Different cognitive styles can affect performance in laparoscopic surgery skill training

Cognitive learning versus practical "hands-on" training for acquisition of laparoscopic surgical skills: an optimal combination study

BACKGROUND

Most minimally invasive surgery (MIS) training curricula involve practical training (PT) and cognitive learning (CL) to different extents. It has been proven that acquiring and training specific skills through CL can improve MIS skills. This study aimed to discover the most efficient combination of these two approaches and examine their effects on acquiring MIS skills in novices.

METHODS

Sixty medical students without MIS experience participated in this randomized controlled study and were divided into three groups. The first group received the same amount of PT (50%) as CL (50%). The second group focused on PT (75%) compared to the CL (25%). The third group focused more on CL (75%), with less PT implemented (25%). Before and after training, participants performed an ex vivo laparoscopic cholecystectomy (LCHE). Objective Structured Assessment of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) scores were used for MIS skill evaluation.

RESULTS

Group 1 improved all four performance assessments (global GOALS 14.3 vs. 18.0, p < 0.001, LCHE-specific GOALS 5.9 vs. 6.9, p = 0.016, global OSATS 19.4 vs. 26.4, p < 0.001, LCHE-specific OSATS 37.9 vs. 46.5, p = 0.004). Group 2 and Group 3 improved three of four performance scores (Group 2: global GOALS 15.0 vs. 18.4, p < 0.001, LCHE-specific GOALS 7.0 vs. 7.7, p = 0.115, global OSATS 19.6 vs. 25.8, p < 0.001, LCHE-specific OSATS 41.3 vs. 50.7, p = 0.001; Group 3: global GOALS 13.8 vs. 17.9, p < 0.001, LCHE-specific GOALS 5.8 vs. 6.6, p = 0.148, global OSATS 18.9 vs. 25.5, p < 0.001, LCHE-specific OSATS 36.8 vs. 43.5, p = 0.034).

CONCLUSIONS

A balanced combination of PT and CL seems to offer the most effective training compared to predominantly PT or CL training. All three training modes improved MIS skills in novices.

Conscientiousness Counts: How Personality Traits Impact Laparoscopic Surgical Skill Improvement in Medical Students

OBJECTIVE

Studies have shown that personality traits affect cognitive performance; however, little is known about their influence on surgical performance. This study aimed to assess the impact of the Big Five personality traits on medical students' laparoscopic surgical skills.

DESIGN

In this prospective study, medical students' laparoscopic surgical skills were assessed using the Hiroshima University Laparoscopic Surgical Assessment Device (HUESAD). The participants performed the HUESAD tasks 10 times before they underwent training. After completing the simulator training, they performed the tasks 10 times. Thereafter, they answered Big Five personality trait questionnaires (Extraversion, Neuroticism, Openness to experience, Conscientiousness, and Agreeableness).

SETTING

Academic medical centers.

PARTICIPANTS

Forty medical students (10 women) were recruited. The selection criterion was a lack of simulations or clinical experience in laparoscopic procedures.

RESULTS

No significant correlations were found between personality traits and HUESAD assessment scores before training. Laparoscopic surgical skills improved significantly after the training (p < 0.001). The Big Five personality traits were correlated with improved laparoscopic surgical performance after training (r = -0.44, p < 0.05). Moreover, statistically significant positive correlations were observed between Conscientiousness and improvement rates (r = 0.36, p < 0.05).

CONCLUSIONS

The results suggest that medical students scoring high on Conscientiousness were more likely to have improved laparoscopic surgical skills, regardless of their initial skills. The ability to predict laparoscopic surgical skills would be useful in designing tailor-made training programs for safe and high-quality operations.

Der erfahrene Chirurg als unabhängiger Risikofaktor für die Morbidität nach Cholezystektomie. Eine multivariate Analyse von 710 Patienten

Einleitung Bei komplexeren chirurgischen Eingriffen wie der Kolonresektion, herzchirurgischen Eingriffen, arteriellen Rekonstruktionen oder Leberresektionen ist der Einfluss des Chirurgen auf die postoperative Morbidität nachgewiesen. Bei Routineeingriffen wie der Cholezystektomie liegen bislang keine Erkenntnisse zum Zusammenhang von Operateur und Morbidität vor. Insbesondere Untersuchungen bei erfahrenen Chirurgen fehlen.

Methoden Es wurden 710 konsekutive Patienten, die zwischen Januar 2014 und Dezember 2018 von erfahrenen Chirurgen (über n = 300 Cholezystektomien vor Beginn der Untersuchung, über 5 Jahre nach bestandener Facharztprüfung) cholezystektomiert wurden, untersucht. In einer univariaten Analyse wurde der Einfluss von Patientenmerkmalen, Laborparametern, chirurgischen Parametern und des Operateurs auf die postoperative Morbidität analysiert. Die Variablen mit statistischer Signifikanzen wurden dann einer multivariaten logistischen Regressionsanalyse unterzogen.

