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Arteaga M, Vidal C, Ruz C, Zilleruelo R, Pino E, Dauvergne J, Besa P, Irarrázaval S. An online training and feedback module enhances the musculoskeletal examination performance of medical interns. BMC MEDICAL EDUCATION 2024; 24:917. [PMID: 39180050 PMCID: PMC11344423 DOI: 10.1186/s12909-024-05683-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/20/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Pathologies of the locomotor system are frequent and can cause disability and impact the quality of life of the people affected. In recent years, online training and feedback have emerged as learning tools in many fields of medicine. OBJECTIVE This study aims to evaluate medical interns' musculoskeletal examination performance after completing an online training and feedback module. METHODS This study employed a quasi-experimental design. Medical interns were invited to complete a 4-week musculoskeletal physical examination training and feedback module via an e-learning platform. The course included written and audiovisual content pertaining to medical history, physical examination, and specific tests for the diagnosis of the most common knee, spine, shoulder, ankle, and foot conditions. Before and after completing the module, their ability to perform the physical examination was evaluated using an objective structured clinical examination (OSCE) with simulated patients that took place face-to-face. A control group of experts was assessed using the OSCE, and their performance was compared to that of the interns before and after the training. At the end of the module feedback on the OSCE was provided to participants through the platform asynchronously and two evaluation questions about the user experience were conducted at the end of the study. RESULTS A total of 35 subjects were assessed using the OSCE, including 29 interns and 6 experts. At the beginning of the training module, the group of interns obtained an average score of 50.6 ± 15.1. At the end of the module, 18 interns retook the OSCE, and their performance increased significantly to an average of 76.6 ± 12.8 (p < 0.01). Prior to the training, the experts performed significantly better than the interns (71.2 vs. 50.6; p = 0.01). After the interns received the training and feedback, there were no significant differences between the two groups (71.2 vs. 76.6; p = 0.43). Two evaluation questions were conducted at the end of the study, revealing that 93% of the participants affirm that the training module will be useful in their clinical practice, and 100% of the participants would recommend the training module to a colleague. CONCLUSION The online training and feedback module enhances the musculoskeletal examination performance of medical interns.
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Affiliation(s)
- Matías Arteaga
- Orthopedics Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay #362, Santiago, 8330077, Chile
| | - Catalina Vidal
- Orthopedics Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay #362, Santiago, 8330077, Chile
| | - Cristián Ruz
- Orthopedics Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay #362, Santiago, 8330077, Chile
| | - Raúl Zilleruelo
- Orthopedics Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay #362, Santiago, 8330077, Chile
| | - Ernesto Pino
- Orthopedics Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay #362, Santiago, 8330077, Chile
| | - Javier Dauvergne
- Orthopedics Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay #362, Santiago, 8330077, Chile
| | - Pablo Besa
- Orthopedics Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay #362, Santiago, 8330077, Chile
| | - Sebastián Irarrázaval
- Orthopedics Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay #362, Santiago, 8330077, Chile.
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Fukuta A, Yamashita S, Maniwa J, Tamaki A, Kondo T, Kawakubo N, Nagata K, Matsuura T, Tajiri T. Artificial intelligence facilitates the potential of simulator training: An innovative laparoscopic surgical skill validation system using artificial intelligence technology. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03253-5. [PMID: 39160382 DOI: 10.1007/s11548-024-03253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE The development of innovative solutions, such as simulator training and artificial intelligence (AI)-powered tutoring systems, has significantly changed surgical trainees' environments to receive the intraoperative instruction necessary for skill acquisition. In this study, we developed a new objective assessment system using AI for forceps manipulation in a surgical training simulator. METHODS Laparoscopic exercises were recorded using an iPad®, which provided top and side views. Top-view movies were used for AI learning of forceps trajectory. Side-view movies were used as supplementary information to assess the situation. We used an AI-based posture estimation method, DeepLabCut (DLC), to recognize and positionally measure the forceps in the operating field. Tracking accuracy was quantitatively evaluated by calculating the pixel differences between the annotation points and the points predicted by the AI model. Tracking stability at specified key points was verified to assess the AI model. RESULTS We selected a random sample to evaluate tracking accuracy quantitatively. This sample comprised 5% of the frames not used for AI training from the complete set of video frames. We compared the AI detection positions and correct positions and found an average pixel discrepancy of 9.2. The qualitative evaluation of the tracking stability was good at the forceps hinge; however, forceps tip tracking was unstable during rotation. CONCLUSION The AI-based forceps tracking system can visualize and evaluate laparoscopic surgical skills. Improvements in the proposed system and AI self-learning are expected to enable it to distinguish the techniques of expert and novice surgeons accurately. This system is a useful tool for surgeon training and assessment.
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Affiliation(s)
- Atsuhisa Fukuta
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | | | - Junnosuke Maniwa
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akihiko Tamaki
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takuya Kondo
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naonori Kawakubo
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kouji Nagata
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Morales S, Lam P, Cerrato R, Mococain P, Ruz C, Filippi J, Villa A, Varas J. A Novel Simulation Model and Training Program for Minimally Invasive Surgery of Hallux Valgus. J Am Acad Orthop Surg 2024; 32:e816-e825. [PMID: 39093460 DOI: 10.5435/jaaos-d-24-00316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/22/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) for hallux valgus (HV) has gained popularity. However, adopting this technique faces the challenges of a pronounced learning curve. This study aimed to address these challenges by developing and validating an innovative simulation model and training program, targeting enhanced proficiency in HV MIS. METHODS A training program and a high-fidelity simulation model for HV MIS were designed based on experts' recommendations. Four foot and ankle surgeons without experience in MIS formed the novice group and took the program that encompassed six-session instructional lessons, hands-on practice on simulated models, and immediate feedback. The program concluded with a cadaveric surgery. Four foot and ankle experienced MIS surgeons formed the expert group and underwent the same procedure with one simulated model. Participants underwent blind assessment, including Objective Structured Assessment of Technical Skills (OSATS), surgical time, and radiograph usage. RESULTS Expert evaluation of the simulation model indicated high satisfaction with anatomical representation, handling properties, and utility as a training tool. The expert group consistently outperformed novices at the initial assessment across all outcomes, demonstrating OSATS scores of 24 points (range, 23 to 25) versus 15.5 (range, 12 to 17), median surgical time of 22.75 minutes (range, 12 to 27) versus 48.75 minutes (range, 38 to 60), and median radiograph usage of 70 (range, 53 to 102) versus 232.5 (range, 112 to 280). DISCUSSION Novices exhibited a significant improvement in OSATS scores from the fifth session onward (P = 0.01), reaching the desired performance of 20 points. Performance at the final training with the simulated model did not differ from cadaveric surgery outcomes for all parameters. CONCLUSION This study validated a simulation model and training program, allowing nonexperienced HV MIS foot and ankle surgeons to enhance their surgical proficiency and effectively complete a substantial portion of the learning curve at the fifth session, and this performance was successfully transferred to a cadaver model. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sergio Morales
- From the Orthopedic Surgery Department, Pontificia Universidad Católica de Chile, Santiago, Chile (Morales, Ruz, Filippi, and Villa), the Orthopedic Surgery Department, Complejo Asistencial Dr. Sótero Del Río, Santiago, Chile (Morales), the Orthopaedic and Arthritis Specialist Centre, Sydney, Australia (Lam), the Mercy Medical Center, Baltimore, MD (Cerrato), Facultad de Medicina, Clínica Alemana-UDD, Santiago, Chile (Mococain), and the Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile (Varas)
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Kaijser MA, Slagter N, de Heide LJ, van Beek AP, Pierie JPE, Emous M. Measuring Small Bowel Length in Bariatric Surgery: An Ex Vivo Laparoscopic Training Experiment. Surg Innov 2024; 31:407-414. [PMID: 38626174 PMCID: PMC11264542 DOI: 10.1177/15533506241244854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Determining limb length in gastric bypass procedures is a crucial step to ensure significant weight loss without risking malnutrition. This study investigated the effect of ex vivo training on the skills needed to determine limb lengths. MATERIALS AND METHODS This was a single-center ex vivo training experiment in a teaching hospital in the Netherlands. We designed a training exercise with marked ropes in a laparoscopic trainer box. All ten surgical residents participated and practiced the skill of estimating limb length. Before and after the two-week period their results on a 150-centimeter limb length task were evaluated. RESULTS Before training, 10 surgical residents estimated 150 centimeters of small bowel with an absolute deviation of 21% [range 9-30]. After the training experiment, the residents measured with 8% [2-20] deviation (P = .17). The 8 residents who trained sufficiently improved statistically significantly to an absolute deviation of 5% [2-17] (P = .012). Over 70% of the participants felt their skills had improved. CONCLUSIONS With sufficient training, surgical residents' skills in measuring small bowel length improved when tested in an ex vivo model. Residents became more confident in their laparoscopic measurement skills. This ex vivo training model is a alternative and addition to on-site training.
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Affiliation(s)
- Mirjam A. Kaijser
- Center for Obesity Northern-Netherlands (CON), Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Post Graduate School of Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nienke Slagter
- Center for Obesity Northern-Netherlands (CON), Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Post Graduate School of Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Loek J.M. de Heide
- Center for Obesity Northern-Netherlands (CON), Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - André P. van Beek
- Post Graduate School of Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean-Pierre E.N. Pierie
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Post Graduate School of Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marloes Emous
- Center for Obesity Northern-Netherlands (CON), Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Rojas MF, Torres J, Figueroa Ú, Varas J, Achurra P, Navia A, Cuadra Á, Searle S. Validation of a synthetic simulation model of endoscopic rectus sheath plication. Hernia 2024; 28:1381-1390. [PMID: 38767716 DOI: 10.1007/s10029-024-03059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. METHODS A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. RESULTS Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24-25) vs 14 (range 5-22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10-11) vs 8 (range 3-10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. CONCLUSION Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication.
