MC. A systematic review of performance assessment tools for laparoscopic cholecystectomy. Surg Endosc 2015; 30:832-44. [PMID: 26092014 DOI: 10.1007/s00464-015-4285-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/23/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple tools are available to assess clinical performance of laparoscopic cholecystectomy (LC), but there are no guidelines on how best to implement and interpret them in educational settings. The purpose of this systematic review was to identify and critically appraise LC assessment tools and their measurement properties, in order to make recommendations for their implementation in surgical training. METHODS A systematic search (1989-2013) was conducted in MEDLINE, Embase, Scopus, Cochrane, and grey literature sources. Evidence for validity (content, response process, internal structure, relations to other variables, and consequences) and the conditions in which the evidence was obtained were evaluated. RESULTS A total of 54 articles were included for qualitative synthesis. Fifteen technical skills and two non-technical skills assessment tools were identified. The 17 tools were used for either: recorded procedures (nine tools, 60%), direct observation (five tools, 30%), or both (three tools, 18%). Fourteen (82%) tools reported inter-rater reliability and one reported a Generalizability Theory coefficient. Nine (53%) had evidence for validity based on clinical experience and 11 (65%) compared scores to other assessments. Consequences of scores, educational impact, applications to residency training, and how raters were trained were not clearly reported. No studies mentioned cost. CONCLUSIONS The most commonly reported validity evidence was inter-rater reliability and relationships to other known variables. Consequences of assessments and rater training were not clearly reported. These data and the evidence for validity should be taken into consideration when deciding how to select and implement a tool to assess performance of LC, and especially how to interpret the results.
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Affiliation(s)
- Yusuke Watanabe
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada.
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
| | - Elif Bilgic
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada
| | - Ekaterina Lebedeva
- The Henry K.M. De Kuyper Education Centre, McGill University Health Centre, Montreal, QC, Canada
| | - Katherine M McKendy
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada
| | - Gerald M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada
| | - Melina C Vassiliou
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650, Cedar Avenue, L9. 316, Montreal, QC, H3G 1A4, Canada.
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Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg 2015; 400:429-53. [PMID: 25850631 DOI: 10.1007/s00423-015-1300-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/24/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both acute and elective surgery. Nevertheless, reports from national surveys still seem to represent some doubts regarding its diffusion. There is neither a wide consensus on its indications nor on its possible related morbidity. On the other hand, more than 25 years have passed since the introduction of LC, and we have all witnessed the exponential growth of knowledge, skill and technology that has followed it. In 1995, the EAES published its consensus statement on laparoscopic cholecystectomy in which seven main questions were answered, according to the available evidence. During the following 20 years, there have been several additional guidelines on LC, mainly focused on some particular aspect, such as emergency or concomitant biliary tract surgery. METHODS In 2012, several Italian surgical societies decided to revisit the clinical recommendations for the role of laparoscopy in the treatment of gallbladder diseases in adults, to update and supplement the existing guidelines with recommendations that reflect what is known and what constitutes good practice concerning LC.
