A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program

Single-Incision Laparoscopy in Abdominal Trauma: Current Evidence, Clinical Applications, and Evolving Role-A Narrative Review

Background/Objectives: Laparoscopic surgery plays a central role in the management of abdominal trauma, particularly in patients with hemodynamic stability. Recently, single-port laparoscopic surgery (SPLS) has emerged as a technique that further reduces access-related trauma while preserving the benefits of conventional laparoscopy. Thus, this review aimed to examine the current landscape of SPLS in trauma care, summarizing available clinical data and highlighting practical considerations for its use. Despite the limited experience, early evidence suggests that SPLS can achieve diagnostic and therapeutic outcomes comparable to those achieved by multi-port approaches in selected cases. Particular attention is given to a hybrid method that combines intracorporeal assessment with extracorporeal small bowel examination and repair through a single umbilical incision. This technique offers a pragmatic balance between thorough exploration and minimal invasiveness. Methods: We searched PubMed, Scopus, Web of Science, and Google Scholar through December 2023 using the terms "single-port laparoscopy", "single-incision laparoscopic surgery", "trauma laparoscopy", and related phrases. Case reports, case series, comparative studies, and reviews describing single-incision laparoscopic surgery in trauma were included in this narrative analysis. Results: SPLS may offer advantages in terms of postoperative pain, wound complications, and cosmetic outcomes, especially in younger patients. As familiarity with the approach increases and dedicated instrumentation becomes more accessible, its role in trauma protocols may expand. Conclusions: Further prospective research is needed to define long-term outcomes, refine patient selection, and integrate SPLS more systematically into trauma care protocols.

Advancing the assessment of clinical competence in Latin America: a scoping review of OSCE implementation and challenges in resource-limited settings

BACKGROUND

Objective Structured Clinical Examination (OSCE) is important to assess clinical competencies in health professions. However, in Latin America, a region with limited resources, the implementation and quality of OSCEs remain underexplored despite their increasing use. This study analyses how the OSCE has been applied and how its quality has evolved in Latin America.

METHODS

A scoping review methodology was used, including a search across PubMed, Scopus, WOS, LILACS and Scielo, including studies on the implementation of OSCE in Latin America, written in English, French, Portuguese, or Spanish. Their quality was assessed using the AMEE guidelines 81 and 49 criteria and MMERSQI. Data were extracted regarding OSCE structure, evaluator training, validity, reliability, and the use of simulated patients.

RESULTS

365 articles were obtained, of which 69 met the inclusion criteria. The first report on OSCE implementation in the region dates back to 2000. Three countries accounted for 84.06% of the reports (Chile, Mexico, Brazil). 68.12% was applied in undergraduate programs. In this group, the implementation was mainly in Medicine (69.57%), with lesser use in physiotherapy (7.95%) and nursing (2.9%). The number of stations and duration of each varied, with 18-station circuits being the most common. Evidence of validity and reliability of the OSCE was reported in 26.09%, feedback to students in 33,33%, and simulated patient training in 37.68% of the reports. A notable trend in the quinquennial analysis is the increased use of high-fidelity simulations and the shift towards remote OSCEs during the pandemic. The inclusion of inactive stations, inadequate training for simulated patients, and the absence of evidence supporting instrument validation are recurrently reported challenges in OSCE studies. The overall methodological quality has improved, as evidenced by OSCE Committee and Blueprint in nearly 50% of the studies and rising MMERSQI scores, especially in recent years.

CONCLUSION

While there has been progress in OSCE implementation, particularly in medical education, gaps remain in standardization, validation, training, and resource allocation. Further efforts are needed to ensure consistent quality, particularly in training simulated patients, addressing inactive stations, and ensuring instrument reliability. Addressing these gaps is crucial for enhancing the effectiveness of OSCEs in resource-limited settings and advancing health professional education across the region.

Distance simulation in surgical education

Distance and remote simulation have emerged as vital tools in modern surgical education, offering solutions to challenges such as limited operating hours, growing clinical demands, and the need for consistent, high-quality training. This review examines the benefits, limitations, and strategies for implementing sustainable distance simulation, structured around 3 foundational pillars: (1) effective hardware and infrastructure, including simulators and realistic scenarios that enable trainees to develop essential skills; (2) validated training programs grounded in educational theory with a clear focus on skill transfer and predictive validity; and (3) timely access to effective feedback. Distance simulation permits adaptable, scalable training environments, but the addition of remote and deferred feedback has further broadened its impact, helping to overcome the challenges posed by faculty availability and clinician time constraints. Remote-asynchronous feedback not only makes teaching time more efficient but also allows instructors to organize their time flexibly, maximizing their impact. Furthermore, web-based feedback oriented platforms facilitate the creation of a sustainable teaching network through train-the-trainer initiatives, enabling near-peer and nonclinical experts to provide standardized, high-quality teaching. This scalable model reduces the reliance on senior faculty, building a culture of mentorship and support within the surgical education community. In addition, distance simulation platforms are increasingly incorporating artificial intelligence-enhanced assessment tools capable of detecting errors, analyzing procedural steps, and generating automated feedback. Integrating artificial intelligence into innovative simulation modalities not only enhances access to quality feedback but also could provide deeper insights into the learning process, as learners progress through these enriched learning curves. Growing evidence shows how tools for sustainable distance simulation can positively impact education at multiple levels, benefiting undergraduate and postgraduate students, residents, and faculty across a spectrum of skills from basic tasks to complex surgical procedures. Moreover, its applications extend beyond simulated environments, providing frameworks that can be adapted to teach real surgical performance in clinical settings. As surgical education evolves, distance simulation demonstrates immense value in supporting accessible, high-quality training, particularly in resource-limited environments.