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Affiliation(s)
- María Fernanda Rojas
- General Surgeon at Clínica Bupa Santiago, Vaticano 4008, Las Condes, Región Metropolitana, Santiago, Chile.
| | - Javier Torres
- Plastic and Reconstructive Surgeon at Hospital Dr. Victor Ríos Ruiz, Los Angeles, Chile
| | - Úrsula Figueroa
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julian Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfonso Navia
- Plastic and Reconstructive Surgeon at Pontificia, Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Cuadra
- Plastic and Reconstructive Surgeon at Pontificia, Universidad Católica de Chile, Santiago, Chile
| | - Susana Searle
- Plastic and Reconstructive Surgeon at Pontificia, Universidad Católica de Chile, Santiago, Chile
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Zahradniková P, Babala J, Pechanová R, Smrek M, Vitovič P, Laurovičová M, Bernát T, Nedomová B. Inanimate 3D printed model for thoracoscopic repair of esophageal atresia with tracheoesophageal fistula. Front Pediatr 2023; 11:1286946. [PMID: 38034821 PMCID: PMC10682092 DOI: 10.3389/fped.2023.1286946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background Thoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) poses significant technical challenges. This study aimed to develop an inexpensive, reusable, high-fidelity synthetic tissue model for simulating EA/TEF repairs and to assess the validity of the simulator. Methods By using 3D printing and silicone casting, we designed an inexpensive and reusable inanimate model for training in thoracoscopic EA/TEF repair. The objective was to validate the model using a 5-point Likert scale and the Objective Structured Assessment of Technical Skills (OSATS) to evaluate participants' surgical proficiency. Results A total of 18 participants (7 medical students, 4 pediatric surgery trainees, and 7 experienced surgeons), after being instructed and trained, were asked to perform TEF ligation, dissection, as well as esophageal anastomosis using six sliding knots on the EA/TEF simulator. All participants in the expert group completed the task within the 120-minute time limit, however only 4 (57%) participants from the novice/intermediate completed the task within the time limit. There was a statistically significant difference in OSATS scores for the "flow of task" (p = 0.018) and scores for the "overall MIS skills" (p = 0.010) task distinguishing between novice and intermediates and experts. The simulator demonstrated strong suitability as a training tool, indicated by a mean score of 4.66. The mean scores for the model's realism and the working environment were 4.25 and 4.5, respectively. Overall, the face validity was scored significantly lower in the expert group compared to the novice/intermediate groups (p = 0.0002). Conclusions Our study established good face and content validity of the simulator. Due to its reusability, and suitability for individual participants, our model holds promise as a training tool for thoracoscopic procedures among surgeons. However, novices and trainees struggled with advanced minimally invasive surgical procedures. Therefore, a structured and focused training curriculum in pediatric MIS is needed for optimal utilization of the available training hours.
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Affiliation(s)
- Petra Zahradniková
- Department of Pediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Jozef Babala
- Department of Pediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Rebeka Pechanová
- Department of Pediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Martin Smrek
- Department of Pediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Pavol Vitovič
- Faculty of Medicine, Institute of Medical Education and Simulations, Comenius University, Bratislava, Slovakia
| | - Miroslava Laurovičová
- Faculty of Medicine, Institute of Medical Education and Simulations, Comenius University, Bratislava, Slovakia
| | - Tomáš Bernát
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Barbora Nedomová
- Department of Paediatric Anaesthesiology and Intensive Medicine, Faculty of Medicine, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
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Santander MJ, Sepúlveda V, Iribarren J, Rosenbaum A, Albrich D, Varas J, Lagos A, Napolitano C. Development and Validation of a Laryngeal Microsurgery Simulation Training System for Otolaryngology Residents. Otolaryngol Head Neck Surg 2023; 169:971-987. [PMID: 37232508 DOI: 10.1002/ohn.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/28/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study aims to create a synthetic laryngeal microsurgery simulation model and training program; to assess its face, content, and construct validity; and to review the available phonomicrosurgery simulation models in the literature. STUDY DESIGN Nonrandomly assigned control study. SETTING Simulation training course for the otolaryngology residency program at Pontificia Universidad Católica de Chile. METHODS Resident (postgraduate year 1 [PGY1]/PGY2) and expert groups were recruited. A laryngeal microsurgery synthetic model was developed. Nine tasks were designed and assessed through a set of programmed exercises with increasing difficulty, to fulfill 5 surgical competencies. Imperial College Surgical Assessment Device sensors applied to the participants' hands measured time and movements. The activities were video-recorded and blindly assessed by 2 laryngologists using a specific and global rating scale (SRS and GRS). A 5-point Likert survey assessing validity was completed by experts. RESULTS Eighteen participants were recruited (14 residents and 4 experts). Experts performed significantly better than residents in the SRS (p = .003), and GRS (p = .004). Internal consistency was demonstrated for the SRS (α = .972, p < .001). Experts had a shorter execution time (p = .007), and path length with the right hand (p = .04). The left hand did not show significant differences. The survey assessing validity resulted in a median 36 out of 40 points score for face validity; and 43 out of 45 points score, for global content validity. The literature review revealed 20 available phonomicrosurgery simulation models, only 6 with construct validity. CONCLUSION The face, content, and construct validity of the laryngeal microsurgery simulation training program were established. It could be replicated and incorporated into residents' curricula.
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Affiliation(s)
- María Jesús Santander
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valeria Sepúlveda
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Iribarren
- Faculty of Medicine, Division of Undergraduate Education-School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Rosenbaum
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diego Albrich
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julian Varas
- Department of Digestive Surgery, Experimental Surgery and Simulation Center, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Lagos
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carla Napolitano
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Tonbul G, Topalli D, Cagiltay NE. A systematic review on classification and assessment of surgical skill levels for simulation-based training programs. Int J Med Inform 2023; 177:105121. [PMID: 37290214 DOI: 10.1016/j.ijmedinf.2023.105121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Nowadays, advances in medical informatics have made minimally invasive surgery (MIS) procedures the preferred choice. However, there are several problems with the education programs in terms of surgical skill acquisition. For instance, defining and objectively measuring surgical skill levels is a challenging process. Accordingly, the aim of this study is to conduct a literature review for an investigation of the current approaches for classifying the surgical skill levels and for identifying the skill training tools and measurement methods. MATERIALS AND METHODS In this research, a search is conducted and a corpus is created. Exclusion and inclusion criteria are applied by limiting the number of articles based on surgical education, training approximations, hand movements, and endoscopic or laparoscopic operations. To satisfy these criteria, 57 articles are included in the corpus of this study. RESULTS Currently used surgical skill assessment approaches have been summarized. Results show that various classification approaches for the surgical skill level definitions are being used. Besides, many studies are conducted by omitting particularly important skill levels in between. Additionally, some inconsistencies are also identified across the skill level classification studies. CONCLUSION In order to improve the benefits of simulation-based training programs, a standardized interdisciplinary approach should be developed. For this reason, specific to each surgical procedure, the required skills should be identified. Additionally, appropriate measures for assessing these skills, which can be defined in simulation-based MIS training environments, should be refined. Finally, the skill levels gained during the developmental stages of these skills, with their threshold values referencing the identified measures, should be redefined in a standardized manner.
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Affiliation(s)
- Gokcen Tonbul
- Graduate School of Natural and Applied Sciences, Atilim University, Ankara, Turkey; Strategy and Technology Research Center, Baskent University, Ankara, Turkey.
| | - Damla Topalli
- Department of Computer Engineering, Atilim University, Ankara, Turkey
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Farzaneh SB, Devetzis K, Kamyab AA, Sousi S, Zargaran A, Zargaran D. Emergency burn education: Evaluating a surgical simulation-based intervention. J Plast Reconstr Aesthet Surg 2023; 82:137-140. [PMID: 37167714 DOI: 10.1016/j.bjps.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/15/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Medical simulation has provided favorable outcomes in the improvement of clinical competence at both the undergraduate and postgraduate levels. The recall of information demonstrably increases when it has been taught in environments similar to the workplace. This study aimed to evaluate the role of a one-day burn simulation session in improving students' knowledge of burn management and interest in plastic surgery as a specialty. METHOD A one-day course was designed to deliver multiple lectures covering surgical topics such as the classification and management of burns, followed by a series of practical workshops. Participants were instructed to undergo a pre-course knowledge assessment and a survey focusing on interest in plastic surgery. Students were subsequently instructed to complete a post-course assessment and a survey of knowledge and confidence in managing burns as well as interest in plastic surgery both immediately and 6 weeks post-course. RESULTS The students' knowledge demonstrated a 54.2% increase in the post-course assessment (p < 0.01). 27% of participants (n = 14) participated in a 6-week post-course quiz. The knowledge assessment of these participants at 6 weeks post-course also demonstrated a sustained increase of 61.0% (p < 0.01). Interest in plastic surgery was increased by 31.4% post-course (p < 0.01). At 6 weeks post-course, a sustained increase of 14.7% was demonstrated in comparison to pre-course data (p = 0.03). CONCLUSION Simulation teaching provides good outcomes in both information retention and interest in plastic surgery as a specialty. Therefore, medical school curriculums may benefit from including burn simulations.