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Affiliation(s)
- Ferdinando Agresta
- Department of Surgery, Presidio Ospedaliero di Adria (RO), Adria, RO, Italy,
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Kon H, Botelho MG, Bridges S, Leung KCM. The impact of complete denture making instructional videos on self-directed learning of clinical skills. J Prosthodont Res 2015; 59:144-51. [DOI: 10.1016/j.jpor.2015.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/05/2015] [Accepted: 01/17/2015] [Indexed: 11/17/2022]
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Esposito C, Escolino M, Saxena A, Montupet P, Chiarenza F, De Agustin J, Draghici IM, Cerulo M, Sagaon MM, Di Benedetto V, Gamba P, Settimi A, Najmaldin A. European Society of Pediatric Endoscopic Surgeons (ESPES) guidelines for training program in pediatric minimally invasive surgery. Pediatr Surg Int 2015; 31:367-73. [PMID: 25667047 DOI: 10.1007/s00383-015-3672-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of this paper was to propose structured guidelines for a European pediatric MIS training program created by ESPES. METHODS A questionnaire, focused on how the pediatric training program in MIS has to be structured, was proposed to all participants at the ESPES Congress in Marseille in 2013. RESULTS We received 178 questionnaires but only 139 questionnaires were fully completed and analyzed. All respondents agree that the training program has to be divided into 4 steps: (1) theoretical part: 2 theoretical courses in laparoscopy (101/139 respondents, 72.7 %), 1 theoretical course in retroperitoneoscopy (99/139 respondents, 71.2 %) and 1 in thoracoscopy (91/139 respondents, 65.5 %); (2) experimental part: 10-20 h of training on pelvic trainer (103/139 respondents, 74.1 %) and 10 h of training on animal models (91/139 respondents, 65.5 %); (3) stages in European centers of reference for MIS: a 1-3 months stage (96/139 respondents, 69.1 %); (4) personal experience: 30 procedures as cameraman (98/139 respondents, 70.5 %) and >50 basic MIS procedures as main surgeon under supervision (114/139 respondents, 82 %). CONCLUSIONS On the basis of our survey ESPES MIS training curriculum for pediatric surgeons must contain the following educational components: (1) theoretical knowledge; (2) practice-based learning and improvement in experimental setting; (3) stages in European centers of reference for MIS; (4) personal operative experience. At the end of the training program, ESPES will analyze the candidate training booklet and release for each applicant an ESPES certification after an exam.
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Affiliation(s)
- Ciro Esposito
- Department of Traslational Medical Sciences, Pediatric Surgery Unit, Federico II University, Via Pansini 5, 80131, Naples, Italy,
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Abstract
Videos can promote learning by either complementing classroom activities, or in self-paced online learning modules. Despite the wide availability of online videos in medicine, it can be a challenge for many educators to decide when videos should be used, how to best use videos, and whether to use existing videos or produce their own. We outline 12 tips based on a review of best practices in curriculum design, current research in multimedia learning and our experience in producing and using educational videos. The 12 tips review the advantages of using videos in medical education, present requirements for teachers and students, discuss how to integrate video into a teaching programme, and describe technical requirements when producing one's own videos. The 12 tips can help medical educators use videos more effectively to promote student engagement and learning.
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Dijkstra FA, Bosker RJI, Veeger NJGM, van Det MJ, Pierie JPEN. Procedural key steps in laparoscopic colorectal surgery, consensus through Delphi methodology. Surg Endosc 2014; 29:2620-7. [DOI: 10.1007/s00464-014-3979-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
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Bethlehem MS, Kramp KH, van Det MJ, ten Cate Hoedemaker HO, Veeger NJGM, Pierie JPEN. Development of a standardized training course for laparoscopic procedures using Delphi methodology. JOURNAL OF SURGICAL EDUCATION 2014; 71:810-816. [PMID: 24913426 DOI: 10.1016/j.jsurg.2014.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/23/2014] [Accepted: 04/27/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Content, evaluation, and certification of laparoscopic skills and procedure training lack uniformity among different hospitals in The Netherlands. Within the process of developing a new regional laparoscopic training curriculum, a uniform and transferrable curriculum was constructed for a series of laparoscopic procedures. The aim of this study was to determine regional expert consensus regarding the key steps for laparoscopic appendectomy and cholecystectomy using Delphi methodology. METHODS Lists of suggested key steps for laparoscopic appendectomy and cholecystectomy were created using surgical textbooks, available guidelines, and local practice. A total of 22 experts, working for teaching hospitals throughout the region, were asked to rate the suggested key steps for both procedures on a Likert scale from 1-5. Consensus was reached with Crohnbach's α ≥ 0.90. RESULTS Of the 22 experts, 21 completed and returned the survey (95%). Data analysis already showed consensus after the first round of Delphi on the key steps for laparoscopic appendectomy (Crohnbach's α = 0.92) and laparoscopic cholecystectomy (Crohnbach's α = 0.90). After the second round, 15 proposed key steps for laparoscopic appendectomy and 30 proposed key steps for laparoscopic cholecystectomy were rated as important (≥4 by at least 80% of the expert panel). These key steps were used for the further development of the training curriculum. CONCLUSION By using the Delphi methodology, regional consensus was reached on the key steps for laparoscopic appendectomy and cholecystectomy. These key steps are going to be used for standardized training and evaluation purposes in a new regional laparoscopic curriculum.
