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Treil L, Neumann N, Chanes N, Lejay A, Bourcier T, Bismuth J, Lee JT, Sheahan M, Rouby AF, Chakfé N, Eidt J, Georg Y, Mitchell EL, Rigberg D, Shames M, Thaveau F, Sheahan C. Objective Evaluation of Clock Face Suture Using the Objective Structured Assessment of Technical Skill (OSATS) Checklist. EJVES Vasc Forum 2022; 57:5-11. [DOI: 10.1016/j.ejvsvf.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
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Haiser A, Aydin A, Kunduzi B, Ahmed K, Dasgupta P. A Systematic Review of Simulation-Based Training in Vascular Surgery. J Surg Res 2022; 279:409-419. [PMID: 35839575 PMCID: PMC9483723 DOI: 10.1016/j.jss.2022.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 05/22/2022] [Indexed: 11/25/2022]
Abstract
Introduction Recent advancements in surgical technology, reduced working hours, and training opportunities exacerbated by the COVID-19 pandemic have led to an increase in simulation-based training. Furthermore, a rise in endovascular procedures has led to a requirement for high-fidelity simulators that offer comprehensive feedback. This review aims to identify vascular surgery simulation models and assess their validity and levels of effectiveness (LoE) for each model in order to successfully implement them into current training curricula. Methods PubMed and EMBASE were searched on January 1, 2021, for full-text English studies on vascular surgery simulators. Eligible articles were given validity ratings based on Messick’s modern concept of validity alongside an LoE score according to McGaghie’s translational outcomes. Results Overall 76 eligible articles validated 34 vascular surgery simulators and training courses for open and endovascular procedures. High validity ratings were achieved across studies for: content (35), response processes (12), the internal structure (5), relations to other variables (57), and consequences (2). Only seven studies achieved an LoE greater than 3/5. Overall, ANGIO Mentor was the most highly validated and effective simulator and was the only simulator to achieve an LoE of 5/5. Conclusions Simulation-based training in vascular surgery is a continuously developing field with exciting future prospects, demonstrated by the vast number of models and training courses. To effectively integrate simulation models into current vascular surgery curricula and assessments, there is a need for studies to look at trainee skill retention over a longer period of time. A more detailed discussion on cost-effectiveness is also needed.
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Affiliation(s)
- Alexander Haiser
- Guy's, King's and St Thomas' School of Medical Education, King's College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.
| | - Basir Kunduzi
- Department of Transplant Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
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Torres IO, Becari A, Escudeiro GDPM, de Carvalho JPLM, Simão da Silva E, Puech-Leão P, De Luccia N. The use of a low-fidelity simulator to improve vascular anastomosis skills of residents during the COVID-19 pandemic. Ann Vasc Surg 2022; 83:87-96. [PMID: 35398200 PMCID: PMC8985405 DOI: 10.1016/j.avsg.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
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Lawaetz J, Skovbo Kristensen JS, Nayahangan LJ, Van Herzeele I, Konge L, Eiberg JP. Simulation Based Training and Assessment in Open Vascular Surgery: A Systematic Review. Eur J Vasc Endovasc Surg 2020; 61:502-509. [PMID: 33309171 DOI: 10.1016/j.ejvs.2020.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/30/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review the literature and give evidence based recommendations for future initiatives for simulation based training (SBT) and assessment in open vascular surgery. DATA SOURCES PubMed, Embase, and the Cochrane Library. REVIEW METHODS A systematic review of PubMed, Embase, and the Cochrane Library was performed, with the last search on 31 March 2020, to identify studies describing SBT and assessment in open vascular surgery. Kirkpatrick's levels for efficacy of training were evaluated. Validity evidence for assessment tools was evaluated according to the recommended contemporary framework by Messick. RESULTS Of 2 844 studies, 51 were included for data extraction. A high degree of heterogeneity in reporting standards and varying types of simulation was found. Vascular anastomosis was the most frequently simulated technical skill (43%). Assessment was mostly carried out using the Objective Structured Assessment of Technical Skills (55%). Validity evidence for assessment tools was found using outdated frameworks, and only one study used Messick's framework. Self directed training is valuable, the low trainer to trainee ratio is important to maximise efficiency, and experienced vascular surgeons are the most effective trainers. CONCLUSION Carefully designed and structured SBT is effective and can improve technical skills, especially in less experienced trainees. However, the supporting evidence lacks homogeneity in the reporting standards and types of simulations. Pass/fail standards that support proficiency based learning and studies investigating skills transfer should be the focus in future studies. Validity evidence of assessment tools needs to be addressed using contemporary frameworks.