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Affiliation(s)
| | | | - Arya Anthony Kamyab
- St George's University of London, Cranmer Terrace, Tooting, SW17 0RE London, UK
| | - Sara Sousi
- Department of Surgery and Cancer, Imperial College London, W12 0NN London, UK; King's College London, London SE1 1UL, Greater London, UK
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Ledermann G, Kuroiwa A, González N, Silva I, Villa A. Training Program for Orthopedic Residents in Forefoot Osteotomy Skills: Transference From a Simulator to a Cadaveric Surgical Scenario. Simul Healthc 2023; 18:181-186. [PMID: 35921612 DOI: 10.1097/sih.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION An effective simulation program allows both the acquisition of surgical skills on the simulated model and the transfer of these skills to a surgical scenario. We designed a forefoot osteotomy training program and sought to determine the transferability to a cadaveric surgical scenario. METHODS Eleven orthopedic residents and 2 foot and ankle surgeons were included. A foot simulator was used. All residents were instructed on the surgical techniques of Chevron, Akin, and triple Weil osteotomies. Eight junior residents (trainees) were enrolled in a supervised simulation program. Baseline assessment was performed on the simulator with the Objective Structured Assessment of Technical Skills (OSATS) and the Imperial College Surgical Assessment Device (ICSAD). After baseline, trainees completed a training program and had a final evaluation of proficiency on the simulator and on cadaveric specimens. Three senior residents with no simulated training (controls) and experts were assessed for comparison. RESULTS All trainees improved from a baseline OSATS score of 11 points (9-20) to a final score of 35 points (33-35) in the simulator and 34 points (32-34) in the cadaveric specimen ( P < 0.01). Compared with baseline, the ICSAD results improved in path length (391 [205-544] to 131 [73-278] meters, P < 0.01) and number of movements (2756 [1258-3338] to 992 [478-1908], P < 0.01). The final OSATS and ICSAD scores did not differ from experts ( P = 0.1) and were significantly different from untrained residents ( P = 0.02). CONCLUSIONS Simulated training of Chevron, Akin, and triple Weil osteotomies in orthopedic residents improved procedural proficiency, enabling successful skill transfer to a surgical scenario in cadavers. LEVEL OF EVIDENCE II (Prospective Cohort Study).
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Affiliation(s)
- Gerardo Ledermann
- From the Departamento de Traumatología (G.L., A.K., N.G., A.V.), Facultad de Medicina, Pontificia Universidad Católica de Chile; Servicio de Traumatología (G.L., A.K.); Servicio de Salud Metropolitano Sur-Oriente; and Facultad de Medicina (I.S.), Pontificia Universidad Católica de Chile, Santiago, Chile
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11
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Rhodin KE, Leraas HJ, Tracy E, Sudan R, Migaly J. A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage. ANNALS OF SURGERY OPEN 2023; 4:e274. [PMID: 37601474 PMCID: PMC10431394 DOI: 10.1097/as9.0000000000000274] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Kristen E Rhodin
- From the Department of Surgery, Duke University Medical Center, Durham, NC
| | - Harold J Leraas
- From the Department of Surgery, Duke University Medical Center, Durham, NC
| | - Elisabeth Tracy
- From the Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ranjan Sudan
- From the Department of Surgery, Duke University Medical Center, Durham, NC
| | - John Migaly
- From the Department of Surgery, Duke University Medical Center, Durham, NC
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12
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Duran Espinoza V, Belmar Riveros F, Jarry Trujillo C, Gaete Dañobeitia MI, Montero Jaras I, Miguieles Schilling M, Valencia Coronel B, Escalona G, Tirado PA, Quezada N, Crovari F, Cohen JV. Five-Year Experience Training Surgeons with a Laparoscopic Simulation Training Program for Bariatric Surgery: a Quasi-experimental Design. Obes Surg 2023:10.1007/s11695-023-06616-0. [PMID: 37118641 DOI: 10.1007/s11695-023-06616-0] [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: 12/18/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE Nearly 200,000 laparoscopic Roux-en-Y gastric bypass (LRYGB) are performed yearly. Reported learning curves range between 50 and 150, even 500 cases to decrease the operative risk. Simulation programs could accelerate this learning curve safely; however, trainings for LRYGB are scarce. This study aims to describe and share our 5-year experience of a simulated program designed to achieve proficiency in LRYGB technical skills. MATERIALS AND METHODS A quasi-experimental design was used. All recruited participants were previously trained with basic and advanced laparoscopic simulation curriculum completing over 50 h of practical training. Ex vivo animal models were used to practice manual and stapled gastrojejunostomy (GJ) and stapled jejunojejunostomy (JJO) in 10, 3, and 4 sessions, respectively. The main outcome was to assess the manual GJ skill acquisition. Pre- and post-training assessments using a Global Rating Scale (GRS; max 25 pts), Specific Rating Scale (SRS; max 20 pts), performance time, permeability, and leakage rates were analyzed. For the stapled GJ and JJO, execution time was registered. Data analysis was performed using parametric tests. RESULTS In 5 years, 68 trainees completed the program. For the manual GJ's pre- vs post-training assessment, GRS and SRS scores increased significantly (from 17 to 24 and from 13 to 19 points respectively, p-value < 0.001). Permeability rate increased while leakage rate and procedural time decreased significantly. CONCLUSION This simulated training program showed effectiveness in improving laparoscopic skills for manual GJ and JJO in a simulated scenario. This new training program could optimize the clinical learning curve. Further studies are needed to assess the transfer of skills to the operating room.
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Affiliation(s)
- Valentina Duran Espinoza
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Francisca Belmar Riveros
- Surgery Resident, Universidad de Chile, Av. Independencia 1027 Independencia, Santiago, Región Metropolitana, 8380453, Chile
| | - Cristian Jarry Trujillo
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Maria Ines Gaete Dañobeitia
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Av. Libertador Bernardo O'Higgins 340, 8331150, Santiago, Región Metropolitana, Chile
| | - Isabella Montero Jaras
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Mariana Miguieles Schilling
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Brandon Valencia Coronel
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile
| | - Pablo Achurra Tirado
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Av. Libertador Bernardo O'Higgins 340, 8331150, Santiago, Región Metropolitana, Chile
| | - Nicolas Quezada
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Av. Libertador Bernardo O'Higgins 340, 8331150, Santiago, Región Metropolitana, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Av. Libertador Bernardo O'Higgins 340, 8331150, Santiago, Región Metropolitana, Chile
| | - Julian Varas Cohen
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 377, 8330024, Santiago, Región Metropolitana, Chile.
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13
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Villagrán I, Rammsy F, Del Valle J, Gregorio de Las Heras S, Pozo L, García P, Torres G, Varas J, Mandrusiak A, Corvetto M, Fuentes-Cimma J. Remote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students. BMC MEDICAL EDUCATION 2023; 23:267. [PMID: 37081551 PMCID: PMC10116106 DOI: 10.1186/s12909-023-04229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students. METHODS Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric. RESULTS Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality. CONCLUSION The remote, asynchronous training and feedback model proved to be an effective strategy for students' development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.
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Affiliation(s)
- Ignacio Villagrán
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Francisca Rammsy
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Javiera Del Valle
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Sofía Gregorio de Las Heras
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Liliana Pozo
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Patricio García
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Gustavo Torres
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Julián Varas
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Marcia Corvetto
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Fuentes-Cimma
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
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Belmar F, Gaete MI, Durán V, Chelebifski S, Jarry C, Ortiz C, Escalona G, Villagrán I, Alseidi A, Zamorano E, Pimentel F, Crovari F, Varas J. Taking advantage of asynchronous digital feedback: development of an at-home basic suture skills training program for undergraduate medical students that facilitates skills retention. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:32. [PMID: 38013870 PMCID: PMC9900196 DOI: 10.1007/s44186-023-00112-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/27/2022] [Accepted: 01/28/2023] [Indexed: 02/08/2023]
Abstract
Purpose To date, there are no training programs for basic suturing that allow remote deliberate practice. This study seeks to evaluate the effectiveness of a basic suture skills training program and its 6-month skill retention applying unsupervised practice and remote digital feedback. Methods Fourth-year medical-student trainees reviewed instructional videos from a digital platform and performed unsupervised practice as needed at their homes. When they felt competent, trainees uploaded a video of themselves practicing the skill. In < 72 h, they received expert asynchronous digital feedback. The course had two theoretical stages and five video-based assessments, where trainees performed different suturing exercises. For the assessment, a global (GRS) and specific rating scale (SRS) were used, with a passing score of 20 points (max:25) and 15 (max:20), respectively. Results were compared to previously published work with in-person expert feedback (EF) and video-guided learning without feedback (VGL). A subgroup of trainees underwent a 6-month skills retention assessment. Results Two-hundred and forty-three trainees underwent the course between March and December 2021. A median GRS of 24 points was achieved in the final assessment, showing significantly higher scores (p < 0.001) than EF and VGL (20.5 and 15.5, respectively). Thirty-seven trainees underwent a 6-month skills retention assessment, improving in GRS (23.38 vs 24.03, p value = 0.06) and SRS (18.59 vs 19, p value = 0.07). Conclusion It is feasible to teach basic suture skills to undergraduate medical students using an unsupervised training course with remote and asynchronous feedback through a digital platform. This methodology allows continuous training with the repetition of quality practice, personalized feedback, and skills retention at 6 months.