Ergebnisse Die Mortalität lag bei 5 von 710 (0,7%), die Morbidität bei 58 von 710 (8,2%). 37 von 710 Patienten erlitten eine chirurgische Komplikation, 21 von 710 Patienten eine nicht chirurgische Komplikation. Hinsichtlich der Gesamtmorbidität waren in multivariater Analyse der Kreatininwert (OR 1,29; KI 1,01–1,648; p = 0,042), GOT (OR 1,0405; KI 1–1,01; p = 0,03), offene und Konversions-Cholezystektomie (OR 4,134; KI 1,587–10,768; p = 0,004) und der individuelle Chirurg (OR bis 40,675; p = 0,001) ein unabhängiger Risikofaktor. Bei Analyse der chirurgischen Komplikationen blieben offene und Konversions-Cholezystektomie (OR 8,104; KI 3,03–21,68; p < 0,001) sowie der individuelle Chirurg (OR bis 79,69; p = 0,005) ein statistisch signifikanter unabhängiger Risikofaktor.

Schlussfolgerung Der individuelle Chirurg ist auch bei einem Routineeingriff wie der Cholezystektomie ein unabhängiger Risikofaktor für die Morbidität. Dies gilt auch für erfahrene Chirurgen mit Facharztstatus und hoher Caseload. Im Hinblick auf die Patientensicherheit und Verbesserungen der Ergebnisqualität muss daher diskutiert werden, ob eine routinemäßige risikoadjustierte Messung der individuellen Ergebnisse eines jeden Chirurgen als Basis eines gezielten Qualifizierungprogramms sinnvoll ist.

An Application-Based Review of Haptics Technology

Recent technological development has led to the invention of different designs of haptic devices, electromechanical devices that mediate communication between the user and the computer and allow users to manipulate objects in a virtual environment while receiving tactile feedback. The main criteria behind providing an interactive interface are to generate kinesthetic feedback and relay information actively from the haptic device. Sensors and feedback control apparatus are of paramount importance in designing and manufacturing a haptic device. In general, haptic technology can be implemented in different applications such as gaming, teleoperation, medical surgeries, augmented reality (AR), and virtual reality (VR) devices. This paper classifies the application of haptic devices based on the construction and functionality in various fields, followed by addressing major limitations related to haptics technology and discussing prospects of this technology.

Changes in attentional resources during the acquisition of laparoscopic surgical skills

Background

Increasing familiarity and practice might free up mental resources during laparoscopic surgical skills training. The aim of the study was to track changes in mental resource allocation during acquisition of laparoscopic surgical skills.

Methods

Medical students with no previous experience in laparoscopic surgery took part in a 5-week laparoscopic training curriculum. At the beginning and end of the training period, one of the training tasks was combined with a secondary auditory detection task that required pressing a foot switch for defined target tones, creating a dual-task situation. During execution of the two concurrent tasks, continuous electroencephalographic measurements were made, with special attention to the P300 component, an index of mental resources. Accuracy and reaction times of the secondary task were determined.

Results

All 14 participants successfully completed the training curriculum. Target times for successful completion of individual tasks decreased significantly during training sessions (P  <0.001 for all tasks). Comparing results before and after training showed a significant decrease in event-related brain potential amplitude at the parietal electrode cluster (P300 component, W = 67, P = 0.026), but there were no differences in accuracy (percentage correct responses: W = 48, P = 0.518) or reaction times (W = 42, P = 0.850) in the auditory detection task.

Conclusion

The P300 decrease in the secondary task over training demonstrated a shift of mental resources to the primary task: the surgical exercise. This indicates that, with more practice, mental resources are freed up for additional tasks.

Comparison of the Indicators of Psychological Stress in the Population of Hubei Province and Non-Endemic Provinces in China During Two Weeks During the Coronavirus Disease 2019 (COVID-19) Outbreak in February 2020

BACKGROUND During February 2020, the coronavirus disease 2019 (COVID-19) epidemic in Hubei Province, China, was at its height, requiring isolation of the population. This study aimed to compare the emotional state, somatic responses, sleep quality, and behavior of people in Hubei Province with non-endemic provinces in China during two weeks in February 2020.  MATERIAL AND METHODS Questionnaires were completed by 939 individuals (357 men; 582 women), including 33 from Hubei and 906 from non-endemic provinces. The Stress Response Questionnaire (SRQ) determined the emotional state, somatic responses, and behavior. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the duration of sleep and sleep quality. RESULTS There were 939 study participants, aged 18-24 years (35.89%) and 25-39 years (35.57%); 65.92% were university students. During a two week period in February 2020, the emotional state and behavior of participants in Hubei improved, but the quality of sleep did not. Health workers and business people became increasingly anxious, but other professionals became less anxious. The data showed that most people in Hubei Province developed a more positive attitude regarding their risk of infection and the chances of surviving the COVID-19 epidemic. CONCLUSIONS During a two-week period, front-line health workers and people in Hubei Province became less anxious about the COVID-19 epidemic, but sleep quality did not improve. Despite public awareness, levels of anxiety exist that affect the quality of life during epidemics, including periods of population quarantine. Therefore, health education should be combined with psychological counseling for vulnerable individuals.