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Affiliation(s)
- Jonathan Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Leizl J Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Falconer R, Semple CM, Walker KG, Cleland J, Watson AJM. Simulation for technical skill acquisition in open vascular surgery. J Vasc Surg 2020; 73:1821-1827.e2. [PMID: 33248120 DOI: 10.1016/j.jvs.2020.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Simulation has an increasingly prominent role in modern vascular surgery training. However, it is important to understand how simulation is most effectively delivered to best use the time and resources available. The aim of this narrative review is therefore to critically appraise open technical skill acquisition in the operating room environment and provide recommendations for the future development of evidence-based simulation for open vascular surgery. METHODS A systematic search strategy was used to retrieve relevant studies from PubMed, Medline, Web of Science, EMBASE, and the Cochrane databases in July 2019. Included papers were independently screened by two reviewers. Data were subsequently extracted using a standardized proforma and thematically analyzed. RESULTS Thirteen studies were included. All demonstrated that simulation is effective in improving confidence and/or competence in performing open technical skills when assessed by previously validated metrics. However, not all participants or course schedules achieved equal benefit, with distributed practice for junior trainees over several weeks achieving a greater improvement in technical skill compared with senior trainees or longer course schedules for some tasks. CONCLUSIONS Simulation can be an effective adjunct to traditional operative experience for technical skill acquisition in open vascular surgery. Future work should focus on developing models to address a wider range of training needs, as well as further defining the optimum schedule for the style, content, and timing of simulation for specific learner groups.
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Affiliation(s)
| | - Cariona M Semple
- Department of Vascular Surgery, Victoria Hospital, Kirkcaldy, United Kingdom
| | - Kenneth G Walker
- NHS Education for Scotland, Inverness, United Kingdom; Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom
| | - Jennifer Cleland
- Medical Education Research & Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Angus J M Watson
- Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom
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Antas JDS, de Holanda AKG, Andrade ADS, de Araujo AMS, Costa IGDC, Dantas LR, de Lima SKM, Sarmento PLDFA. Arteriovenous anastomosis learning curve using low cost simulator. J Vasc Bras 2020; 19:e20190144. [PMID: 34211509 PMCID: PMC8218093 DOI: 10.1590/1677-5449.190144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Background In order to reduce difficulties with learning surgical techniques, supplementary tools for training were developed. This paper describes the learning curve followed by student volunteer research subjects who used an alternative model for practicing vascular anastomosis. Objectives To evaluate the vascular anastomosis technique learning curve and development of manual skills using a low-cost experimental model. Methods Experimental and prospective study using end-to-side vascular anastomosis in latex balloons over five successive phases, initiated after theoretical and practical guidance given by experienced vascular surgeon. The study subjects were six undergraduate medical students from Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil, in their third to fifth years of the course. Cluster analysis was used to interpret the data collected on the quality of anastomoses and the time taken. Results The time taken to perform anastomosis reduced for all students, with statistical differences from phase 1 compared to phases 4 and 5. There was also a trend to increasing scores on the quality index as the phases progressed. However, no statistical differences were detected using the Friedman test, which is appropriate for data measured with ordinal levels (quality was assessed on a scale of 1 to 5). Conclusions It was found that the training model used was effective for increasing learning of this technique. It is believed that future studies with larger samples or a higher number of phases could demonstrate both reduced time and improved quality of the anastomoses performed with statistical significance.