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Affiliation(s)
- Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Slavka Chelebifski
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Cristián Jarry
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Catalina Ortiz
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA USA
| | - Elga Zamorano
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Fernando Pimentel
- Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
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Gaete MI, Belmar F, Cortés M, Alseidi A, Asbun D, Durán V, Escalona G, Achurra P, Villagrán I, Crovari F, Pimentel F, Varas J. Remote and asynchronous training network: from a SAGES grant to an eight-country remote laparoscopic simulation training program. Surg Endosc 2023; 37:1458-1465. [PMID: 35764838 DOI: 10.1007/s00464-022-09386-5] [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: 03/21/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Limitations in surgical simulation training include lack of access to validated training programs with continuous year-round training and lack of experts' ongoing availability for feedback. A model of simulation training was developed to address these limitations. It incorporated basic and advanced laparoscopic skills curricula from a previously validated program and provided instruction through a digital platform. The platform allowed for remote and asynchronous feedback from a few trained instructors. The instructors were continuously available and provided personalized feedback using a variety of different media. We describe the upscaling of this model to teach trainees at fourteen centers in eight countries. METHODS Institutions with surgical programs lacking robust simulation curricula and needing instructors for ongoing education were identified. The simulation centers ("skills labs") at these sites were equipped with necessary simulation training hardware. A remote training-the-administrators (TTA) program was developed where personnel were trained in how to manage the skills lab, schedule trainees, set up training stations, and use the platform. A train-the-trainers (TTT) program was created to establish a network of trained instructors, who provided objective feedback through the platform remotely and asynchronously. RESULTS Between 2019 and 2022, seven institutions in Chile and one in each of the USA, Bolivia, Brazil, Ecuador, El Salvador, México, and Perú implemented a digital platform-based remote simulation curriculum. Most administrators were not physicians (19/33). Eight Instructors were trained with the TTT program and became active proctors. The platform has been used by 369 learners, of whom 57% were general surgeons and general surgery residents. A total of 6729 videos, 28,711 feedback inputs, and 233.7 and 510.2 training hours in the basic and advanced programs, respectively, were registered. CONCLUSION A remote and asynchronous method of giving instruction and feedback through a digital platform has been effectively employed in the creation of a robust network of continuous year-round simulation-based training in laparoscopy. Training centers were successfully run only with trained administrators to assist in logistics and setup, and no on-site instructors were necessary.
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Affiliation(s)
- María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Matías Cortés
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, USA
| | - Domenech Asbun
- Hepatobiliary & Pancreatic Surgery, Miami Cancer Institute, Miami, USA
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Fernando Crovari
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Fernando Pimentel
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile.
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Ortiz C, Vela J, Contreras C, Belmar F, Paul I, Zinco A, Ramos JP, Ottolino P, Achurra P, Jarufe N, Alseidi A, Varas J. A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program. Surg Endosc 2022; 36:8441-8450. [PMID: 35237901 PMCID: PMC8890468 DOI: 10.1007/s00464-022-09098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents' exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. METHODS A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 different programs were recruited. Each station was videotaped in high definition and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specific rating scales alongside procedural times. Self-confidence to perform the procedure as the leading surgeon was evaluated before and after training. RESULTS Statistically significant differences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants significantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A significant improvement in self-confidence was shown in all stations. CONCLUSION An OSCE scenario for training surgical skills in trauma was effective in improving proficiency level and self-confidence. Low pre-training scores and level of confidence in the cardiac and lung injury stations represent a deficit in residency programs that should be addressed. The incorporation of simulation-based teaching tools at early stages in residency would be beneficial when future surgeons face extremely severe trauma scenarios.
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Affiliation(s)
- Catalina Ortiz
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Vela
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Caterina Contreras
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Belmar
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ivan Paul
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Analia Zinco
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Juan Pablo Ramos
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Pablo Ottolino
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Jarufe
- Department of Surgery, Clínica Las Condes, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Julian Varas
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Experimental Surgery and Simulation Center, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Belmar F, Gaete MI, Escalona G, Carnier M, Durán V, Villagrán I, Asbun D, Cortés M, Neyem A, Crovari F, Alseidi A, Varas J. Artificial intelligence in laparoscopic simulation: a promising future for large-scale automated evaluations. Surg Endosc 2022:10.1007/s00464-022-09576-1. [PMID: 36192656 PMCID: PMC9529161 DOI: 10.1007/s00464-022-09576-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022]
Abstract
Introduction A limitation to expanding laparoscopic simulation training programs is the scarcity of expert evaluators. In 2019, a new digital platform for remote and asynchronous laparoscopic simulation training was validated. Through this platform, 369 trainees have been trained in 14 institutions across Latin America, collecting 6729 videos of laparoscopic training exercises. The use of artificial intelligence (AI) has recently emerged in surgical simulation, showing usefulness in training assessment, virtual reality scenarios, and laparoscopic virtual reality simulation. An AI algorithm to assess basic laparoscopic simulation training exercises was developed. This study aimed to analyze the agreement between this AI algorithm and expert evaluators in assessing basic laparoscopic-simulated training exercises. Methods The AI algorithm was trained using 400-bean drop (BD) and 480-peg transfer (PT) videos and tested using 64-BD and 43-PT randomly selected videos, not previously used to train the algorithm. The agreement between AI and expert evaluators from the digital platform (EE) was then analyzed. The exercises being assessed involve using laparoscopic graspers to move objects across an acrylic board without dropping any objects in a determined time (BD < 24 s, PT < 55 s). The AI algorithm can detect object movement, identify if objects have fallen, track grasper clamps location, and measure exercise time. Cohen’s Kappa test was used to evaluate the agreement between AI assessments and those performed by EE, using a pass/fail nomenclature based on the time to complete the exercise. Results After the algorithm was trained, 79.69% and 93.02% agreement were observed in BD and PT, respectively. The Kappa coefficients test observed for BD and PT were 0.59 (moderate agreement) and 0.86 (almost perfect agreement), respectively. Conclusion This first approach of AI use in basic laparoscopic skills simulated training assessment shows promising results, providing a preliminary framework to expand the use of AI to other basic laparoscopic skills exercises. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09576-1.
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Affiliation(s)
- Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Martín Carnier
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile.,Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Domenech Asbun
- Hepatobiliary & Pancreatic Surgery, Miami Cancer Institute, Miami, USA
| | - Matías Cortés
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Andrés Neyem
- Department of Computer Science, Engineering Faculty, Catholic University of Chile, Santiago, Chile
| | - Fernando Crovari
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile.,Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile. .,Faculty of Medicine, Catholic University of Chile, Santiago, Chile.
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Ortiz C, Belmar F, Rebolledo R, Vela J, Contreras C, Inzunza M, Ramos JP, Zinco A, Alseidi A, Varas J, Jarufe N, Achurra P. Validity Argument for a Simulation-Based Objective Structured Clinical Examination Scenario for Evaluation of Surgical Skills in Trauma. J Surg Res 2021; 268:507-513. [PMID: 34450554 DOI: 10.1016/j.jss.2021.06.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Trauma is one of the main causes of death globally, and appropriate surgical care is crucial to impact mortality. However, resident-performed trauma cases have diminished in the last 10 years. Simulation-based tools have proven to be effective to evaluate practical skills in a variety of settings. However, there is a lack of evidence regarding proper validation of trauma surgery models. OBJECTIVE The aim of this study was to evaluate under a contemporary validity framework, an objective structured clinical evaluation (OSCE) scenario for the assessment of basic and advanced surgical skills in trauma and emergency surgery. METHODS An OSCE-type simulation assessment program was developed incorporating six stations representing basic and advanced surgical skills that are essential in trauma surgery. Each station was designed using ex-vivo animal tissue. The stations included basic knots and sutures, bowel resection and anastomosis, vascular end-to-end anastomosis, lung injury repair, cardiac injury repair, and laparoscopic suturing. Eight postgraduate year 2 (PY-2), eight recently graduated surgeons (RGS), and 3 experts were recruited, and their performance was blindly assessed by experts using the validated general rating scale OSATS (Objective Structured Assessment of Technical Skills) as well as the time taken to complete the procedure. RESULTS Significant differences were identified among groups. The average OSATS score was 82 for the PY2 group, 113 for the RGS group, and 147 for the experts (P < 0.01). The average procedural time to complete all the stations was 98 minutes for the PY2 group, 68 minutes for the RGS group, and 35 minutes for the expert surgeons (P < 0.01). CONCLUSION An OSCE scenario designed using ex-vivo tissue met 4 out of 5 criteria of the Messick validity framework: content, relation to other variables, response process and consequences of the test. The results show it is a valid strategy for the evaluation of practical skills in trauma surgery.
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Affiliation(s)
- Catalina Ortiz
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rolando Rebolledo
- Institute for Biomedical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Vela
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Caterina Contreras
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Ramos
- Trauma Surgery and Emergency Medicine Department, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Analía Zinco
- Trauma Surgery and Emergency Medicine Department, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Jarufe
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile.