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Affiliation(s)
- Martijn S Bethlehem
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Kelvin H Kramp
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marc J van Det
- Leeuwarden Institute for Minimal Invasive Surgery, Leeuwarden, The Netherlands; Department of Surgery, Hospital Group Twente (ZGT), Almelo, The Netherlands
| | - Henk O ten Cate Hoedemaker
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Post Graduate School of Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nicolaas J G M Veeger
- Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jean Pierre E N Pierie
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Leeuwarden Institute for Minimal Invasive Surgery, Leeuwarden, The Netherlands; Post Graduate School of Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Gurusamy KS, Nagendran M, Toon CD, Davidson BR. Laparoscopic surgical box model training for surgical trainees with limited prior laparoscopic experience. Cochrane Database Syst Rev 2014; 2014:CD010478. [PMID: 24585169 PMCID: PMC10875408 DOI: 10.1002/14651858.cd010478.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a box model physical simulator is an option to supplement standard training. However, the value of this modality on trainees with limited prior laparoscopic experience is unknown. OBJECTIVES To compare the benefits and harms of box model training for surgical trainees with limited prior laparoscopic experience versus standard surgical training or supplementary animal model training. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded to May 2013. SELECTION CRITERIA We planned to include all randomised clinical trials comparing box model trainers versus other forms of training including standard laparoscopic training and supplementary animal model training in surgical trainees with limited prior laparoscopic experience. We also planned to include trials comparing different methods of box model training. DATA COLLECTION AND ANALYSIS Two authors independently identified trials and collected data. We analysed the data with both the fixed-effect and the random-effects models using Review Manager 5. For each outcome, we calculated the risk ratio (RR), mean difference (MD), or standardised mean difference (SMD) with 95% confidence intervals (CI) based on intention-to-treat analysis whenever possible. MAIN RESULTS We identified eight trials that met the inclusion criteria. One trial including 17 surgical trainees did not contribute to the meta-analysis. We included seven trials (249 surgical trainees belonging to various postgraduate years ranging from year one to four) in which the participants were randomised to supplementary box model training (122 trainees) versus standard training (127 trainees). Only one trial (50 trainees) was at low risk of bias. The box trainers used in all the seven trials were video trainers. Six trials were conducted in USA and one trial in Canada. The surgeries in which the final assessments were made included laparoscopic total extraperitoneal hernia repairs, laparoscopic cholecystectomy, laparoscopic tubal ligation, laparoscopic partial salpingectomy, and laparoscopic bilateral mid-segment salpingectomy. The final assessments were made on a single operative procedure.There were no deaths in three trials (0/82 (0%) supplementary box model training versus 0/86 (0%) standard training; RR not estimable; very low quality evidence). The other trials did not report mortality. The estimated effect on serious adverse events was compatible with benefit and harm (three trials; 168 patients; 0/82 (0%) supplementary box model training versus 1/86 (1.1%) standard training; RR 0.36; 95% CI 0.02 to 8.43; very low quality evidence). None of the trials reported patient quality of life. The operating time was significantly shorter in the supplementary box model training group versus the standard training group (1 trial; 50 patients; MD -6.50 minutes; 95% CI -10.85 to -2.15). The proportion of patients who were discharged as day-surgery was significantly higher in the supplementary box model training group versus the standard training group (1 trial; 50 patients; 24/24 (100%) supplementary box model training versus 15/26 (57.7%) standard training; RR 1.71; 95% CI 1.23 to 2.37). None of the trials reported trainee satisfaction. The operating performance was significantly better in the supplementary box model training group versus the standard training group (seven trials; 249 trainees; SMD 0.84; 95% CI 0.57 to 1.10).None of the trials compared box model training versus animal model training or versus different methods of box model training. AUTHORS' CONCLUSIONS There is insufficient evidence to determine whether laparoscopic box model training reduces mortality or morbidity. There is very low quality evidence that it improves technical skills compared with standard surgical training in trainees with limited previous laparoscopic experience. It may also decrease operating time and increase the proportion of patients who were discharged as day-surgery in the first total extraperitoneal hernia repair after box model training. However, the duration of the benefit of box model training is unknown. Further well-designed trials of low risk of bias and random errors are necessary. Such trials should assess the long-term impact of box model training on clinical outcomes and compare box training with other forms of training.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Myura Nagendran