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Affiliation(s)
- Jéssika da Silva Antas
- Universidade Federal da Paraíba - UFPB, Faculdade de Medicina, Departamento de Cirurgia, João Pessoa, PB, Brasil
| | - Ana Karolina Gama de Holanda
- Universidade Federal da Paraíba - UFPB, Faculdade de Medicina, Departamento de Cirurgia, João Pessoa, PB, Brasil
| | - Achilles de Sousa Andrade
- Universidade Federal da Paraíba - UFPB, Faculdade de Medicina, Departamento de Cirurgia, João Pessoa, PB, Brasil
| | | | | | - Luciano Ribeiro Dantas
- Universidade Federal da Paraíba - UFPB, Faculdade de Medicina, Departamento de Cirurgia, João Pessoa, PB, Brasil
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Learning Curves and Competences of Vascular Trainees Performing Open Aortic Repair in a Simulation-Based Environment. Ann Vasc Surg 2020; 72:430-439. [PMID: 32949741 DOI: 10.1016/j.avsg.2020.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study was to analyze learning curves and competency gains of novice vascular trainees when performing open aortic repair in a simulation-based environment. METHODS This was a prospective study of 16 vascular trainees performing infrarenal open aortic repair on an inanimate abdominal aortic aneurysm simulator with pulsatile pressure and flow. Each participant performed 4 procedures as a primary surgeon while getting structured feedback by a supervising experienced vascular surgeon. All sessions were video recorded and were anonymously and independently assessed by 3 rater-trained experts on an online platform using the newly validated open abdominal aortic aneurysm repair of technical expertise assessment tool. All supervisor interferences and procedure time was noted. RESULTS Reliability between raters was excellent (intraclass correlation coefficient = 0.92). Participants' mean scores almost doubled during the course between the first (13.4, 95% confidence interval [CI], 6.8-20) and fourth session (29.8, 95% CI, 26.3-33.3) with a mean difference of 14.6 (P < 0.001). Supervisor interference also decreased significantly from mean 3.0 (95% CI, 1.5-3.6) in the first to 0.7 (95% CI, 0.4-1.0) in the fourth session (P = 0.004). Procedure time decreased with a mean of 24 minutes: from 81 min (95% CI, 71.8-90.3) to 57 min (95% CI, 51.1-63.2, P < 0.001). There was a significant negative correlation between procedure time and the Open Abdominal Aortic Aneurysm Repair of Technical Expertise score (Pearson's r = -0.72, P < 0.01). Only half of the participants passed the pass/fail score of 27.7 points during the course. CONCLUSIONS Novice vascular trainees achieve skills and competencies in open aortic repair in a simulated setting with dedicated supervision and feedback and can become ready for supervised surgery on real patients. Learning rates are individual, and it is important to construct training programs with emphasis on proficiency and not merely attending a course.
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Systematic review of the implementation of simulation training in surgical residency curriculum. Surg Today 2016; 47:777-782. [DOI: 10.1007/s00595-016-1455-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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Admire JR, Pounds LL, Adams AJ, Gomez PP, Willis RE. Development and construct validity of a low-fidelity training platform for driving large and small suture needles. JOURNAL OF SURGICAL EDUCATION 2015; 72:387-393. [PMID: 25456157 DOI: 10.1016/j.jsurg.2014.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/22/2014] [Accepted: 10/16/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The objective of this study was to describe and validate a novel training platform for driving large and small suture needles, which can ultimately be used for elemental vascular surgical training. METHODS We developed a novel trainer and proficiency-based training curriculum that provides a platform for practice with handling fine vascular tools and needles as well as precision in suture targeting. The trainer comprises 2 concentric circles printed on cotton fiber material with 8 evenly spaced targets on each circle. The first exercise was designed for practice with Castroviejo needle drivers and a fine needle such that the needle is passed through all targets in sequential order. A second, larger figure serves the same function but is designed for conventional needle drivers and a larger needle. A total of 5 attending surgeons from vascular and trauma surgery were recruited to serve as "expert" participants. These surgeons completed 3 repetitions of each task, which were used to develop proficiency timing and quality standards for practice. The curriculum was validated by recruiting 10 senior surgical residents and 12 surgical interns. Senior residents completed 3 repetitions of each task. Each first-year resident completed a proctored pretest, trained to proficiency by self-paced practice on the trainer according to standards set by the attending surgeons, and completed a proctored posttest. RESULTS First-year residents performed significantly worse on the pretest compared with senior residents and faculty surgeons on both exercises (small figure = 58.9 vs 174.2 vs 201.3, p < 0.001; large figure = 112.1 vs 202.9 vs 198.1, p < 0.001). After proficiency-based practice, first-year residents improved significantly from pretest to posttest (small figure = 216.0 vs 58.9, p < 0.001; large figure = 211.7 vs 112.1, p = 0.001). CONCLUSIONS The vascular trainer platform demonstrated construct validity for self-paced elemental vascular surgical practice.