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19
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Vela J, Cárcamo L, Contreras C, Arenas C, Ramos JP, Rebolledo R, Varas J, Martínez J, Jarufe N, Achurra P. SELF-CONFIDENCE ON ACQUIRED SURGICAL SKILLS TO DEAL WITH SEVERE TRAUMA PATIENTS IN RECENTLY GRADUATED SURGEONS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2021; 34:e1561. [PMID: 34008705 PMCID: PMC8121062 DOI: 10.1590/0102-672020210001e1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Level of competence by procedure. Trauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old. Appropriate surgical skills are required to deal with these complex patients. Self-confidence to practice trauma procedures after the General Surgery Residency have not been reported in our country. AIM Describe the level of self-confidence to deal with trauma procedures of surgeons who recently graduated from a General Surgery Residency. METHOD Descriptive cross-sectional study. We designed and applied a survey in 2015, 2016 and 2017 to recently graduated surgeons, to inquire about self-confidence of surgical skills to deal with trauma scenarios. Eighteen trauma surgery procedures (including cervical, thoracic, abdominal and vascular procedures) were evaluated using a 5-grade Likert scale. The number of procedures performed during the residency was also queried. RESULTS Eighty-eight recently graduated surgeons from 11 different training programs in Chile were included. The report of competencies was high in procedures such as intestinal injuries, were 98% felt competent or very competent in their repair. On the other hand, in complex traumas such as major vessel injury, up to 76% reported not being competent. Self-confidence on procedures was directly associated with the number of procedures performed during residency. CONCLUSIONS Recently graduated surgeons from General Surgery Programs report high levels of confidence to deal with low and intermediate complexity traumas, but a lower level of confidence to treat high complexity cases.
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Affiliation(s)
- Javier Vela
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
| | - Leonardo Cárcamo
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
| | - Caterina Contreras
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
| | - Claudia Arenas
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
| | - Juan Pablo Ramos
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
| | - Rolando Rebolledo
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Intituto de Ingenería Biológica y Médica, Santiago, Región Metropolitana, Chile
| | - Julián Varas
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
| | - Jorge Martínez
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
| | - Nicolas Jarufe
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
| | - Pablo Achurra
- Pontificia Universidad Católica de Chile, Digestive Surgery, Santiago, Región Metropolitana, Chile
- Pontificia Universidad Católica de Chile, Simulation and Experimental Surgery Center, Santiago, Región Metropolitana, Chile
- Complejo Asistencial Dr. Sótero del Río, Unidad de Trauma y Urgencias, Santiago, Región Metropolitana, Chile
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20
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Achievement of effective cardiopulmonary trauma surgical skills training throughout the incorporation of a low-cost and easy to implement pulsatile simulation model. Injury 2021; 52:1215-1220. [PMID: 33422290 DOI: 10.1016/j.injury.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES . In the last decade, concern regarding the preparedness of general surgery graduates to effectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experience implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation. DESIGN . Firstly, for validation purposes 8 junior residents, 8 recently graduated general surgeons, and 3 cardiothoracic surgery attendings from Pontificia Universidad Católica de Chile Clinical Hospital were recruited. Proficiency in performing a pulmonary tractotomy and a myocardial injury repair was assessed with global and specific rating scales. Secondly, to evaluate the effectiveness of the model as a learning tool, 16 general surgery residents from different programs across the country were recruited receiving intensive, personalized training on the models. Proficiency was measured before and after the training. RESULTS . For the validation phase, significant differences among groups according to the previous level of expertise were shown, and therefore construct validity was established. The results of the second phase showed a significant overall improvement in participant's performance. CONCLUSION . Effective training and assessment for advanced surgical skills in cardiothoracic trauma can be achieved using a low-cost pulsatile simulation model.
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21
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Villagrán I, Moënne-Loccoz C, Aguilera V, García V, Reyes JT, Rodríguez S, Miranda C, Altermatt F, Fuentes-López E, Delgado M, Neyem A. Biomechanical analysis of expert anesthesiologists and novice residents performing a simulated central venous access procedure. PLoS One 2021; 16:e0250941. [PMID: 33930076 PMCID: PMC8087019 DOI: 10.1371/journal.pone.0250941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/11/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Central venous access (CVA) is a frequent procedure taught in medical residencies. However, since CVA is a high-risk procedure requiring a detailed teaching and learning process to ensure trainee proficiency, it is necessary to determine objective differences between the expert's and the novice's performance to guide novice practitioners during their training process. This study compares experts' and novices' biomechanical variables during a simulated CVA performance. METHODS Seven experts and seven novices were part of this study. The participants' motion data during a CVA simulation procedure was collected using the Vicon Motion System. The procedure was divided into four stages for analysis, and each hand's speed, acceleration, and jerk were obtained. Also, the procedural time was analyzed. Descriptive analysis and multilevel linear models with random intercept and interaction were used to analyze group, hand, and stage differences. RESULTS There were statistically significant differences between experts and novices regarding time, speed, acceleration, and jerk during a simulated CVA performance. These differences vary significantly by the procedure stage for right-hand acceleration and left-hand jerk. CONCLUSIONS Experts take less time to perform the CVA procedure, which is reflected in higher speed, acceleration, and jerk values. This difference varies according to the procedure's stage, depending on the hand and variable studied, demonstrating that these variables could play an essential role in differentiating between experts and novices, and could be used when designing training strategies.
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Affiliation(s)
- Ignacio Villagrán
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristóbal Moënne-Loccoz
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Aguilera
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vicente García
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Tomás Reyes
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Rodríguez
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Constanza Miranda
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Fernando Altermatt
- Anesthesiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail:
| | - Eduardo Fuentes-López
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Delgado
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Neyem
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
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22
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Dib M, Jarufe N. Laparoscopic Left Lateral Donor Hepatectomy for Pediatric Liver Transplantation: Worldwide Learning Curves and Safety Implications From Korea to Chile. Liver Transpl 2021; 27:482-483. [PMID: 37160031 DOI: 10.1002/lt.25945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Martin Dib
- Department of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Jarufe
- Department of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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23
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Torres A, Inzunza M, Jarry C, Serrano F, Varas J, Zavala A. DEVELOPMENT AND VALIDATION OF A NEW LAPAROSCOPIC ENDOTRAINER FOR NEONATAL SURGERY AND REDUCED SPACES. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2021; 33:e1559. [PMID: 33503119 PMCID: PMC7836074 DOI: 10.1590/0102-672020200004e1559] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric laparoscopy box with sliding tray. Pediatric procedures have the difficulty of being performed in reduced spaces. Training in reduced spaces has proven to be different in complexity compared to adult laparoscopic endotrainers. AIM To develop and validate a new neonatal/reduced-space endotrainer. METHODS The simulator was tested and assessed by users with different skill levels and experience in laparoscopic pediatric surgery through an 8-item questionnaire. Construct validity was determined by evaluating the performance of each subject on nine exercises. RESULTS A 10.5 x 10 x 18 cm acrylic simulator was created, with an internal working surface of 9 x 9 cm. An HD camera was incorporated, with a 0-180° range of movement. All exercises of a Basic Laparoscopic Training Program were adapted on a scale of 1:0.5 to fit in. From 49 participants, 42 (85.71%) answered the survey; 80.5% considered that the simulator reproduces similar conditions to procedures performed in children under one year of age; 61.1% thought that the simulator represents a difficulty identical to procedures performed in newborns; 73.7% considered that the neonatal simulator is more complicated than the adult simulator. Experts showed significantly better performance in all proposed exercises. CONCLUSION The simulator has a high-quality image and design that allows training with basic tasks. The endotrainer permitted to discriminate between these different skill levels and was well evaluated by users with diverse surgical experience.
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Affiliation(s)
- Alberto Torres
- Pediatric Surgery Section, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martín Inzunza
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristián Jarry
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Serrano
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Zavala
- Pediatric Surgery Section, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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24
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Quezada J, Achurra P, Asbun D, Polom K, Roviello F, Buckel E, Inzunza M, Escalona G, Jarufe N, Varas J. Smartphone application supplements laparoscopic training through simulation by reducing the need for feedback from expert tutors. Surg Open Sci 2020; 1:100-104. [PMID: 32754701 PMCID: PMC7391878 DOI: 10.1016/j.sopen.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022] Open
Abstract
Background Simulation training is a validated, highly effective tool for learning laparoscopy. Feedback plays a crucial role in motor skills training. We present an app to guide students during advanced laparoscopy simulation training and evaluate its effect on training. Methods A smartphone(iOS)-app was developed. A group of trainees were randomized to use the app (YAPP) or not use the app (NAPP). We used blinded analysis with validated rating scales to assess their performance before and after the training. The number of requests for tutor feedback per session was recorded. Finally, the participants in the YAPP group completed a survey about their experience with the app. Results Fifteen YAPP and 10 NAPP completed the training program. There were no statistically significant differences between their skills performance scores (P = .338). The number of tutor feedback requests in the YAPP and NAPP was of 4 (3–6) and 13 (10–14) (P < .001), respectively. All participants in the YAPP group found the app was useful. Conclusion The use of a smartphone app reduces the need for expert tutor feedback without decreasing the degree of skills acquisition. Simulation training is a validated, highly effective tool for learning laparoscopy. Feedback plays a crucial role in motor skills training. Expert feedback is often scarce, and tutors are usually not always available. Simulation and mobile technology must be further combined to improve training efficacy.