- Department of SurgeryUCL Division of Surgery and Interventional Science9th Floor, Royal Free HospitalPond StreetLondonUKNW3 2QG
| | - Clare D Toon
- West Sussex County CouncilPublic Health1st Floor, The GrangeTower StreetChichesterWest SussexUKPO19 1QT
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
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van Det MJ, Meijerink WJHJ, Hoff C, Middel B, Pierie JPEN. Effective and efficient learning in the operating theater with intraoperative video-enhanced surgical procedure training. Surg Endosc 2013; 27:2947-54. [PMID: 23436098 DOI: 10.1007/s00464-013-2862-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/28/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND INtraoperative Video Enhanced Surgical procedure Training (INVEST) is a new training method designed to improve the transition from basic skills training in a skills lab to procedural training in the operating theater. Traditionally, the master-apprentice model (MAM) is used for procedural training in the operating theater, but this model lacks uniformity and efficiency at the beginning of the learning curve. This study was designed to investigate the effectiveness and efficiency of INVEST compared to MAM. METHODS Ten surgical residents with no laparoscopic experience were recruited for a laparoscopic cholecystectomy training curriculum either by the MAM or with INVEST. After a uniform course in basic laparoscopic skills, each trainee performed six cholecystectomies that were digitally recorded. For 14 steps of the procedure, an observer who was blinded for the type of training determined whether the step was performed entirely by the trainee (2 points), partially by the trainee (1 point), or by the supervisor (0 points). Time measurements revealed the total procedure time and the amount of effective procedure time during which the trainee acted as the operating surgeon. Results were compared between both groups. RESULTS Trainees in the INVEST group were awarded statistically significant more points (115.8 vs. 70.2; p < 0.001) and performed more steps without the interference of the supervisor (46.6 vs. 18.8; p < 0.001). Total procedure time was not lengthened by INVEST, and the part performed by trainees was significantly larger (69.9 vs. 54.1 %; p = 0.004). CONCLUSIONS INVEST enhances effectiveness and training efficiency for procedural training inside the operating theater without compromising operating theater time efficiency.
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Affiliation(s)
- M J van Det
- Department of Surgery, Medical Center Leeuwarden, PO Box 888, 8901 BR, Leeuwarden, The Netherlands.
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Miller S, Causey MW, Damle A, Maykel J, Steele S. Single-incision laparoscopic colectomy: training the next generation. Surg Endosc 2013; 27:1784-90. [PMID: 23389059 DOI: 10.1007/s00464-012-2684-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 10/23/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Single-incision laparoscopic colectomy (SILC) is touted to be an improved approach for minimally invasive surgery although no data currently exists regarding the acquisition of skills for the safe performance of this technique. The authors report their early experience with proctoring of surgical residents in SILC by experienced colorectal surgeons. METHODS Data regarding patient demographics, operative data, and short-term outcomes were prospectively collected at two surgical training hospitals. Residents and staff independently rated individual components of this technique to compare them with learning standard multiport colectomy (MP). RESULTS A total of 31 SILC cases (15 men; mean age 53 years) were managed. The average BMI was 26.5 kg/m(2) (range 16-39 kg/m(2)). The surgical indications included cancer (n = 13), polyps (n = 8), diverticular disease (n = 4), Crohn's disease (n = 2), familial adenomatous polyposis (n = 2), volvulus (n = 1), and rectal prolapse (n = 1). The average operative time was 164 ± 86 min, and the mean blood loss was 80 ± 83 mL. The mean incision length was 4.1 ± 1.1 cm. One case required additional trocar placement (stoma creation), and three cases required conversion to open procedure because of failure to progress, difficult colorectal anastomosis, or poor visualization. The median hospital stay was 5.7 ± 1.3 days. The 30-day morbidity included minor wound infections (9.7 %), ileus (6.5 %), blood transfusion (3.2 %), and intraabdominal abscess (3.2 %). No deaths occurred. Residents rated vascular pedicle isolation, mobilization, critical structure exposure, instrument conflict/handling, and ergonomics as significantly more difficult with SILC. CONCLUSIONS Senior-level residents can safely perform SILC under appropriate experienced supervision. The required advanced skills reflect complex laparoscopic training occurring during residency. Opportunities exist for better preparation and training of surgical residents to perform this complex surgery independently and safely at completion of residency.