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Affiliation(s)
- John R Admire
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Lori L Pounds
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Andrew J Adams
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Pedro Pablo Gomez
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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Elhage O, Challacombe B, Shortland A, Dasgupta P. An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int 2015; 115:274-81. [PMID: 25756137 DOI: 10.1111/bju.12680] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate, in a simulated suturing task, individual surgeons’ performance using three surgical approaches: open, laparoscopic and robot-assisted. subjects and methods: Six urological surgeons made an in vitro simulated vesico-urethral anastomosis. All surgeons performed the simulated suturing task using all three surgical approaches (open, laparoscopic and robot-assisted). The time taken to perform each task was recorded. Participants were evaluated for perceived discomfort using the self-reporting Borg scale. Errors made by surgeons were quantified by studying the video recording of the tasks. Anastomosis quality was quantified using scores for knot security, symmetry of suture, position of suture and apposition of anastomosis. RESULTS The time taken to complete the task by the laparoscopic approach was on average 221 s, compared with 55 s for the open approach and 116 s for the robot-assisted approach (anova, P < 0.005). The number of errors and the level of self-reported discomfort were highest for the laparoscopic approach (anova, P < 0.005). Limitations of the present study include the small sample size and variation in prior surgical experience of the participants. CONCLUSIONS In an in vitro model of anastomosis surgery, robot-assisted surgery combines the accuracy of open surgery while causing lesser surgeon discomfort than laparoscopy and maintaining minimal access.
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A Prospective Randomized Study Assessing Optimal Method for Teaching Vascular Anastomoses. Ann Vasc Surg 2014; 28:1087-93. [DOI: 10.1016/j.avsg.2013.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/30/2013] [Accepted: 10/16/2013] [Indexed: 11/18/2022]
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Khalil PN, Kleespies A, Rentsch M, Thasler WE, Jauch KW, Bruns CJ. Description and evaluation of a bench porcine model for teaching surgical residents vascular anastomosis skills. BMC Res Notes 2010; 3:189. [PMID: 20626856 PMCID: PMC2912942 DOI: 10.1186/1756-0500-3-189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 07/13/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous models, of variable quality, exist to impart the complex skills required to perform vascular anastomosis. These models differ with regard to the kinds of materials used, as well as their sizes, the time needed for their preparation, their availability, and the associated costs. The present study describes a bench model that uses formalin-fixed porcine aorta, and its evaluation by young surgical residents during a recent skills course. FINDINGS The aortic segments used were a by-product of slaughtering. They were fixed and stored after harvesting for eventual use. Ten young surgical residents participated, and each performed one end-to-side vascular anastomosis. The evaluation was a questionnaire maintaining anonymity of the participant containing questions addressing particular aspects of the model and the experiences of the trainee, along with their ratings concerning the need for a training course to learn vascular anastomosis techniques. The scoring on the survey was done using a global 6-point rating scale (Likert Scale). In addition, we ranked the present model by reviewing the current literature for models that address vascular anastomosis skills.The trainees who participated were within their first two years of training (1.25 +/- 0.46). A strong agreement in terms of the necessity of training for vascular anastomosis techniques was evident among the participating trainees (5.90 +/- 0.32), who had only few prior manual experiences (total number 1.50 +/- 0.53). The query revealed a strong agreement that porcine aorta is a suitable model that fits the needs for training vascular anastomosis skills (5.70 +/- 0.48). Only a few bench models designed to teach surgical residents vascular anastomosis techniques were available in the literature. CONCLUSIONS The preparatory and financial resources needed to perform anastomosis skills training using porcine aorta are few. The presented bench model appears to be appropriate for learning vascular anastomosis skills, as rated by the surgical trainees themselves.
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Affiliation(s)
- Philipe N Khalil
- Department of Surgery - Campus Innenstadt, Ludwig-Maximilians University, Nussbaumstrasse 20, 80336 Munich, Germany.
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