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Affiliation(s)
- Jose Quezada
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Karol Polom
- General Surgery and Surgical Oncology Department, University of Siena, Siena, Italy.,Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Franco Roviello
- General Surgery and Surgical Oncology Department, University of Siena, Siena, Italy
| | - Erwin Buckel
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Escalona
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Jarufe
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julian Varas
- Digestive Surgery Department, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy. Simul Healthc 2020; 16:157-162. [DOI: 10.1097/sih.0000000000000491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay. Updates Surg 2020; 73:93-100. [PMID: 32607844 DOI: 10.1007/s13304-020-00840-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/21/2020] [Indexed: 10/24/2022]
Abstract
Reconstruction after laparoscopic right colectomy (LRC) can be achieved by performing an intracorporeal (IA) or an extracorporeal anastomosis (EA). This study aims to assess the safety of implementing IA in LRC, and to compare its perioperative outcomes with EA during an institution's learning curve. Patients undergoing elective LRC with IA or EA in a teaching university hospital between January 2015 and December 2018 were included. Demographic, clinical, perioperative and histopathological data were collated and outcomes investigated. One hundred and twenty-two patients were included; forty-three (35.2%) had an IA. The main indication for surgery was cancer in both groups (83.7% for IA and 79.8% for EA; p = 0.50). Operative time was longer for IA (180 [150-205] versus 150 [120-180] minutes; p < 0.001). A Pfannenstiel incision was used as extraction site in 97.7% of patients receiving an IA; while a midline incision was used in 97.5% of patients having an EA (p < 0.001). Hospital stay was significantly shorter for IA (3 [3, 4] versus 4 [3-6] days; p = 0.003). There were no differences in postoperative complications rates between groups. There was a 4.7% and 3.8% anastomotic leak rate in the IA and EA group, respectively (p = 1). Re-intervention and readmission rates were similar between groups, and there was no mortality during the study period. The implementation of IA in LRC is safe. Despite longer operative times, IA is associated with a shorter hospital stay when compared to EA in the setting of an institution's learning curve.
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Oviedo-Peñata CA, Tapia-Araya AE, Lemos JD, Riaño-Benavides C, Case JB, Maldonado-Estrada JG. Validation of Training and Acquisition of Surgical Skills in Veterinary Laparoscopic Surgery: A Review. Front Vet Sci 2020; 7:306. [PMID: 32582781 PMCID: PMC7283875 DOI: 10.3389/fvets.2020.00306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
At present, veterinary laparoscopic surgery training is lacking in experiences that provide a controlled and safe environment where surgeons can practice specific techniques while receiving experts' feedback. Surgical skills acquired using simulators must be certified and transferable to the operating room. Most models for practicing laparoscopic skills in veterinary minimally invasive surgery are general task trainers and consist of boxes (simulators) designed for training human surgery. These simulators exhibit several limitations, including anatomic species and procedural differences, as well as general psychomotor training rather than in vivo skill recreation. In this paper, we review the existing methods of training, evaluation, and validation of technical skills in veterinary laparoscopic surgery. Content includes global and specific scales, and the conditions a structured curriculum should meet for improving the performance of novice surgeons during and after training. A focus on trainee-specific assessment and tailored-technical instruction should influence training programs. We provide a comprehensive analysis of current theories and concepts related to the evaluation and validation of simulators for training laparoscopic surgery in small animal surgery. We also highlight the need to develop new training models and complementary evaluation scales for the validation of training and acquisition of basic and advanced skills in veterinary laparoscopic surgery.
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Affiliation(s)
- Carlos A Oviedo-Peñata
- Tropical Animal Production Research Group, Faculty of Veterinary Medicine and Zootechny, University of Cordoba, Monteria, Colombia.,Surgery and Theriogenology Branch OHVRI-Group, College of Veterinary Medicine, University of Antioquia, Medellin, Colombia
| | | | - Juan D Lemos
- Bioinstrumentation and Clinical Engineering Research Group (GIBIC), Bioengineering Department, Engineering Faculty, Universidad de Antioquia, Medellín, Colombia
| | - Carlos Riaño-Benavides
- Surgery and Theriogenology Branch OHVRI-Group, College of Veterinary Medicine, University of Antioquia, Medellin, Colombia
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Juan G Maldonado-Estrada
- Surgery and Theriogenology Branch OHVRI-Group, College of Veterinary Medicine, University of Antioquia, Medellin, Colombia
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Danion J, Breque C, Oriot D, Faure J, Richer J. SimLife® technology in surgical training – a dynamic simulation model. J Visc Surg 2020; 157:S117-S122. [DOI: 10.1016/j.jviscsurg.2020.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Fernández MJ, Toledo E, Cañón M, Manuel-Palazuelos JC, M. Maestre J. Desarrollo y validación de una herramienta para la evaluación de la anastomosis intestinal laparoscópica en simulación. Cir Esp 2020; 98:274-280. [DOI: 10.1016/j.ciresp.2019.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/28/2019] [Accepted: 10/20/2019] [Indexed: 01/22/2023]
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30
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Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator. Simul Healthc 2020; 14:415-419. [PMID: 31804426 PMCID: PMC6903325 DOI: 10.1097/sih.0000000000000399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Supplemental digital content is available in the text. Introduction Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries. The objective of this study was to present the design and simulator performance of a low-cost BG-PDT simulator. Methods A simulator was designed with materials available in a hardware store, synthetic skin pads, ex vivo bovine tracheas, and a pipe inspection camera. The simulator was tested in 8 experts and 9 novices. Sessions were video recorded, and participants were equipped with the Imperial College Surgical Device, a hand motion–tracking device. Performance was evaluated with a multimodal approach, including first attempt success rate, global success rate, total procedural time, Imperial College Surgical Device–derived proficiency parameters, and global rating scale applied blindly by 2 expert observers. A satisfaction survey was applied after the procedure. Results A simulator was successfully constructed, allowing multiple iterations per assembly, with a fixed cost of US $30 and $4 per use. Experts had greater global and first attempt success rate, performed the procedure faster, and with greater proficiency. It presented high user satisfaction and fidelity. Conclusions A low-cost BG-PDT simulator was successfully constructed, with the ability to discriminate between experts and novices, and with high fidelity. Considering its ease of construction and cost, it can be replicated in almost any intensive care unit.
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Orthopaedic Residents' Transfer of Knee Arthroscopic Abilities from the Simulator to the Operating Room. J Am Acad Orthop Surg 2020; 28:194-199. [PMID: 31415299 DOI: 10.5435/jaaos-d-19-00245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The ultimate goal for any surgical simulation program is to prove the capability of transferring the skills learned to real-life surgical scenarios. We designed an arthroscopic partial meniscectomy (APM) training program and sought to determine its ability to transfer skills to real patients. METHODS Eleven junior orthopaedic residents and three expert knee surgeons were included. A low-fidelity knee simulator was used. Trainees had two baseline assessments of completing APM on a supervised real patient and on the simulator, measured using the Arthroscopic Surgical Skill Evaluation Tool (ASSET). After baseline, the trainees completed an APM training program and had a final evaluation of proficiency on the simulator and in real patients. Experts were also assessed for comparison. Statistical analysis was performed, assuming nonparametric behavior of variables. RESULTS All trainees improved from a base score of 14 points in real patients and 10 points on the simulator to a final score of 39 points and 36 points, respectively (P < 0.01). The final trainee simulator score did not differ from experts on the simulator and was lower in real patients (36 versus 39 points, respectively, P ≤ 0.01), which resulted in a 92% transfer ratio for the simulator. DISCUSSION Simulated training of APM in orthopaedic residents using a low-fidelity knee simulator proved to not only improve simulated proficiency but also successfully transfer skills to a real clinical scenario with a high model transfer ratio. LEVEL OF EVIDENCE Level II (Prospective Cohort Study).
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Nurczyk K, Perez AJ, Murty NS, Patti MG. A Novel University of North Carolina Laparoscopic Ventral Hernia Repair Simulator. J Laparoendosc Adv Surg Tech A 2020; 30:608-611. [PMID: 31928496 DOI: 10.1089/lap.2019.0770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Simulation plays an important role in surgical training. We developed a simulator for laparoscopic ventral hernia repair (LVHR) surgery based on porcine tissue, characterized by low cost and high reality. Methods: Our LVHR model is based on porcine tissue mounted in a human mannequin. The anterior abdominal wall is constructed to allow laparoscopic training. Training sessions are conducted in a simulated operating room environment. Results: During preliminary tests, the LVHR simulator was found to be highly realistic in terms of tissue feedback, instrumentation usage, and performing the key steps of the LVHR procedure. The model was evaluated as a very useful tool for residents' training allowing to gain laparoscopic skills, learn the key steps of LVHR, and practice team work. Conclusions: Our simulator, based on porcine tissue mounted in a mannequin, offers a very realistic and cost-effective model for simulating LVHR surgery.
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Affiliation(s)
- Kamil Nurczyk
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Multidisciplinary Simulation Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,2nd Department of General and Gastrointestinal Surgery, and Surgical Oncology of Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Arielle J Perez
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,University of North Carolina Health Care Hernia Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neal S Murty
- Multidisciplinary Simulation Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marco G Patti
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Multidisciplinary Simulation Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
Burns are devastating injuries which represent a significant global health burden. In the UK alone, it is estimated that 175 000 people suffer from burns injuries requiring hospital attention every year. The global treatment of burns can be improved through a more systematic team-based approach, which can be achieved through simulation training. Simulation has an increasingly important role in medical education, not only allowing practitioners to apply their knowledge in a controlled and safe environment, but also allowing them to gain technical and non-technical skills. This article explores the role of simulation as an important and effective tool for burns education worldwide.
