A simulation model of nail bed suture and nail fixation: description and preliminary evaluation

Simulation Models for Training in Pediatric General, Thoracic, Plastic, and Urologic Surgery in Low-resource Settings: A Scoping Review

BACKGROUND

Simulation is an educational tool that can be used to augment surgical training. We sought to provide an overview of existing pediatric surgical simulation models, with a focus on low-cost models amenable for use in low-resource settings.

METHODS

PubMed and Google Patents were searched for studies describing simulation models for pediatric surgery. Studies were included if cost, construct validity, face validity, or reproducibility were described, and if the model was either already utilized in low-resource settings or amenable for use in low-resource settings.

RESULTS

A total of 18 studies and 7 patents were included. Over half (58.3 %) of the models were created in the last five years. Only four models were created in an upper-middle income country, and none were created in a low or lower-income middle income country (LMIC) (16.7 %). Most models were designed for general pediatric surgical procedures, with esophageal atresia repair being the most common procedure (20.8 %). The cost of models ranged between $0.61 USD to $301.44 USD, and cost per simulation episode ranged from $0.61 to $38 USD. Seven models (41.1 %) were 3D printed. Thirteen models (54.2 %) were simulators for minimally-invasive procedures. Sixteen models (66.7 %) were deemed to be reproducible based on their descriptions in published manuscripts or available patents.

CONCLUSION

The utilization of simulation models in pediatric surgery is growing. Unfortunately, there are few validated models that can be used for training in low-resource settings. Significant work remains to be done on developing educational simulation tools for pediatric surgery in low-resource settings.

Simulation in plastic and reconstructive surgery: a scoping review

Since the origins of surgery, simulation has played an important role in surgical education, particularly in plastic and reconstructive surgery. This has greater relevance in contemporary settings of reduced clinical exposure resulting in limited work-based learning opportunities. With changing surgical curricula, it is prescient to examine the role of simulation in plastic and reconstructive surgery.

A scoping review protocol was used to identify relevant studies, with an iterative process identifying, reviewing and charting the data to derive reported outcomes and themes.

Of the 554 studies identified, 52 studies were included in this review. The themes identified included simulator modalities, curriculum elements targeted and relevant surgical competencies. There was a predominance of synthetically based simulators, targeting technical skills largely associated with microsurgery, paediatric surgery and craniomaxillofacial surgery.

Existing simulators largely address high-complexity procedures. There are multiple under-represented areas, including low-complexity procedures and simulation activities addressing communication, collaboration, management and leadership. There are many opportunities for simulation in surgical education, which requires a contextual appreciation of educational theory. Simulation may be used both as a learning method and as an assessment tool.

This review describes the literature relating to simulation in plastic and reconstructive surgery and proposes opportunities for incorporating simulation in a broader sense, in the surgical curriculum.

Analysis of Tools Used in Assessing Technical Skills and Operative Competence in Trauma and Orthopaedic Surgical Training: A Systematic Review

BACKGROUND

Robust assessment of skills acquisition and surgical performance during training is vital to ensuring operative competence among orthopaedic surgeons. A move to competency-based surgical training requires the use of tools that can assess surgical skills objectively and systematically. The aim of this systematic review was to describe the evidence for the utility of assessment tools used in evaluating operative performance in trauma and orthopaedic surgical training.

METHODS

We performed a comprehensive literature search of MEDLINE, Embase, and Google Scholar databases to June 2019. From eligible studies we abstracted data on study aim, assessment format (live theater or simulated setting), skills assessed, and tools or metrics used to assess surgical performance. The strengths, limitations, and psychometric properties of the assessment tools are reported on the basis of previously defined utility criteria.

RESULTS

One hundred and five studies published between 1990 and 2019 were included. Forty-two studies involved open orthopaedic surgical procedures, and 63 involved arthroscopy. The majority (85%) were used in the simulated environment. There was wide variation in the type of assessment tools in used, the strengths and weaknesses of which are assessor and setting-dependent.

CONCLUSIONS

Current technical skills-assessment tools in trauma and orthopaedic surgery are largely procedure-specific and limited to research use in the simulated environment. An objective technical skills-assessment tool that is suitable for use in the live operative theater requires development and validation, to ensure proper competency-based assessment of surgical performance and readiness for unsupervised clinical practice.

CLINICAL RELEVANCE

Trainers and trainees can gain further insight into the technical skills assessment tools that they use in practice through the utility evidence provided.

Management of Allen type III nail bed injuries and distal phalangeal fractures with and without fixation

For combined nail bed injuries and distal phalangeal fractures, fixation may be indicated when there is fracture instability and if a K-wire can be successfully placed in the fracture fragments. We determined the outcomes when these criteria were applied for patients with Allen type III injuries without substantial tissue loss. We retrospectively analyzed 57 patients who had surgery for nail bed injuries with distal phalangeal fractures between October 2017 and January 2020. All patients underwent anatomical nail bed repair, and some had fracture fixation, according to specific surgical criteria. We obtained data about demographic and clinical characteristics, postoperative radiographs, complications, range of motion, and satisfaction. To achieve our primary objective, we evaluated the patient population as a whole. The median follow-up was 12 months (range, 7-21). After 90 days, all 57 patients achieved satisfactory fracture union, 54 (95%) had excellent range of motion, and 54 (95%) were either satisfied or very satisfied with the outcome. Though 6 (10%) patients had residual fracture displacement, none had complications. In patients with Allen type III fingertip injuries without substantial tissue loss, anatomical nail bed repair and triage of patients to fixation or no fixation are likely to result in excellent functional outcomes and high patient satisfaction. However, fixation can neither be recommended nor rejected for these injuries based on this study alone. Level of evidence: IV.