Training in Lumbar Pedicle Screw Instrumentation Using a 3D-Printed Model: From Validation to Transferability Onto a Cadaver Model

Lumbar pedicle screw placement in spinal surgery is complex and prone to errors, with notable risks to patients. Standard training methods, such as mentorship in operating rooms, pose safety concerns, prompting the need for alternative training tools. This study aimed to validate and use a three-dimensional (3D)-printed simulation model for lumbar pedicle screw insertion training and assess its effectiveness compared with standard methods. The study proceeded through four phases: model design and validation, construct validation, learning curve assessment, and transfer to a cadaver model. A 3D-printed lumbar spine model was created and refined based on expert feedback. Construct validation demonstrated the model's ability to differentiate between experts and novices. Training sessions with residents showed a notable improvement in performance over multiple attempts, but performance still lagged that of experts. However, skills learned on the simulation model were effectively transferred to a cadaver model, with no notable difference in performance observed. The trained group outperformed a control group trained using standard methods in the cadaver test. The study concludes that the 3D-printed simulation model is a valid training tool for lumbar pedicle screw insertion, effectively transferring skills to a cadaver setting and improving resident performance compared with standard training methods. Additional research is warranted to explore the sustainability of acquired skills and optimize training protocols.

Educational research on medical residency programs in Chile: a scoping review and analysis of the impact of the new accreditation policy

BACKGROUND

Accrediting medical specialties programs are expected to influence and standardize training program quality, align curriculum with population needs, and improve learning environments. Despite global agreement on its necessity, methods vary widely. In the Chilean context, a recent new accreditation criteria includes research productivity in relation to educational research on resident programs, so we aimed to define it. What is the profile of publications in educational research produced by Chilean medical specialty residency programs in the last five years? Based on these results, we intend to analyze the potential impact of the new accreditation policy on medical specialty programs in Chile.

METHODS

We performed a preliminary bibliometric search to identify the use of the term "resident" in literature. After that, we conducted a literature search, using a six-step approach to scoping reviews, including the appraisal of the methodological quality of the articles.

RESULTS

Between 2019 and 2023, an average of 6.2 articles were published yearly (19%). The bibliometric analysis revealed that the dominant thematic area of the journals was clinical, accounting for 78.1%. Most articles focused on residents (84.38%), with only two articles including graduates as participants. One university was responsible for 62.50% of the articles and participated in all multicenter studies (9.38%). Surgical specialties produced 15 research articles focused on procedural training using simulation. Psychiatry was the second most productive specialty, with 5 articles (15.63%) covering standardized patients, well-being, and mental health assessment. The most frequent research focus within residency programs over the five-year period was teaching and learning methodologies, with 19 articles representing almost 60% of the total analyzed.

CONCLUSIONS

Research on medical education in Chile's postgraduate residency programs is limited, with most studies concentrated in a few universities. The new accreditation criteria emphasize educational research, posing challenges for many institutions to meet higher standards. Understanding unexplored areas in educational research and learning from successful programs can enhance research productivity and align efforts with accreditation expectations. Continuous evaluation and new research on residents' satisfaction, skills acquisition, and well-being are needed to ensure training quality and accountability.

Principles and Practice in Pediatric Vascular Trauma: Part 1: Scope of Problem, Team Structure, Multidisciplinary Dynamics, and Solutions

As of 2020, penetrating injuries became the leading cause of death among children and adolescents ages 1-19 in the United States. For the patients who initially survive and receive advanced medical care, vascular injuries are a significant cause of morbidity and additionally trigger notable trauma team angst. Moreover, penetrating injuries can lead to life-threatening hemorrhage and/or limb-threatening ischemia if not addressed promptly. Vascular injury management demands timely and unique expertise, particularly for pediatric patients. As the frequency of vascular injuries requiring operative management increases, it becomes clear that an ad hoc approach is not ideal. An integrated team would provide the best approach for rapid hemorrhage control and revascularization, but the structure of vascular response teams at children's hospitals is highly variable. In part 1 of this review, we will evaluate the scope and extent of the epidemic of traumatic vascular injuries in pediatric patients, review current evidence and outcomes, discuss various challenges and advantages of different team structures, and outline potential outcome targets and pediatric vascular trauma response solutions. LEVEL OF EVIDENCE: n/a.

Innovations in surgical training: exploring the role of artificial intelligence and large language models (LLM)

The landscape of surgical training is rapidly evolving with the advent of artificial intelligence (AI) and its integration into education and simulation. This manuscript aims to explore the potential applications and benefits of AI-assisted surgical training, particularly the use of large language models (LLMs), in enhancing communication, personalizing feedback, and promoting skill development. We discuss the advancements in simulation-based training, AI-driven assessment tools, video-based assessment systems, virtual reality (VR) and augmented reality (AR) platforms, and the potential role of LLMs in the transcription, translation, and summarization of feedback. Despite the promising opportunities presented by AI integration, several challenges must be addressed, including accuracy and reliability, ethical and privacy concerns, bias in AI models, integration with existing training systems, and training and adoption of AI-assisted tools. By proactively addressing these challenges and harnessing the potential of AI, the future of surgical training may be reshaped to provide a more comprehensive, safe, and effective learning experience for trainees, ultimately leading to better patient outcomes. .