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Affiliation(s)
- Jia Choong
- Core Surgical Trainee, Department of Plastic Surgery, Royal Stoke University Hospital, Stoke on Trent ST4 6QG
| | - Zhi Yong Tan
- Foundation Doctor, Department of General Surgery, York Teaching Hospital NHS Foundation Trust, York
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Quezada J, Achurra P, Jarry C, Asbun D, Tejos R, Inzunza M, Ulloa G, Neyem A, Martínez C, Marino C, Escalona G, Varas J. Minimally invasive tele-mentoring opportunity—the mito project. Surg Endosc 2019; 34:2585-2592. [DOI: 10.1007/s00464-019-07024-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
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Cognitive load and performance in immersive virtual reality versus conventional virtual reality simulation training of laparoscopic surgery: a randomized trial. Surg Endosc 2019; 34:1244-1252. [PMID: 31172325 DOI: 10.1007/s00464-019-06887-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/31/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Virtual reality simulators combined with head-mounted displays enable highly immersive virtual reality (VR) for surgical skills training, potentially bridging the gap between the simulation environment and real-life operating room conditions. However, the increased complexity of the learning situation in immersive VR could potentially induce high cognitive load thereby inhibiting performance and learning. This study aims to compare cognitive load and performance in immersive VR and conventional VR simulation training. METHODS A randomized controlled trial of residents (n = 31) performing laparoscopic salpingectomies with an ectopic pregnancy in either immersive VR or conventional VR simulation. Cognitive load was estimated by secondary-task reaction time at baseline, and during nonstressor and stressor phases of the procedure. Simulator metrics were used to evaluate performance. RESULTS Cognitive load was increased by 66% and 58% during immersive VR and conventional VR simulation, respectively (p < 0.001), compared to baseline. A light stressor induced a further increase in cognitive load by 15.2% and a severe stressor by 43.1% in the immersive VR group compared to 23% (severe stressor) in the conventional VR group. Immersive VR also caused a significantly worse performance on most simulator metrics. CONCLUSION Immersive VR simulation training induces a higher cognitive load and results in a poorer performance than conventional VR simulation training in laparoscopy. High extraneous load and element interactivity in the immersive VR are suggested as mechanisms explaining this finding. However, immersive VR offers some potential advantages over conventional VR such as more real-life conditions but we only recommend introducing immersive VR in surgical skills training after initial training in conventional VR.
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Tejos R, Avila R, Inzunza M, Achurra P, Castillo R, Rosberg A, Cordero O, Kusanovich R, Bellolio F, Varas J, Martínez J. IMPACT OF A SIMULATED LAPAROSCOPIC TRAINING PROGRAM IN A THREE-YEAR GENERAL SURGERY RESIDENCY. ACTA ACUST UNITED AC 2019; 32:e1436. [PMID: 31038561 PMCID: PMC6488269 DOI: 10.1590/0102-672020190001e1436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022]
Abstract
Background: A General Surgery Residency may last between 2-6 years, depending on the
country. A shorter General Surgery Residency must optimize residents’
surgical exposure. Simulated surgical training is known to shorten the
learning curves, but information related to how it affects a General Surgery
Residency regarding clinical exposure is scarce. Aim: To analyze the effect of introducing a validated laparoscopic simulated
training program in abdominal procedures performed by residents in a
three-year General Surgery Residency program. Methods: A non-concurrent cohort study was designed. Four-generations (2012-2015) of
graduated surgeons were included. Only abdominal procedures in which the
graduated surgeons were the primary surgeon were described and analyzed. The
control group was of graduated surgeons from 2012 without the laparoscopic
simulated training program. Surgical procedures per program year, surgical
technique, emergency/elective intervention and hospital-site (main/community
hospitals) were described. Results: Interventions of 28 graduated surgeons were analyzed (control group=5;
laparoscopic simulated training program=23). Graduated surgeons performed a
mean of 372 abdominal procedures, with a higher mean number of
medium-to-complex procedures in laparoscopic simulated training program
group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic
simulated training program performed a higher number of total abdominal
procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148,
p<0.05). Conclusions: The introduction of laparoscopic simulated training program may increase the
number and complexity of total and laparoscopic procedures in a three-year
General Surgery Residency.
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Affiliation(s)
- Rodrigo Tejos
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén Avila
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Richard Castillo
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Anne Rosberg
- International Internship, School of Medicine, Albert-Ludwigs-University of Freiburg, Baden-Württemberg, Germany
| | - Octavio Cordero
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Kusanovich
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Bellolio
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julián Varas
- Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Martínez
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Hoops HE, Haley C, Cook MR, Lopez O, Dewey E, Brasel KJ, Spight D, Kiraly LN. Factors influencing amount of guidance in the operating room during laparoscopic cases. Am J Surg 2019; 217:979-985. [PMID: 30929750 DOI: 10.1016/j.amjsurg.2019.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Identifying factors associated with resident autonomy may help improve training efficiency. This study evaluates resident and procedural factors associated with level of guidance needed in the operating room. METHODS Intraoperative performance and yearly performance on Fundamentals of Laparoscopic Surgery (FLS) tasks from 74 general surgery residents were retrospectively reviewed. The effect of post-graduate year (PGY), procedure complexity, case difficulty, intraoperative performance, and FLS task performance were analyzed using a mixed-effects model. RESULTS PGY level, procedure complexity, case difficulty, operative technique, and operative knowledge were significantly associated with level of intraoperative guidance. In PGY2-4 residents, ratings of medical knowledge and communication were also significantly associated with guidance. There was no significant association between FLS performance and level of guidance for any PGY level. CONCLUSIONS The amount of intraoperative guidance is influenced by many factors, including resident performance and case characteristics. FLS tasks performance was not significantly associated with intraoperative guidance.
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Affiliation(s)
- Heather E Hoops
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA.
| | - Caleb Haley
- Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Mackenzie R Cook
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Olga Lopez
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Elizabeth Dewey
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Karen J Brasel
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Donn Spight
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Laszlo N Kiraly
- Department of Surgery, Oregon Health and Sciences University, Portland, OR, USA
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Toledo Martínez E, Martín Parra JI, Magadán Álvarez C, López Useros A, Fernández Santiago R, Regaño Díez S, Ruiz Gómez JL, Rodriguez Sanjuan JC, Manuel Palazuelos C. Influence of previous experience on the benefits of laparoscopic surgical training based on simulation. Cir Esp 2019; 97:314-319. [PMID: 30709545 DOI: 10.1016/j.ciresp.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Surgical training based on simulation seeks the acquisition of skills in novice participants and ongoing sill development in experts. The aim of this study is to assess the evolution of students in an intensive laparoscopic anastomosis course and to analyse their results depending on their level and previous experience. METHODS The students of all the anastomosis courses conducted during 30 months in the Valdecilla virtual hospital (Santander) were analysed. Manual side-to-side intestinal anastomoses with porcine 'ex vivo' viscera were performed in a laparoscopic endotrainer. The technical and quality differences between the first and the last anastomoses were analyzed and the progression between residents and specialists was compared. RESULTS We analyzed 45 participants, 22 of them residents and 23 specialists. A statistically significant improvement of 80.5% was observed in all procedural parameters (94.8% residents vs. 67.3% specialists). The time was reduced by 48.1% in the residents and 43.2% in the specialists (p<.001). In terms of quality, significant improvements were obtained in the group of residents: an increase of 90% in adequate tension, and a reduction of 75% of everted edges and 60% of leaks. In addition, they obtained results comparable to the specialists (27.3% leak in the last anastomosis vs. 34.8% by the specialists, p=.59), which presented improvement without statistical significance. CONCLUSIONS The group of residents presented a major and significant improvement in procedural skills and in the quality of the technique, reaching the level of the specialists after completion of the course.
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Affiliation(s)
- Enrique Toledo Martínez
- Servicio de Cirugía, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | | | | | - Antonio López Useros
- Servicio de Cirugía, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | | | - Sara Regaño Díez
- Servicio de Cirugía, Hospital de Laredo, Laredo, Cantabria, España
| | - José Luis Ruiz Gómez
- Servicio de Cirugía, Hospital Comarcal Sierrallana, Torrelavega, Cantabria, España
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Tejos R, Chahuán J, Uslar T, Inzunza M, Villagrán I, Riquelme V, Padilla O, Pizarro M, Corvetto M, Varas J, Riquelme A. Simulated training program in abdominal paracentesis for undergraduate medical students. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:239-247. [PMID: 30471721 DOI: 10.1016/j.gastrohep.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Abdominal paracentesis is an area that every general physician should know about, and the current learning model is unsafe for patients. Simulation allows students to develop their skills prior to clinical confrontation with minimal risks. The aims of this study were to design and evaluate a paracentesis simulation workshop for undergraduate students. METHODS A workshop was implemented using a specially designed and validated simulation model for abdominal paracentesis. The simulated technique considered the recognition of materials, operator equipment, asepsis, anesthesia, puncture and obtaining liquid, collecting samples for analysis, withdrawal of the material and occlusion. A 24-point direct observation checklist was administered to assess the student. We assessed two students at the beginning of the workshop and all the students at the end. A perception survey was applied to attendees at the end of the workshop. RESULTS 247 students were included and a workshop that involved 8 students per session was held. Students significantly improved their skills comparing pre- and post-evaluation results [13.36±4.46 (55.7%) vs. 22.3±1.83 (92.9%) respectively (n=69) p<0.001]. The students' perception questionnaire (n=38) showed that the training sessions were highly valued, averaging 4.8±0.38 on a Likert scale of 1-5. CONCLUSIONS Simulated training in abdominal paracentesis is a very good teaching method. This teaching methodology should be highly recommended as an educational strategy in medicine because it could accelerate the acquisition of clinical skills in a safe learning environment.