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Affiliation(s)
- Seth Miller
- Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
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Madsen K, Grønbeck L, Rifbjerg Larsen C, Østergaard J, Bergholt T, Langhoff-Roos J, Sørensen JL. Educational strategies in performing cesarean section. Acta Obstet Gynecol Scand 2013; 92:256-63. [DOI: 10.1111/aogs.12055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 11/07/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Kristine Madsen
- Department of Obstetrics and Gynecology; Juliane Marie Centre for Women, Children and Reproduction; Rigshospitalet, University Hospital of Copenhagen; Copenhagen; Denmark
| | - Lene Grønbeck
- Department of Obstetrics and Gynecology; Juliane Marie Centre for Women, Children and Reproduction; Rigshospitalet, University Hospital of Copenhagen; Copenhagen; Denmark
| | - Christian Rifbjerg Larsen
- Department of Obstetrics and Gynecology; University Hospital of Copenhagen; Hillerød Hospital; Hillerød; Denmark
| | - Jeanett Østergaard
- Department of Obstetrics and Gynecology; Juliane Marie Centre for Women, Children and Reproduction; Rigshospitalet, University Hospital of Copenhagen; Copenhagen; Denmark
| | - Thomas Bergholt
- Department of Obstetrics and Gynecology; University Hospital of Copenhagen; Hillerød Hospital; Hillerød; Denmark
| | - Jens Langhoff-Roos
- Department of Obstetrics and Gynecology; Juliane Marie Centre for Women, Children and Reproduction; Rigshospitalet, University Hospital of Copenhagen; Copenhagen; Denmark
| | - Jette Led Sørensen
- Department of Obstetrics and Gynecology; Juliane Marie Centre for Women, Children and Reproduction; Rigshospitalet, University Hospital of Copenhagen; Copenhagen; Denmark
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Müller SC, Strunk T, Alken P. [Quality and objectifiability of training and advanced training in urology]. Urologe A 2013; 51:1065-73. [PMID: 22782191 DOI: 10.1007/s00120-012-2934-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The attraction to study medicine has not changed, however we are facing a lack of trainees especially in surgical subspecialties like urology. Possible explanations are a 70% proportion of female students and different views on the work-life balance in the future. A high burden of theory and unrealistic multiple choice examinations support those who can learn but there are no objective and reproducible criteria to recognize the competence of a good physician early in the career. This problem continues during residency, especially in surgical subspecialities. The different medical boards in Germany responsible for the training programs have no concepts. Many attempts in other countries to objectively measure surgical skills have so far been ignored. If we do not want to lose our traditionally high competence in medicine we should join those who attempt to improve teaching and to use methods for selecting suitable candidates for surgery as soon and as objectively as possible.
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Affiliation(s)
- S C Müller
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Deutschland.
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Can both residents and chief physicians assess surgical skills? Surg Endosc 2012; 26:2054-60. [DOI: 10.1007/s00464-012-2155-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 12/22/2011] [Indexed: 02/02/2023]
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