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Affiliation(s)
- Rodrigo Tejos
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Javier Chahuán
- Departamento Medicina Interna, Escuela de Medicina. Pontificia Universidad Católica de Chile, Chile
| | - Thomas Uslar
- Departamento Medicina Interna, Escuela de Medicina. Pontificia Universidad Católica de Chile, Chile
| | - Martin Inzunza
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Ignacio Villagrán
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Valentina Riquelme
- Escuela de Arte, Facultad de Artes, Pontificia Universidad Católica de Chile, Chile
| | - Oslando Padilla
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Margarita Pizarro
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Marcia Corvetto
- Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Julián Varas
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Arnoldo Riquelme
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Educación Médica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile.
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Pinheiro EFM, Barreira MA, Moura Junior LGD, Mesquita CJGD, Silveira RAD. Simulated training of a laparoscopic vesicourethral anastomosis. Acta Cir Bras 2018; 33:713-722. [PMID: 30208133 DOI: 10.1590/s0102-865020180080000007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/08/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To develop a model and curriculum for simulated training of an effective and well accepted laparoscopic vesicourethral anastomosis (VUA). METHODS Experimental longitudinal study of quantitative character. The sample consisted of 12 general surgery residents and 6 urology residents (R3). The training consisted of making twelve VUAs on synthetic organs. The training was divided into four sessions and accompanied by an instructor who performed positive feedback. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). RESULTS Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The best-rated items were the facilitator positive feedback and the fact that the training was carried out at the teaching hospital premises. CONCLUSIONS The proposed training model was well accepted and proved to be effective in reducing operative time and improving laparoscopic skills. The training should be fractionated (4 sessions in 3 weeks), repetitive (12 anastomoses) and have positive feedback.
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Affiliation(s)
- Eudes Fontenele Moraes Pinheiro
- MD, Instituto Dr. José Frota, Fortaleza-CE, Brazil. Conception and design of the study; technical procedures; acquisition, interpretation and analysis of data; manuscript preparation and writing
| | - Márcio Alencar Barreira
- MD, Instituto Dr. José Frota, Fortaleza-CE, Brazil. Manuscript preparation, critical revision
| | - Luiz Gonzaga de Moura Junior
- PhD, Assistant Professor, Professional Master's degree, Program in Minimally Invasive Technology and Simulation in Health, Centro Universitário Christus (UNICHRISTUS), Fortaleza-CE, Brazil. Conception and design of the study, critical revision
| | - Charles Jean Gomes de Mesquita
- PhD, Assistant Professor, Professional Master's degree, Program in Minimally Invasive Technology and Simulation in Health, UNICHRISTUS, Fortaleza-CE, Brazil. Conception and design of the study, interpretation and analysis of data, critical revision
| | - Rômulo Augusto da Silveira
- MD, Holy House of Mercy of Fortaleza, Fortaleza-CE, Brazil. Conception and design of the study, technical procedures, interpretation and analysis of data, critical revision, final approval
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A scoping review of assessment tools for laparoscopic suturing. Surg Endosc 2018; 32:3009-3023. [PMID: 29721749 DOI: 10.1007/s00464-018-6199-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A needs assessment identified a gap in teaching and assessment of laparoscopic suturing (LS) skills. The purpose of this review is to identify assessment tools that were used to assess LS skills, to evaluate validity evidence available, and to provide guidance for selecting the right assessment tool for specific assessment conditions. METHODS Bibliographic databases were searched till April 2017. Full-text articles were included if they reported on assessment tools used in the operating room/simulation to (1) assess procedures that require LS or (2) specifically assess LS skills. RESULTS Forty-two tools were identified, of which 26 were used for assessing LS skills specifically and 26 for procedures that require LS. Tools had the most evidence in internal structure and relationship to other variables, and least in consequences. CONCLUSION Through identification and evaluation of assessment tools, the results of this review could be used as a guideline when implementing assessment tools into training programs.
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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: 7] [Impact Index Per Article: 1.2] [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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Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents. Surgery 2017; 163:488-494. [PMID: 29277387 DOI: 10.1016/j.surg.2017.10.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements. METHODS Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents. RESULTS Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training. CONCLUSIONS We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents' readiness for independent practice.
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Avila R, Achurra P, Tejos R, Varas J, Solovera M, Salas P. Uniportal video-assisted thoracic surgery lobectomy using a novel perfused ex vivo simulation model. J Vis Surg 2017; 2:155. [PMID: 29078541 DOI: 10.21037/jovs.2016.08.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/30/2016] [Indexed: 11/06/2022]
Abstract
Simulation may provide a solution to acquire advanced skills in thoracic surgery, however to date there are no reports in the English literature about a perfused ex vivo model. We developed a low cost and hi fidelity model using an ex vivo in bloc heart and lung specimen from a swine. The swine was previously used in a non-thoracic experiment, so we extracted the lung and heart for this ex vivo based model to reduce animal use. The cost of the whole model is 70 USD and it can be reused many times changing the ex vivo tissue, so this model may help reduce the costs and animal use associated to this high complexity surgery.
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Affiliation(s)
- Ruben Avila
- Experimental Surgery and Simulation Center, Division of Surgery, Clinic Hospital, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Division of Surgery, Clinic Hospital, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rodrigo Tejos
- Experimental Surgery and Simulation Center, Division of Surgery, Clinic Hospital, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Julian Varas
- Experimental Surgery and Simulation Center, Division of Surgery, Clinic Hospital, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - María Solovera
- Thoracic Surgery Unit, Division of Surgery, Clinic Hospital, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Patricio Salas
- Thoracic Surgery Unit, Division of Surgery, Clinic Hospital, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Simulation as a surgical teaching model. Cir Esp 2017; 96:12-17. [PMID: 29054573 DOI: 10.1016/j.ciresp.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/21/2017] [Accepted: 09/09/2017] [Indexed: 01/22/2023]
Abstract
Teaching of surgery has been affected by many factors over the last years, such as the reduction of working hours, the optimization of the use of the operating room or patient safety. Traditional teaching methodology fails to reduce the impact of these factors on surgeońs training. Simulation as a teaching model minimizes such impact, and is more effective than traditional teaching methods for integrating knowledge and clinical-surgical skills. Simulation complements clinical assistance with training, creating a safe learning environment where patient safety is not affected, and ethical or legal conflicts are avoided. Simulation uses learning methodologies that allow teaching individualization, adapting it to the learning needs of each student. It also allows training of all kinds of technical, cognitive or behavioural skills.
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Norero E, Muñoz R, Ceroni M, Manzor M, Crovari F, Gabrielli M. Two-Layer Hand-Sewn Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy for Gastric Cancer. J Gastric Cancer 2017; 17:267-276. [PMID: 28970957 PMCID: PMC5620096 DOI: 10.5230/jgc.2017.17.e26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/05/2017] [Accepted: 07/20/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose Different esophagojejunostomy (EJ) reconstruction methods are used after totally laparoscopic total gastrectomy (TLTG), and none is considered a standard technique. This report describes a 2-layer hand-sewn EJ technique during TLTG; we also evaluated postoperative morbidity associated with this technique. Materials and Methods This retrospective cohort study included all consecutive patients who underwent TLTG for gastric cancer (GC) from 2012 to 2016 at 2 affiliated teaching hospitals. All participating surgeons performed standardized intracorporeal 2-layer hand-sewn EJ. Results We included 51 patients who underwent TLTG for GC and standardized EJ anastomosis. Twenty-seven (53%) were male, and the median age was 60 (36–87) years. The average operative time was 337±71 minutes and intraoperative bleeding was 160±107 mL. There were no open conversions related to EJ. Postoperative morbidity was observed in 9 (17.0%) patients. There was no postoperative mortality. EJ leakage was observed in 2 patients (3.8%) and 1 patient (1.9%) developed EJ stenosis. Patients with leakage were managed non-operatively and the patient with stenosis required endoscopic dilation. The median length of hospital stay was 8 (6–29) days. Conclusions Two-layer hand-sewn EJ during TLTG for GC is a feasible and safe technique. This method avoids a laparotomy for reconstruction and the disadvantages associated with laparoscopic introduction of mechanical staplers for EJ, and provides an alternative for alimentary tract reconstruction after TLTG.
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Affiliation(s)
- Enrique Norero
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Muñoz
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Ceroni
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Manzor
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Gabrielli
- Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
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Schlottmann F, Murty NS, Patti MG. Simulation Model for Laparoscopic Foregut Surgery: The University of North Carolina Foregut Model. J Laparoendosc Adv Surg Tech A 2017; 27:661-665. [DOI: 10.1089/lap.2017.0138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neal S. Murty
- Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marco G. Patti
- Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Delpech P, Danion J, Oriot D, Richer J, Breque C, Faure J. SimLife a new model of simulation using a pulsated revascularized and reventilated cadaver for surgical education. J Visc Surg 2017; 154:15-20. [DOI: 10.1016/j.jviscsurg.2016.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barreira MA, Siveira DG, Rocha HAL, Moura Junior LGD, Mesquita CJGD, Borges GCDO. Model for simulated training of laparoscopic gastroenterostomy. Acta Cir Bras 2017; 32:81-89. [DOI: 10.1590/s0102-865020170110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/20/2016] [Indexed: 11/22/2022] Open
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